ManipalCigna Health Insurance

ManipalCigna Health Insurance Overview

In the age of fast moving world and chaotic lifestyle, most of us tend of ignore our daily health requirement. Nobody knows when they could find themselves in a medical exigency situation. It is then, when the magnitude of a health insurance plans is comprehended.

ManipalCigna Health Insurance Company Limited gratifies the needs of copious customer who wants to safeguard their health related expenses through health insurance plans.
The various kinds of Health Insurance Products offered by ManipalCigna Health Insurance are

• ManipalCigna ProHealth Insurance
• ManipalCigna Lifestyle Protection – Critical Care ManipalCigna Lifestyle Protection-Accident Care
• ManipalCigna ProHealth Cash
• ManipalCigna Global Health Group Policy

ManipalCigna Health Insurance Plans Overview

ManipalCigna ProHealth Insurance- Protect Plan

All round health care solutions  that give you complete protection and help you lead a healthy smooth life. The protection solutions are exclusively designed to provide financial support to you and your family in Illness and Wellness

Key Highlights

Wide range of Sum Insured from Rs 3.5 Lacs to Rs 50 Lacs on Individual and Family floater basis.

• Comfort of high end hospital rooms
• Covers 546 Day Care procedures under your policy up to Sum Insured
• Guaranteed Inflation Protection Cumulative Bonus of 5% max up to 200% of Sum Insured
• Healthy Rewards that allow discount in Renewal Premium up to 20%
• Unlimited Restoration of Sum Insured to give extra cover for your family
• All-inclusive Top-up plans up to 10 Lacs to extend Family protection
• Option to avail Hospital Daily Cash Benefit up to Rs.1000 for each 24 hrs hospitalization, max. for 30 days in a Policy Year
• Critical Illness Add-on cover available up to Sum Insured.

Features

• Family Discount of 25% for covering 2 and more family members under the same individual policy.
• Long Term Discount of 7.5% on opting for a 2 year and 10% on opting for a 3 year single policy term.
• Co-Pay discount of 7.5% for opting 10% co-pay and 15% discount for opting a 20% co-pay
• Lifetime renewal available
• Grace Period of 30 days on renewal with all continuation benefit
• Tax benefit available under section 80D, Income Tax Act 1961 (as amended)

Waiting Period

• First 30 days waiting period is applicable for all illnesses other than accident
• 24 months waiting period is applicable on specific ailments
• Pre-existing diseases will get covered after 48 months from inception of the policy.
• First 90 days waiting period and 30 days survival period is applicable to Critical Illness Add-on cover (if opted)

Benefit of ManipalCigna ProHealth Protect Plan

In-patient hospitalization - If you are admitted to a hospital for more than 24 hrs of illness or injury, expenses of room charges, ICU, nursing charges, doctor fees , surgeon fees, blood, oxygen, operation theatre charges and other medical expenses while your stay in hospital will be taken care of up to full Sum Insured.

• Pre Hospitalization medical expense will be reimbursed up to 60 days before the date of hospitalisation.
• Post Hospitalization expenses such as like consultation fees, diagnostic tests, pharmacy related medical costs will be reimbursed for a period up to 90 days after post discharge of patient.
• Expense incurred for 546 listed Day Care treatment which requires hospitalizations less 24 hours for certain procedures like dialysis, radiation therapy, cataract surgery will be covered up to full Sum Insured
• Medical treatment taken at home is also covered up to full sum insuredin condition where hospital transfer is not favorable or hospital bed is not available. Expenses for Pre and Post Hospitalization at Home are covered up to 30 days.
• Expenses towards emergency ambulance service for amount up to Rs. 2000 /-per hospitalization event
• We will cover in-patient hospitalization cost of the donor for major organ transplant.Provision for second opinion on listed critical illnesses from expert at no extra cost.
• Unlimited restoration of Sum Insured if the balance Sum Insured and Cumulative Bonus or Cumulative bonus booster (if any) is insufficient to settle a claim (For unrelated illness/injury)
• 500/- each year towards expenses incurred in any preventive health measures such as doctor’s consultation, pharmacy expenses or diagnostic tests.
• Get 5% guaranteed additional Sum Insured as bonus at the time of renewal irrespective of claim in the expiring policy. Cumulative Bonus can maximum be accumulated up to 200% of Sum Insured.
• Earn Healthy reward points equal up to 20% of last premium paid by opting for wellness programs. This accumulated points can be redeemed as discount in premium from 1^st renewal of policy,or reimburse under Health Maintenance benefit anytime in the policy year.
• For the global traveler, World Wide emergency coverto take care of in-patient medical expenses outside the country for full Sum Insured on re-imbursement basis.
• Health Checkup facility available for insured above 18 years once every 3 years irrespective of claims.
• Add on cover available for critical illness for individuals aged between 18 to 65 years.

