Manipal Cigna Prime Senior (Elite)

Manipal Cigna Prime Senior (Elite) is a health insurance policy offered by Manipal Cigna Health Insurance Company Limited.

This plan is designed for senior citizens and provides comprehensive coverage. It offers notable benefits, including the ability to waive the mandatory co-payment and significantly reduce the waiting period for pre-existing diseases from 24 months to just 90 days. The downside is that it lacks the option for monthly premium payments and the insurer has received a higher number of complaints related to policy purchase and claim settlement.

What are the benefits offered by the Manipal Cigna Prime Senior (Elite) Plan?

• Inpatient hospitalisation coverage: Similar to all other health insurance plans, the Manipal Cigna Prime Senior (Elite) Plan provides coverage for expenses related to inpatient hospitalisation. This includes costs that arise when you are admitted to a hospital for more than 24 hours. Inpatient hospitalisation expenses encompass charges for room boarding and nursing services, fees for medical practitioners, the cost of prescribed medications and drugs, ICU charges, and any other associated expenses.
• Pre-hospitalisation coverage: Pre-hospitalisation charges include medical costs that arise prior to being admitted to a hospital. These expenses include consultations, tests, checkups, lab reports, etc. The insurer will only provide coverage for these expenses if they are associated with the medical condition that ultimately leads to your hospitalisation and if your claim is approved as part of inpatient hospitalisation coverage. With the Manipal Cigna Prime Senior (Elite) Plan, you can receive coverage for pre-hospitalisation expenses for 60 days before hospitalisation up to the sum insured. However, please note that pre-hospitalisation costs related to domiciliary treatments and organ donor will be covered for 30 days instead of 60 days.
• Post-hospitalisation coverage: Post-hospitalisation expenses include the medical expenses that may arise once you are discharged from the hospital. These costs typically include follow-up appointments with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related services. In order to qualify for coverage, it is important that these post-hospitalisation expenses are directly linked to the condition for which you were hospitalised and that your claim is approved under inpatient hospitalisation. With the Manipal Cigna Prime Senior (Elite) Plan, you can rest assured knowing that your post-hospitalisation expenses are covered for up to 90 days after your hospital stay up to the sum insured. However, please note that post-hospitalisation costs related to domiciliary treatments and organ donor will be covered for 30 days instead of 90 days.
• Daycare Treatment Coverage: A daycare treatment refers to a medical procedure or surgery that used to require a prolonged hospital stay but can now be completed within 24 hours, thanks to advancements in medical technology. The Manipal Cigna Prime Senior (Elite) Plan covers all daycare procedures up to the sum insured.
• Domiciliary Treatment Coverage: Domiciliary treatments are medical treatments for illnesses or injuries that necessitate immediate attention at the hospital but are given at home due to the severity of the patient’s condition or the absence of hospital beds in the vicinity. With the Manipal Cigna Prime Senior (Elite) Plan, you can have peace of mind knowing that domiciliary treatment costs, except for 14 illnesses, will be covered up to the sum insured. 
• Organ Donor Coverage: The Manipal Cigna Prime Senior (Elite) Plan covers the inpatient costs associated with organ donations, where you are the recipient, up to the sum insured that you have chosen for your policy.
• Modern Treatment Coverage: The healthcare industry is experiencing rapid evolution due to technological advancements, resulting in the emergence of modern treatments that were once deemed impossible. These treatments, including radio surgeries, stem cell therapy, etc. are aimed at curing ailments that were previously considered incurable. The Manipal Cigna Prime Senior (Elite) Plan is specifically designed to keep up with these advancements and provides coverage for the expenses associated with modern treatments up to the sum insured.
• Non-Medical Expenses Coverage: The Manipal Cigna Prime Senior (Elite) Plan goes beyond just covering medical expenses. It also includes coverage for non-medical expenses, specifically the cost of essential consumables like gloves, nebulization kits, oxygen masks, and other treatment necessities. These consumables can often be quite costly and can quickly accumulate. Fortunately, the plan offers coverage for these expenses up to the sum insured - if you opt for an add-on.
• No Claim Bonus: The No-Claim Bonus is a reward provided by the insurance company if you don’t make any claims during a policy year. With the Manipal Cigna Prime Senior (Elite) Plan, you will be entitled to a No Claim Bonus equivalent to 10% of the sum insured. It's important to note that even if you do make a claim during the policy period, your accumulated bonus will not be reduced. The maximum bonus that can be accumulated under this plan is 100% of the sum insured.
• Super No Claim Bonus: This is a more enhanced version of the No Claim Bonus and functions in the same manner. However, it's important to note that the Manipal Cigna Prime Senior (Elite) Plan does not include the Super No Claim Bonus feature.
• Restoration Benefit: The Restoration Benefit is a valuable feature that replenishes your sum insured if it is exhausted during a policy year. With the Manipal Cigna Prime Senior (Elite) Plan, this refill benefit is applicable for unrelated illnesses and related illnesses. The benefit will activate when both the sum insured and No Claim Bonus are partially utilised. Additionally, the refill benefit can be utilised unlimited times in a policy year and is applicable for subsequent claims.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured. 

