ManipalCigna ProHealth Insurance Plan

Let’s Know The Plan Better!

ManipalCigna ProHealth is a health insurance policy provided by ManipalCigna Health Insurance Company Limited. It offers comprehensive coverage to protect you and your family against skyrocketing medical expenses. The ProHealth Plan has 5 variants - Protect, Plus, Preferred, Premier, and Accumulate, which are designed to meet your various healthcare needs. You can select the variant that suits your requirements best. Additionally, it offers a range of choices to help lower your insurance premiums.

Are You Eligible?

?Minimum Entry Age

• Adults: 18 years
• Dependent Children: 91 days

?Maximum Entry Age

• Adults: No Limit
• Dependent Children: No Limit

However, if you’ve opted for the Floater Policy, dependent children are covered for 23 years. Beyond this age limit, they can be covered under individual policy.      

An Overview Of The Plan’s Benefits & Limits

The ManipalCigna ProHealth provides coverage for the expenses you may incur during your hospital stay exceeding 24 hours. This includes the cost of your room, nursing fees, doctors' fees, prescribed medications and drugs, charges for intensive care unit (ICU) services, and other related expenses. Furthermore, the plan extends coverage to the below-mentioned expenses as well -

• Pre & Post Hospitalisation Expenses
  You may encounter various medical expenses both before and after your hospital stay. With the ManipalCigna ProHealth Plan, you can have peace of mind knowing that you are covered for these costs for a reasonable period of time -
  • Pre Hospitalisation: Covered up to the sum insured for a duration of 60 days prior to your hospitalisation, across all five variants.
  • Post Hospitalisation:
    1. ProHealth Protect and Accumulate Variant: Covered up to 90 days after discharge.
    2. ProHealth Plus, Preferred & Premier Variant: Covered up to 180 days after discharge.

Please bear in mind that the insurer will only cover these expenses if they are directly linked to the medical condition that resulted in your hospitalisation and your claim is approved as part of your inpatient hospitalisation coverage.

• Daycare Treatment Coverage
  Daycare treatments are medical treatments or procedures that used to require lengthy hospital stays, but thanks to advancements in healthcare technology, they can now be completed within just 24 hours. With the ManipalCigna ProHealth Plan, you can have peace of mind knowing that 546 daycare procedures are covered up to the sum insured without any limits. This coverage applies to all 5 plan variants.

• Domiciliary Treatment Coverage
  Domiciliary treatments are medical treatments that are administered at home if the patient is too sick or injured to be safely moved to a hospital, or because there are no available hospital beds nearby. With the ManipalCigna ProHealth Plan, you are covered for the costs of domiciliary treatment up to the sum insured you opt for. This coverage applies to all 5 plan variants.

• Organ Donor Coverage
  The ManipalCigna ProHealth Plan covers the inpatient hospitalisation expenses of the organ donor up to the sum insured you choose under your policy for all 5 plan variants, where you (the insured) are the recipient.

• Modern Treatment Coverage
  The healthcare industry is changing quickly because of path breaking new technologies. This has led to the development of modern treatments that can treat illnesses and medical conditions that were once thought to be incurable. The ManipalCigna ProHealth Plan aims to keep up with these changes and covers these modern treatments, up to the sum insured.

• Room Rent Limit
  The room rent limit is the highest amount that your insurance company will pay for the room you choose when you're in the hospital. If you pick a room that falls within this limit, you won't have to pay anything extra. But if you choose a room that costs more than your eligibility limit, a proportionate deduction applies. This means you'll have to pay a proportionate share of the total bill, not just the difference in room rent. With the ManipalCigna ProHealth Plan, you have the freedom to choose the room that suits you best except suite or above under all the 5 variants.

• Cumulative Bonus
  A cumulative bonus is a special reward given by the insurer if you stay healthy and don’t file any claims during a policy year. ManipalCigna ProHealth Plan provides the following cumulative bonuses every year under its variants -
  • Protect & Accumulate variant: 5% of the sum insured
  • Plus, Preferred & Premier variant: 10% of the sum insured.
    
