ManipalCigna Health Insurance Claim Settlement Ratio 2025

Selecting a health insurance provider may not only depend on choosing a good plan but also on ensuring that the claim gets settled at the moment it is most required. Stress over medical emergencies can be overwhelming for many people, and certainly, nobody wants to see their time delayed or their claim rejected. So, that's why, considering CSR among other criteria is also important while selecting an insurer. 

In this article, we delve into ManipalCigna Health Insurance Company's Claim Settlement Ratio in greater detail, what it really means, and how it compares to its peers in the insurance market. We further explore why CSR alone doesn't tell the full story and what else to consider when making this important choice about a health insurer for yourself.  Whether you are a first-time policy buyer or evaluating your options, knowing the big picture can be a smart way to make a healthy financial decision.

What Is The Claim Settlement Ratio And How It Is Calculated?

The health insurance claim settlement ratio represents the percentage of claims that an insurer settles against the total number of claims received during a given fiscal year. A simple formula to calculate the claim settlement ratio is as follows:

Claim Settlement Ratio = Number of claims settled/ (Claims received + outstanding claims at the start of the year) × 100

This ratio is widely quoted by insurance companies to showcase their dependability, but on its own, it cannot present the whole story. There are other determinants to figure out the insurer's claim settlement performance.

Let's see the ManipalCigna Health Insurance Company's Claim Settlement Ratio along with some other parameters.

ManipalCigna Health Insurance Company’s Key Features and Benefits

ManipalCigna Health Insurance Company Limited was incorporated in 2014 in Mumbai, Maharashtra, being a joint venture between the Manipal Group and Cigna Corporation. ManipalCigna provides health insurance services independently in India for individual and group health insurance, critical illness coverage, hospital cash policy, and family floater plans, along with personal accident insurance. Mr. Prasun Sikdar is the company's CEO and Managing Director.

These are a few major facets of ManipalCigna Health Insurance Company Limited-

Source: ManipalCigna Health Insurance Company’s website and public disclosure for the 2023-2024 financial year.

ManipalCigna Health Insurance Company’s Benefits:

Health insurance reduces the financial burden of medical treatments and hospital stays. It mainly serves to pay for health care, which otherwise would burden your finances. Some key benefits include:

• Coverage for Inpatient Hospitalisation Costs
  Health insurance covers your hospital bills, providing immediate financial relief in case of a medical emergency. Health insurance coverage for inpatient care usually mandates a minimum hospital stay of 24 consecutive hours. Inpatient cover is usually effective only if the hospital stay is for more than 24 hours. This ranges from room charges to nursing fees, the cost of medical tests, surgery, and other such expenses incurred while admitted in the hospital.
   
• Coverage for Pre- and Post-Hospitalisation Expenses
  Health insurance goes beyond covering hospital stays. It is also extended to pre- and post-hospitalisation expenses for a limited period. Expenditures incurred by the patient before hospitalisation are not covered unless it is directly related to the illness for which they were hospitalised and are covered under inpatient care. Similarly, the expenditure after hospitalisation should also fall under the in-patient category and must be related to the same illness.
   
• Coverage for Daycare Procedures
  Advancements in medical technology have progressed significantly, allowing treatments and surgeries to be performed without the need for an overnight hospital stay. These daycare procedures are covered by health insurance, thus ensuring financial support for quick treatments such as gallbladder removal, hernia repair, chemotherapy, etc.
   
• Coverage for Domiciliary Treatments
  Domiciliary treatments under health insurance include medical care that is offered when a patient cannot be hospitalised. The reason behind this could either be the immobility of the patient due to critical conditions or the unavailability of hospital beds. This ensures access to necessary treatment even in a home setting.
   
• Free Health Check-Ups
  Most health insurance plans offer free health check-ups as one of the preventive care benefits. Normal screenings and tests can facilitate the early detection of health issues, thus promoting responsible management of health.
   
• No Claim Bonus (NCB)
  A no-claim bonus or NCB is a bonus that many health insurance plans extend to their customers as a gift for not making a claim throughout a policy year. The bonus comes in the form of a percentage increase in the sum insured or some discount on renewal premium and always encourages people toward a healthy life.
   
• Tax Benefits
  In addition to health coverage, health insurance provides tax benefits. The premium amount paid for health insurance is eligible for income tax deductions under Section 80D of the Income Tax Act, provided that certain conditions are met. The amount for deduction varies as per the insured persons, along with extra benefits available for senior citizen parents and dependent children.
   
• Cashless Treatment
  One of the most convenient facilities of health insurance is cashless treatment. When a patient visits a network hospital, all his medical bills are settled directly by the insurer without any advance payments. The hassles during emergency situations are reduced considerably, as only the out-of-pocket expenses need to be incurred by the insured since the remaining expenditure is taken care of by the plan.

Health insurance provides significant financial security to manage unpredictable medical expenses. Health insurance provides an array of benefits, including inpatient care, preventive healthcare, tax advantages, and other options for extra coverage.

A quick word of caution, Health insurance policies vary across insurers, with differences in coverage, terms, and conditions. It’s always wise to review the policy documents carefully to understand the exact coverage. Additionally, tax benefits depend on current tax laws and may change over time.

What Is The ManipalCigna Health Insurance Company Limited Claim Settlement Ratio?

As of March 2024, ManipalCigna Health Insurance Company Limited has a claim settlement ratio of 87.68% (Source: Public Disclosure, FY 2023-24).

What Is The Claim Process Of ManipalCigna Health Insurance?

ManipalCigna Health Insurance Company Limited offers two options for submitting claims:

Cashless Claims

You can take advantage of a cashless facility if you receive treatment from the network hospital. The insurer has tie-ups with a lot of hospitals where medical expenses get settled directly with the hospital concerned. Those costs that are not covered under your health insurance policy you would have to pay for.

