ManipalCigna Plans

ManipalCigna Health

ManipalCigna offers their health insurance insureds the option of availing quality treatment at more than 6500+ leading hospitals across the country. They have an incurred claims ratio of 62.00%, and also covered 11.01 lac lives during the same year 2018-19, as per the data provided by IRDAI.

Buy Manipal Cigna Health Insurance

 Plan type
 
 Coverage type
 Coverage State
 Coverage City
 Coverage amount
Date of Birth
  OR age      years
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Policy duration
Start Date
End Date

Who is eligible?

  • Minimum Entry Age: Child - 91 days, Adult - 18 years
  • Max Entry Age: No limit
  • Coverage Type: Individual and Family Floater
  • Policy Period: 1, 2 and 3 years

Key features of ManipalCigna Health Insurance

  • Room Rent: Room eligibility as defined by hospital based on plan opted
  • Co-pay: No co-pay if entry age < 65 years / 10%-20% co-pay for ages > 65 years
  • Restoration Benefit : Multiple Restorations per year for unrelated illnesses

ManipalCigna Health Insurance Review

ManipalCigna Health Insurance
ManipalCigna Health Insurance sum insured
2.5 lacs − 100 lacs options available
Incurred Claims Ratio *
62.00%
ManipalCigna Health Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio **
90.02%
List of network hospitals
6,500+ hospitals
Number of policies issued *
229,817
Maximum family floater coverage
Self, Spouse + 3 dependent children
Number of lives covered *
1,101,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Why Should One insure themselves through ManipalCigna Health Insurance plans?

  • ManipalCigna is one of India’s leading Standalone Health Insurance Companies in India
  • Cashless Hospitalization across the Large Network With More Than 6500+ Hospitals in India
  • Wide Range Of Health Insurance Products From Individual Plans to Family Floater Schemes with Sum Insureds ranging from ₹2 lacs to ₹100 lacs (₹1 cr)
  • Covers Hospitalisation Treatment including coverage for Covid 19 Expenses
  • Includes cover for Modern Treatment & procedures
  • Affordable all India Health coverage
  • One can increase 25% of your sum insured every year up to 200% with ProHealth Insurance, as per plan opted
  • Life Time Renewal of all policies + No Upper Entry Age limit for all plans
  • With ProHealth Insurance, get 100% sum restoration every time your coverage is exhausted / insufficient by multiple claims.
  • Free Look Cancellation Period of 15 days.
  • Additional Features like Tax Benefit under section 80D
ManipalCigna Health Insurance is today one of the fastest growing insurance players in India with a lot of focus on both retail and group insurance products. Today the ManipalCigna health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 6,500+ and growing. Most of the customer’s ManipalCigna health insurance reviews have been positively influencing the growth of their business year on year. One can also follow the ManipalCigna health insurance renewal link on https://www.eindiainsurance.com/ for renewal of their existing policies and if one needs to file a claim, all they need to do is to fill in the ManipalCigna health insurance claim form available on the same website.

ManipalCigna Health Insurance Plans

  • Min Entry Age: Child - 91 days, Adult - 18 years
  • Max Entry Age: No limit
  • Cover Type: Individual and Family Floater
  • Policy Period: 1, 2 and 3 years
Key Features:
  • ManipalCigna Lifestyle Protection-Critical Care offers you payment of the entire Sum Insured on first diagnosis of 15 or 30 major illnesses and procedures.
Key Features:
  • ProHealth Hospital Cash provides a wide choice of daily cash benefits
  • It Pays cash directly to you when you need it most
  • Can be used to compensate expenses not covered by health insurance
  • Can offset lost wages due to a hospitalization
Key Features:
  • ProHealth Select Plan, which not only helps you secure your health, but also protects your future expenses.