Manipal Cigna Prime Senior (Elite): Financial Limits

• Room Rent Limit: The room rent limit is the maximum amount that your insurance company will pay for the room you are admitted to during your hospitalisation. By choosing a room that falls within this limit, you won't have to pay any additional costs out of your own pocket. However, if you decide on a room that has a higher cost than what you are eligible for, a proportionate deduction will apply. This means that you will be responsible for paying a proportionate portion of the total bill, rather than just the difference in the room rent. With the Manipal Cigna Prime Senior (Elite) Plan, you have the freedom to choose any type of room without any limitations - if you opt for an add-on.
• ICU Rent Limit: It is the highest amount that the health insurance policy will cover for a stay in the intensive care unit (ICU) of a hospital. Manipal Cigna Prime Senior (Elite) Plan covers the entire cost of an ICU stay without any limit.
• Copayment: A copayment, also known as a copay, refers to the portion of the approved claim amount that you are required to pay from your end. The insurance company takes care of the remaining amount. The Manipal Cigna Prime Senior (Elite) Plan comes with a copay, but if you opt for an add-on, you can avail of 0% co-pay.
• Deductible: A deductible refers to an amount that you are required to pay from your end before your health insurance plan takes effect and starts covering your medical expenses. The Manipal Cigna Prime Senior (Elite) Plan offers you a range of optional deductibles to choose from - Rs 10,000, Rs 25,000, Rs 50,000, Rs 1,00,000, Rs 2,00,000, Rs 3,00,000, Rs 4,00,000 and Rs 5,00,000.
• Limits on Surgeries/Treatments: It is the highest amount that your health insurance policy will pay for certain medical procedures or treatments. Some policies may have limits on how much they will cover for certain procedures, while others may not. With the Manipal Cigna Prime Senior (Elite) Plan, there are no limits on important surgeries and treatments like cataract treatment, joint replacement surgery, etc. They are covered up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs. 

Manipal Cigna Prime Senior (Elite): Waiting Periods & Exclusions

👉Waiting period

After buying health insurance, there is a certain period during which certain illnesses and diseases are not covered. This timeframe is called the waiting period. Once this period is over, you can start claiming for these conditions. There are different types of waiting periods, including -

• Initial waiting period: For all medical conditions, except accidents, there is a 30-day waiting period before you can make a claim for hospitalisation. This means that during the first 30 days, you won't be able to make a claim unless it's due to an accident.
• Waiting period for pre-existing diseases: A pre-existing disease refers to any medical condition or illness that you had in the 36 months before applying for your health insurance policy. With the Manipal Cigna Prime Senior (Elite) Plan, there is a waiting period of 24 months for pre-existing diseases. This means that during this time, the policy will not cover any expenses related to your pre-existing diseases. However, a unique offering of this plan is that you can reduce the pre-existing disease waiting period to 90 days if you go for an add-on.
• Waiting period for specific diseases: Insurers have a list of specific medical conditions or illnesses for which they may apply a waiting period, even if you haven't had those diseases before. This waiting period is determined by the insurer and not based on your current health. The Manipal Cigna Prime Senior (Elite) Plan applies a waiting period of 24 months for specific diseases.

