Manipal Cigna Pro-health Group Insurance Plan

With growing medical inflation and increasing diseases, having robust health insurance coverage has become a necessity for every individual and their family. ManipalCigna ProHealth Group Insurance Policy provides comprehensive benefits and enables access to quality health care in case of unfortunate events of hospitalisation for illness/injury safeguarding your financial well-being.

Key Features and Benefits

 
The key features and benefits covered under Manipal Cigna Pro-health Group Insurance Plan are as follows:

  • In-patient hospitalisation expenses cover

    If you are admitted to a hospital for more than 24 hours of illness or injury, the policy will cover your room charges, ICU expenses, nursing charges, doctor fees, surgeon fees, blood, oxygen, operation theatre charges and other medical expenses.

    Also, there will be additional coverage towards modern treatment methods and medical expenses related to any admission (under in-patient hospitalisation, day care treatment or domiciliary hospitalisation) primarily for enteral feedings. The coverage will be provided for up to 15 days in a policy year.

  • Pre-hospitalisation

    Medical expenses incurred before the date of hospitalisation will be reimbursed.

  • Post-hospitalization

    The policy also covers you after hospitalisation, during your recovery stage. Medical expenses incurred after you are discharged will be covered under the policy.

  • Day care treatment

    Medical expenses for treatments that need less than 24 hours of hospitalisation are covered under the policy.

  • Road ambulance cover

    The policy covers expenses towards hospital transportation by registered ambulance services for treatment of illness or injury during an emergency. The coverage is provided up to the Rs. 2,000 per hospitalisation.

  • Domiciliary treatment

    The plan covers prescribed home care expenses for at least three days, as the patient’s condition did not allow hospital transfer or in case of unavailability of hospital bed for the required treatment.

  • Donor cover

    The plan provides in-patient medical expenses towards the donor, if the insured is required to go for a major organ transplant.

  • Restoration of sum insured

    Restoration of the base sum insured once in a policy year for unrelated/related illnesses in addition to the sum insured opted.

  • In-patient hospitalisation cover for AYUSH treatment

    The plan covers in-patient medical expenses for an insured for non- allopathic treatments such as Ayurveda, Unani, Sidha, Homeopathy, Yoga and Naturopathy arising from accident or illness.

  • Disease category sub-limit*

    Covers for specific disease category as per the amount specified for each insured or family (as applicable). Multiple claims can be made within the disease category limit.

  • Voluntary co-pay for in-patient hospitalisation*

    10% to be borne by the insured, remaining payable amount will be borne by the insurer.

  • Per claim deductible*

    Deductible amount will be applied on every claim made by the insured person.

    Note*: - The condition under disease category sublimit will be applicable on restored sum insured also. - Voluntary co-pay for inpatient hospitalization or per claim deductible, whichever is lower shall be applicable.

  • Tax Benefits

    The health insurance plan offers tax exemptions under Section 80D of the Income Tax Act 1961.

Policy Details

ManipalCigna Pro-health Group Insurance Plan
Policy Type Individual/ Family Floater (Only for Customers of Bajaj Finance Ltd.)
Entry Age Minimum Entry Age: 18 years
Maximum Entry Age: 65 years
Dependent child: 91 days - up to 25 years
Tenure One year
Sum Insured Rs. 15 lakh and Rs. 30 lakh
Renewal* Lifetime renewability
Starting Premium Rs. 6,606
Number of members covered 6 members (2 adults + 4 children)
 
*Subject to master policy contract renewal

Plans Available

Health Insurance helps you to be stress-free while dealing with medical contingencies due to sickness and accidental injuries for you and your loved ones. The plans are available starting from Rs.6606, with maximum coverage of Rs. 30 lakh.

How to Purchase the Policy

To purchase the policy, follow these steps:

  • To apply for the ManipalCigna Pro-health Group Insurance Plan, you can purchase it easily online by filling in your basic and health details.
  • Ensure that the information given in the form is complete and accurate.
  • You may be required to undergo a pre-policy medical examination at the network diagnostic centre.
  • On purchasing this plan online, your policy will be generated instantly along with your policy kit and card. This is applicable for cases which do not require further underwriting or medical check-up

List of Documents Required for Purchasing the Policy

The following mandatory documents will be needed to purchase the policy:

  • Photograph of the applicant
  • Age proof such as birth certificate, Voter’s ID, PAN card, passport, etc.
  • Identity proof such as passport, Aadhaar card, PAN card, Voter’s ID, etc.
  • Income Proof such as Form 16, salary slips, employment certificate, etc.
  • Address proof such as telephone bill, electricity bill, passport, bank statement, Voter’s ID, etc.
  • Medical test that the insurer requires you to undergo.

