ManipalCigna ProHealth Prime Plan

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ManipalCigna ProHealth Prime is an exceptional health insurance policy crafted by ManipalCigna Health Insurance Company Limited. This plan stands as a strong and comprehensive solution, carefully designed to fulfil the diverse healthcare needs of you and your family. With its three distinct variants – Protect, Advantage, and Active – this plan ensures a perfect fit for a wide array of medical requirements and needs. By offering a range of alluring discounts, it guarantees not only excellent coverage but also added value.

Who is Eligible For the Plan?

?Minimum Age Requirements

Protect & Advantage Plan

Adults: 18 years.
Dependent children: 91 days.

Active Plan

Adults: 18 years.
Children: 91 days

?Maximum Age Requirements

Protect & Advantage Plan

Adults: No upper age limit.
Dependent Children: 25 years.

Active Plan

Adults: 70 years.
Dependent children: 17 years.

Exploring the Benefits and Limitations of the Plan!

The ManipalCigna ProHealth Prime Plan covers expenses incurred when you are admitted to the hospital for more than 24 hours. These are called inpatient hospitalisation expenses which include room and board charges, nursing fees, medical professional's fees, necessary medications, ICU costs, and associated costs.

Here are various other expenses covered under this comprehensive plan -

Pre & Post Hospitalisation Expenses
Expenses you incur before and after hospitalisation are called pre-hospitalisation and post-hospitalisation expenses respectively. The ManipalCigna ProHealth Prime Protect & Advantage Plan will pay for expenses within a reasonable time frame - up to 60 days before your hospitalisation and 180 days after you get discharged. With the ProHealth Prime Active plan, pre-hospitalisation expenses are covered for 30 days, and post-hospitalization expenses for 60 days. You should keep in mind that these costs are eligible for coverage by the insurer only if they are directly related to the medical condition that led to your hospitalisation. Plus, they need to be approved as part of your inpatient hospitalisation claim.
Daycare Treatment Coverage
With medical technology advancements, many procedures and surgeries that once needed lengthy hospital stays can now be completed within a day. These are called daycare treatments. The ManipalCigna ProHealth Prime Plan covers all daycare procedures under all 3 variants. There is no limit on these treatments and this means that your expenses will be taken care of up to the sum insured.
Domiciliary Treatment Coverage
In case you are seriously ill or injured and cannot make it to a hospital or there are no hospital beds available nearby, you can get treated at home. This is known as domiciliary treatment. The ManipalCigna ProHealth Prime Plan, under all 3 variants, covers domiciliary treatment expenses up to 10% of the sum insured.
Organ Donor Coverage
The ManipalCigna ProHealth Prime Plan (all 3 variants) covers in-patient hospitalisation expenses in the event of organ transplantation (where you, the insured, are the recipient) up to the sum insured.
Modern Treatment Coverage
The healthcare landscape is undergoing rapid transformation with technological breakthroughs. This enables the availability of cutting-edge treatments that were previously deemed unattainable.
The ManipalCigna ProHealth Prime Protect & Advantage Plan is meticulously crafted to stay aligned with these innovations, providing coverage for expenses linked to these modern treatments, up to the selected sum insured. It's important to note that under the ProHealth Prime Active Plan, coverage for these expenses is capped at 50% of the sum insured.
Non-Medical Expenses
The ManipalCigna ProHealth Prime Plan includes coverage for non-medical expenses too. These expenses are related to consumables like gloves, nebulization kits, oxygen masks, etc. If you choose an add-on, the plan will cover these costs up to the sum insured, helping you avoid these additional expenses.
Room Rent Limit
The room rent limit is the maximum amount your insurance covers for the hospital room you stay in during your hospitalisation. If you choose a room within this limit, you will not have to pay extra. But, if you go for a room beyond your eligibility, a proportionate deduction may apply. This means that you will be responsible for a proportionate share of the total bill, not just the extra room cost.

Under the ManipalCigna ProHealth Prime Plan (all 3 variants), there is a room rent limit set for the Single Private AC Room. But, if you go for an add-on cover, you have the flexibility to choose higher room categories like suites, etc. under the ProHealth Prime Protect & Advantage Plan.

Cumulative Bonus
Staying healthy and not making claims in a policy year comes with a reward.
- With the Protect & Advantage Plan, each claim-free year earns you a bonus of 25% of the sum insured. This can stack up to a maximum of 200% of your base sum insured. This bonus you accumulate will remain the same - irrespective of the claims you make in the future.
- And if you choose the Active Plan, you can receive a bonus of 10% of your sum insured, up to a maximum of 100%. Here, the accumulated bonus will decrease at the same rate it went up, if you make a claim.
Restoration Benefit
The Restoration Benefit restores your sum insured in case you use it up in a policy year. Under the ProHealth Prime Plan (all 3 variants), your basic sum insured is entirely restored. The Restoration Benefit gets activated as soon as you use up part of your base sum insured and accumulated cumulative bonus (if any). This benefit will only be accessible for subsequent claims made under the in-patient benefit category during the policy year and is available as many times as you need within the policy year, regardless of whether the condition is related or unrelated (in the case of Protect & Advantage Plan) and unrelated (in case of the Active Plan).

