Frequently Asked Questions

Insured can opt for a reduction in maternity waiting period by paying one-time additional premium.
On availing this benefit, the mandatory waiting period for maternity cover will be reduced from 36 to
24 months. New born cover and First Year Vaccination will follow reduction in waiting period.

Maternity benefits include expenses for the delivery of child or expenses related to medically necessary and lawful termination of pregnancy.

Maximum 2 deliveries / terminations are covered during the lifetime of an insured between the age group of 18-45 years (both age included) after a waiting period of 36 months

Coverage will be restricted to the sum insured as per policy.

ManipalCigna offers comprehensive coverage of medical expenses for Inpatient hospitalization including Daycare, Pre and Post hospitalization expenses. It offers Ayush inpatient hospitalization/day care procedures, Restoration benefit and Smart non- reducing guaranteed Cumulative bonus as inbuilt features.

Policy also offers Optional Cumulative Bonus Booster which works on non-reducing basis and adds more to the policy every  year irrespective of claims. It also covers Worldwide Emergency, Domiciliary treatment and Donor expenses upto Sum Insured

Outpatient treatment, AYUSH, Doctor consultation, diagnostics and pharmacy bills are covered under Health Maintenance benefit. We offer Healthy Rewards as value added benefit associated with our ProActiv Living Program.

All above features are also offered for policies where Optional Deductible or Voluntary co-pay has been opted**

*Voluntary Co-pay and Deductible cannot be taken under a single plan.

 Note - Above is the list of covers under the product and are applicable as per availability in the plan chosen.

AYUSH treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems

Pre-existing diseases/illness/injury/conditions will be covered post 24/36 months of continuous cover depending upon the plan opted.

*Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations.

Pre-existing disease means any condition, ailment, injury or disease

a. that is/are diagnosed by a physician not more than 36 months prior to the date of commencement of the policy issued by the insurer; or

b. for which medical advice or treatment was recommended by, or received from, or received from, a physician, not more than 36 months prior to the date of commencement of the policy.

The pre-policy medical check-up cost will be paid by ManipalCigna Health Insurance Company.

In case we are unable to underwrite your proposal we will intimate the same to you.

Unless necessary endorsements or exemptions are made below diseases and expenses arising out of or attributable to any of the following will not be covered in the policy.

1. Investigation & Evaluation

2. Rest Cure, rehabilitation and respite care

3. Obesity/ Weight Control

4. Change of gender except for sex reassignment surgery for transgender persons

5. Cosmetic or Plastic Surgery

6. Hazardous or Adventure sports

7. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof

8. Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters

 Above List is only indicative and not exhaustive. Please refer the Policy Wordings for detailed list.

You can buy ProHealth Online by visiting our website www.manipalcigna.com

Healthy Rewards are points earned for each year of premium payment. Points can also be earned by enrolling and completing our array of wellness programs.

Details of reward points that can be accrued are listed below.

Reward Points, wherever offered under any specific Sponsored Program will be the same for all customers.

Each program can be opted once per Policy Year by a particular Insured Person. .(in Individual & Family Floater Policy)

There will be no limitation to the number of programs one can enrol however maximum rewards that one can earn in a single policy period will be limited to 20% of premium paid in the Policy.

These earned points can be:

- Used to get a discount against payable premium (including taxes) from 1^st renewal of policy.

- Redeemed for equivalent value of Health Maintenance Benefit anytime during policy.

- Redeemed as equivalent value while availing services through any of Our Network Providers.

- Unutilized reward points can not be carried forward to the next policy year subject to renewal.

- If policy is cancelled the unutilized reward points will get lapsed.

Premium payment modes available under ProHealth Insurance are Single, Yearly, Half-Yearly, Quarterly, Monthly. Premium payment mode can only be selected at the inception of the Policy or at the renewal of the Policy. Loading will be applied on the premium for Half-Yearly, Quarterly and Monthly premium mode.

You can avail of the following discounts on the premium on Your policy:

Family Discount : 25% for Protect and Plus Plan and 10% for Preferred, Premier and Accumulate Plans covering 2 and more family members under the same individual policy.

Long Term Policy Discount : 7.5% for selecting a 2 years policy and 10% for selecting a 3 years policy. This discount is available only with ‘Single’ premium payment mode.

Worksite Marketing Discount : A discount of 10% will be available on polices which are sourced through worksite marketing channel.

Voluntary Co-pay Discount : A discount of 7.5% for opting 10% Co-pay and a discount of 15% for opting a 20% Co-pay on the Policy in case of Protect and Plus Plan.

A discount of 5% for opting 10% Co-pay and 10% for opting 20% Co-pay on the Policy in case of Accumulate Plan.

Maximum discount applicable on a single policy shall not exceed 40%, excluding discount for Voluntary Co-pay.

Under a health insurance policy co-payment works as a cost sharing mechanism where the policy holder/insured will bear an agreed specified percentage of each & every admissible claim amount.

In Protect, Plus and Accumulate plans one can opt for a 10% or 20% Voluntary co- pay.

It will apply on each claim under the policy.

Voluntary co-pay and Deductible cannot be opted under the same plan.

This option allows removing mandatory co-pay on payment of additional premium. This option is applicable for persons aged 65 years and above on payment of additional premium.

It allows an increase in the Sum Insured by a fixed percentage of 25 % for a policy granted by the insurer. The maximum accumulation is upto 200%. This benefit is available with additional premium. Cumulative Bonus Booster (CBB) if opted will be in place of Cumulative Bonus in the base policy.

Cumulative Bonus Booster is not applicable under Premier Plan.

Cumulative Bonus Booster shall not be available for claims made for maternity expenses, new born baby cover, first year vaccination.

It means medical treatment for an illness/disease/injury which normally would require care and treatment at a hospital but is actually taken while confined at home because:

- The condition of the patient is such that he/she cannot be move to a hospital, or

- The patient takes treatment at home under the care of a medical practitioner on account of non- availability of room in a hospital.

Claims for pre-hospitalization and post-hospitalization expenses will be payable upto 30 days each.

ProHealth Insurance covers 500 plus listed Day Care treatments or surgery that requires less than 24 hours hospitalization due to advancement in technology and which is undertaken in a hospital / nursing home/day care centre on the recommendation of a medical practitioner. Coverage is available upto the Sum Insured opted under the plan.

If cashless facility is not authorized you can go for reimbursement mode of claim settlement.

24 months waiting period is applicable on specific ailments. Below list is only indicative and not exhaustive:

1. Cataract

2. Knee Replacement Surgery

3. Urinary Stones

4. All types of Hydrocele

5. Sinusitis, surgery on tonsils

6. Gastric, Cysts, Polyps, internal/skin tumors, breast lumps

7. Congenital disorder (Internal)

8. Surgery of Genito-Urinary system.

Please refer the Policy Wordings for detailed list.

Customer can choose one cover or more than one from all the optional covers available (as per plan). However, Co-pay and Deductible cannot be opted together in a single policy.