Manipal Cigna ProHealth Prime (Advantage)

ManipalCigna ProHealth Prime (Advantage) is a health insurance policy offered by ManipalCigna Health Insurance Company Limited.

This policy offers comprehensive coverage for a variety of expenses, including hospitalisation and related expenses. These include such as maternity costs, infertility treatment costs, and consumable costs. Moreover, it offers a variety of ways to receive premium discounts.

However, the plan is on the pricier side when compared to other products available in the market and lacks a monthly premium payment option as well. Further, we found that the insurer received a greater number of complaints regarding claim settlement and policy purchase. This shows that the insurer has a poor track record when it comes to both purchase and claims service experience. So, customers should exercise caution and research thoroughly before opting for this plan.

What are the benefits offered by ManipalCigna ProHealth Prime (Advantage)?

• Inpatient hospitalisation coverage: Expenses incurred when you are admitted to a hospital for more than 24 hours are called inpatient hospitalisation expenses. These include room boarding and nursing charges, medical practitioners' fees, the cost of prescribed medicines and drugs, ICU charges, and other related expenses. ManipalCigna ProHealth Prime (Advantage) covers such expenses.
• Pre-hospitalization coverage: Medical expenses incurred prior to hospitalisation including consultations, tests, physicals, and lab reports are called pre-hospitalisation expenses. The insurer will cover these expenses only if they are related to the medical condition for which you are later hospitalised and the claim is approved as part of your inpatient hospitalisation coverage. The ManipalCigna ProHealth Prime (Advantage) covers pre-hospitalization expenses incurred up to 60 days prior to hospitalisation - up to the sum insured.
• Post-hospitalization coverage: Medical expenses incurred after you are discharged from the hospital are called post-hospitalisation expenses. These expenses include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, etc. In order to qualify for coverage, your post-hospitalization expenses must be related to the condition that you were hospitalised for and the claim must be approved under inpatient hospitalisation. ManipalCigna ProHealth Prime (Advantage) covers post-hospitalization expenses incurred up to 180 days after hospitalisation - up to the sum insured.
• Daycare treatment coverage: In the past, several treatments required an extended hospital stay, but are now completed within 24 hours, thanks to advancements in medical technology. These are called daycare treatments. ManipalCigna ProHealth Prime (Advantage) covers all daycare procedures. There is no limit on the coverage of daycare treatments, so the expenses will be covered up to the sum insured.
• Domiciliary treatment coverage: Medical treatments can be administered at home in case -

1. You cannot be transported to a hospital due to the severity of your illness or injury.
2. There are no beds in the nearby hospital.

These treatments are called domiciliary treatments. ManipalCigna ProHealth Prime (Advantage) covers domiciliary treatment costs up to 10% of the sum insured if the treating doctor certifies the same. And, there are 8 illnesses that are not covered by the plan. Also, pre-hospitalization costs associated with the domiciliary treatment will be covered for 30 days instead of 60 days. Post-hospitalization costs associated with domiciliary treatment will be covered for 30 days instead of 180 days.

• Organ donor coverage: The ManipalCigna ProHealth Prime (Advantage) also provides coverage for organ donor expenses. It covers the inpatient expenses up to the sum insured you select under the policy.
• Modern treatment coverage: Technology has revolutionised medical care, resulting in the development of modern treatments that provide patients with more effective and accessible care. These treatments include radiosurgery, stem cell therapy, etc., that cure diseases that were previously considered incurable. The ManipalCigna ProHealth Prime (Advantage) plan covers the expenses associated with modern treatments up to the sum insured.
• Non-medical expenses coverage: Non-medical expenses, also known as consumables are medical items such as gloves, nebulization kits, oxygen masks, etc. Often, these consumables tend to add up and get expensive but are not covered under health insurance. However, ManipalCigna ProHealth Prime (Advantage) covers such expenses. It offers coverage for these expenses up to the sum insured - providing you with much-needed financial relief. You can opt for this coverage as an add-on by paying an extra premium.
• No Claim Bonus: If you do not claim under your health insurance policy during the previous policy year, you will be eligible for a reward called a no claim bonus. However, in the case of ManipalCigna ProHealth Prime (Advantage), a no claim bonus of 25% of the sum insured is offered - irrespective of the claims made - up to a maximum of 200% of the sum insured. And, you will not lose your accumulated bonus even if you make a claim during your policy period. 
• Super No Claim Bonus: Essentially, it is the accelerated version of the no claim bonus offered under the ManipalCigna ProHealth Prime (Advantage) plan. A super no claim bonus of 50% of the sum insured is offered (if you opt for the add-on) - regardless of whether a claim is made - up to a maximum of 200% of the sum insured. And, you will not lose any of your accumulated bonus even if you make a claim during the policy period. 
• Restoration Benefit: The Restoration Benefit restores your sum insured once it gets exhausted within a policy year. As part of the ManipalCigna ProHealth Prime (Advantage) plan, the refill benefit is available for both related and unrelated illnesses and it kicks in after the sum insured and the no claim bonus are partially exhausted. Refills are applicable to subsequent claims and can be applied unlimited times in a policy year.

