Frequently Asked Questions

Cover under the policy for any particular insured person shall automatically terminate on the earliest happening of the following events:

i. Premiums owed under the Policy is not received within the Grace Period
ii. Non-Indian Nationals returning to their country of domicile
iii. There is misrepresentation, fraud, non-disclosure of material fact
iv. On death of the insured person
v. Insured Person ceases to be a member of the group
vi. Cover will end for spouse or any unmarried partners
vii. If an employee/ member gets divorced or the unmarried partners no longer live together or a civil/ contractual partnership is dissolved, then the spouse or unmarried, civil/contractual partner will no longer be considered as a Dependent for the purposes of this Policy.

Home care services includes one or more choice (as per selection):

• Physiotherapy at home, as prescribed by the treating Medical Practitioner,
• Nursing attendant at home, as prescribed by the treating Medical Practitioner,
• Stroma care, colostomy, tube feeding at home, as prescribed by the treating Medical Practitioner
• Doctor visits at home
• Delivery of Medically prescribed medicine at home
• Health Check at home
• Vaccination at home, prescribed by the treating Medical Practitioner
• Custodial or personal care (like bathing, dressing, or using the bathroom)

Deductible is the amount beyond which all admissible claims will be settled by the insurer. Deductible option can be selected on annual aggregate or per claim basis.

Co-pay is a fixed percentage of the admissible claim amount that insured person will pay each time a claim is made during the policy year.

Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.

Examples of Accidents can be as follows:

• Motor Vehicle Accidents (MVA's), irrespective of whether you are the Driver, Passenger or Pedestrian

• Injuries on Duty (Accidents whilst performing your business duties),

• Animal attacks (to be specifically opted for cover)

• Sporting Injuries (to be specifically opted for cover)

• Home-based Injuries eg. Fall from stairs, drowning (suicide not covered)

• Injuries sustained as a result of a natural calamity, terrorism.

List of perils/events/ailments/risks includes: All Surgery; All Day Care Surgery; Nervous system; Endocrine; Cardiovascular; Eye; Dental; ENT; Respiratory; Lymphatic; Urinary; Muscle or soft tissue; Skin; GI/mouth; Reproductive; Bone, cartilage and joint; Bariatric Surgery; Emergency Surgery; Diagnostic surgery; Organ Transplant; Cancer; Any other disease or body system specific (defined for a group).

Yes, on the occurrence of any Illness contracted or Injury sustained by an Insured Person due to an Accident in a Place of visit, whilst on a Trip, which requires Emergency Care, We will pay

1.In-patient treatment and/or Day Care treatment expenses in a local Hospital at the place the Insured Person is staying at the time of occurrence of an Insured Event.
2. Medical Expenses towards room charges, ICU/CCU/HDU, operation theatre, doctor fees, specialist fees, surgeon fees, anesthetist’s fees, radiologist, pathologist fees, nursing charges, medicines, diagnostic tests, medical and/or surgical appliances, surface ambulance charges, Blood storage & processing charges. The cover is available on indemnity and/or benefit and/or regular cash.

i. In the event of theft of the Insured Person’s Electronic items / equipment / gadget in the Place of visit whilst on a Trip, we will pay the Market Value of such Electronic items/ equipment / gadget, up to the limit specified in the Policy Schedule / Certificate of Insurance.
 

For the purpose of this Benefit, “Electronic item/ equipment / gadget” shall mean camera, tablet, music player, e-readers, GPS devices, iron, smart suitcase, pocket sized washing machine, portable Wi-Fi, hotspot or power bank, travel drone, smart phone gimbal, travel vacuum, Bluetooth speaker, flash light, video recording sun glasses, hi-tech foot warmers, smart phone breathalyser, compact air pollution monitor, germ eliminating travel wand, owned and declared by the Insured person.

ii. In the event of theft of the Insured Person’s Laptop in the Place of visit whilst on a Trip, We will pay the Market Value of such Laptop, up to the limit as specified in the Policy Schedule / Certificate of Insurance.
 

For the purpose of this Benefit, “Laptop” shall mean a laptop computer, or any handheld tablet computers excluding any accessories or attachments that come as standard equipment with such devices.

iii. In the event of theft of the Insured Person’s Mobile Phone in the Place of visit whilst on a Trip, we will pay the Market Value of such Mobile Phone, up to the limit as specified in the Policy Schedule / Certificate of Insurance.  
 

For the purpose of this Benefit, “Mobile Phone” shall mean any handheld mobile phone excluding any accessories or attachments that come as standard equipment with such devices.

We will pay the Market Value of such wearable device, up to the limit specified in the Policy Schedule / Certificate of Insurance in the event of Theft of the Insured Person’s wearable devices in the Place of visit whilst on a Trip. For the purpose of this Benefit, “wearable device” shall mean health device, smart watch, GPS wrist phones, wearable charging cable, fitness trackers, e-alarm, owned and declared by the Insured person.