Key Features:
  • Min Entry Age: 18 Years
  • Max Entry Age: 75 Years
  • Dependent Children, grandchildren and siblings can be covered from 5 years up to 25 years of age in Group Personal Accident and from 18 years to 25 years in Group Critical Illness policy.
  • Minimum number of members required to buy a group policy is 7
  • Policy Period: 1 year only. Only for credit linked policy, term can be upto 5 years.
Key Features:
  • Min Entry Age: 18 Years
  • Max Entry Age: 95 Years
  • Dependent Children can be covered from day 1 of birth up to 25 years of age.
  • Minimum number of members required to buy a group policy is 7
  • Policy Period: 1 year only


Key Features:
  • Min Entry Age: day 1 of birth up to 25 years of age.
  • Sum Insured options from ₹ 5, 000 up to ₹ 100 Lacs.
  • It is available to any homogeneous group/association/ institution/corporate body provided it has a Central administration and subject to minimum group size of 7 persons.
Key Features:
  • Min Entry Age: Child: 3 months (91 days) and Adult: 18 years
  • Max Entry Age: Child: 25 years (family floater policy) and Adult: 65 years



Key Features:
  • Min Entry Age: Child: 3 months (91 days) and Adult: 18 years
  • Max Entry Age: Child: 23 years (family floater policy) and Adult: No limit

Key Features:
  • Policy can be availed by persons between the age of 18 years and 65 years (inclusive of both ages). Proposer with higher age can obtain policy for adult members of the family, without covering self.
Key Features:
  • Policy can be availed by persons between the age of 18 years and 65 years (inclusive of both ages). Proposer with higher age can obtain policy for adult members of the family, without covering self.

Benefits of ManipalCigna Pro Health Insurance Plans

Coverage Benefits ProHealth Protect ProHealth Plus ProHealth Preferred ProHealth Premier ProHealth Accumulate
Sum Insured (SI) 2.5lakhs, 3.5lakhs, 4.5lakhs, 5.5lakhs, 7.5lakhs, 10lakhs, 15lakhs, 20lakhs, 25lakhs, 30lakhs, 50lakhs 4.5lakhs, 5.5lakhs, 7.5lakhs, 10lakhs, 15lakhs, 20lakhs, 25lakhs, 30lakhs, 50lakhs 15lakhs, 30lakhs, 50lakhs 100lakhs 5.5lakhs, 7.5lakhs, 10lakhs, 15lakhs, 20lakhs, 25lakhs, 30lakhs, 50lakhs
BASIC
In-patient Hospitalization Covered upto Single Private Room for SI upto 5.5 Lacs & any hospital room except suite and higher for SI above 5.5 lacs Any hospital room except Suite Any hospital room except Suite Any hospital room except Suite Covered upto Single Private Room for SI upto 5.5 Lacs & any hospital room except suite and higher for SI above 5.5 Lacs
Pre - Hospitalization Upto 60 days
Post - Hospitalization Upto 90 days Upto 180 days Upto 90 days
Day Care treatment 500 plus listed Day Care treatments covered upto Sum Insured
Domiciliary Treatment Treatment at home covered upto Sum Insured
Ambulance Expenses Upto Rs.2000 per event Upto Rs.3000 per event Actual expenses per event Actual expenses per event Upto Rs.2000 per event
Donor Expenses Covered upto Sum Insured
Worldwide Emergency Cover Covered up to full Sum Insured once in a Policy Year
Restoration Of Sum Insured Multiple Restoration is available in a Policy Year for unrelated illnesses, injury in addition to the Sum Insured opted
AYUSH Cover In-patient hospitalization covered upto Sum Insured
Health Maintenance Benefit Upto Rs.500 Upto Rs.2,000 Upto Rs.1,500 Upto Rs.1,500 Option - Rs.5,000, Rs.10,000, Rs.15,000, Rs.20,000
Maternity Expenses^ Rs.15,000 for normal; Rs.25,000 for C-section (per event) Rs.50,000 for normal; Rs.1 lac for C-section (per event) Rs.1 lac for normal; Rs.2 lacs for C-section (per event)
New Born Baby Expenses^ - Covered within maternity expenses -
First Year Vaccinations^ - Covered over & above maternity expenses -
VALUE ADDED
Health Check-Up (for all insured aged 18 years & above) Available once every 3rd policy year Available each policy year(excluding the fi rst year) Available once every 3rd policy year
Expert Opinion on Critical illness Available once during the Policy Year
Cumulative Bonus(% increase in Sum Insured) Guaranteed 5%, Max -200% Guaranteed 10%, Max - 200% Guaranteed 5%, Max -200%
Healthy Rewards Earn points equivalent to 1% of premium paid and additional points max. upto 19% from our wellness programs. Redeem earned points against renewal premium or as Health Maintenance Benefit anytime or as equivalent value while availing services through our Network Providers
OPTIONAL
Hospital Daily Cash Benefit (for each 24 hours hospitalization Rs.1000 Rs.2000 Rs.3000 Rs.3000 Rs.1000
Deductible* Rs 1/2/3/4/5/7.5/10 Lacs - - Rs. 50,000, 1/2/3/4/5/7.5/10 Lacs
Reduction in Maternity Waiting - Maternity waiting period Reduced from 48 months to 24 months -
Voluntary CoPayment* 10% or 20% as opted - - 10% or 20% as opted
Waiver of Mandatory Co-pay
Cumulative Bonus Booster Guaranteed 25%, Max - 200% - Guaranteed 25%, Max - 200%
ADD ON
Critical Illness# (lumpsum additional 100% of SI opted)
* Voluntary Co-pay & Deductible cannot be opted under the same plan.
^ Waiting Period of 48 months applies.
# Available with 1 & 2 years policy terms.