    This has the potential to increase up to 200% of the sum insured. It's important to note that if you do make a claim during a policy term, the accumulated bonus will remain unaffected. Terms and conditions are applicable.
• Restoration Benefit
  The Restoration Benefit is a great feature that restores your sum insured if it runs out during a policy year. It kicks in when partially you use up your base sum insured and any accumulated cumulative bonus. You can use the Restore Benefit for subsequent claims unlimited times per policy year. The restored sum insured can be used by all members of the policy for unrelated illnesses and by different insured persons for related illnesses in case of a floater policy.

Noteworthy Features You Should Be Aware Of!

• Worldwide Emergency Cover
  This feature offers financial protection if you experience a medical emergency while outside India. It guarantees that you'll receive prompt and high-quality medical care during unexpected situations while travelling abroad, without having to worry about excessive costs. ManipalCigna ProHealth provides coverage for in-patient hospitalisation expenses that you incur outside India, up to the sum insured across all five variants. This benefit can be availed once in a policy year and is subject to certain conditions.

• Health Maintenance Benefit:
  To encourage your participation in preventive healthcare and promote a healthy lifestyle, ManipalCigna ProHealth Plan offers this benefit. It covers various expenses such as doctor fees, diagnostic tests, drugs, dental treatments, alternative medicines, and more. While the Protect/Plus/Preferred/Premier plans provide this benefit on an outpatient basis, the Accumulate Plan offers coverage on both outpatient and in-patient basis - up to a specific limit. Fresh coverage will be provided at each policy year for all variants. However, any unutilized Health Maintenance Benefit (HMB) cannot be carried forward to the next policy year, except for ProHealth Accumulate. Certain terms and conditions are applicable.

Here's a table showing the limits for all the policy variants:

• Cumulative Bonus Booster / Super Claim Bonus:
  Introducing the 'Enhanced Cumulative Bonus' add-on - an enhanced version of the cumulative bonus. Just like the standard no claim bonus, this feature works on the same principles. You'll receive a 25% annual bonus. With this valuable add-on, you can receive up to 200% of the basic sum insured. Even if you file a claim, your accumulated bonus will remain intact. This benefit is available in all the plans except the Premier variant.

Understanding Waiting Periods

Once you purchase a health insurance policy, you'll need to wait before making claims for certain illnesses and diseases. This waiting period is a specific timeframe when you won't be able to claim for these conditions. However, once this waiting period is over, you will be able to file claims for these conditions.

Here are some types of waiting periods -

• Initial Waiting Period
  After purchasing your policy, note that there is a waiting period of 30 days before you can make a claim for any medical condition, except for accidents. This means that during this time, you will not be able to make a claim for any hospitalisation unless it is directly related to an accident.

• Waiting Period For Pre-Existing Diseases
  A pre-existing disease is a medical condition or illness that you had in the 48 months before purchasing a health insurance plan. It's worth noting that the ManipalCigna ProHealth Plan comes with different waiting periods as per the variant to opt for:
  • Preferred and Premier Plans: 24 months
  • Plus and Accumulate Plan: 36 months
  • Protect Plan: 48 months

This means that during this time, the policy will not cover any expenses related to pre-existing conditions.

• Waiting Period For Specific Diseases
  Insurers often have a list of medical conditions or illnesses for which they impose waiting periods, regardless of whether you have experienced them before or not. These waiting periods are determined by the insurer and are not influenced by your current health status. In the case of ManipalCigna ProHealth, there is a waiting period of 24 months for specific diseases under all 5 variants.

What The Plan Does Not Cover?

