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ManipalCigna ProHealth Insurance
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ManipalCigna ProHealth Insurance

 Medical expenses are skyrocketing, and in case of an emergency, there are chances that the huge bills generated by the hospitals are not easily affordable for the common man. In such a scenario, health insurance policies such as ManipalCigna ProHealth works as a savior to carry the burden of those unexpected expenses.

What is ManipalCigna ProHealth Insurance?

ManipalCigna Health Insurance, formerly known as Cigna TTK Health Insurance Company, is an amalgamation between Cigna Corporation (US-based exceptional health service provider) and Manipal Group, an Indian multinational. Expanded over 11 cities, this insurance company is headquartered in Mumbai with a plethora of health insurance plans and policies which can be purchased for self, family, and groups.

Among the various health insurance products, ProHealth Plan, is one of the most sought-after plans that offers financial support and covers expenses for hospitalisation, drugs, diagnostic tests, treatment costs, room and boarding costs, etc.

Features of the ManipalCigna ProHealth Insurance

The key features of the policy are mentioned below:

Tenure

1 – 2 years policy available

Renewals

Lifelong

Sum Insured Options

Rs 2.5 lakh – 100 lakh

Premium

Depends on factors like:

• Sum insured

• Gender

• Tenure of the Policy

• Add-on benefits

• Riders

• Medical condition

• Number of members

• Zone of coverage etc.

 

Premium Payment Option

Premium is payable in cash/credit/cheque or online payment. Also, the option of making monthly/quarterly/half-yearly and annual payment of the Health Insurance is available

 

Benefits

Numerous benefits can be availed like a cumulative bonus, health rewards, second opinions, expert advice on critical illness, free medical check-ups etc.

 

Types of coverage

Two types of coverages are available:

• Individual Cover – It is for individual purchase – self, spouse or parent or children

• Family Floater – each member of the family, will share a sum insured and a maximum of 2 adults and 3 children (dependents) can be a part of it

Free-look Period

Free-look period of 15 days is available within which the insured can take the decision to cancel the policy

Waiting Period

To avail benefits like critical illness insurance, maternity benefits and expenses incurred on pre-existing diseases, a waiting period of 24 to 48 months is applicable

 


Benefits of ManipalCigna ProHealth Insurance

This ManipalCigna health insurance policy comes with the following benefits:

  • Cumulative Bonus– A Cumulative Bonus should be more than 50% of the sum insured and is not applicable for a new-born, first-year vaccinations, maternity, and emergency. To avail the service, renewal needs to be done on time that is within the grace period.
  • Expert Opinion on Critical Illnesses– If the policyholder is diagnosed with a critical illness, he/she can avail the benefit of a second opinion from a renowned chain of medical professionals.
  • Health Rewards– Several online reward programs can be availed as the insured secures 1% of the total premium deposited by the insured as reward points which can be redeemed through:
  • Savings on renewal for the first time
  • The equal worth of health maintenance benefit in the 3rdyear

Types of Wellness Programs:

Programs

Points earned which have been accumulated by paying the premium in the previous year

 

Health Risk Assessment (HRA)

0.50%

Targeted Risk Assessment (TRA)

0.50%

Online Lifestyle Management Program (LMP)

1%

Chronic Condition Management Programs

1%

ManipalCigna sponsored programs and worksite/online/offline initiatives on health

Up to 2%

Health Check-Up

0.50%


Variants and Basic Coverage of ManipalCigna ProHealth Insurance

Basic coverage and compensation provided by ManipalCigna ProHealth Insurance include:

  • In-patient hospitalisation like ICU charges, drugs and diagnostic bills, nursing and doctor fee, etc. will be included in this.
  • Pre-hospitalisation within 60 days is covered.
  • Post-hospitalisation expenses within 90/180 days after getting discharged are covered (depending on the plan variant).
  • Road Ambulance cover  up to Rs 3000 is offered.
  • Domiciliary hospitalisation, provided the medical treatment lasts for at least 3 days under the supervision of a professional doctor.
  • Daycare Treatments – Around 171 treatments within 24 hours are listed in the policy.
  • Organ Donor expenses up to a percentage of the sum insured.
  • Vaccination of the child up to the first year.
  • Maternity Expenses covering two deliveries after a waiting period of 48 months are included.
  • Worldwide emergency coverage is provided.
  • One-time opportunity to reload or refill the sum insured.
  • New-born bay expenses up to 90 days after delivery are covered.
  • Health check-ups are included in most of the policies.