ManipalCigna Lifestyle Protection - Critical Care

The ManipalCigna Lifestyle Protection - Critical Care is a customized insurance plan to reassure the financial assistance in the times of medical exigency for critical diseases .The key Features of this plan are

• Disbursement of the entire Sum Insured on first diagnosis of any of the 15 OR 30 major Critical Illnesses (as per plan).
• Additional 10% of the Sum Insured in case of Staggered claim Payment
• Advantage of medical second opinion and any expense related to it
• Available for Individual and Family basis plans
• Relationship covered - Self, spouse, dependent parents and dependent parents in laws in addition to dependent children, dependent grandchildren and dependent siblings up to the age of 25 years
• Additional 10 % discount on the premium amount for enrolling more than 2 family members under a single policy.
• Apart from this , startling discount of 7.5% discount on selecting 2 years and 10% discount on selecting 3 years on a single premium policy
  • 90 days waiting period from the policy inception date to make any claim in case if diagnosis of any listed critical illness
  • Available for age group of 18 to 65 years
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  • Access to online wellness program for its customers.
  • Available in two variant (a) Basic plan to cover 15 Critical Illnesses (b) Enhanced plan to cover 30 Critical Illnesses with enhanced sum insured payout structure.
  • Flexibility to choose an annual premium installment for 2 and 3 years policy.
  • Policy Term - 1, 2 or 3 years
  • Discount - 7.5% on selecting 2 years and 10% on selecting 3 years single premium policy.
    • A grace period of 30 days for renewal of a single premium policy from the date of expiry.
    • Income tax rebate benefits under the section u/s 80D as per IT Act 1961 for premium paid towards this policy
    • Staggering Sum Insured amount up to Rs 3 Crores to cover all possible critical illness ailments in any unforeseen situations.

Benefit of ManipalCigna Lifestyle Protection - Critical Care

The basic plan covers below mentioned critical illnesses:Cancer of specific severity

• First Heart Attack – of Specific Severity
• Open Chest CAB
• Open Heart Replacement or Repair of Heart Valves
• Coma of Specified Severity
• Kidney Failure Requiring Regular Dialysis
• Stroke Resulting in Permanent Symptoms
• Major Organ / Bone Marrow Transplant
• Permanent Paralysis of Limbs
• Motor Neurone Disease with Permanent Symptoms
• Multiple Sclerosis with Persisting Symptoms
• Primary Pulmonary Hypertension
• Aorta Graft Surgery
• Loss of Hearing
• Loss of Sight

The Enhanced Insurance Policy Covers 30 Critical Illnesses as Mentioned Below.

1. Cancer of specific severity
2. First Heart Attack – of Specific Severity
3. Open Chest CAB
4. Open Heart Replacement or Repair of Heart Valves
5. Coma of Specified Severity
6. Kidney Failure Requiring Regular Dialysis
7. Stroke Resulting in Permanent Symptoms
8. Major Organ / Bone Marrow Transplant
9. Permanent Paralysis of Limbs
10. Motor Neurone Disease with Permanent Symptoms
11. Multiple Sclerosis with Persisting Symptoms
12. Primary Pulmonary Hypertension
13. Aorta Graft Surgery
14. Loss of Hearing
15. Loss of Sight
16. Coronary Artery Disease
17. Aplastic Anaemia
18. End Stage Lung Disease
19. End Stage Liver Failure
20. Major Burns
21. Fulminant Hepatitis
22. Alzheimer’s Disease
23. Bacterial Meningitis
24. Benign Brain Tumor
25. Apallic Syndrome
26. Parkinsons Disease
27. Medullary Cystic Disease
28. Muscular Dystrophy
29. Loss of Speech
30. Systemic Lupus Erythematous

Exclusions in Critical Illness Insurance Plan by ManipalCigna Healthcare

• Any claim pertaining to or any consequential illness due to the below mentioned cases shall not be reimbursed under this plan .
• Any illness other than specified critical illnesses as mentioned in the above list of inclusions o0f critical diseases
• Any pre-existing diseases
• HIV/AIDS and its complications
• rs
• Mental disorders
• Suicide or drug abuse
• Any loss resulting from child birth or pregnancy

ManipalCigna Lifestyle Protection - Accident Care

Life can take an atrocious turn for those who are not well planned ahead for crisis situation especially when it comes for any unforeseen event such as accident or any loss of body part for self and loved ones in the family.