ManipalCigna Insurance Features

  • Key features
  • Benefits
  • Claim
  • Exclusion
  • Family discount of 25% for Protect and Plus Plans and 10% for Preferred, Premier and Accumulate Plans covering 2 and more family members under the same individual policy.
  • Long term discount 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.
  • Renewals: Lifetime renewals available.
  • Grace Period: 30 days on renewal with all continuation benefits.
  • Free-look: A period of 15 days to cancel the policy with full refund. For any medical tests (if conducted) 50% of medical cost will be retained.
  • Tax Benefit: Income tax deduction available under Sec 80 D, Income Tax Act 1961 (as amended).
  • Cancellation: Request can be placed during the policy. Premium refund will be on short period basis.

Benefits under ManipalCigna Health Insurance plans include

  • Cashless facility – ManipalCigna aims to process all cashless claims within 30 minutes at over 6,500+ quality hospitals in their network
  • Coverage Sum Insured upto Rs. 1 Crore
  • No entry age restriction - There is no maximum entry age limit to buy ManipalCigna ProHealth Insurance plans. A child aged 91 days onwards can be covered under the policy and for an adult the minimum entry age is 18 years. It is best advised that you start early, pay less & get more benefits:
    Age Limits
    Adults 18 and above
    Children 91 days to 23 years as dependent children *
    * - subject to
    • Children from 91 days to 18 years will only be covered if one of the parents is the proposer
    • Children up to 23 years can be covered under the floater.
    • Children beyond 23 years can be covered under an individual policy.
    • Renewals will be available for lifetime.
  • Pre-Hospitalization coverage: You may incur some expenses before you are hospitalized, like doctors fees, pharmacy-related expenses, or diagnostic tests. All such costs will be covered by us for up to 60 days (in all ProHealth plans) before your hospitalization
  • Post-Hospitalization coverage: After you get home from the hospital, there are still many expenses to be taken care of, like consultation fees, diagnostic tests, pharmacy-related costs among other things. We will cover such expenses related to your hospitalization up to 90/180 days (as per plan) after your discharge.
  • In-patient Hospitalization: We pay for room charges, intensive care unit charges, doctor's fee, diagnostic tests, medications, blood, oxygen, operation theater charges, etc. if you get admitted to a hospital for in-patient care, for more than 24 consecutive hours.
  • Day Care Treatment (Hospitalization less than 24 Hours): Treatments such as operations on the eyes, ligament tear, chemotherapy, Haemodialysis etc require you to stay hospitalized for less than 24 hours. We cover 546 such day-care treatments
  • Cumulative Bonus(Guaranteed Claim Bonus): You shall get guaranteed cumulative bonus (Upto 200% of Sum Insured). While no claim bonus only increases the sum insured for every claim-free year, guaranteed cumulative bonus is available irrespective of any claims. The Sum Insured increases by 5/10% (as per plan)
    • If you take a ProHealth Plus Plan of 5,50,000 Lakhs, sum insured shall increase by Rs.55,000(10%) post renewal.
  • Health Maintenance Benefit (For Out-patient Medical Expenses and more): We cover expenses incurred by you on Diagnostic tests, drugs, medical aids such as spectacles, contact lenses, walker etc. under Health Maintenance Benefit. Coverage shall depend on plan taken. To know more about about the coverage and limits associated with each plan, kindly refer the brochure
  • AYUSH Cover: We want you to avail the treatment of your choice. Hence, our ProHealth plans also support alternate treatments including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.