This Benefit shall be payable subject to the following:

• Such Theft is required to be reported to the Police having jurisdiction at the place of loss within 24 hours of the occurrence of the incident, and a written report being obtained for the same.

• The Company is provided with the original invoice/receipt evidencing the proof of purchase and ownership of such item, or document evidencing the authorized custody of the same, if such item is provided by his/her employer/business organization.

• The Company is satisfied that the Insured Person took reasonable care to protect his/her item and did not in any way exposed it to the Theft.

Alternative Treatments include (one or more of the items listed):

i. Physiotherapy,
ii. Acupuncture and Acupressure
iii. Chiropody and Chiropractic
iv. Osteopathy,
v. Homeopathy
vi. Ayurveda.

If the Insured Person enrolls into any of the fitness activities mentioned below, we will pay the membership fees, program fees, enrolment fees, registration fees, trainer fees, fitness instrument and gadgets & associated costs, with respect to the Insured person.

Fitness activities:

• Yoga
• Zumba
• Dance
• Aerobics
• Fitness group (Cycling group, Running group)
• Fitness club eg. Swimming club, Tennis club, Badminton club etc.
• Meditation
• Spiritual therapy

The benefit is payable provided the Insured Person enroll in a recognized center, registered with appropriate authority and the activity is not done in professional capacity.

It covers medically necessary expenses towards:

i. Consultations with Medical practitioners and specialist;
ii. Prescribed medicines, drugs and dressings;
iii. Diagnostics tests such as laboratory test, radiology and pathology, MRI, CAT scan and PET scan.

Yes and if opted, We will provide the Insured person the choice to avail a medical second opinion for an Insured person who is diagnosed with a Critical illness, Terminal illness or suffers Permanent Total Disablement, Permanent Partial Disablement, Temporary Total Disablement, life-threatening and life altering diagnosis during the policy year.

The benefit will be payable up to the limits as specified in the Policy Schedule/Certificate of Insurance.

We will add a Cumulative Bonus (if cover opted) as a percentage (specified in the Policy Schedule/ Certificate of Insurance) of the Base Sum Insured at the end of the Policy Year if the Policy is Renewed with Us.

Our Healthy Living Reward Program encourages the Insured Persons to regularly assess their health status and engage in activities which aid in improving their overall well-being. Any one or a combination of the following activities will be offered under the program.

• Enrollment into Wellness Program

• Health Risk Assessment (HRA)

• Targeted Risk Assessment (TRA)

• Online Lifestyle Management Program (LMP)

• Chronic Condition Management Programs

• Participating in ManipalCigna Sponsored Programs and Worksite or Online/Offline Health Initiatives

• Health Check Up

Healthy Reward Points may be awarded on enrollment in the policy or completing various programs.

Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in the following ways (Select any one or more)

- A discount in premium from 1st Renewal of the Policy.

- Equivalent value of OPD, if opted for, anytime during the policy.

- Equivalent value for non-payable/ co-pay/ deductible limit, if opted for, anytime during the policy.

Any unutilized Healthy Reward Points at the end of a Policy Year will be carried forward to the next Policy Year at renewal and will lapse at the end of the Grace Period if the coverage is not Renewed with Us.

We will pay the charges for expenses incurred towards Medically Necessary treatment/ program, including Specialist consultations which is prescribed by a Medical Practitioner with an intention to manage Smoke, Tobacco, Drugs, Alcohol addiction of the Insured Person.

We will pay the charges for expenses incurred towards Medically Necessary treatment/ program, including Specialist consultation, that are prescribed by Medical Practitioners with an intention to manage weight or any specific illness of the Insured Person.

We will track the fitness program or/and activities of the Insured Person through fitness tracking devices and/ or applications.

Fitness Rewards may be rewarded on completion of each level.

Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in the following ways –

• A discount in premium from 1st Renewal of the Policy.
• Equivalent value of OPD, if opted for, anytime during the policy.
• Equivalent value of non-payables, co-pay, deductible limit, if opted for, anytime during the policy.
• Purchasing fitness devices/ gadgets.

We will pay the charges for expenses incurred towards specialist consultations for Diet and Nutrition management, Physical and Mental health management.

The benefit will be payable up to the limits as specified in the Policy Schedule/Certificate of Insurance.

If the Insured Person is diagnosed with a Mental illness, Stress, Anxiety, Depression or a medical condition impacting mental health, we will pay for expenses incurred towards medically necessary out-patient treatment/ program, including Specialist consultations that are prescribed by a Medical Practitioner, where the intention of the treatment/program is to offer care to the Insured Person towards mental Illness.

If the Insured Person is diagnosed with Cancer, HIV/AIDS, Chronic Kidney failure, Tuberculosis, Disability or suffers Stroke, Paralytic attack, Menopause, post-partum psychosis, we will pay the charges towards psychological counselling of the Insured Person with a specialist, on an Out-patient basis, at a Hospital or a recognized unit.