How to Process Claims

Cashless Claims

Documents needed to process cashless claim:

With ManipalCigna Pro-health Group Insurance Plan, you can avail the benefit of cashless treatment from 3500+ network hospitals by following the below process:
  • Get admitted to any one of the ManipalCigna network hospitals.
  • Use your ManipalCigna Pro-health Group Insurance card or share your policy number with the concerned team at the hospital along with your passport/PAN card/voter’s ID as identification proof.
  • The network hospital will then verify your identity for validation and submit the pre-authorization request to the insurer.
  • After validation, the insurer will review and provide their confirmation to the network hospital by fax and email. The insurer ensures you are also notified of the same through text message and email. The insurer will respond to your request within 30 minutes of filing the claim request.
  • The only activity left to do now is the final settlement of your claim (as per the policy terms and conditions) with the hospital after completion of all the necessary formalities

Reimbursement Claims

Documents needed to process reimbursement claim:

  • If you get hospitalized, notify the insurer within 48 hours of admission in our network or non-network hospital. After getting admitted pay the amount directly to the hospital you were admitted to.
  • After you get discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports, and discharge certificates with you. The insurer would need the originals of all the mentioned documents to process your reimbursement.
  • Send all the documents to the insurer which should be filled and signed in the claim form. Send your valid ID proof and age proof as well.
  • After receiving your documents, the insurer will review your claim request and accordingly will give approval, raise a query or reject the same (as per the policy terms and conditions).
  • Finally, the insurer will settle the claim (as per the policy terms and conditions) and reimburse the approved amount.
Collect below mentioned relevant document in original form from the hospital and submit them to the insurer within 15 days of discharge from the hospital
  • Original investigation reports
  • Final hospital discharge summary FIR or post-mortem report if happened
  • Pharmacy bills along with the prescription
  • Cancelled cheque or NEFT details for payment
  • Original bills, receipts, and discharge report
  • Indoor case papers and duly filled claim form
  • Original hospital bills and a valid photo ID proof Treating doctor's report
  • Original consultation notes Nature of operation performed and surgeon's bill and receipt
  • Test reports along with attending doctor’s or surgeon’s report.

Major Policy Exclusions

  1. Dental treatments and cosmetic surgeries
  2. Ailments requiring treatment due to use or abuse of any substance, drug, or alcohol and treatment for de-addiction.
  3. Circumcision unless required for the treatment of Illness or accidental bodily injury.
  4. Cosmetic, aesthetic, and re-shaping treatments & surgeries.
  5. Psychiatric or psychological disorders, mental disorders.
  6. Ailment wise capping and ambulance charges
  7. Hearing aids, spectacles, or contact lenses including optometric therapy. Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances.
  8. Sexually transmitted diseases such as AIDS and HIV.
  9. Waiting Period:
  10. • Initial waiting period for hospitalisation is 30 days since the date of inception of cover.

    • 24 months from date of inception of the policy for specific diseases like cataract, hernia, hysterectomy, joint replacement etc.

    • 24 months from date of inception of the policy for pre-existing diseases

  11. Refer to the policy document to know more exclusions in detail

Claim/Assistance Contact Details

Toll free number –  08698010101/1800-209-0144 /1800-209-5858

E-mail –  wecare@bajajfinserv.in

Mailing address: Ground Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411014.

 

*For claim related issues please refer your policy document or certificate of insurance (COI).

Disclaimer

Conditions apply. This product is offered under the Group Insurance scheme wherein Bajaj Finance Limited is the Master policyholder. The insurance coverage is provided by our partner Insurance Company Manipal Cigna Health Insurance UIN: MCIHLGP21172V032021. Bajaj Finance Limited does not underwrite the risk. IRDAI Corporate Agency Registration Number CA0101. The above-mentioned benefits and premium amount are subject to various factors such as the age of insured, lifestyle habits, health, etc. (if applicable). BFL does NOT hold any responsibility for the issuance, quality, serviceability, maintenance, and any claims post-sale. This product provides insurance coverage. Please refer insurer's website for Policy Wordings. Purchase of this product is purely voluntary. BFL does not compel any of its customers to mandatorily purchase any third-party products