ManipalCigna ProHealth (Accumulate)

The Manipal Cigna ProHealth (Accumulate) Plan is a health insurance policy offered by Manipal Cigna Health Insurance.

The ManipalCigna ProHealth (Accumulate) Plan falls short of providing comprehensive coverage and comes with a comparatively higher price tag than other plans in the market. While it does cover various medical expenses beyond hospitalization and related costs, the plan excludes essential aspects such as maternity, infertility treatments, and other critical healthcare needs. Furthermore, the payment terms for this plan do not offer the flexibility of monthly premium payments. This might be inconvenient for many individuals.

Moreover, our research reveals that they have received a high number of complaints related to claim settlements and policy purchases. These findings suggest that the insurer has a less-than-stellar reputation when it comes to both purchase and claims services.

What are the benefits offered by the Manipal Cigna ProHealth (Accumulate) Plan?

• Inpatient hospitalization coverage: As with many health insurance plans, the Manipal Cigna ProHealth (Accumulate) Plan offers coverage for expenses related to inpatient hospitalization. These expenses typically occur when an individual is hospitalized for more than 24 hours. The plan provides extensive coverage, encompassing a range of expenses such as room and board fees, nursing charges, medical practitioner fees, prescription drugs, ICU expenses, and other relevant medical costs. Please note that enteral feeding will be covered for a maximum of 15 days in a policy year only if deemed medically necessary and prescribed by a medical professional.
• Pre-hospitalization coverage: Pre-hospitalization charges are the medical expenses that you incur before being admitted to a hospital. Like consultation fees, lab tests, checkups, medical reports, etc. The plan will only cover these expenses if they are related to the medical condition that leads to hospitalization and your claim is approved as part of inpatient hospitalization. The Manipal Cigna ProHealth (Accumulate) Plan offers coverage for pre-hospitalization expenses incurred up to 60 days before hospitalization - up to the sum insured.
• Post-hospitalization coverage: Following your hospital discharge, you may encounter additional medical expenses known as post-hospitalization costs. These may include physician consultations, medical check-ups, rehabilitation programs, physical therapy, etc. To receive coverage for these expenses, they must be directly related to the condition you were hospitalized for and your claim must be approved under inpatient hospitalization. The Manipal Cigna ProHealth (Accumulate) Plan offers coverage for post-hospitalization expenses incurred up to 90 days of your hospital discharge - up to the sum insured.
• Daycare treatment coverage: With the advancements in medical technology, many medical procedures that once required extensive hospitalization can now be completed in less than 24 hours. These procedures are referred to as daycare treatments. The Manipal Cigna ProHealth (Accumulate) Plan offers coverage for 546 daycare treatments up to the sum insured.  
• Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments that are administered at home due to the severity of the patient's condition or a shortage of hospital beds. The Manipal Cigna ProHealth (Accumulate) Plan offers comprehensive coverage for domiciliary treatment expenses, except for 8 illnesses, up to the sum insured.  
• Organ donor coverage: The Manipal Cigna ProHealth (Accumulate) Plan offers coverage for organ donor expenses. This coverage includes inpatient expenses related to organ donation up to the sum insured, where the insured is the recipient.
• Modern treatment coverage: Medical technology has made remarkable progress, making advanced treatments like stem cell therapy and radio surgeries a reality. These treatments offer new hope for individuals battling various medical conditions that were once thought incurable. The Manipal Cigna ProHealth (Accumulate) Plan provides coverage for expenses related to modern treatments up to the sum insured.
• Non-medical expenses coverage: Non-medical expenses include the costs that are crucial for your treatment, such as nebulization kits, gloves, oxygen masks, etc. However, the Manipal Cigna ProHealth (Accumulate) Plan does not provide coverage for such expenses.
• No Claim Bonus: The Manipal Cigna ProHealth (Accumulate) Plan offers a No-Claim Bonus if you don’t file any claims in a policy year. This bonus, fixed at a consistent 5% regardless of claims history, can accumulate up to 200% of the sum insured. This bonus remains unaffected even if you file a claim during the policy term. 
• Super No Claim Bonus: The Manipal Cigna ProHealth (Accumulate) Plan comes with an accelerated version of the standard No Claim Bonus, known as the Super No Claim Bonus. The feature operates under the same principles as the standard no claim bonus, offering an annual bonus of 25%. It is important to note that this bonus is available as an add-on. It is applied irrespective of your claims history, and unlike other policies, there is no reduction in the accumulated bonus if you do file a claim. The maximum bonus accumulation achievable through this add-on is 200% of the sum insured.  
• Restoration Benefit: The Manipal Cigna ProHealth (Accumulate) Plan offers a Refill Benefit, which reinstates the sum insured if it is used up within a policy year. This benefit activates after partial utilization of both the sum insured and the No-Claim Bonus. It is applicable for unrelated illnesses and even related illnesses of different insured persons. It can be used an unlimited number of times in a policy year 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 ProHealth (Accumulate): Financial Limits

