ManipalCigna ProHealth Group Insurance Policy
A group, health insurance policy, aims to provide insurance coverage to a group of people. The people insured in a group health insurance plan generally form a part of a homogeneous group such as employees of an organisation, etc. Usually, the members of a group get insured at a reduced rate because the risk of the insurer gets diluted among a group of people. One such policy that worth one’s money is ManipalCigna ProHealth Group Plan.
What is ManipalCigna ProHealth Group Insurance Policy?
ManipalCigna ProHealth Group Insurance Plan provides insurance coverage to a definite group of people such as members of a social or professional association, employees of an organisation, etc. This health insurance policy enables the group to choose from the optional covers depending upon the requirements of the group.
This insurance policy provides a wide range of sum insured that is Rs. 5,000 to Rs. 100 Lakhs. A minimum of 7 members is required to form a group for taking this policy. The policy provides cover under both individual and family floater basis.
Benefits of ManipalCigna ProHealth Group Insurance Policy
The insured can avail the following benefits under this ManipalCigna health insurance plan:
- In-patient Hospitalisation Expenses: This insurance policy provides a cover for room rent (depending on the category or limit specified in the policy), intensive care unit charges, operation theatre cost, fees of the medical practitioner, specialists' fee, surgeon's fee and anaesthetist's fee, cost of diagnostic tests, surgical and medical appliances etc. to the extent of the limit specified in the policy.
- Daycare Treatment Expenses: The medical expenses incurred by the insured during the policy year for treatments which do not require hospitalisation of more than 24 hours are covered. Such treatment must be undertaken in an in-patient department of a hospital or nursing home or a daycare centre. Outpatient department (OPD) treatments are not covered under the plan.
- Pre-hospitalisation Expenses: The pre-hospitalisation expenses incurred during the policy year immediately preceding the admission of the insured to the hospital will be covered under this plan. This cover is subject to the condition that the insured or the policyholder has made a claim for in-patient or daycare expenses and, the pre-hospitalisation expenses relate to the same medical condition(s).
- Post-hospitalisation Expenses: Just like pre-hospitalisation expenses, the expenses incurred during the policy year immediately succeeding the hospitalisation of the insured, i.e. post-hospitalisation expenses is covered under ManipalCigna ProHealth Group Insurance Planprovided, the claim for in-patient treatment or daycare treatment of the same condition has been made by the insured.
- Road Ambulance Cover: The expenses incurred on transportation of the patient in an ambulance is covered under this policy if an accident or a medical emergency necessitates such transportation. The necessary transportation in an ambulance from one hospital to another is also covered under the plan.
- Domiciliary Treatment Expenses: The treatment taken at home is known as a domiciliary treatment. Expenses in regard to such treatment are also covered under this plan provided, such treatment lasts for 3 or more days and, the insured could not be transported to a hospital or, due to the unavailability of hospital beds. If the insured makes a claim under domiciliary cover, the post-hospitalisation expenses will not be covered, and the pre-hospitalisation expenses will be covered for the number of days specified.
- Donor Expenses: The expenses incurred by the donor of an organ used for the insured are covered provided such donation has been made with respect to the provisions of the Transplantation of Human Organs Act. The pre and post-hospitalisation expenses, expenses regarding donor screening etc. are not claimable.
- Disease Category Sub Limit: One can opt for limiting some amount of the sum insured towards specified disease(s). Any number of claims can be made under that particular disease up to the limit specified.
- Maternity Expenses: Medical expenses incurred towards the delivery of a child or lawful termination of the pregnancy is covered under the maternity expenses cover. The claim is limited to a maximum of 2 deliveries or 2 terminations or 1 delivery and 1 termination during the lifetime of the insured, subject to a few conditions. The treatment of a newborn baby is also covered if one opts for this cover under the policy.
- Out-patient Treatment Cover: One can opt for out-patient treatment cover by choosing one or more of the options ranging from diagnostics, consultation, pharmacy and medical aids.