  • Ambulance Cover: Medical emergencies can happen anytime. So, we cover expenses incurred for transportation by an ambulance service provider to the hospital for treatment. The coverage limit shall depend upon the plan taken by you
  • Healthy Rewards: Step into Health & Savings with ManipalCigna. Earn reward points by opting for an array of Our wellness programs. Points can be redeemed as below:
    • Against payable premium including taxes from 1st renewal and onwards.
    • Get equivalent value of Health Maintenance Benefit anytime in the policy.
    • Equivalent value while availing services through any of our network providers
  • Discounts Available:
    • Family Discount: Upto 25%(as per plan) off on covering 2 and more family members under single Individual insurance policy
    • Long Term Discount:
      • 7.5% Discount on 2 years policy
      • 10% Discount on 3 years policy.

Claims process at Manipal Cigna

Things to keep in mind while raising a claim:
  • You must Intimate and submit a claim in accordance with the Claim Process defined in the Policy.
  • You must follow the advice provided by a Medical Practitioner.
  • You must upon Our request, submit Yourself for a medical examination by Our nominated Medical Practitioner as often as We consider reasonable and necessary. The cost of such examination will be borne by Us.
  • Provide Us with complete documentation and information that We have requested to establish admissibility of the claim, its circumstances and its quantum under the provisions of the Policy.

Assistance Contact Numbers

For Health Claims
  • Call at: Toll Free 1800-419-1159 (for Claims)
  • Call at: Toll Free 1800-102-4462 (for Service)
  • Email ID: cigna@mediassistindia.com

Cashless Claims Process

Step 1 Get admitted to any one of ManipalCigna network hospitals, currently they have 6500+ hospitals across India…hospital list at https://www.eindiainsurance.com/manipalcigna/health/
Contact Toll free Healthline 1800-419-1159
Before you seek medical treatment we request that you contact us 3 days in advance. This will allow our health relationship managers to help you follow the next few steps. In case of emergency, you can contact us within 24 hours of admission to the hospital.
Step 2 Your Identification : At the network hospital you will need to show your ManipalCigna Health Insurance health card and valid photo ID*, along with your policy number, to be able to use your insurance. This will give the network hospital the details they need to contact us for the cashless hospitalization process.
* - Passport / PAN card / voter’s ID for identification purposes
Step 3 Hospital sends cashless hospitalization request form : The network hospital will send us the preauthorization request form which has details of medical history, line of treatment and estimated treatment cost.
Step 4 ManipalCigna Health Insurance contacts Hospital : Wherever the information provided in the request is sufficient to ascertain the authorization, we will issue the authorization Letter to the network hospital. Wherever additional information or documents are required we will call for the same from the Network hospital and upon satisfactory receipt of last necessary documents the authorization will be issued.
Step 5 Updates from Claims Service Associate : If such a service is requested by you, our claims service associate helps you navigate through the paper work and forms
Step 6 At the time of Discharge : Hospital will send us the final request for authorization of any residual amount along with final hospital bill and discharge summary. You will be discharged from the hospital upon receipt of final authorization letter from us. Any inadmissible expenses, copayments, deductions will have to be paid by you.
Step 7 Payment to the network hospital made by ManipalCigna Health Insurance : Once the Hospitalization is done, hospital will send the original claim documents to us. The claim will be assessed by us and payment will be made to the network hospital

