ManipalCigna ProHealth Insurance Review

ManipalCigna ProHealth Insurance

ManipalCigna Health Insurance Company Limited is a joint venture between the U.S. based global health services leader, Cigna Corporation and Indian conglomerate, Manipal Group.

ManipalCigna’s Protect Plan shields your well-being with financial assistance for costs related to hospitalization such as room rent, treatment expenses, diagnostics, consumables, and medicines. It also covers costs before and after hospitalization for a defined number of days, depending on the plan variant you choose.

Highlights
  • Flexibility in offering through four separate plan alternatives – Protect, Plus, Preferred & Premier
  • No maximum entry age
  • Provides lifetime renewal opportunity
  • The option of 1 year, two years and three years term
  • 10% discount on the premium amount for enrolling more than two family members under a single individual policy.
  • Additional discount of 7.5% for choosing a two year and 10% for a three-year single premium policy

Scope of cover

Individual Plan

Entry Age

For children: 91 days

Adults :

Minimum: 18 years

Maximum: No Age Bar

Number of Members Covered

Maximum Members: 6

Maximum Adults: 4

Maximum Children: 2

Sum Insured

 2.5 – 100 lakhs

discount

For longer policy term
family discount

Policy Periods Available

1, 2 years

Pre-Policy Medical Check-up

2.5 – 7.5 – 46 and above

10 lakhs – 41 and above
15 lakhs and more – 18 and above

Family Floater Plan

Entry Age

For children: 91 days

Adults :

Minimum: 18 years

Maximum: No Age Bar

Number of Members Covered

Maximum Members: 5

Maximum Adults: 2

Maximum Children : 3

Sum Insured

 2.5 – 100 lakhs

discount

For longer policy term
family discount

Policy Periods Available

1, 2 years

Pre-Policy Medical Check-up

2.5 – 7.5 – 46 and above

10 lakhs – 41 and above
15 lakhs and more – 18 and above

Permanent Exclusions

The Plan will not cover any liabilities towards the treatments of the following conditions-

  • whose signs or symptoms first occur within 30 days of the policy period
  • attempted suicide
  • use of alcohol or drug
  • AIDS
  • Cost of donor screening
  • Genetic disorder and stem cell implantation/surgery.
  • Dental treatment is other than due to an accident.
  • Congenital disease
  • infertility and in vitro fertilization.
  • hospitalization out of war, riot, strike and nuclear weapons

The details list on what the policy does not cover is available in the policy wordings.

Review of ManipalCigna ProHealth Insurance Protect

One of the greatest highlights of ManipalCigna’s Prohealth policy is the luxury of choice. With a broad range of sum insured and linked benefits, it is simpler to pick and choose the coverage that best suits your requirements as well as pocket. Most of the advantages like an optional cover for critical illness and worldwide coverage does not limit the policy’s offering. Thus, if you are looking for comprehensive coverage for yourself or family, you can surely consider the plan.

Important Features

DAY CARE TREATMENTS

Due to scientific advancement, some procedures/treatments do not require you to be hospitalized for a minimum of 24 hours to raise a claim. This plan covers such procedures.

NO-CLAIM BENEFITS

In this policy no-claim bonus equal to 5% or 10% (depending on the variant) of basic sum insured up to a maximum of 100% is available. However, this benefit is not available in the Premium variant.

ORGAN DONOR COVER

This benefit covers for any expenses related the organ donation for you up to the sum insured.

PRE HOSPITALIZATION

The insurance company will compensate you for the medical expenses related to your hospitalization up to 60 days before it.

POST HOSPITALIZATION

The insurance company will pay you for the medical expenses related to your hospitalization up to 90 to 180 days (depending on the plan variant) post-hospitalization.

RESTORE BENEFITS

It offers to restore benefit equal to 100% of the sum insured. However, this advantage is not available in the Premium variant.

DEDUCTIBLE

You have the option to choose a voluntary deductible of Rs.1 lakh, Rs.2 lakh or Rs.3 lakh. Although you’ll have to bear this amount during a claim, it will reduce the premium.

