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Manipal Cigna Pro-health Group Insurance Plan

In today’s world of growing medical inflation, and the rising infectious diseases having a robust health insurance coverage has become a necessity for every individual and family to protect against the medical expenses of the future.

Manipal CIGNA ProHealth Group Insurance Policy is designed to provide comprehensive benefits and access to quality health care in case of unfortunate events of hospitalisation for illness/injury safeguarding your financial well-being.

Benefits at Glance

  • In-patient Hospitalisation Expenses Cover

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

    Also, there will be additional protection with coverage towards Modern treatment methods & medical Expenses related to any admission (under In-patient Hospitalisation, Day Care Treatment or Domiciliary Hospitalisation) primarily for enteral feedings will be covered, up to 15 days in a Policy Year.

  • Pre-Hospitalization

    We will reimburse medical expenses incurred before the date of hospitalization.

  • Post-hospitalization

    We don’t just cover you when you are in the hospital but are also with you through the recovery process. Medical expenses incurred after you are discharged will also be covered.

  • Day care treatment

    We will pay for medical expenses if you undergo a treatment that needs less than 24 hours of hospitalization.

  • Road ambulance cover

    Provides for expenses towards hospital transfer by registered Ambulance services for treatment of illness or injury during an emergency, up to the Rs 2000 per Hospitalisation.

  • Domiciliary treatment

    Covers prescribed home care expenses as the patient’s condition did not allow hospital transfer or hospital bed is not available provided treatment is required for at least 3 days.

  • Donor cover

    Provides for 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

    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*

    Pays for specific disease category, the amount as specified per 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 raised as a claim by the insurer.

  • Per claim deductible*

    Deductible amount will be applied on every claim made by an 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
  With Co-pay Without Co-pay
Policy Type Individual/ Family Floater (Only for Customers of Bajaj Finance Ltd.) 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
Minimum Entry Age: 18 years
Maximum Entry Age: 65 years
Dependent Child: 91 days - up to 25 years
Tenure One year One year
Sum Insured Rs. 5 lakh and Rs. 10 lakh Rs. 5 lakh to Rs. 30 lakh
Renewal* Lifetime renewability Lifetime renewability
Starting Premium Rs. 6,606 Rs. 7,134
Number of members covered 6 members (2 adults + 4 children) 6 members (2 adults + 4 children)
*Subject to master policy contract renewal

How to Purchase the Policy

To purchase the policy, follow these steps:

  • To apply for the Manipal Cigna 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 our network diagnostic centres.
  • 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 the Manipal Cigna Pro-health Group Insurance Plan, you can avail the benefit of cashless treatment with our 3500+ network hospitals by following the following process:
  • Get admitted to any one of the ManipalCigna network hospitals.
  • Use your Manipal Cigna Pro-health Group Insurance card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/ Voter’s ID as identification proof.
  • Now, the network hospital will 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 policy terms & 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 are in.
  • After you are discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports, and discharge certificate 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 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 our approval, raise a query or reject the same (as per policy terms & conditions)
  • Finally, the insurer will settle the claim (as per policy terms & conditions) and reimburse the approved amount.
  • Collect below mentioned relevant document in original from the hospital and submit them to us 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 

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