Unveiling Additional Features of the Plan

Mental Illness Cover
- The ProHealth Prime Plan (Protect & Advantage Plan) provides comprehensive coverage for all expenses associated with mental health, up to the selected sum insured. Additionally, it extends this coverage to include HIV/AIDS and STDs.
- However, under the ProHealth Prime Active Plan, expenses related to mental illness are covered up to 50% of the sum insured after a waiting period of 24 months.

This feature is subject to specific terms and conditions.

Premium Waiver
The Premium Waiver feature of the ManipalCigna ProHealth Prime Plan is a reassuring feature. If you have an accident or are diagnosed with any of the critical illnesses listed in the policy, the ProHealth Prime Plan waives your premiums for the next policy year. This way, when you are recuperating and managing medical costs and other bills, you will not need to stress about paying for your health insurance.

Note: This is subject to the plan’s T&Cs.

Tele Consultation
In our fast-changing world, healthcare requirements and their solutions have progressed. Teleconsultation is a progressive method that lets you reach skilled medical professionals through digital tools, mainly over the phone or chat. You can use this service anytime you need within a policy year - without any limits. It is available under all 3 variants.

Decoding Waiting Periods under the Plan

Certain illnesses and conditions may not be covered during a specific duration after purchasing a health insurance policy. This timeframe is called the waiting period. Once the waiting period ends, you can start making claims for these specific health issues.

Waiting periods come in various types, including –

Initial Waiting Period: There is an initial 30-day waiting period for all medical conditions except accidents. This means you cannot make a claim for hospitalisation during the first 30 days unless it is due to an accident.
Pre-existing Disease Waiting Period: A pre-existing disease is any health condition or illness you have had in the 48 months before the issuance of the health insurance policy. For the ManipalCigna ProHealth Prime Plan (all 3 variants), there is a 24-month waiting period for pre-existing diseases. During this time, the policy will not cover costs linked to these conditions. However, if you have chosen the Active Plan of ProHealth Prime, the waiting period for conditions like asthma, diabetes, hypertension, dyslipidemia, and obesity is just 90 days.
Waiting Period for Specific Diseases: Apart from your pre-existing conditions, insurance companies might have a list of certain diseases or illnesses. These medical conditions will have a waiting period, regardless of whether you have had such diseases before or not. This waiting period is set by the insurance provider and is not related to your present health condition. In the case of the ManipalCigna ProHealth Prime Plan, there is a 24-month waiting period for these specific diseases.

What is Not Covered Under the Plan?

Exclusions are specific situations that are not covered by your health insurance policy. These include –

Standard Permanent Exclusions: The IRDAI (Insurance Regulatory and Development Authority of India) has mandated a set of 'standard permanent exclusions' that must be followed by all insurance companies. Some of these include –

Investigation and Evaluation: Being admitted to a hospital only for observation or monitoring purposes.
Rest Cure, Rehabilitation, and Respite Care: Staying in a facility for rest without active medical treatment.
Obesity/Weight Control: Treatment or surgery for controlling weight or obesity.
Gender Change Treatment: Treatment aiming to change one's characteristics to those of the opposite sex.
Plastic/Cosmetic Surgery: Procedures to modify appearance or body features.
Hazardous Sports: Medical expenses from participating professionally in adventure sports like rafting, mountain biking, paragliding, cave diving, etc.
Breach of Law: Expenses associated with the treatment of an individual involved in a criminal act or attempted breach of the law.
Excluded Providers: Treatment from medical practitioners or hospitals excluded by the insurer.
Narcotics: Treatment for addiction like alcohol, drug abuse, etc.
Domestic Establishments: Costs for treatment in spas, nursing homes, etc., used mainly for non-medical reasons.
Non-Prescription Substances: Vitamins, minerals, etc., not prescribed by a doctor.
Refractive Error: Expenses for improving eyesight by correcting refractive errors up to 7.5 diopters.
Unproven Treatments: Medical procedures not proven to be effective.
Birth Control and Infertility: Contraception, artificial insemination, sterilisation, advanced reproductive technologies like IVF, gestational surrogacy, ZIFT, ICSI, GIFT, etc.
Maternity Expenses: Costs related to pregnancy, childbirth, pre/ post-natal care, etc.

Additional Permanent Exclusions: Apart from the standard permanent exclusions mentioned earlier, insurance companies might also exclude specific situations or medical conditions from coverage. If you have certain diseases or severe medical conditions that insurers view as risky, they might permanently exclude them from your policy. However, it is important to note that insurers are restricted to a list of illnesses approved by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion.

Non-Standard Exclusions (Specific Exclusions): These are particular exclusions that go beyond the standard permanent exclusions outlined by the IRDAI. These exclusions can differ among insurance companies and depend on the terms and conditions of the policy.