Reimbursement Claims Process

Step 1 Contact Toll free Healthline 1800-419-1159
Before you seek medical treatment we request that you contact us 3 days in advance. This will allow our claims service associate to help you follow the next few steps. In case of emergency, you can contact us within 24 hours of admission to the hospital.
Step 2 Avail treatment at the hospital: You can avail treatment at hospital and settle all hospitalization expenses. Collect original hospital bill, receipts, discharge summary, investigation reports, pharmacy bills and other documents from hospital at the time of discharge from hospital.
Step 3 Submit the claim document: You have to download the claim form from our website www.manipalcigna.com. Copy of this form is also included in the policy kit provided to you. Alternatively, you can contact your Health advisor or visit nearest ManipalCigna Health Insurance branch. Submit the claim documents at nearest ManipalCigna Health Insurance branch or Corporate office. The documents should be submitted within 15 days from discharge from the hospital.
Step 4 We assess the claim: Wherever the information provided in the claim documents is sufficient to ascertain the admissibility of claim, we will approve the claim. Wherever additional information or documents are required we will call for the same from you and upon satisfactory receipt of last necessary documents the claim will be settled by us.
Step 5 Updates from Claims Service Associate: If such a service is requested by you, our claims service associate helps you navigate through the paper work and forms.
Step 6 Settlement of claim: Upon approval of claim by us, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD.

Exclusions Under the Policy

Some of the permanent exclusions under the ManipalCigna Health Insurance Plans are below, kindly review the policy wordings which are available with your policy kit for the entire list of exclusions under your opted plan. The exclusions include:
  • Stem cell implantation/surgery, harvesting, storage or any kind of treatment using stem cells.
  • Dental treatment, dentures or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours hospitalisation or treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage
  • Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder or due to an accident
  • Birth control procedures, contraceptive supplies or services including complications arising due to supplying services, hormone replacement therapy and voluntary termination of pregnancy during the first 12 weeks from the date of conception, surrogate or vicarious pregnancy
  • Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic purposes or corrective surgeries, contact lenses or hearing aids, cochlear implants, vaccinations except post-bite treatment or for new born baby up to 90 days, any physical, psychiatric or psychological examinations or testing , any treatment and associated expenses for alopecia, baldness, wigs, or toupees and hair fall treatment & products, issue of medical certificates and examinations as to suitability for employment or travel
  • Laser Surgery for treatment of focal error correction other than for focal error of +/- 7 or more and is medically necessary.
  • All expenses arising out of any condition directly or indirectly caused due to or associated with human T-call Lymph tropic virus type III (HTLV-III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) and its variants or mutants, Acquired Immune Deficiency Syndrome (AIDS) whether or not arising out of HIV, AIDS related complex syndrome (ARCS) and all diseases / illness / injury caused by and/or related to HIV
  • All sexually transmitted diseases including but not limited to Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis
  • Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed by a Medical Practitioner
  • Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment
  • Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health
  • Treatment for developmental problems including learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder(ADHD)
  • Treatment for general debility, ageing, convalescence, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, ,run down condition or rest cure, congenital external anomalies or defects, sterility, fertility, infertility including IVF and other assisted conception procedures and its complications, subfertility, impotency, venereal disease, or intentional self-injury, suicide or attempted suicide(whether sane or insane)
  • Certification / Diagnosis / Treatment by a family member, or a person who stays with the Insured Person, or from persons not registered as Medical Practitioners under the respective Medical Councils, or from a Medical Practitioner who is practicing outside the discipline that he is licensed for, or any diagnosis or treatment that is not scientifically recognised or experimental or unproven, or any form of clinical trials or any kind of self-medication and its complications
  • Ailment requiring treatment due to use, abuse or a consequence or influence of an abuse of any substance, intoxicant, drug, alcohol or hallucinogen and treatment for de-addiction, or rehabilitation
  • Any illness or hospitalisation arising or resulting from the Insured Person or any of his family members committing any breach of law with criminal intent.
  • Prostheses, corrective devices and medical appliances, which are not required intra-operatively for the disease/ illness/ injury for which the Insured Person was hospitalised
  • Any cosmetic surgery, aesthetic treatment unless forming part of treatment for cancer or burns, surgery for sex change or treatment of obesity/ morbid obesity (unless certified to be life threatening) or treatment/surgery /complications/illness arising as a consequence thereof
  • Any robotic, remote surgery or treatment using cyber knife
  • Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment even if the same requires confinement at a Hospital
  • Costs of donor screening or costs incurred in an organ transplant surgery involving organs not harvested from a human body.
  • Any form of Non-Allopathic treatment, Hydrotherapy, Acupuncture, Reflexology, Chiropractic treatment or any other form of indigenous system of medicine.
  • Insured Persons whilst engaging in speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports or involving a naval military or air force operation
  • Insured Person whilst flying or taking part in aerial activities (including cabin crew) except as a passenger in a regular scheduled airline or air Charter Company.
  • All expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
  • All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defense, rebellion, revolution, insurrection, military or usurped power
 

