Manipal Cigna ProHealth Group Insurance Retail Plan

ManipalCigna ProHealth Insurance plan offered by ManipalCigna Health Insurance Co. Limited is designed to cater to your health needs at every stage of life. The plan rewards you for staying healthy, covers you against illnesses, provides financial protection and helps you to bounce back to good health. There is no maximum age limit for policy enrolment and the sum insured ranges from Rs. 2.5 lakh to 50 lakh.

Key Features and Benefits

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  In-patient hospitalisation expenses

  The scheme offers in-patient hospital expenses that includes medical expenses for hospitalisation of more than 24 hours for any room category.

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  Pre-hospitalization Expenses

  This policy covers medical costs incurred due to any illness or injury suffered 60 days immediately before hospitalisation.

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  Post-hospitalization expenses

  The plan covers medical costs incurred due to any illness or injury caused 90 days immediately after hospitalisation.

• 

  Day care treatments

  In case you are not hospitalised, then the medical expenses incurred during home treatment will be covered under this plan. While some individuals prefer to take their treatment at home, a few are advised to take treatment home by the doctors.

• 

  Organ donor expenses

  Medical expenses incurred for an organ donor’s treatment for the harvesting of the organ donated will be covered under the policy.

• 

  Domiciliary hospitalisation cover

  Medical treatment taken at home is also covered in case your condition isn’t suitable for hospital transfer or if there is no hospital bed available.

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  Road ambulance cover

  The plan also covers the charges incurred towards the ambulance that is used for transportation to the hospital for treatment.

• 

  Worldwide emergency protection

  Get coverage for in-patient medical expenses for emergency treatment outside the country. The full sum insured will be provided on reimbursement basis once in a policy year.

• 

  AYUSH cover

  Get treatment under AYUSH cover i.e. Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy.

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  Maternity expenses

  The plan covers expenses for the delivery/medically necessary termination of pregnancy (maximum up to 2 events) during the lifetime of an insured between 18 to 45 years after a waiting period of 48 months.

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  Optional voluntary co-pay

  Get discount on premium when you choose to pay the first 10/20% of the claim and the balance would be covered by your plan (available with protect, plus and accumulate plans).

• 

  Optional waiver of mandatory co-pay

  The policy covers unlimited times of restoration with 100% additional Sum Insured for an unrelated illness, injury.

• 

  Optional cumulative bonus booster

  Get an option to increase policy sum insured with 25% cumulative bonus every year irrespective of the claim. Maximum accumulation is up to 200% of sum insured. The benefit is available in place of cumulative bonus.

• 

  Critical illness add-on cover

  Get lump sum benefit up to your opted sum insured, in case of the first diagnosis of the covered critical illnesses.

To purchase the policy, follow these steps:

• To apply for the ManipalCigna ProHealth Group Insurance Policy, simply fill-in your basic and health details online.
• 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.
• his plan is available for Bajaj Finance customers only.

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.

Cashless Claims

Documents needed to process cashless claim:

• With the ManipalCigna ProHealth Group Insurance Policy, you can avail the benefit of cashless treatment with our 6500+ network hospitals by following the following process:
  • Get admitted to any one of Manipal Cigna network hospitals.
  • Use your ManipalCigna health 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

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

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. Breach of law with Criminal Intent, intentional self-injury.
5. Cosmetic, aesthetic, and re-shaping treatments & surgeries.
6. Psychiatric or psychological disorders, mental disorders.
7. Ailment wise capping and ambulance charges
8. Hearing aids, spectacles, or contact lenses including optometric therapy Abuse or the consequences of the abuse of intoxicants or hallucinogenic
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.
    • First 90 days waiting period and 30 days survival period is applicable to Critical Illness Add-on Cover (if opted)
11. Refer to the policy document to know more exclusions in detail

BFL Helpline Number: –  08698010101

ManipalCigna Helpline Number: – 1800-102-4462

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).