- Other Optional Covers: Accumulate Cover, corporate deductible cover, per claim deductible, annual aggregate deductible, voluntary co-payment cover, reimbursement only cover, Hospital daily cash benefit cover, critical illness cover, personal accident benefit cover, dental expenses cover, home nursing charges cover, vision expenses cover, routine immunisation cover, etc. are a few of the many optional benefits available.
Features of ManipalCigna ProHealth Group Insurance Plan
This policy provides easy and flexible options to manage your insurance policy.
- One gets a wide variety of optional covers to choose from depending on his/her requirements.
- The plan provides for an efficient and accurate implementation.
- A free-look period of 15 days is available to the policyholder. If the holder finds any terms and conditions of the policy unacceptable, he/she may request for termination of the policy provided no claim has been made.
- The policyholder or insured gets expert guidance on health issues under the ManipalCigna ProHealth Group Insurance Policy.
- The extent of coverage provided by the insurer is wide. An extensive range of hospitals is available for the insured.
- The policyholders can also get access to a wide range of innovative health risk and wellness management programmes.
- A dedicated customer support system is set up by the insurer to ensure the smooth processes of renewal, claim settlement, etc.
Exclusions of the ManipalCigna ProHealth Group Insurance Policy
This ManipalCigna health insurance plan doesn’t cover the insured for the following:
- Pre-existing Diseases: Any expenses incurred for the treatment of pre-existing diseases will not be covered until the specified period from the date of first health insurance policy has elapsed.
- Dental Treatment: Any expenditure incurred towards dental treatment is not covered under the base cover unless such treatment is necessitated by accident or requires hospitalisation of more than 24 hours.
- Self-inflicted Injuries: Intentional self-injury, i.e. suicide or an attempt to suicide either in a sane state or insane state, will not be covered under ManipalCigna ProHealth Group Insurance Plan.
- Substance Abuse: Any disease or illness caused due to consumption of toxic substances such as alcohol, nicotine, drugs, hallucinogen, etc. is not covered under this policy. Any treatment relating to de-addiction and rehabilitation of the insured is also not claimable under the policy.
- Sexually Transmitted Diseases: All sexually transmitted diseases, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice, Trichomoniasis, etc. are not covered.
- Treatment Received Outside India: Any treatment undergone outside the geographical boundaries of India is not covered under this policy.
- Any Form of Alternative Treatments: Alternative treatments such as AYUSH treatment, chiropractic treatments, hydrotherapy, acupuncture, reflexology, etc. are not covered.
- Other Exclusions: Regular eye checkups, ear checkups, injury caused by wars, participation in adventurous sports such as scuba diving, cosmetic surgery or any other aesthetic treatments, vaccines other than post-bite treatment, hair fall treatments, infertility treatments etc. are a few of the other exclusions from the policy.
Who is Eligible for Buying ManipalCigna ProHealth Group Insurance?
To be eligible for purchasing this ManipalCigna Health Insurance:
- One needs to be a member of a group or an employee of the policyholder to be eligible to get a cover under this plan.
- At least 7 members need to form a group to avail the benefits under this policy.
- There are no prescribed minimum and maximum age limits for the entry to this policy.
- Newborn babies are covered provided the maternity cover is opted, and at least one of the parents is insured under the policy. The insurance provider must be informed of the birth within 30 days, and the specified premium must be paid within a further 30 days period.
- Eligible relationships include member’s/employee’s legal spouse, his/her unmarried children of age less than 25 years, residing in his/her own house or pursuing full-time education. Other relationships which may be covered include blood-related brother/sister of the employee/member, grandchildren, grandparents, parents in law, son/daughter-in-law, uncle, aunt, niece, nephew, etc.
Claim Process of the ManipalCigna ProHealth Group Insurance Policy
The claim steps are so easy that one can file a claim with the insurer without much hassle. Claim steps are:
- Intimation: The insured must inform the insurer about the hospitalisation at least 3 days before the admission, in case of planned hospitalisation and within 48 hours of admission but before discharge, in case of an emergency.