Manipal Cigna health insurance FAQ's

Which hospitals are covered under ManipalCigna Health Insurance?

ManipalCigna has an extensive network of 6500+ network hospitals across India. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the ManipalCigna network hospital list which is available on the website https://www.eindiainsurance.com/manipalcigna/health/

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured, unless the chosen plan has a Sum Insured Refill benefit, which provides additional coverage even after filing a claim.

In case of an Individual policy, each Insured person under the policy will have a separate sum insured for them. Individual plan can be bought for self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunty, nephew & niece.

In case of a floater cover, one family will share a single sum insured as opted. A floater plan can cover self, lawfully wedded spouse, children upto the age of 23 years or parents. A floater cover can cover a maximum of 2 adults and 3 children under a single policy.

You can buy the policy for one, two or three continuous years at the option of the Insured. One Policy Year shall mean a period of one year from the inception date of the policy.

No, as per the guidelines of ManipalCigna ProHealth Insurance, medical check up shall be required only if:
  • any insured member covered is greater than 55 years
  • Or sum insured >50 lakh.
  • Insured member >45 years and upto 55 years will undergo an underwriting call and medicals (if required) will be scheduled.

Medical check-up depends upon the disease declared, age of insured person and Sum Insured. Pre-policy medical check-up typically has Medical Examination Report by the Physician, few blood & Urine tests & ECG. Additional test like TMT, 2D echo, Sonography etc can also be part of the PPC check up list depending on the health status, Sum insured and age of the customer.

Pre-existing waiting period for ManipalCigna ProHealth Insurance Plan is 48/36/24 months (as per plan). That means, your pre-existing diseases declared at the time of policy purchase will be covered after 4/3/2 years subject to continuous renewals.

You can port your existing health insurance policy to ProHealth. The below supporting documents will be required:
  • Portability Form
  • Proposal Form
  • Previous insurance policy copies of last 4 years

A compulsory co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and above irrespective of the age of entry in to the Policy. Co-pay will be applied on the admissible claim amount. For persons who have opted for a Waiver of Mandatory Co-pay the same will not apply. In case the Insured has selected the Voluntary co-pay under Optional Cover and/or chooses to avail treatment outside his Zone of Cover, then the co-pay percentages will apply in conjunction

A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36 months prior to 1st health insurance policy issued by Us under which the insured person was covered.

Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

A waiting period is the length of time you, the insured, will have to wait before the benefits under the health policy can be utilised.

The following KYC documents are required from the insured person/proposer in cases of reimbursement-
  • If claim amount is below 1 lakh- Photo Id proof & address proof
  • If claim amount is above 1 lakh- Photo Id proof, address proof and a recent photograph

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.

We cover reasonable and customary charges for medical expenses incurred during the insured person’s medically necessary and medically advised in-patient hospitalisation during the policy period for treatments like Ayurveda, Unani, Sidha and Homeopathy (AYUSH). However, treatment must take place in a government hospital or in any institute recognised by the government and/or accredited by the Quality Council of India/the National Accreditation Board of Health.

You can avail of our cashless facility arrangement with over 6500+ network hospitals across india. Decision of the cashless claim will be given to you/hospital within 90 mins of receipt of last necessary document( i.e last document necessary for us to decide admissibility of cashless). At the time of discharge, we will confirm the final approved amount. The deductions on account of non payable expenses if any will have to paid by you at the time of discharge. Post discharge of patient from hospital, hospital sends us the original claim documents for us to reimburse the expenses to the extent of the approved amount.
Alternatively, you can pay all hospitalization bills directly and submit the original claims documents post discharge for reimbursement to nearest ManipalCigna branch. Once we approve the claim, a cheque will be sent to you for the benefit amount payable under your policy.

The following details are to be provided to the company at the time of intimation of claim:
  • Policy number
  • Name of the policyholder
  • Name of the insured person in whose relation the claim is being lodged
  • Nature of illness / injury
  • Name and address of the attending medical practitioner and hospital
  • Date of admission
  • Any other information as requested by us

In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, pace maker implantation, total knee replacement etc are examples for which the hospitalisation can be planned.The insured person should at least 3 days prior to admission to the hospital approach the network provider for hospitalization for medical treatment.

In emergency hospitalization the patient is admitted to the hospital in an emergency situation, for e.g. Severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 48 hours of admission to the hospital.

You should submit your claim within 15 days from date of discharge from the hospital.

We will not be liable to pay for any claim arising out of an injury/ accident/ condition that occurred during the grace period.

If two of more policies are taken by you during the same period from one or more insurers to indemnify treatment costs and the amount of claim is within the sum insured limit of any of the policies, you will have the right to opt for a full settlement of your claim in terms of any of your policies.
Where the amount to be claimed exceeds the sum insured under a single policy after considering deductibles, co-pays (if applicable), you can choose the insurer with which you would like to settle the claim. Wherever we receive such claims we have the right to apply the contribution clause while settling the claim.

For cashless claims, the payment shall be made to the network hospital whose discharge would be complete and final. For reimbursement claims, the payment will be made to you. In the unfortunate event of death of policy holder, we will pay the nominee (as named in the policy schedule) and in case of no nominee to the legal heir who holds a succession certificate or indemnity bond to that effect, whichever is available and whose discharge shall be treated as full and final discharge of its liability under the policy.

You may submit the claim form along with the documents for reimbursement of the claim to the nearest ManipalCigna branch or head office at your own expense not later than 15 days from the date of discharge from the hospital.

List of necessary claim documents to be submitted for reimbursement are as following:
  • Claim form duly signed
  • Copy of photo id of patient
  • Hospital discharge summary
  • Operation theatre notes
  • Hospital main bill
  • Hospital break up bill
  • Investigation reports
  • Original investigation reports, X ray, MRI, CT films, HPE, ECG
  • Doctors reference slip for investigation
  • Pharmacy bills
  • MLC/ FIR report, post mortem report if applicable and conducted

You will receive an update on status of your claim through sms and emails on the registered contact details with us. Hence, it is important that your contact details are updated with us at all times. You can also reach out to your health advisor or connect with our health relationship managers to get an update or clarification on the claim. In case of cashless claims, we will issue the authorisation letter to the hospital through fax or email.