The ManipalCigna Lifestyle Protection - Accident Care assures financial support through the ups and down of life and provides a safety cushion for a better tomorrow.

The Key Features of this Plan are

• Complete coverage in case of Accidental Death and Disablement
• Worldwide Coverage with a vast chain of network hospitals
• Financial assistance in case Loss of Employment
• Financial backing towards the Education & other Benefit for Orphan Child
• Minimum Sum Insured is Rs 50,000 to a maximum of Rs 10 Crore
• Minimum entry age is 5 years for children and 18 years for adults. Maximum age at entry is 25 years for children and 80 years for adults.
• Option to pay via single premium mode or annually in case of a 2 & 3 year policy term.
• Available on individual and family basis. Relationship covered is self, spouse, dependent parents and dependent parents in-laws in addition to dependent children and dependent siblings up to the age of 25 years.
• Additional 10 % discount on the premium amount for enrolling more than 2 family members under a single policy.
• Apart from this , startling discount of 7.5% discount on selecting 2 years and 10% discount on selecting 3 years on a single premium policy

Benefit of ManipalCigna Lifestyle Protection - Accident Care plan

The Plans is offered in three variants

1. Basic Cover Plans
2. Enhanced Cover Plans
3. Comprehensive Cover Plans

1. Basic Cover Plans

The Plan includes

• Accidental Death
• Emergency Ambulance Cover
• Funeral Expenses

2. Enhanced Cover Plans

This plan includes any expense related to

• Accidental Death
• Permanent Total Disablement
• Education Fund
• Emergency Ambulance Cover
• Funeral Expenses

3. Comprehensive Cover Plans

This plan includes any expense related to

• Accidental Death
• Permanent Total Disablement
• Permanent Partial Disablement
• Education Fund
• Emergency Ambulance Cover
• Orphan Benefit
• Loss of Employment
• Funeral Expenses

Apart from the above mentioned expenses, Customer may go for add on covers basis some additional premium. The additional coverage shall include

• Temporary Total Disablement
• Burns Benefit
• Broken Bones Benefit
• Coma Benefit
• Accidental Death Benefits wherein an amount of 100% of sum insured in case of accidental death and 200% of sum insured if death occurs while traveling as a fare paying passenger on a common carrier.
• Lump sum payment towards cases of injury resulting in broken bones. (Hair line fracture excluded)
• Expenses towards the ailment of any burns or related expenses up to an amount of 10-100% of sum insured, depending on the degree of burns.
• 25% of the sum insured as lump sum in the event of suffering from a Coma due to accident.
• Education continuity benefits for surviving child to continue their education even after the demise of parent.
• Expenses incurred towards availing the Emergency ambulance service for an amount up to Rs.10,000 based on sum insured selected by applicant.
• One-time funeral or cremation expenses payment of Rs.5000 for sum insured up to 50 lakhs and Rs.10,000 for sum insured above Rs 50 lakhs.
• Payment of 3 months basic salary in case of loss of employment due to permanent total or partial disablement caused in any accident
• Financial assistance to orphans for an amount in tune of amount equal to the sum insured towards dependent child

ManipalCigna ProHealth Cash

Any unforeseen medical exigency not only makes a hole in the pocket, but also comes with a cluster of out of pocket expenses. Such expenses are generally not covered in traditional health care plan. To diminish such situation, wherein one runs out of cash in such medical exigency situation, ProHealth Cash Plan comes handy. The key features of this plan are

• Daily Cash Benefit (DCB) available from Rs 500 (1unit) to Rs 5000 (10 units)Accidental Death(AD) and Permanent Total Disability (PTD) cover from Rs 50,000 to Rs 25 Lacs
• Option to choose maximum number of days of coverage from 60, 90 & 180 per policy year.
• Protection for self and family member under individual cover
• Choice of policy term of 1,2 & 3 years.
• 2 times daily cash benefit for Accidental Hospitalization
• 3 times daily cash benefit towards ICU and Worldwide cover
• 5 times daily cash benefit for hospitalization of 10 or more continuous days. 50% of the daily cash benefit will be payable in respect of accompanying person taking care of insured Benefit Coverage under the  ManipalCigna ProHealth Cash

The plan is offered by ManipalCigna Health Insurance in 3 different variant and the insured may choose according to their requirement.