Exclusions refer to situations or conditions that are not covered by your health insurance policy. Here are some types of exclusions -

1. Standard Permanent Exclusions
   IRDAI has put forth a set of 'standard permanent exclusions' that all insurance companies must adhere to -
   1. Obesity/weight control: Treatments or surgeries for weight control or obesity.
   2. Profession in hazardous or adventure sports: Injuries sustained while engaging in adventurous activities like mountaineering, surfing, paragliding, etc. as a professional.
   3. Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
   4. Investigation and evaluation: Hospital admissions for observation or monitoring purposes.
   5. Rest cure, rehabilitation, and respite care: Admission to a bed rest facility without active treatment.
   6. Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
   7. Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
   8. Breach of law: Expenses related to treating someone who has committed/attempted to commit a breach of law with criminal intent.
   9. Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
   10. Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that a medical practitioner hasn’t prescribed.
   11. Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
   12. Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
   13. Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, and more.
   14. Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
   15. Expenses related to birth control, sterility, and infertility: Treatments like contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
        
2. Additional Permanent Exclusions
   In addition to the standard permanent exclusions mentioned earlier, insurance providers may also add specific exclusions to your policy for certain circumstances or medical conditions. If you have certain diseases or severe medical conditions that are considered high-risk to cover, the insurance provider may choose to permanently exclude them from your policy. In India, insurers can permanently exclude only a list of illnesses as outlined by the Insurance Regulatory and Development Authority of India (IRDAI). They are not permitted to exclude any illnesses that are not on this list.
    
3. Non-Standard Exclusions (Specific Exclusions)
   Insurers have additional exclusions that go beyond the standard exclusions set by the IRDAI. It's important to remember that these exclusions may differ between insurance companies and depend on the policy's terms and conditions. Here are some of the specific exclusions under the ManipalCigna ProHealth Plan:
   1. Circumcision unless it is necessary for the treatment of a disease, illness, injury, or due to an accident.
   2. External congenital anomalies, defects, or complications arising from them.
   3. The costs of donor screening and organ transplant surgery involving organs that are not harvested from a human body.
   4. Any form of non-allopathic treatment, including hydrotherapy, acupuncture, reflexology, chiropractic treatment, and any other indigenous system of medicine except AYUSH in-patient treatment.
   5. Instruments such as C.P.A.P and C.P.A.D for sleep apnea syndrome, oxygen concentrator for bronchial asthmatic condition, Infusion pump, and other external devices used during or after treatment.
   6. Illness/injuries from ionising radiation, contamination by radioactivity (nuclear fuel/waste), nuclear/chemical/biological attack, or any other circumstances.
   7. Dental treatment, orthodontic treatment, dentures, and any kind of surgery unless it is necessary due to an accident and requires at least 24 hours of hospitalisation.
   8. Treatments for gum disease or tooth disease or damage unless they are related to irreversible bone disease in the jaw that cannot be treated in any other way unless specified in the policy.
   9. All costs related to foreign invasion, acts of foreign enemies, warlike activities (whether declared or not), military duties, civil war, public defence, rebellion, revolution, insurrection, riots, confiscation, nationalisation, requisition, or destruction.

A Quick Recap Of The Benefits & Limits

The OG Reading Material for Your Reference

• Brochure: https://www.manipalcigna.com/documents/20124/0/ProHealth_V7_Accordian_April'23_02%20(1).pdf/5b07bf55-34c8-9eec-0686-308038d9c87e

• Policy Wording: https://www.manipalcigna.com/documents/20124/1722480/ProHealth_TnC_Oct21.pdf

FAQs

1. What is the highest coverage amount available under the ManipalCigna ProHealth Plan?
   The maximum coverage varies depending on the variant you select. For the Premier Plan, it is INR 1 crore, while for the other 4 variants, it is INR 50 Lakhs.
    
2. Is critical illness add-on cover available with ManipalCigna ProHealth?
   Yes, you can add critical illness coverage to your ManipalCigna ProHealth plan except in the case of Premier variant.
    
3. Is restoration benefit available under the ManipalCigna ProHealth Plan?
   Absolutely! All five variants of the ProHealth Plan offer 100% restoration of the sum insured for an unlimited number of times.
    
4. Are AYUSH treatments covered under ManipalCigna ProHealth?
   ManipalCigna ProHealth provides coverage for inpatient hospitalisation of Ayush treatments up to the sum insured.
    
5. Are maternity expenses covered under ManipalCigna ProHealth?
   ManipalCigna ProHealth Plus, Preferred, and Premier options cover maternity-related expenses according to the terms and conditions outlined in the policy.