Cashless Claim Process

Here are the steps you must stick to while filing a cashless claim-

• Verify whether the hospital you’ve chosen accepts cashless services from your insurance provider.
• Check that your cashless claim service is available in the hospital that you have shortlisted and, accordingly, the hospital should be within the insurance company's network and accept the cashless payments.
• Go through the policy document for the details that might restrict it or even involve some out-of-pocket expenses from your end.
• Gather essential documents, including your policy copy or cashless card, the proposer’s KYC documents such as PAN card, Aadhaar card, and passport-size photo, the patient’s ID proof, and medical records like hospitalisation documents, follow-up reports, and initial consultation papers.
• Submit your claim request on time, at least 3-4 days before admission for planned hospitalisation or within 24 hours of admission for emergency hospitalisation.
• All documents required for pre-authorization must be provided, such as the health card issued by the insurer, KYC documents of both the proposer and insured person, the patient's ID proof, the policy number, and the insured's name.
• An advance deposit must be paid if the pre-authorisation process takes more time than expected.
• The hospital's insurance desk must submit all the paperwork to the insurer once your discharge date is finalised.
• Follow up with your insurer regularly in order to promptly respond to additional document requests or queries.
• Be informed concerning your claim status at each stage of processing, which will avoid delays.
• Review the discharge letter and final bill carefully enough to confirm what is covered.
• For any other questions or concerns, contact your insurer or a financial advisor.
• Ensure that you’re prepared to settle any expenses not covered by your insurance policy before being discharged from the hospital.

Reimbursement Claims

If you use a non-networked hospital for medical treatment, then you need to pay all those medical and hospital expenses directly. Later on, you can also claim reimbursement from the insurer, as the money from the insurer would be paid to you after considering all the terms and conditions written in your health insurance policy.

Reimbursement Claim Process

To make a reimbursement claim, you have to follow some procedures:

• Ensure that the hospital you decide to receive treatment at is not on the excluded list of your health insurance company.
• Notify your insurance company within 24 hours of your hospital admission for processing your reimbursement claims.
• Upon leaving the hospital, gather all your original documents, including receipts, bills, MRI/X-ray films, discharge summary, prescriptions by doctors, medical reports, and a claim form correctly filled out by the hospital.
• Demand a detailed bill from the hospital mentioning all expenditures. It would be helpful if one could have the indoor case papers and patient case sheets photocopied.
• Review all documents attentively for errors in name, age, and gender, and get them corrected right away, if necessary.
• All documents, including the health card or policy copy, KYC documents of the proposer such as PAN card, Aadhaar card, and passport-size photo, along with a bank statement containing the account number, bank name, and IFSC code.
• All documents should be well-organised in a file, and it is recommended to keep copies for future purposes.
• Submit the completed claim form along with the required documents to your insurer.
• Obtain an acknowledgement receipt from the insurer for each original document submitted.
• Stay in regular communication with your insurer to track your claims and promptly provide any additional documents if requested.
• Once the claim is settled, one should peruse carefully the summary of the claim settlement, taking keen note of any deductions that are made.
• If there are questions to be asked or for clarification, one may seek a response from their insurer and/or financial advisor.

Documents Required For ManipalCigna Health Insurance  Claims

Filing a health insurance claim with ManipalCigna Health Insurance Company sounds like a series of procedures. However, if one is well-prepared, it will be very easy. For either a cashless or reimbursement claim, the list of documents you are going to need usually involves the following:

For Cashless Claims:

• The health card provided by the insurance company. 
• KYC details of the proposer with PAN card, Aadhaar card, and a passport-size photograph.
• Valid ID proof of the patient.
• KYC details of the insured.
• Policy number to be used while making the claim.
• Name of the policyholder.
• Name and address of the insured person whose claim is being submitted.
• Details of the illness or injury, along with the necessary treatment or surgical procedure.
• Contact details and name of the attending doctor or healthcare provider.
• Expected date of hospital admission.
• Complete past medical history, both relevant and unrelated to the current condition, ensuring it aligns with the details disclosed during policy issuance to prevent claim rejection.

For Reimbursement Claims:

• A photocopy of the health card or policy document issued by the insurer.
• KYC details of the proposer, including a PAN card, Aadhaar card, and a passport-size photograph.
• A bank statement with account number, bank name, and IFSC code. In lieu of the above, a bank passbook with the latest transaction details or an original cancelled cheque with the insured's printed name can be submitted.
• Valid identification proof of the patient.
• A duly completed and signed claim form.
• All medical documents, such as test reports, prescriptions, diagnostic films, and payment receipts, are based on the treatment.
• Original hospital discharge summary
• A detailed hospital bill. For medical implantation claims, such as cataract surgeries or knee replacements, an IOL (intra ocular lens) sticker or relevant documentation should be included.

Note: It is recommended to contact ManipalCigna Health Insurance Company directly to verify any specific documentation requirements or additional procedures that may be necessary.

How To Track Your ManipalCigna Health Insurance Company Claim Status?

You can log into the website where ManipalCigna Health Insurance Company Limited shares the status of your claim. Otherwise, you can reach their customer service at 1800-102-4462 and tell the representative that you want to track the status of the claim, and they will be able to help you with the procedure.

To Conclude

As of March 31, 2024, ManipalCigna Health Insurance Company has a claim settlement ratio of 87.68%. Whichever claim process you choose, cashless or reimbursement, having knowledge of the process and being ready with all necessary documents will ensure a smooth process. In the health insurance space, choosing a reliable service provider means financial protection and peace of mind in unexpected medical situations.

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