• Room rent limit: The room rent limit determines the maximum amount that your insurance provider will pay for the room you use during your hospital stay. If you opt for a room that falls within this limit, you won't have to worry about any additional expenses. However, if you choose a room that exceeds your eligibility, you will be subject to a proportional deduction. This means that you will be responsible for paying a percentage of the total bill rather than just paying the difference in room rent. With the Manipal Cigna ProHealth (Accumulate) Plan, you have the flexibility to choose any type of room except suite.
• ICU rent limit: The Manipal Cigna ProHealth (Accumulate) Plan offers extensive coverage for expenses arising from an ICU stay, ensuring that your medical bills will be covered, with no restrictions. This means you can receive top-notch medical care without worrying about the financial implications.
• Copayment: A copayment, often referred to as a copay, is a portion of the approved claim amount that you are responsible for covering directly. The insurance company will take care of the remaining balance. Some plans offer you the choice to voluntarily select a copay, which can result in a reduction in your premium. You have the option to choose a copayment percentage of either 10% or 20% under the Manipal Cigna ProHealth (Accumulate) Plan if you want to lower your premiums. However, it is important to note that copayment is mandatory for individuals aged 65 and older under the Manipal Cigna ProHealth (Accumulate) Plan.
• Deductible: A deductible is a certain amount you need to pay from your end before your health insurance steps in to cover your medical expenses. Under the Manipal Cigna ProHealth (Accumulate) Plan, you can select a voluntary deductible limit ranging from Rs 0.5, 1, 2, 3, 4, 5, 7.5, or 10 lakhs. 
• Limits on surgeries/treatments: Many health insurance policies impose maximum limits on coverage for various medical procedures and treatments. However, the Manipal Cigna ProHealth (Accumulate) Plan offers comprehensive coverage for procedures like cataract treatment and joint replacement surgery up to the full sum insured without any limitations.  

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 ProHealth (Accumulate): Waiting Periods & Exclusions

👉Waiting period

A waiting period refers to a specific time frame during which particular medical conditions or illnesses are not covered by your health insurance policy. Only after the completion of this waiting period can you make a claim for these specific health issues. Different types of waiting periods - 

• Initial waiting period: The Manipal Cigna ProHealth (Accumulate) Plan mandates an initial waiting period of 30 days for all medical conditions, except for those arising from accidents. Once this initial waiting period concludes, you can make claims for all covered medical conditions.
• Waiting period for pre-existing diseases: Any medical condition or illness that you had within 48 months before applying for a health insurance policy is classified as a pre-existing disease. In the case of the Manipal Cigna ProHealth (Accumulate) Plan, there is a waiting period of 36 months before the policy covers expenses related to pre-existing conditions. 
• Waiting period for specific diseases: Manipal Cigna ProHealth (Accumulate) Plan has waiting periods for specific medical conditions that are unrelated to pre-existing diseases. These waiting periods are pre-established by the insurer and are not associated with your current health status. For this plan, a waiting period of 24 months is enforced before coverage becomes effective for such conditions.

👉Exclusions

Health insurance policies come with certain exclusions, indicating that they don't provide coverage for certain medical conditions or situations, like - 

• Standard permanent exclusions: The Insurance Regulatory and Development Authority of India (IRDAI) mandates that insurance companies in India abide by a standardized list of permanent exclusions - 

