Manipal Cigna ProHealth Group Insurance Retail Plan

The Pro-health insurance plan by Manipal Cigna safeguards you and your family from unanticipated medical contingencies. This plan is designed to suit your health needs at all stages of life and ensure physical, emotional, and financial well-being. This plan is your best health partner as it makes you choose its smart healthcare features with a simple claim handling process.

Key Features & Benefits

• 

  Cashless claim facility

  The insurer can enjoy the cashless facility in times of medical emergencies under all the network hospitals of Manipal Cigna TTK Pro-Health.

• 

  In-patient Hospitalisation Expenses

  Manipal Cigna Pro-health Insurance Plan offers inpatient hospital expenses which include:
  
   •  Room Rent/Boarding and Nursing Expenses
   •  ICU Rent/ Boarding and Nursing Expenses
   •  Fees of Medical Practitioner, Surgeon, Anesthetist, Nurses, and Specialist Doctor
   •  Operation theatre charges, Anesthesia, surgical appliances, diagnostic tests, medicines, blood, oxygen, and cost of prosthetic and other devices or equipment if implanted internally like pacemaker during a surgical process.
  

• Health Maintenance Benefit

  The plan gives the insurer the choice of utilizing 50% of Health Maintenance Benefit (HMB) towards premium payment from the first payment of renewal.

• 

  Global Emergency Cover

  This plan gives worldwide coverage to the insurer in case of a medical emergency outside India.

• Critical Illness & Expert Opinion Coverage

  The plan covers critical illness charges and also covers the expenses incurred if an expert opinion is taken for the critical illness. Please refer to the policy document o the list of critical illnesses covered.

• 

  Restoration of the sum insured

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

• 

  500+ Day Care Procedures

  The plan covers 500+ day-care procedures that need hospitalization, but not for more than 24-hours. All the costs incurred such treatments are also covered under the Manipal Cigna Pro-health Insurance.

• 

  OPD Coverage

  The plan covers the immediate OPD (Out Patient Department) coverage with Health Maintenance Benefit up to Rs. 20000.

• 

  Modern treatment methods covered

  The plan includes new-age Treatments such as HIV/AIDS, artificial life maintenance, and listed modern treatments covered.

• 

  Pre-hospitalization Expenses

  This policy covers medical costs incurred due to an illness or injury 30 days immediately before hospitalization.

• 

  Post-hospitalization Expenses

  The plan pays for the medical costs incurred due to an illness or injury 60 days immediately after hospitalization.

• 

  Domiciliary cover

  If in case, you are not hospitalized, and all your treatments are done at home then all those expenses are also covered in this plan. Some individuals prefer their treatment to be done at home rather than in a hospital. On the other hand, some doctors also advise staying at home for the treatment.

• 

  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.

• 

  Free Look Period

  Get a 15 days free look period from the date of receipt of the policy document to review the terms and conditions of this policy and decide if they need to buy the policy or go for another plan.

• 

  Free health check-up

  For both individual and family floater plans, the insured can avail of the benefit of annual free health check-ups which are based on the age and the sum insured opted for.

• 

  AYUSH Treatment

  Policyholders who believe in AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) treatment can also benefit from buying the plan as it covers the in-patient treatment charges for the same.

• 

  Tax Benefits

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

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. 4400 with maximum coverage of Rs. 1 crore.

• To apply for the Manipal Cigna Pro-health Insurance Plan, you can buy 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 buying 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.

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 Manipal Cigna Pro-health 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 Manipal Cigna network hospitals.
  • Use your Manipal Cigna Pro-health 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. 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
substances.
9. Miscarriage, Abortion, and C-section deliveries Sexually transmitted diseases such as AIDS and HIV.
10. Refer to the policy document to know more exclusions in detail