ManipalCigna ProHealth (Plus)

ManipalCigna ProHealth (Plus) is a health insurance policy provided by the Manipal Cigna Health Insurance company. 

In addition to covering hospitalisation and its associated costs, this plan extends coverage to various other expenses, including maternity-related expenses, outpatient department costs, such as medications, diagnostic tests, medical consultations, and more. On the flip side, the plan does not offer the flexibility of a monthly premium payment option. Further, as per our research, the insurer has received a higher number of claim settlement and policy purchase complaints, indicating a poor track record with respect to both purchase and claims service.

What are the benefits offered by the ManipalCigna ProHealth (Plus) Plan? 

• Inpatient hospitalisation coverage: ManipalCigna ProHealth (Plus) Plan provides coverage for hospitalisation expenses, which include all costs associated with admission that exceed 24 hours, such as nursing care, medical consultations, prescription medication, intensive care unit (ICU), and any other related expenses.
• Pre-hospitalisation coverage: Pre-hospitalisation coverage includes the expenses incurred before hospitalisation, like consultations, tests, checkups, etc. To be eligible for this coverage, the charges must be related to the medical condition that resulted in hospitalisation and should be approved as part of the inpatient hospitalisation coverage. The ManipalCigna ProHealth (Plus) Plan provides coverage for pre-hospitalisation expenses for 60 days before hospitalisation, up to the sum insured. 
• Post-hospitalisation coverage: Post-hospitalisation expenses are the medical costs incurred after hospitalisation, including follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related expenses. However, these expenses are eligible for coverage only if they are related to the medical condition for which you required hospitalisation and must be approved as part of inpatient hospitalisation coverage. ManipalCigna ProHealth (Plus) Plan covers post-hospitalisation expenses for 180 days after hospitalisation up to the sum insured. 
• Daycare treatment coverage: Daycare treatment is a medical procedure or surgery that previously required an extended hospital stay but can now be completed within 24 hours because of advances in medical technology. The ManipalCigna ProHealth (Plus) Plan offers coverage for 546 such treatments without any limit, which implies that the costs will be covered 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. The ManipalCigna ProHealth (Plus) Plan covers expenses incurred for all domiciliary treatments up to the sum insured except for 8 specific illnesses.
• Organ donor coverage: The ManipalCigna ProHealth (Plus) Plan covers the inpatient expenses of the organ donor up to the sum insured, where you are the recipient.
• Modern treatment coverage: With technological advancements, healthcare is rapidly progressing, and modern treatments are emerging. These treatments, including stem cell therapy, robotic surgery, etc., treat diseases that were previously considered incurable. The ManipalCigna ProHealth (Plus) Plan covers the expenses of such modern treatments up to the sum insured. 
• Non-medical expenses coverage: In addition to medical expenses, non-medical expenses, such as gloves, oxygen masks, nebulization kits, and other similar items, are covered by some insurance policies. However, the ManipalCigna ProHealth (Plus) Plan does not cover such expenses.
• No Claim Bonus: Health insurers offer a No Claim Bonus as a reward if no claims are made during a policy year. However, the ManipalCigna ProHealth (Plus) Plan provides a bonus of 10% of the sum insured as No Claim Bonus, regardless of whether any claims are made during a policy year. It does not reduce the accumulated bonus even if a claim is filed. Furthermore, you can accumulate a maximum bonus of 200% of the sum insured under the policy. 
• Super No Claim Bonus: The Super No Claim Bonus is an enhanced version of the No Claim Bonus and works similarly. The ManipalCigna ProHealth (Plus) Plan provides a Super No Claim Bonus of 25% of the sum insured annually - regardless of whether any claims are made during the policy period - if you opt for an add-on. This policy does not reduce the accumulated bonus even if claims are made. Moreover, you can accumulate a maximum bonus of up to 200% of the sum insured.
• Restoration Benefit: The refill benefit is a feature that restores the sum insured after it has been used up during a policy year. The ManipalCigna ProHealth (Plus) Plan provides this benefit for unrelated illnesses and is also available for related illnesses to other insured persons. This feature is activated when both the sum insured and the No Claim Bonus have been partially used up. Moreover, you can enjoy this benefit unlimited times in a policy year for subsequent claims.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

ManipalCigna ProHealth (Plus): Financial Limits

• Room rent limit: A room rent limit covers the expenses related to the room you stay in during your hospitalisation. If the room you choose falls within the limit specified by your health insurance policy, you won’t have to pay any additional costs. However, if the room you select exceeds the eligibility limit, a proportionate deduction applies. And you will be responsible for paying a proportionate share of the total bill, not just the difference in the room rent. ManipalCigna ProHealth (Plus) Plan offers the flexibility to select any type of room, except a suite.
• ICU rent limit: It is the maximum amount covered by your health insurance policy for your ICU stay in the hospital. The ManipalCigna ProHealth (Plus) Plan provides coverage for the ICU rent without any limit. This means the plan covers the entire cost up to the sum insured. 
• Co-payment: A co-payment refers to a certain percentage of the claim amount that you must pay out of your own pocket. Once this amount is paid, the insurer will cover the remaining expenses. Under the ManipalCigna ProHealth (Plus) Plan, you can voluntarily choose the copay option of either 10% or 20%. However, it is mandatory for individuals who are 65 years of age or older.
• Deductible: A deductible refers to the amount of medical expenses that you must pay from your end before your coverage kicks in to cover your medical expenses. With the ManipalCigna ProHealth (Plus) Plan, you can choose from a range of deductible amounts - Rs 1 lakh, Rs 2 lakh, Rs 3 lakh, Rs 4 lakh, Rs 5 lakh, Rs 7.5 lakh, or Rs 10 lakh.  
• Limits on surgeries/treatments: It is the maximum amount that a health insurance policy will pay for certain medical procedures or treatments. While some insurers have limits on the amount they will cover for certain procedures, others may not. Under the ManipalCigna ProHealth (Plus) Plan, there are no such limitations. Important surgeries/procedures such as joint replacement surgery and cataract treatment 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. 