You should carry the health card provided by the company with this policy, along with a valid photo identification proof (voter id card / driving license / passport / pan card / any other identity proof as approved by the company).

We shall scrutinize the claim and accompanying documents. Any deficiency of documents, shall be intimated to you and the network provider, as the case may be within 5 days of their receipt. If the deficiency in the necessary claim documents is not met or are partially met in 10 working days of the first intimation, we shall remind you of the same and every 10 (ten) days thereafter. We will send a maximum of 3 (three) reminders following which we will send a closure letter.

We may investigate claims at our own discretion to examine validity of claim. Such investigation shall be concluded within 15 days from the date of assigning the claim for investigation and not later than 6 months from the date of receipt of claim intimation. Verification carried out, if any, will be done by individuals or entities authorised by us to carry out such verification / investigation(s) and the costs for such verification / investigation shall be borne by the us.

We shall settle claims, including its rejection, within 5 (five) working days of the receipt of the last ‘necessary’ document but not later than 30 days.

You should submit the post-hospitalization claim documents at your own expense within 15 days of completion of post-hospitalization treatment or period, whichever is earlier. We shall receive pre and post- hospitalization claim documents either along with the inpatient hospitalization papers or separately and process the same based on merit of the claim derived on the basis of documents received.

The sum insured opted under the plan shall be reduced by the amount payable / paid under the benefit(s) and the balance shall be available as the sum insured for the unexpired policy period. We are not obliged to make payment for any claim or that part of any claim that could have been avoided or reduced you/ insured person could reasonably have minimized the costs incurred, or that is brought about or contributed to by you/insured person failing to follow the directions, advice or guidance provided by a medical practitioner. If you/ insured person suffers a relapse within 45 days of the date of discharge from the hospital for which a claim has been made, then such relapse shall be deemed to be part of the same claim and all the limits for “instance of same illness” under this policy shall be applied as if they were under a single claim.

Where a rejection is communicated by us, you may if so desired within 15 days represent to us for reconsideration of the decision.

Completed claim forms and documents must be furnished to us within the stipulated timelines. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if you can satisfy us that it was not reasonably possible for you to submit / give proof within such time. The due intimation, submission of documents and compliance with requirements by you as mentioned above shall be essential failing which we shall not be bound to entertain a claim.

This benefit covers reimbursement of outpatient expenses incurred by insured person upto the limits specified under the plan. It can be used to cover diagnostic tests, medical aids, drugs, prosthetics, dental treatments and alternative forms of medicines.

You can submit your request for a expert opinion by calling our call centre or register request through email. We will schedule an appointment or facilitate delivery of medical records of the insured person to a medical practitioner. The expert opinion is available only in the event of the insured person being diagnosed with covered critical illness.

If the insured person has completed 18 years of age, the insured person may avail a comprehensive health check-up with our network provider as per the eligibility details mentioned in the plan opted. Health check ups will be and arranged by us and conducted at our network providers.
  • For protect plan – available once every 3rd policy year
  • For plus, preferred and premier plan – available at each renewal
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.

In an unlikely event of you/insured person requiring emergency medical treatment outside India, the same shall be availed at his/her own cost. You/insured person, must notify us either at the call center or in writing within 48 hours of such admission. You shall file a claim for reimbursement in accordance with claim process of the policy.

In the event that the cost of hospitalization exceeds the authorized limit as mentioned in the authorization letter, the network provider shall request us for an enhancement of authorisation limit including details of the specific circumstances which have led to the need for increase in the previously authorized limit. We will verify the eligibility and in our sole discretion evaluate the request for enhancement on the availability of further limits.

In the event of a change in the treatment during hospitalization to the insured person, the network provider shall obtain a fresh authorization letter from us in accordance with the process.

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    InstantCover Insurance Web Aggregator Private limited
    710, 6th B Cross, 16th Main Road, Koramangala 3rd Block, Bangalore - 560 034.

  • +91-(80)-41744345
  • Send an email
CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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