1. Investigation and evaluation: This policy does not provide coverage for hospitalization solely for monitoring or observation purposes.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for rest or respite where no active medical treatment is given, including rest cure, rehabilitation, and respite care, is not covered by this policy.
3. Obesity/weight control: This policy does not cover any surgical or medical procedures intended for weight control or obesity.
4. Change of gender treatment: Medical treatment aimed at altering the body's characteristics to that of the opposite gender is excluded from this policy.
5. Plastic/cosmetic surgery: Any surgical or medical procedures intended for modifying appearance or body characteristics are not covered under this policy.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while participating as a professional in adventure activities such as mountaineering, river rafting, scuba diving, horse racing, etc., are not covered by this policy.
7. Breach of law: This policy does not cover any expenses related to the treatment of a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment from medical practitioners or hospitals excluded by the insurance company is not covered by this policy.
9. Narcotics: Expenses related to the treatment of addictive conditions like alcohol addiction, drug usage, etc., are not covered by this policy.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons are not covered under this policy.
11. Dietary supplements, substances purchased without prescription: Expenses on vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner are not included in this policy.
12. Refractive error: This policy excludes expenses associated with correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective are not covered by this policy.
14. Expenses related to birth control, sterility, infertility: Expenses related to contraception, sterilization, artificial insemination, and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc., are not covered under this policy.
15. Maternity expenses: This policy does not cover costs related to pre/post-natal care, childbirth related hospitalization expenses, etc.

• Additional permanent exclusions: In addition to the standard permanent exclusions set by the IRDAI, insurance companies also have the discretion to impose ‘specific exclusions’ that apply to certain medical conditions or situations. If an ailment is deemed high-risk, insurers may opt to permanently exclude it from coverage. However, they are limited to including only those diseases that are on the IRDAI's pre-approved list of illnesses when imposing permanent exclusions.
• Non-standard exclusions (Specific exclusions): These exclusions extend beyond the standard permanent exclusions outlined by the IRDAI. Their specifics can differ among insurance providers and may depend on the specific terms and conditions of the policy. Below are some of the specific exclusions to keep in mind when considering the Manipal Cigna ProHealth (Accumulate) Plan  -

1. Dental treatment except for treatment required due to an accident.
2. Circumcision unless necessary for treating a disease or injury.
3. Instruments used in treatment for sleep disorders.
4. Expenses for screening, consulting or treating external birth defects.
5. Expenses associated with organ donor screening and organ transplant surgery involving organs not harvested from a human body.
6. Any non-allopathic treatment (except for AYUSH in-patient treatments).
7. Injury or illness due to nuclear, chemical or biological attack or weapons.
8. Injury or disease due to war, invasion, act of foreign enemy, and warlike operations.

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

• Speed of claims: Manipal Cigna Health Insurance Company has demonstrated an impressive level of efficiency when it comes to claim settlement with a remarkable 99.08% of claims being processed within a span of 30 days. This means that you can expect prompt resolution of your claim.
• Claim-related complaints: After conducting thorough research, it appears that Manipal Cigna Health Insurance Company has a higher incidence of complaints concerning claims than other insurance providers at 0.10%. This indicates that their claim settlement process is not as efficient.
• Claims incurred ratio: The financial stability of an insurer can be assessed through their claims incurred ratio. It is the proportion of total claims paid out against premiums received within a fiscal year. Manipal Cigna Health Insurance Company has a claim incurred ratio of 64.66%. 
• Claim settlement ratio: Manipal Cigna Health Insurance Company has a claim settlement ratio of 88.32%. It signifies the proportion of total claims settled versus the number of claims received by the company during a fiscal year.
• Network hospitals: Manipal Cigna Health Insurance Company provides access to an extensive network of 8500+ hospitals, allowing you to choose from a broad range of healthcare facilities. This comprehensive network provides customers with the peace of mind that comes with receiving cashless treatment, without worrying about the financial aspect of medical care.

How is the customer service of Manipal Cigna Health Insurance?

• Policy purchase-related complaints: Our research shows that Manipal Cigna Health Insurance Company has a high rate of post-sales service complaints at 0.01%. This indicates that you may not have a satisfactory buying experience. 
• Response on Toll-Free: In our research, it was noted that Manipal Cigna Health Insurance Company has a slower response time for their toll-free customer service number compared to other insurance providers.
• Response on Twitter: Manipal Cigna Health Insurance Company's Twitter response time is slower compared to other insurance companies, as per our research findings.

About Manipal Cigna Health Insurance

Manipal Cigna Health Insurance, headquartered in Mumbai, Maharashtra, was established in 1994. As a standalone health insurance company in India, it is a joint venture between Manipal Group and Cigna Corporation. The company offers a broad spectrum of insurance products, including individual insurance, family floater, critical illness, personal accident, group health insurance, and hospital cash policies, catering to the varied needs of its customers. Mr. Prasun Sikdar serves as the company's CEO and MD.