- Cashless Claim Settlement: One can also opt for the facility of a cashless settlement of claims when treatment is undertaken in a network hospital of the insurer. The terms regarding intimation to the provider remain the same in this case as well.
Claim Reimbursement Steps
- Step 1: The insured or the policyholder must inform the insurance provider regarding the hospitalisation within the stipulated time limits.
- Step 2: The policyholder must submit the necessary documents to the provider.
- Step 3: in case of delay in such submission, one must submit the reason for such delay with the relevant documents.
- Step 4: The provider will carry on with the scrutinising of the claims and documents.
- Step 5: Upon satisfaction of the conditions mentioned above, claims will be settled.
Following documents are necessary:
- To buy ManipalCigna ProHealth Group Insurance Policy: One needs to fill the proposal form with all the necessary details, including medical history.
- For making claims: Claim form, copy of consultation, hospital bills, investigation reports, pharmacy bills, KYC documents, FIR report, death certificate and post mortem report (if applicable) and other supporting documents are required.
How to Buy ManipalCigna ProHealth Group Insurance Policy
The policy can be bought through Paisawiki.com by following the below steps:
- Step 1: Read and understand the product brochure, policy benefits, premium and exclusions carefully before buying the policy.
- Step 2: Once the details of the policy are understood, one needs to fill up the proposal form with all the personal and medical details.
- Step 3: Submit the proposal form with the required documents and premium
- Step 4: If you are compulsorily required to undergo the medical tests, the provider will arrange the same for you.
- Step 5: On acceptance of the proposal, you will receive all policy documents.
On rejection of the proposal, the premium will be refunded within 15 days from the date of such decision.
Renewal of ManipalCigna ProHealth Group Insurance Policy
A grace period of 15 days is available for the renewal of the policy. If the insured or the policyholder fails to pay the renewal premium within the grace period, the policy will stand terminated.
One may request for alterations in the policy such as an increase or decrease in the sum insured etc. during the renewal period. The provider reserves the sole discretion to accept or reject such alterations.
- Step 1: Visit the provider’s website.
- Step 2: Click on ‘Renew Now’.
- Step 3: Enter your policy number and click renew.
- Step 4: You will see all your policy details.
- Step 5: On making the necessary payment as the premium, your policy will be successfully renewed.
Ans: No, home nursing and domiciliary treatment are two different aspects. A domiciliary treatment means treatment taken at home due to the unavailability of hospital beds or unfavourable condition of the patient. Home nursing means a qualified nurse provides services such as washing, dressing, etc. to the patient at his/her premises. Domiciliary treatment is included in the base cover of the policy while home nursing is available as an optional cover.
Ans: Under the base plan, a total of 1% of the sum insured is for the room rent allowance. However, one can opt for a specific room type or ask for setting limits on room rent allowance or select a per day room rent limit under optional covers. In case of intensive care units (ICU), the limit is twice the base room rent.
Ans: One can opt for setting limits under distinct diseases or illness. There will be no cap on the number of claims for a particular disease under such circumstances, provided the amount of claim does not exceed the specified limit.
Ans: Both outpatient treatment and accumulate benefit cover provide the option to choose one or more of consultation, medical aids, pharmacy expenses, AYUSH expenses, and diagnostic expenses. However, accumulate benefit can also be used for co-payments, deductible, and non-payable expenses of in-patient treatment. Further, the unutilised accumulate benefit can be carried forward to next year along with a cumulative bonus.
Ans: The deductible amount is a limit beyond which the insurer pays all expenses as per the terms and conditions of the policy. Such a limit can be selected on an aggregate basis or a per claim basis.
Voluntary co-payment means a fixed percentage of the expenses per claim, will be paid by the insured as out of pocket expenses.
One can not opt for both deductible and voluntary co-payments simultaneously.
Written By: Paisawiki - Updated: 22 October 2020