Let's take a look at some key specific exclusions of the ManipalCigna ProHealth Prime Plan –

- Circumcision, unless it is required for the treatment of a medical condition/illness/injury that falls within the policy's coverage or if it is due to an accident.
- Any external devices used in treating conditions like Sleep Apnea Syndrome (C.P.A.P.), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.), and bronchial asthmatic conditions requiring oxygen concentrators, infusion pumps, or any other external devices used during or after treatment.
- Expenses related to external congenital anomalies, defects, complications, or conditions resulting from them.
- Expenses for donor screening or for organ transplant procedures involving organs that are not harvested from a human body.
- Any form of non-allopathic treatment except for AYUSH in-patient treatments like Hydrotherapy, Acupuncture, Reflexology, Chiropractic treatment, and other indigenous medical systems.
- Medical expenses due to ionising radiation, radioactivity contamination from nuclear fuel or waste, chemical or biological attacks, and related losses.
- Dental treatments, orthodontics, dentures, and surgeries unless they result from an accident and require at least 24 hours of hospitalisation. This includes expenses related to gum or tooth diseases barring irreversible jaw bone disease that can't be treated any other way unless covered in the policy.
- Expenses arising from foreign invasion, foreign enemy actions, war-related operations etc.

Summing Up

Product Benefits	Coverage Limits
Pre & Post Hospitalisation Expenses	Protect & Advantage Plan: Expenses covered 60 days before hospitalisation and 180 days after hospitalisation up to the sum insured. Active Plan: Expenses covered 30 days before hospitalization and 60 days after hospitalization up to the sum insured.
Daycare Treatment Coverage	Up to the sum insured under all 3 variants.
Domiciliary Treatment Coverage	Up to 10% of the sum insured under all three variants.
Organ Donor Coverage	Inpatient hospitalisation expenses up to the sum insured under all three variants.
Modern Treatment Coverage	Protect & Advantage Plan: Expenses covered up to the sum insured. Active Plan: Expenses covered up to 50% of the sum insured.
Non-Medical Expenses	Up to the sum insured with an add-on under all three variants.
Room Rent Limit	Single Private AC Room under all three variants. With an add-on, you can choose any room category under ProHealth Prime - Protect & Advantage Plan.
Cumulative Bonus	Protect & Advantage Plan: 25% bonus of the sum insured up to a maximum of 200%. This will remain intact even if you make a claim. Active Plan: 10% bonus of the sum insured, up to a maximum of 100%. This will decrease at the same rate if you make a claim.
Restoration Benefit	100% restoration of the sum insured available after partial exhaustion of the sum insured and any accrued cumulative bonus.
Pre-existing Diseases	Covered after a waiting period of 24 months under all three variants. Under the Active Plan, Asthma, Diabetes, Hypertension, Dyslipidaemia and Obesity-related conditions are covered after 90 days.
Specific Diseases	Covered after a waiting period of 24 months under all three variants.

Explore the Brochure and Policy Details!

Brochure –

ManipalCigna ProHealth Prime Protect & Advantage Plan
https://www.manipalcigna.com/documents/20124/0/prohealth-prime-protect-and-advantage-onepager-phase2-02.pdf/2907ac73-d8f8-4758-6a78-36fcadff3192

ManipalCigna ProHealth Prime Active Plan
https://www.manipalcigna.com/documents/20124/0/prohealth-primeactive-onepager-phase2-02.pdf/216e7769-d72a-ec4f-a9ff-e192187e99fd

Policy Wording –

ManipalCigna ProHealth Prime Protect & Advantage Plan
https://www.manipalcigna.com/documents/20124/0/prohealth-prime-p-a-plan-tnc-june-22.pdf/962333c4-bf91-c49e-a96d-1a02620d681e

ManipalCigna ProHealth Prime Active Plan
https://www.manipalcigna.com/documents/20124/0/prohealth-prime-active-plan-tnc-June-22.pdf/c5f9cb33-3c68-0bee-c3a1-9b570aec987d

FAQs

What is the highest coverage you can choose with the ManipalCigna ProHealth Prime Plan?
The ProHealth Prime Protect & Advantage Plan provides a health cover of up to Rs. 1 crore. On the other hand, if you go for the ProHealth Prime Active Plan, the maximum coverage available is Rs. 15 lakhs.
Does the ManipalCigna ProHealth Prime offer a critical illness add-on cover?
Yes, you can get a critical illness add-on cover with the ManipalCigna ProHealth Prime Protect & Advantage Plan.
Does the ManipalCigna ProHealth Prime Plan include coverage for OPD expenses?
Yes, the ProHealth Prime Advantage Plan (all 3 variants) covers expenses related to outpatient department visits, including consultations and diagnostic tests, which also extend to dental and vision treatments.
Is coverage provided for AYUSH treatments under ManipalCigna ProHealth Prime?
Yes, all 3 variants of the plan cover AYUSH treatments.
Is maternity coverage included in the variants of the ManipalCigna ProHealth Prime Plan?
The ManipalCigna ProHealth Prime Plan does cover maternity expenses, except for the Active Plan. This coverage becomes applicable after a waiting period of 36 months and is subject to the terms and conditions of the policy.