ManipalCigna ProHealth Insurance Plans Comparison Table

The coverage offered under different ManipalCigna ProHealth policy variants are defined below:

ProHealth Insurance

 

SI

In-Patient

Health Maintenance

Health Maintenance covered up to

Maternity Expenses

Ambulance cover

Post Hospitalisation

ProHealth Protect

2.5 – 10 lakh

Single room facility

48 months

Rs 500

Not Applicable

Rs 2000

Up to 90 days

ProHealth Plus

4.5 – 10 lakh

Single room facility

36 months

Rs 2000

Normal Delivery – Rs 15000

C Section – 1 Lakh

(Waiting period of 49 moths)

Rs 3000

Up to 180 days

ProHealth Accumulate

5.5. – 25 lakhs

Single room facility

48 months

Rs. 5000, 10000, 15000, 20000

NA

Rs. 2000

Not Applicable

ProHealth Preferred

15 – 50 lakhs

All rooms except suite

24 months

Rs. 15000

Normal Delivery – Rs. 50000

C Section – 1 Lakh

(Waiting period of 49 moths)

Actual expenses incurred

Up to 180 days

ProHealth Premier

100 lakhs

All rooms except suite

24 months

Rs. 15000

Normal Delivery – Rs. 50000

C Section – 1 Lakh

(Waiting period of 49 moths)

Actual expenses incurred

Up to 180 days


Exclusions under the ManipalCigna ProHealth Insurance

The policy doesn’t provide coverage for the below health condition:

  • Critical illness suffered during the first 90 days.
  • Illness suffered during the first 30 days of the plan.
  • A genetic disorder, alcohol or drug intake, participation in any adventure sports or hazardous activities, criminal activities, suicide, war, etc. are not covered.
  • Non-allopathic treatments, treatments due to AIDS/HIV or any sexually transmitted disease, cosmetic surgeries, weight loss treatments, etc. are not covered.
  • Pre-existing illness and maternity expenses are not covered for 48 months.
  • Specific illnesses not covered in the first 2 years of the policy.

Eligibility Criteria to Buy the ManipalCigna ProHealth Insurance

The eligibility criteria to buy this ManipalCigna health insurance plan are:

Minimum Age – 91 days for children:

  • 91 days – 18 years (if one of the parents is included in the policy)
  • 91 days – 23 years (if the dependent is covered under an individual policy and a family floater plan

How to Claim ManipalCigna ProHealth Insurance?

The policy can be claimed as cashless and reimbursement claim. Cashless claims can be claimed at specified network hospitals which are covered under the terms and conditions of the policy. The insured needs to:

  • Intimate the Insurance Company within 48 hours of hospitalisation or medical emergency.
  • Identification of self by showing his health card and a valid ID Proof.
  • Preauthorisation process will be initiated by the hospital and will be sent to the insurance company for approval.
  • For approval, several documents, and the prescription will be asked by the insurance company to verify the claim. Discharge formalities need to be fulfilled, and necessary documentation as asked will have to be submitted for authorisation to the insurance company for approval.
  • After necessary approval, the hospital authorities themselves coordinate with the insurance company and settle the claims without any intervention or intrusion of the policyholder.

For Reimbursement Claims

In case of any medical contingency or emergency, the insured must take the relevant medical treatment from any hospital, and he would have to settle all the expenses like the bills personally, receipts, discharge summary, investigation test and diagnostic reports and bills, pharmacy bills, and other expenses. And file a claim later for reimbursement. The claim steps include:

  • The policyholder needs to download the claim form and attach the relevant documents as specified in the website or in the policy with the original document of the claim.
  • The applicant needs to fill in all relevant details – personal and medical. The form, along with the documents, need to be submitted either online or to the nearest insurance branch within 15 days of discharge of the policyholder.
  • On receipt of the documents, the form and the documents attached will be thoroughly assessed, scrutinised, and verified by the insurance company and only after that will it be authorised and approved by the insurance company.
  • After the approval, the policyholder will be intimated about the same, and the amount that was initially spent by the policyholder on medical expenses will be reimbursed by the insurance company directly to the policyholder through NEFT.

Claim Documents

Documents required to claim the ManipalCigna ProHealth Insurance are

  • Duly filled in and signed claim form
  • Valid ID proof with a photograph
  • Hospitalisation letter approved by medical professionals
  • Test reports, Receipts of medications, drugs and diagnostic receipts, and consultations
  • Original bills, receipts, and discharge summary
  • Original Pharmacy bills

How to Purchase ManipalCigna ProHealth Insurance?