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

ManipalCigna ProHealth Prime (Advantage): Financial Limits

• Room rent limit: A room rent limit is the maximum amount that your insurance company will cover for the room in which you are hospitalised. If you choose a room that falls within your plan's room rent limit, you will not have to pay anything out of pocket. However, a proportionate deduction will apply if you choose a room with a higher rent than your eligibility. So, instead of only paying the difference in the room rent, you'll have to pay a proportionate share of the total bill. With ManipalCigna ProHealth Prime (Advantage), you have the freedom to choose any type of room - since there is no room rent limit.
• ICU rent limit: Basically, this is the maximum amount that the health insurance policy will pay for an ICU stay in the hospital. It is important to note that ManipalCigna ProHealth Prime (Advantage) has no ICU rent limit if you opt for an add-on at an extra charge.
• Copayment: A copayment, or copay, is a part of the approved claim amount that you need to pay from your end before the insurer pays the rest. ManipalCigna ProHealth Prime (Advantage) has no copayment limit. 
• Deductible: A deductible is an amount you are responsible for paying before your health insurance kicks in to cover your medical expenses. ManipalCigna ProHealth Prime (Advantage) has no deductible limit.
• Limits on surgeries/treatments: Some health insurance policies may cover a specific medical procedure or treatment up to a certain amount. Others may not have any such limits. ManipalCigna ProHealth Prime (Advantage) covers important surgeries and treatments such as cataract surgery and joint replacement surgery without any limit. So, the policy covers the full cost of cataract treatment and joint replacement surgery - 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 (Advantage): Waiting Periods & Exclusions

👉Waiting period: Certain illnesses and diseases may not be covered by your health insurance policy for a specific period of time, known as the waiting period. As soon as this period ends, you can claim for these conditions. Types of Waiting Periods-

• Initial waiting period: Except for accidents, all medical conditions have an initial waiting period of 30 days. So, you will not be able to claim any hospitalisation expenses for the first 30 days of your coverage, except for accidents. 
• Waiting period for pre-existing diseases: Any condition or illness you have had in the 48 months prior to applying for health insurance is considered a pre-existing disease. Pre-existing diseases are subject to a 24-month waiting period under ManipalCigna ProHealth Prime (Advantage). So, you will not be covered for any expenses related to your pre-existing disease during this period. 
• Waiting period for specific diseases: Other than your pre-existing conditions, insurers may also apply a waiting period for a specified list of medical conditions or illnesses - regardless of whether you have had them in the past. Please note that this waiting period is decided by the insurer and is not determined based on your current health status. Specific diseases are subject to a 24-month waiting period under ManipalCigna ProHealth Prime (Advantage). 

👉Exclusions: The term "exclusions" refers to situations that your health insurance policy will not cover at any cost.

