Frequently Asked Questions

Critical Illness insurance is a policy that pays an amount equal to the sum insured upon first diagnosis of a critical illness covered under the policy.

A basic health insurance policy generally pays hospitalization bills. But will a health insurance be enough if you are diagnosed of a critical illness. To help you tide over such medical exigencies, there are critical illness insurance plans that you should consider. Known as defined benefit plans, these pay you lump sum so that you can pay for the incidents. In that sense these work as income supplements.

Some health insurance plans come bundled with critical illness (as rider or add-on), but a standalone critical illness plan is more comprehensive both in terms of illnesses covered and the amount of cover it offers.

ManipalCigna  Lifestyle Protection Critical Care plan not only assures you financial support in critical times but also gives you access to a worldwide network of hospitals. Moreover, it brings you the best-in class medical care and services.

This plan is brought to you by ManipalCigna Health insurance, ManipalCigna Health insurance is a joint venture between Manipal Group, an eminent player in the field of healthcare delivery and higher education in India and Cigna Corporation, a global health services company with over 200 years of experience.

The Key Benefits under this policy includes:

A.  Critical Illness Cover for 15 or 30 illnesses as per plan
B.  Medical Second Opinion
C.  Access to Online Wellness Program

The Policy is available for a Sum Insured from Rs 1 Lac to 3 Crores. Higher cover is available subject to underwriting on case to case basis. You can choose to opt for a Basic Plan covering 15 Critical Illnesses or Enhanced Plan covering 30 Critical Illnesses.

1. Cancer of Specified Severity

2. Myocardial Infarction (First Heart Attack – of Specific Severity)

3. Open Chest CABG

4. Open Heart Replacement or Repair of Heart Valves

5. Coma of Specified Severity

6. Kidney Failure Requiring Regular Dialysis

7. Stroke Resulting in Permanent Symptoms

8. Major Organ / Bone Marrow Transplant

9. Permanent Paralysis of Limbs

10. Motor Neuron Disease with Permanent Symptoms

11. Multiple Sclerosis with Persisting Symptoms

12. Primary (Idiopathic) Pulmonary Hypertension

13. Aorta Graft Surgery

14. Deafness

15. Loss of Sight

16. Coronary Artery Disease

17. Aplastic Anaemia

18. End Stage Lung Disease

19. End Stage Liver Failure

20. Third Degree Burns

21. Fulminant Hepatitis

22. Alzheimer’s Disease

23. Bacterial Meningitis

24. Benign Brain Tumor

25. Apallic Syndrome

26. Parkinsons Disease

27. Medullary Cystic Disease

28. Muscular Dystrophy

29. Loss of Speech

30. Systemic Lupus Erythematous

Policy can be issued or renewed for one, two or three continuous years at the option of the Insured person.

The minimum age at entry under this policy is 18 years and maximum age at entry is 65 years. Renewals will be available for lifetime.

If the insured person is diagnosed for the first time with a covered critical illness, we will make payment upto the sum insured under the policy, provided the waiting periods are met.

The received amount can be used to pay hospitalization expenses.  There is no hospitalization cover or cashless benefit under this policy.

An Insured Person can choose to secure an expert opinion from Our Network of Medical Practitioners, if he/she is diagnosed with a covered Critical Illness during the Policy Period. This benefit can be availed once, by each Insured person during the lifetime of a policy for a particular Critical Illness.

This is ManipalCigna’s customized wellness program. It is a service benefit available to cater to the varied health needs of our customers through specialized programs like Health Risk Assessment, Lifestyle Management and Nutrition. It takes forward our proposition of being your partner in “illness and wellness” and ensures that you maintain your health at all times.

The premium will depend on the plan, sum insured, policy tenure, age on last birthday and gender of the insured person. Also the health status of the individual will be considered.

Premiums modes available in the policy are Monthly, Quarterly, Half Yearly, Yearly and Single

The coverage is available on individual and family basis.

Eligibility of Sum Insured will be maximum 10 times of annual income.

   For family policy, the eligibility will be as per below table.

The policy covers following relationships – Self, Lawfully Wedded Spouse, Dependent Parents and Dependent Parents-in Law. Dependent Children, Dependent Grandchildren and Dependent Siblings up to the age of 25 years and are unmarried.

On first diagnosis of the covered critical illness, we will make payment upto the sum insured under the policy provided the waiting periods are met. There is no specific benefit as “Death Benefit” under the policy.

You can avail the following discounts on your policy.

1. Family Discount of 10% for covering more than 2 family members under the same individual policy.
2. Long Term Discount of 7.5% and 10% on selecting a 2 and 3 years single premium policy respectively.
3. Direct Policy Discount of 10%.

You can port your existing health insurance (Critical Illness) policy to ManipalCigna  Lifestyle Protection Critical Care policy provided you are covered under an Indian Health Retail policy from a Non-life insurance company.

You can claim tax deduction u/s 80D as per IT Act’1961 for premium paid towards this policy. For premiums paid in cash, tax benefit u/s 80D shall not be applicable. Please consult your tax advisor for more details.

The below waiting periods will apply on the policy.

First 90 days waiting period – From the policy inception date a period of 90 days will apply before you can claim in respect of any Critical Illness whose signs or symptoms first occur.