Basic Plan

Sickness Hospital Cash Allowance

• Accident Hospital Cash allowance
• ICU Cash Benefit
• Worldwide Cover

Enhanced Plan

This plan has been diversifies to cover a broad range of expenses for a time duration of 90 days. The allowances allowed under this plan includes:

• Sickness Hospital Cash Benefit
• Accident Hospital Cash Benefit
• ICU Cash Benefit
• Worldwide Cover
• Convalescence Benefit
• Companion Benefit
• Compassionate Benefit

Optional Covers Plan

Apart from the regular benefits in above two plans , customer may avail few more additional coverage for a time span of 180 days

• Day Care Treatment Benefit
• Accidental Death & Permanent Total Disability Cover
• Critical Illness Add-on Cover

ManipalCigna Global Health Group Policy

International Health Insurance Plan by ManipalCigna Health Insurance offers special fortification to Indian locals and expatriates who are residing abroad for employment purpose. Being away from home country and working in different geographic conditions make them exposed to various kinds of risks and health hazard.

The Key benefits of International Health Insurance Plan are

• Available in two variants Ruby and Diamond.
• Wide range of Sum Insured options from Rs 50 Lacs to Rs 12 Crores
• Choice of Area of Coverage from any of the four group
  • India, Africa, Middle East, Oceania, Asia (excluding china,HongKong,Singapore,Japan, Taiwan)
  • India, Europe, Canada, Latin America, Caribbean,
  • Worldwide Excluding United States
  • Worldwide including United States
    * For Worldwide including US, a minimum Sum Insured Rs 25000000 must be selected.
• Inpatient and Day Care expenses covered
• Outpatient Benefits
• AIDS/HIV Cover

Out of Area 30 days cover - Emergency Treatment only Emergency Evacuation & Repatriation

Repatriation of Mortal remains

• Maternity and New born Cover
• Dental Treatment and Vision Benefits
• Psychiatric & Psychological Care
• Wellness Benefit

Other Value Add Services by ManipalCigna Healthcare

ManipalCigna Health Insurance Company Limited offers an high-end online platform for various services. This ensures hassle free enrollment and transparency in all terms & conditions for enrollment in any of the plans.

Online Assistance Provided

• Callback
• Claim Process
• Claims tracker
• FAQ
• Hospital Locator
• ManipalCigna Branch
• Glossary

Proactive Living

• Health tolls & calculators
• Health Games
• Expert opinion on critical illness
• Wellness Podcast
• Health & welfare Articles
• Health & welfare Newsletter
• Discounts & Offers

How to File a Claim for ManipalCigna Health Insurance

The claim procedure of ManipalCigna Health Insurance is different for Cashless Claims and Reimbursement Claims.

Procedure for Cashless Claims

Cashless claims are offered only when the insured undertakes the desired treatment at a network hospital, provided the said treatment is covered by the policy.

1. Contact Toll-free Helpline Number Given by ManipalCigna Health Insurance: In case of planned hospitalization, you should approach the company 3 days in advance. Moreover, the customer care representatives will also help in following steps.
   In the case of an emergency, you should contact the insurance company within 48 hours of admission to the hospital.
2. Identification: You will need to show your ManipalCigna health card and a valid photo ID at the network hospital to be able to use your insurance. The hospital will, then, approach the company for approval of cashless hospitalization.
3. Hospital will Send Cashless Hospitalization Request Form: The network hospital will send a preauthorization request form with the details of your medical history, line of treatment and estimated treatment cost to the insurance company.
4. ManipalCigna will Contact the Hospital: The insurance company will issue a duly signed Authorization Letter to the particular network hospital. The information and/ or any documents required will be reported to the hospital. And, authorization will be issued only upon the receipt of necessary documents.
5. Discharge Formalities: The Network Hospital will send the final request for authorization of any residual amount, final hospital bill, and discharge summary to the insurer. Once the final authorization letter from the company is received, the patient will be discharged. Inadmissible expenses such as co-payments or deductions (if any) will have to be paid by the claimant.
6. Payment by ManipalCigna to the Network Hospital: After the network hospital sends the original claim document, the claim will be assessed and payment will be made by the insurer. 