ManipalCigna ProHealth Prime Protect: Waiting Periods & Exclusions

👉Waiting period

After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period of time. This duration is referred to as the waiting period. But, once the waiting period has ended, you can claim for these conditions -

• Initial waiting period: An initial waiting period of 30 days applies for all medical conditions except accidents. This means that you will not be able to make a claim for any hospitalisation, except for accidents, for the initial 30 days of policy purchase.
• Waiting period for pre-existing diseases: A pre-existing disease refers to a medical condition you have experienced in the past 36 months before purchasing a health insurance policy. Under the ManipalCigna ProHealth (Plus) Plan, there is a waiting period of 36 months for pre-existing diseases. During this period, you cannot claim for medical expenses related to such diseases. 
• Waiting period for specific diseases: Apart from pre-existing conditions, insurers will have a list of specific medical conditions or illnesses that are subject to a waiting period, irrespective of whether you have had those diseases before or not. The duration of this waiting period is decided by the insurer and is not based on your current health status. The ManipalCigna ProHealth (Plus) Plan has a waiting period of 24 months for specific diseases. 

👉Exclusions

Health insurance policies do not cover certain medical conditions. These are known as exclusions. Here are some of the types of exclusions: 

• Standard Permanent Exclusions: All insurance providers are required to implement the ‘standard permanent exclusions’ established by IRDAI, which include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match 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 resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc. as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to the treatment received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements are substances purchased without subscription, such as vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, and infertility: Expenses are related to contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Expenses refer to pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance companies can impose additional exclusions for certain medical conditions or situations apart from the standard permanent exclusions. In case you have a severe medical condition or a specific disease that is considered risky by the insurer, they may choose to permanently exclude it from the policy. The IRDAI has established a list of illnesses for which insurance companies can enforce permanent exclusions. However, insurance companies cannot impose permanent exclusions on illnesses or diseases that are not on this list. 
• Non-standard exclusions (Specific exclusions): Specific Exclusions are the medical conditions that are excluded from a health insurance policy along with the standard permanent exclusions listed by the IRDAI. These specific exclusions are determined by the individual insurance company and can differ based on the policy’s terms and conditions. The specific exclusions under the ManipalCigna ProHealth (Plus) plan are- 

1. Dental treatments except the ones required because of an accident
2. Circumcision, unless it is required to treat a disease or injury
3. Instruments used in the treatment of sleep disorders
4. Expenses related to screening, consulting, or treating external birth defects
5. Expenses associated with organ donor screening and transplant surgeries that involve organs which are not harvested from a human body
6. Any non-allopathic treatments, except AYUSH in-patient treatments 
7. Injury or illness caused because of a nuclear, chemical, or biological attack or weapons
8. Injury or disease caused due to war, invasion, act of a 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 has a record of settling claims quickly and efficiently. It has settled 99.14% of claims in less than 30 days.  
• Claim-related complaints: As per our research, Manipal Cigna Health Insurance has received 0.26% of complaints related to claims, which is significantly higher than other insurance companies. 
• Claims incurred ratio: The claims incurred ratio measures the company’s financial performance and represents the number of claims incurred compared to the total premiums collected. Manipal Cigna Health Insurance company has a claims incurred ratio of 63.78%.
• Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by the insurer as compared to the total number of claims they received in a financial year. Manipal Cigna Health Insurance company has a claim settlement ratio of 87.68%. 
• Network hospitals: Manipal Cigna Health Insurance company has a network of over 8,500+ hospitals across various locations. Such a vast network enables you to receive cashless treatments from a wide range of healthcare providers across various locations.

How is Manipal Cigna Health Insurance's customer service?

• Policy purchase-related complaints: Based on our research, Manipal Cigna Health Insurance has received 0.01% complaints about its after-sales service, which is significantly higher than other insurance companies. 
• Response on Toll-Free: Our research suggests that Manipal Cigna Health Insurance’s response time on their toll-free is average, indicating that you will have to wait a bit to get your problems resolved. 
• Response on Twitter: As per our research, Manipal Cigna Health Insurance has a slower response time on Twitter as compared to others.

About Manipal Cigna Health Insurance Company

Manipal Cigna Health Insurance is an independent Indian health insurance company that was formed through a partnership between the Manipal Group and Cigna Corporation. The company offers a wide range of insurance policies to meet the diverse needs of customers, including family floater, individual insurance, personal accident, critical illness insurance, group health insurance, hospital cash policies, and more. Established in 2014 and headquartered in Mumbai, Maharashtra, the company is led by the CEO and MD Mr. Prasun Sikdar.