Survival Period - Benefit payment will be subject to survival period of 30 days following first diagnosis of Critical Illness or surgical procedure

We will not pay any claims arising out of or attributable to any of the following:

• Any illness other than specified Critical Illnesses
• Any pre-existing diseases
• HIV/AIDS and its complications
• Suicide or Drug Abuse
• Any loss resulting from child birth or pregnancy

Above list is only indicative and not exhaustive. Please refer policy terms and conditions for complete details.

Step -1 The product brochure, policy benefits, exclusions and premium details must be thoroughly understood and discussed with Our advisor/ Company representative, before buying the policy

Step 2: Once the benefits of the policy are understood, the Proposal Form must be filled, wherein details of the prospective Insured Persons including medical information must be provided as accurately as possible.

Step 3: The proposal form with the required documents have to be submitted.

 Step 4: If You are required to undergo medicals tests as per the chosen Sum Insured and Age band, we would arrange the medical check-up’s at Our network of diagnostic centres.

Step 5: Based on the above information we will process Your proposal for Insurance and a policy kit containing the Policy Schedule, Policy Terms & Conditions and associated documents will be sent to you.

In case we are unable to underwrite i.e. if the Proposal is rejected We will intimate the same to You through a rejection letter

Upon assessment if the premium is loaded then We will inform You about any revised terms through a counter offer letter. We will issue the Policy only once you accept the counter offer. Where You do not agree to the counter offer we will cancel your proposal.

Yes, you can take cover for yourself, spouse and dependent children (above 18 years)  on individual basis in one policy.

Pre-existing Disease is any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or received medical advice/ treatment within 36 months prior to the first policy issued by the insurer.

Yes, however any pre-existing disease or any complication arising therefrom would be treated as a permanent exclusion under this policy.
Once you apply, you may have to undergo specific tests as required by our underwriting team to evaluate the risk. Post evaluation and taking into account all information provided the final decision will be communicated to you regarding the proposal.

Yes, we may apply a risk loading on the premium payable. A maximum loading of 100% per insured person can be

applied on the policy. These loadings will be applied from the Inception Date of the first Policy including subsequent

Renewal(s) with Us.We will inform you about the applicable risk loading through a counter offer letter and we will only

issue the Policy once we receive your consent and applicable premium.

Also, In case of premium payment modes other than Single and Yearly, a loading will be applied on the premium.

Loading grid applicable for Half yearly, Quarterly and Monthly payment mode.

Alterations like increase/decrease in Sum Insured or change in plan, addition/deletion of Insured Persons, will be allowed at the time of Renewal of the Policy.

We may require you to undergo a medical check-up based your age, plan and sum insured opted. The cost of all such medicals will be borne by us.

Medical tests will be facilitated by us and conducted at our network of diagnostic centres. We will contact you and fix up an appointment for the Medical Examination to be conducted at a time convenient to you.

In case you are not satisfied with the policy, you can request for a cancellation of the policy by giving 15 days' notice in writing.Refund will be processed as per policy terms and conditions

No, once a claim for a particular Critical Illness has been admitted and paid, the coverage under the Policy will automatically terminate for that Insured person. If the Policy is issued to more than one individual, it will continue to be in force for the remaining members.

You can select between two claim payout options:

• Lump Sum Payout – Under this the full Sum Insured will be paid upon diagnosis of the covered Critical Illness

• Staggered Payout – ·On occurrence of a Critical Illness 25% of the Sum Insured will be paid as lump sum. Balance 75% and additional 10% of Sum Insured will be paid in 60 equated monthly instalments. Only, where staggered pay-out is opted at the time of buying the plan, the insured person will have the option to choose 100% lump sum benefit at the time of claim payment. Example-Staggered payout

Mr. Ram has a Critical Care cover of Rs.10 lacs and opted for staggered payout. At the time of claim, 25%, i.e. Rs.2.5 lacs will be paid as lump sum and balance 75% & 10% additional, i.e. 8.5 lacs will be paid in 60 equated monthly instalments, (Rs.14167.67 each month).

The following documents shall be submitted in original for assessment and upon request we will return the original documents.

• Claim form duly filled and signed;

• Medical Certificate confirming the diagnosis of Critical Illness;

• Certificate from attending Medical Practitioner confirming that the claim does not relate to any Pre-existing Illness or Injury or any Illness or Injury which was diagnosed within the first 90 days of the Inception of the Policy.

• Discharge Card/Death Summary from the Hospital, if applicable;

• Investigation test reports confirming the diagnosis as specified under the definition of the respective Critical Illnesses;

• First consultation letter and subsequent prescriptions;

• Indoor case papers if applicable;

• KYC documents;

• Specific documents listed under the respective Critical Illness

• For reducing balance Sum Insured Option - latest statement from the bank confirming the principle outstanding.

• Any other necessary documents as may be required by Us;

• In the cases where Critical Illness arises due to an accident, FIR copy or medico legal certificate will also be required wherever conducted.

We may call for any additional necessary documents/information as required based on the circumstances of the claim.

The timelines are as below.

Claim Intimation – Notify us within 10 days from the date of diagnosis of covered critical illness.
Document Submission – Claim documents to be submitted to us within 60 days of the date of first diagnosis of the covered critical illness.
Claim Settlement and Repudiation – We will settle or reject a claim within 30 days of the receipt of the last necessary documents.