Procedure for Reimbursement Claims

1. Avail Treatment at the Hospital: The policyholder has to settle all hospitalization expenses. It is important to the collect the original hospital bills, receipts, discharge summary, investigation reports, pharmacy bills and other documents at the time of discharge since these will facilitate the claim process.
2. Submit These Claim Documents: Download the claim form from the website of ManipalCigna . You can also contact your ManipalCigna Health Advisor and then submit the claim documents at the insurance company’s branch or office. The documents must be submitted within 15 days of discharge.
3. Insurer will assess the Claim: On receipt of all claim-related documents, the admissibility of claim will be assessed by ManipalCigna and only then would the claim be processed. In case of the requirement of additional information or documents arises, the insurance company will approach you. Only upon receipt of every last necessary documents will your claim be processed.
4. Updates and help From Claims Service Associate: A claims service associate helps you through the paperwork and forms if you request for this service.
5. Settlement of Claim: Upon approval of the claim, payment of the claim shall be made by the insurance company to the policyholder only through EFT.

ManipalCigna Health Insurance FAQs

1. Who do I call for claim settlement?

You can either contact your ManipalCigna Health Advisor, or directly approach the company through the toll-free helpline number provided by them.

2. Should I tell the company about my hospitalization only when I make a claim?

You have to contact the ManipalCigna Health Insurance Company as soon as an emergency occurs, or inform them in advance in case of a planned hospitalization.

3. What documents are required to make a cashless claim?

The following documents are required at the time of intimation of the claim:

• Name and complete address of the particular Medical Practitioner or/ and Hospital
• You must ask the insurance provider in case any other documents are needed.

4. What are the documents required to make a reimbursement claim?

The following documents are required to make a reimbursement claim:

• Duly signed claim form
• Hospital Break up bill
• Hospital Discharge summary
• Copy of photo ID of patient
• Hospital Main Bill
• Operation Theatre notes
• Investigation reports
• X-Ray, CT films, ECG, MRI, HPE, Original investigation reports
• Doctors’ reference slip for investigation
• Pharmacy Bills
• Post Mortem Report, MLC or FIR report

5. How to know if my claim has been authorized or not?

In case of cashless claims, the authorization will be directly sent to the hospital by the insurance provider. Email and SMS is sent to your registered mail id and mobile number.

In case of reimbursement claims, updates on the status of your claim will be sent to you via email and SMS; which is why it is important to always have your contact details updated in the company records.

6. Is there a limit on the number of claims I can make in a year?

While there is no limit on the number of claims that can be made in a year, the sum insured is limited.

7. What is Health Maintenance Benefit?

The Health Maintenance Benefit is aimed at reimbursing the outpatient expenses (if any) incurred by the policyholder during the policy period.
This benefit also includes coverage for diagnostic tests, dental treatments, drugs, medical aids, prosthetics, and/or any other types of medicines taken.

8. How long does it generally take to process claims?

The insurance company takes 5 working days to accept or reject a claim.

Following this, it takes not more than 30 days to settle the claim.

9. What is Worldwide Emergency Cover?

We will cover Medical Expenses of the Insured Person incurred outside India, up to limits specified in the Schedule, provided that:

• The treatment is Medically Necessary and has been certified as an Emergency by a Medical Practitioner, where such treatment cannot be postponed until the Insured Person has returned to India and is payable under Section II.1 of the Policy.
• The Medical Expenses payable shall be limited to Inpatient Hospitalization only.
• Any payment under this Benefit will only be made in India, in Indian rupees on a re-imbursement basis and subject to Sum Insured.
• The payment of any claim under this Benefit will be based on the rate of exchange as on the date of payment to the Hospital published by Reserve Bank of India (RBI) and shall be used for conversion of foreign currency into Indian rupees for payment of claim. You further understand and agree that where on the date of discharge, if RBI rates are not published, the exchange rate next published by RBI shall be considered for conversion.

10. Does a cashless claim mean I don’t have to pay anything at all?

A cashless claim is convenient since the payment is handled by the insurance company with the Network Hospital, with no involvement of the policyholder in the payment process.

However, any non-payable amounts will be deducted. Inadmissible expenses such as co-payments or deductions (if any) will have to be paid by the insured.