Good to Have Benefits

OPD EXPENSE COVER

This plan does not cover expenses related to outpatient treatment.

DAILY HOSPITALIZATION ALLOWANCE

This policy does not offer any daily hospital cash.

HEALTH CHECK-UP

Offers complimentary health check-up that covers some listed tests, once every three years or every year (depending on the plan variant), irrespective of the claim.

HOME HOSPITALIZATION/ DOMICILIARY HOSPITALIZATION

You can avail treatment at home up to the sum insured, provided it meets the pre-defined conditions.

NON- ALLOPATHIC TREATMENT EXPENSE COVER

This plan does not cover expenses related to non-allopathic treatment.

EMERGENCY AMBULANCE

This plan provides ambulance cover up to Rs.2,000 or actuals (depending on the plan variant) per hospitalization.

Value Adds

EYE-COVER

This plan does not provide coverage for eye treatment expenses.

MATERNITY COVER

This benefit is offered only for Plus, Preferred and Premium variant. For Plus plan, you are covered up to Rs.15,000 for normal delivery and up to Rs.25,000, for a C-Section. Similarly, for Preferred and Premium plan, you are covered up to Rs.50,000 for normal delivery and up to Rs.100,000 for a C-Section.

DENTAL COVERAGE

This policy does not cover any dental treatments.

RECOVERY BENEFIT

This plan does not offer any recovery benefit.

HEALTHY REWARDS

The plan offers a rewards program where you get points equal to 1% of the premium paid each year. You can accumulate them up to 10% of the premium paid in the policy. Each earned reward point equals to Rs.1, and you can redeem them for a discount in premium from next renewal. You can also reimburse them under Health Insurance maintenance benefit or to enjoy services through the company’s network partners.

EXPERT OPINION ON CRITICAL ILLNESS

Under this benefit, you can claim for the cost towards an expert opinion on any of the listed critical illness before you seek the necessary treatment.

HEALTH MAINTAINANCE BENEFIT

Although the plan does not cover the OPD treatments or treatments for alternative medicine directly, it offers a reimbursement between Rs.500 to Rs.15,000 (depending on the plan variant) each year to take care of your OPD consultations or any alternate forms of medicine like Ayush, and so on.

WORLDWIDE EMERGENCY COVER

You can claim for reimbursement up to your sum insured or a maximum of Rs.10 lakh (depending on the plan variant) for any treatments covered under this policy anywhere in the world.

FREE LOOK PERIOD

For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.

Add-on Covers

CRITICAL ILLNESS COVER

At an additional premium, you will get a lump sum amount equal to Sum Insured in the case of the first diagnosis of the covered critical illnesses. In the family floater, once you claim for a critical illness, you will get 100% reinstatement of sum insured once during the lifetime of the plan for the other person covered. However, this option is not available in the Premium variant.

WAIVER OF MANDATORY CO-PAY

With an extra premium, you can choose to waive the co-payment clause even after the age of 65 years.

Terms & Conditions

ROOM RENT / ROOM CATEGORY

The plan has defined limits for room rents and varies from sharing the room to a single private one depending on the plan variant.

CO-PAYMENT

A compulsory co-payment of 20% applies to all claims for anyone aged 65 years and above irrespective of entry age. Likewise, if anyone has opted for a voluntary co-pay and if he chooses to take treatment out of the zone, then the co-pay percentages will apply in conjunction.

Waiting Period
COOLING OFF PERIOD

A 30 days cooling off period for all claims except any arising out of accidental injuries.

SPECIFIC ILLNESSES

The policy covers some specific diseases/treatments only after 24 months. These include Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.

PRE-EXISTING ILLNESSES

A 48/ 36/ 24/ 24 months waiting period will be applicable for any Pre-existing disease for Protect, Plus, Preferred & Premier Plan respectively.

The survival period of 30 days applies for any claim related to critical illness. Similarly, there is a waiting period of 90 days before the symptoms of any critical illness first occur to be able to claim.

WAITING PERIOD FOR MATERNITY

A 48 months waiting period for maternity & newborn cover applies.

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