• Standard permanent exclusions: All insurance companies have to adhere to a set of 'standard permanent exclusions' established by the IRDAI. Here are some -

1. Investigation and evaluation: Admission to a hospital for observation or monitoring only.
2. Rest and rehabilitation: Admission to a hospital for bed rest without active treatment.
3. Obesity or weight control: Treatment or surgery administered for weight loss or obesity.
4. Change of gender treatment: Treatment designed to change the body's characteristics to those of the opposite sex.
5. Plastic/cosmetic surgery: Treatment or surgery intended to alter the physical characteristics or appearance of the body.
6. Profession in hazardous or adventure sports: The treatment of injuries sustained while professionally engaging in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
7. Violation of law: Expenses incurred for treating someone who has violated the law with criminal intent or attempted to break it.
8. Excluded insurers: Medical care provided by a physician or hospital excluded by the insurer.
9. Narcotics: Treatment for addictions such as alcoholism, drug use, etc.
10. Treatments administered for domestic purposes: Expenses associated with treatment at health spas, nursing homes, or similar establishments arranged entirely or partially for domestic purposes.
11. Dietary supplements, substances bought without a medical prescription: Supplements that are not prescribed by a medical practitioner, such as vitamins and minerals.
12. Refractive error: Expenses associated with improving vision by correcting refractive errors of up to 7.5 diopters.
13. Unproven treatments: Surgery, medical procedure, or treatment that has not proven to be successful.
14. Expenses related to birth control, sterility and infertility: Contraception, sterilisation, 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: Apart from the standard permanent exclusions listed above, insurance companies may impose additional exclusions on specific medical conditions or situations. They may not provide coverage if you have certain diseases or severe health conditions they consider risky. However, insurers are only permitted to apply permanent exclusion only for a limited number of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI). Any illness or disease beyond this list cannot be excluded.
• Non-standard exclusions (Specific exclusions): Specific exclusions that go beyond the standard permanent exclusions imposed by the IRDAI. Depending on the terms and conditions of the policy, these exclusions may vary across insurers. Here is a list of some top-specific exclusions under the ManipalCigna ProHealth Prime (Advantage) - 
• Treatment for dental problems other than those arising from accidents.
• The procedure of circumcision unless it is necessary to treat a disease or injury.
• Instruments used in treatment for sleep disorders.
• The cost of screening, consulting, and treating external birth defects.
• Expenses associated with organ transplant surgeries.
• Non-allopathic treatments (except AYUSH inpatient treatments).
• Nuclear, chemical, or biological weapons-related injuries or illnesses.
• Disease or injury caused by war, foreign enemy action, invasion or military operations.

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

• Speed of claims: ManipalCigna Health Insurance Company Limited has settled 99.08% of claims in less than 30 days. This demonstrates the company's commitment to providing efficient and timely claims service.
• Claim-related complaints: Our research revealed that ManipalCigna Health Insurance Company Limited has received a relatively low number of complaints related to claims - compared to other insurers. This indicates that the customers of ManipalCigna Health Insurance Company are highly satisfied with the swift processing of their claims.
• Claims incurred ratio: The claims incurred ratio is a way to assess the financial performance of an insurance company. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. ManipalCigna Health Insurance Company Limited has a claims incurred ratio of 76.17%. 
• Claim settlement ratio: Claims settlement ratio refers to the percentage of claims settled by an insurer to the total number of claims it receives in a financial year. The claim settlement ratio of ManipalCigna Health Insurance Company Limited is 88.32%.
• Network hospitals: Over 8,500 hospitals are a part of MandalCigna Health Insurance Company Limited's network. Since it offers a wide range of network hospitals in different locations, you can take advantage of cashless treatment, saving you the hassle of worrying about hospital bills. This in turn will allow you to focus on the most important thing - recovery.

How is the customer service of ManipalCigna Health Insurance Company Limited?

• Policy purchase-related complaints: Our research shows that ManipalCigna Health Insurance Company Limited has received 0.01% of complaints related to its after-sales service.
• Response on Toll-Free: Based on our research, ManipalCigna Health Insurance Company Limited's toll-free response time is slower than that of its competitors. 
• Response on Twitter: ManipalCigna Health Insurance Company Limited's Twitter response rate is also slow, according to our research.

About ManipalCigna Health Insurance Company Limited
ManipalCigna Health Insurance is a joint venture between the Manipal Group and Cigna Corporation. It is a standalone health insurance company in India, striving to provide quality services to customers. It offers a variety of insurance products including individual health insurance, family floaters, critical illness policies, personal accident covers, group health insurance, hospital cash policies, etc. Established in 1994, ManipalCigna Health Insurance Company Limited is based in Mumbai, Maharashtra. Mr Prasun Sikdar is the company's CEO and MD.