👉Exclusions

Exclusions are situations that your health insurance policy will not cover. Some of these exclusions are as follows:

• Standard permanent exclusions: The IRDAI has created a list of 'standard permanent exclusions' that all insurance companies must follow. Some of these exclusions are:

1. Investigation and evaluation: Hospital admission solely for observation or monitoring purposes.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, where no active treatment is provided.
3. Obesity/weight control: Treatment or surgery for weight control or obesity.
4. Change of gender treatment: Treatment aimed at altering the body's characteristics to those of the opposite sex.
5. Plastic/cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses incurred while participating as a professional in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
7. Breach of law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
8. Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility infertility: Contraception, sterilization, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.

• Additional permanent exclusions: Furthermore, insurance companies may add additional exclusions to your policy for specific situations or medical conditions, apart from the standard permanent exclusions mentioned above. If you have certain diseases or severe medical conditions that insurers consider too risky to cover, they may permanently exclude them from your policy. It's important to know that insurance companies in India can only apply a permanent exclusion to illnesses that are listed by the Insurance Regulatory and Development Authority of India (IRDAI). They cannot exclude illnesses or diseases that are not on this list.
• Non-standard exclusions (Specific exclusions): These are specific exclusions beyond the standard permanent exclusions listed by the IRDAI. These exclusions may differ among insurance companies and may be based on the specific terms and conditions of the policy. Here are some specific exclusions under the Manipal Cigna Prime Senior (Elite) Plan:

1. Dental treatment, except in case it is necessary as a result of an accident.
2. Circumcision, unless it is medically necessary for treating a disease or injury.
3. Instruments used in the treatment of sleep disorders.
4. Expenses for the treatment of external birth defects.
5. Expenses related to organ donor screening and organ transplant surgery involving organs not harvested from a human body.
6. Any non-allopathic treatment, with the exception of AYUSH in-patient treatments.
7. Injuries or medical conditions resulting from nuclear, chemical, or biological attacks or weapons.
8. Injuries or medical conditions caused by war, invasion, acts of foreign enemies, and warlike operations.

What to expect in terms of claims experience if you buy from Manipal Cigna Health Insurance Company Limited?

• Speed of claims: Manipal Cigna Health Insurance Company Limited has settled 99.14% of claims in less than 30 days. This indicates they are quick in processing and settling claims.
• Claim-related complaints: According to our research, we found that Manipal Cigna Health Insurance Company Limited has received 0.26% of complaints related to claims. This is on the higher side and suggests that their claims settlement process isn’t as smooth.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurance company's financial performance. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. The claims incurred ratio of Manipal Cigna Health Insurance Company Limited is 63.78%. 
• Claim settlement ratio: The claim settlement ratio refers to the percentage of claims settled by the insurer as compared to the total number of claims received by them in a financial year. The claim settlement ratio of Manipal Cigna Health Insurance Company Limited is 87.68%.
• Network hospitals: Manipal Cigna Health Insurance Company Limited has a vast network of 8500+ hospitals. The large number of network hospitals offered by Manipal Cigna Health Insurance Company Limited means that you have access to a wide range of healthcare providers in different locations and can also avail of cashless treatments, ensuring a smoother experience.

How is the customer service of Manipal Cigna Health Insurance Company Limited?

• Policy purchase-related complaints: Manipal Cigna Health Insurance Company Limited has received 0.01% of complaints related to their after-sales service as per our research. This is on the higher side when compared to other insurers.
• Response on Toll-Free: When it comes to customer service, our research found Manipal Cigna Health Insurance Company Limited’s response over the toll-free is average compared to other insurance companies. 
• Response on Twitter: Our research suggests that Manipal Cigna Health Insurance Company Limited’s response rate over Twitter is slow.

About Manipal Cigna Health Insurance Company Limited

Manipal Cigna Health Insurance is a standalone health insurance company in India. It is a joint venture between the Manipal Group and Cigna Corporation. It offers a variety of insurance products, including individual insurance, family floater, critical illness insurance, personal accident insurance, group health insurance, hospital cash policies, etc. The company was founded in 1994 and has its headquarters in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Prasun Sikdar.