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ManipalCigna ProHealth Group Insurance Plan

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

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

Key features and benefits

  • In-patient hospitalisation expenses coverage

    Suppose you are admitted to a hospital for more than 24 hours of illness or injury. In that case, this policy will take care of the room charges, ICU expenses, nursing charges, doctor fees, surgeon fees, blood, oxygen, operation theatre charges, and other medical expenses will be taken care of.

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

  • Pre-hospitalisation coverage

    The insurer will reimburse medical expenses incurred before the date of hospitalisation.

  • Post-hospitalisation coverage

    The policy won’t just cover you when you are in the hospital but also through recovery. Medical expenses incurred after you are discharged will also be covered.

  • Daycare treatment coverage

    The insurer will pay for medical expenses if you undergo a treatment that needs less than 24 hours of hospitalisation.

  • 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 coverage

    The policy covers prescribed home care expenses when the patient’s condition does not allow hospital transfer or if a hospital bed is unavailable, provided treatment is required for at least three days.

  • Organ donor’s expenses coverage

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

  • Restoration of the 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 policy covers in-patient medical expenses for an insured individual for non-allopathic treatments such as Ayurveda, Unani, Sidha, Homoeopathy, Yoga, and Naturopathy arising from accident or illness.

  • Disease category sub-limit*

    Pays for a specific disease category; the amount is as specified per insured individual 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, and the remaining payable amount will be raised as a claim by the insurer.

  • Per claim deductible*

    The deductible amount will be applied to every claim made by an insured person.

    Note*: - The condition under the disease category sub-limit will also apply to the restored sum insured.
    - Voluntary co-pay for in-patient hospitalisation 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 ProHealth 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 to 25 years
Minimum entry age: 18 years
Maximum entry age: 65 years
Dependent child: 91 days to 25 years
Policy term 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:

  • Simply fill in your basic and health details online to apply for the ManipalCigna ProHealth Group Insurance Plan.
  • 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

  • With the ManipalCigna ProHealth Group Insurance Plan, you can avail the benefit of cashless treatment with our 3,500+ network hospitals by following the process given below:
  • Get admitted to any one of the ManipalCigna network hospitals.
  • Use your ManipalCigna ProHealth 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 validate your identity and submit the pre-authorisation request to the insurer.
  • After validation, the insurer will review and provide their confirmation to the network hospital by fax and e-mail. The insurer ensures that you are also notified of the same through text message and e-mail. 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 (per policy terms and conditions) with the hospital after completing all the necessary formalities.

Reimbursement claims

Documents needed to process reimbursement claim:

  • If you get hospitalised, notify the insurer within 48 hours of admission to 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 certificates. The insurer would need the originals of all the mentioned documents to process your reimbursement.
  • All the documents should be filled out and signed along with the claim form and sent to the insurer. Send your valid ID proof and age proof as well.
  • After receiving your documents, the insurer will review your claim request and accordingly give their approval, raise a query, or reject the same (per policy terms and conditions).
  • Finally, the insurer will settle the claim (per policy terms and conditions) and reimburse the approved amount.
  • Collect relevant documents mentioned below in original 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 port-mortem, if any
  • 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, ManipalCigna 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 the 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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