The applicant must follow the undermentioned steps to purchase a ManalCigna ProHealth Insurance policy easily from Paisawiki.com:

Step 1 – The applicant needs to visit the website and go to the health insurance section. Go to the ‘Get Free Quotes’ option and mention the required information.

Step 2 – The applicant can compare various health plans and use the insurance calculator to check the premiums offered.

Step 3 – One needs to fill in personal and relevant details like name, age, lifestyle-based questions, type of policy he wants to buy, contact details etc.

Step 4 -Select the plan and click on purchase.

Step 5 – The applicant must make an online payment, and a soft copy of the policy document will be mailed to the applicant.

Documents Required to Purchase the ManipalCigna ProHealth Insurance Plan

The following documents are essential to furnish at the time of buying this ManipalCigna health insurance policy:

  • Application Form – duly filled and signed along with a photograph
  • Identity Proof – Aadhar Card, Passport, Driving License
  • Age Proof – Pan Card, Passport, Voter ID Card
  • Address Proof – Utility Bills, Bank Statement
  • Medical screening report if required.

How to Renew ManipalCigna ProHealth Insurance?

With 3 simple steps, it is an easy process to follow for the insured to renew the policy well within the time period to avoid any lapse or issues regarding the renewal:

  • Step 1 – The applicant needs to visit the website of paisawiki.com and click on the Renewal Tab.
  • Step 2 – The applicant needs to input personal details and the policy number of the previous plan.
  • Step 3 – After making the online payment towards the renewal of the policy, the same will be processed, and an updated document will be sent to the policyholder.

FAQs

  • Q. Besides ProHealth Insurance, which is the other health insurance plans, offered by the insurer?

    Ans: The other health insurance plans offered by ManipalCigna Health Insurance are:

    • ManipalCigna Super Top Up
    • Arogya Sanjeevani Policy, ManipalCigna
    • ManipalCigna Lifestyle Protection – Accident Care
    • ManipalCigna ProHealth Cash
    • ManipalCigna Lifestyle Protection Group Policy
    • ManipalCigna ProHealth Group Insurance Policy
    • ManipalCigna Group Overseas Travel Insurance Policy
    • ManipalCigna ProHealth Select
    • ManipalCigna Lifestyle Protection – Critical Care
  • Q. What are the riders or add-ons that can be covered within ProHealth Plans of ManipalCigna Health Insurance?

    Ans: The Add-on riders and additional coverage that can be bought by paying an extra premium:

    • Reduction in the Maternity Waiting period from 48 to 24 months
    • Deductibles of 1,2 or 3 lakh can be selected on the sum insured, and it is applicable only on Protect and Plus Plans of ProHealth Plans of the ManipalCigna health insurance company.
    • Voluntary Co-pay option wherein the insurer pays 90 or 80% of the total expense, and the rest is borne by the insured.
    • Cumulative Bonus Booster is a 25% increase in the sum insured for each claim-free year, and instant renewal is done. The maximum boost can be up to 100% of the sum insured.
  • Q. Which are the various factors on which the premium rate to be paid by the policyholder is decided?

    A.3. Factors that affect the premium rate are as follows:

    • Age of the life insured
    • Lifestyle choices like the premium for a smoker being higher than normal
    • Sum insured
    • Medical test results
    • 3 zones and the geographical location of the insured
    • If family members are enrolled under a single individually policy
  • Q. What are the conditions under which a medical test will be conducted?

    Ans: The main condition to conduct medical screening are:

    • Depend on the age of the insured and the sum insured chosen
    • If insured is above 46 years of age with a sum insured of Rs 4.5 lakh, Rs 5.5 lakh or Rs 7.5 lakh, he/she will have to go through a medical screening.
    • If the insured is above 46 years and the sum insured is Rs 10 lakh, then the insured will have to undergo a medical test.
  • Q. How long does it take to settle a claim under ManipalCigna Health Insurance?

    Ans: Normally it takes 5 business days to settle a claim, but depending on the authenticity and verification of the documents, it may take longer.

  • Q. How should the insurance company be intimated at the time of claim?

    Ans The insured needs to contact ManipalCigna Health Insurance either through their toll-free number or can also visit the nearest branch or contact the company or his agent before the claim is made. In the case of pre hospitalisation, the insured must inform the insurance company 3 days before hospitalisation, and in case of emergencies, he/she should inform within 48 hours of hospitalisation.

Written By: Paisawiki - Updated: 22 October 2020

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