Manipal Cigna ProHealth (Protect) is a health insurance policy offered by ManipalCigna Health Insurance Company Limited.
The policy provides comprehensive coverage and a range of health benefits, making it a smart choice for anyone looking to protect their health. The cost of this plan is quite reasonable. However, while it covers hospitalisation and related expenses, OPD expenses such as medicines, tests, consultations, etc., it does not cover maternity expenses, infertility treatment expenses, etc. Moreover, it does not offer a monthly premium payment option.
Our research suggests that the insurer has received a high number of complaints regarding claim settlement and policy purchases. Therefore, customers should exercise due diligence before making any policy purchases as they have a poor track record.
What are the benefits offered by Manipal Cigna ProHealth (Protect)?
- Inpatient hospitalisation coverage: The expenses you incur, if you undergo hospitalisation 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. Such expenses are covered by Manipal Cigna ProHealth (Protect).
- Pre-hospitalization coverage: Expenses you incur before you get admitted to the hospital are called pre-hospitalization expenses. These include consultations, tests, physicals, and lab reports. 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. Please note that the policy covers pre-hospitalization expenses up to 60 days prior to hospitalization - up to the sum insured.
- Post-hospitalization coverage: Expenses you incur after hospital discharge are called post-hospitalization expenses. These expenses include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, etc. Your post-hospitalization expenses must be related to the condition you were hospitalised for and the claim must be approved under inpatient hospitalisation. Post-hospitalization expenses incurred up to 90 days after hospitalisation are covered by Manipal Cigna ProHealth (Protect) - up to the sum insured.
- Daycare treatment coverage: Due to advancements in medical technology, treatments can now be completed within 24 hours instead of requiring an extended hospital stay. These procedures are termed ‘daycare treatments’. 546 daycare procedures are covered by Manipal Cigna ProHealth (Protect) - up to the sum insured.
- Domiciliary treatment coverage: It is possible to receive medical treatment at home if you cannot be moved to a hospital because of the severity of your illness or injury or if there are no beds available at a nearby hospital. Such treatments are called domiciliary treatments. Manipal Cigna ProHealth (Protect) covers expenses associated with such treatments up to the sum insured - provided the treating doctor approves the treatment. The plan excludes domiciliary coverage for 8 illnesses.
- Organ donor coverage: The Manipal Cigna ProHealth (Protect) also provides coverage for expenses incurred by the organ donor. The plan covers the inpatient expenses, up to the sum insured selected by you.
- Modern treatment coverage: In the past few decades, technology has transformed medical care, making it more effective and accessible for patients. As a result, many illnesses and diseases can now be prevented or treated with great success with the development of modern treatments. These treatments include radiosurgery, stem cell therapy, etc., that treat diseases that previously were considered incurable. The ManipalCigna ProHealth (Protect) plan covers the expenses associated with modern treatments up to the sum insured.
- No Claim Bonus: If you don't submit a claim under your health insurance policy in a policy year, a no-claim bonus will be awarded to you. Manipal Cigna ProHealth (Protect) offers a no claim bonus of 5% of the sum insured regardless of the number of claims made. The bonus you have accumulated will not be lost if you make a claim during the term of your policy. This plan lets you accumulate a maximum no claim bonus of 200% of the sum insured.
- Super No Claim Bonus: In essence, the super no claim bonus is a boosted version of the No Claim bonus. Manipal Cigna ProHealth (Protect) offers a super no claim bonus of 25% of the sum insured irrespective of the claims you’ve made - if you opt for the add-on. The add-on allows you to accumulate a maximum bonus of up to 200% of the sum insured and it doesn’t reduce even if you make any claims.
- Restoration Benefit: The Restoration Benefit restores your sum insured if you use it up within a policy year - ensuring that you are not left without coverage at times of need. A refill benefit is available under the Manipal Cigna ProHealth (Protect) Plan for unrelated illnesses and related illnesses (for a different insured person). The sum insured and no claim bonus must be partially exhausted for the restoration benefit to become active. It will apply to subsequent claims within a policy year for an unlimited number of times.
Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 lakh sum insured. Enteral feeding will be covered up to a maximum of 15 days in a policy year - provided it is considered medically necessary and prescribed in writing by a medical professional.
Manipal Cigna ProHealth (Protect): Financial Limits
- Room rent limit: A room rent limit is the maximum amount up to which your insurer will cover the rent of your hospital room. If you choose a room within your plan's room rent limit, you'll be spared from any additional financial burden in the event of a hospital stay. If you choose a room that costs more than your eligibility, you will be subject to a proportionate deduction. As a result, you will have to pay a proportionate share of the total bill rather than just the difference in room rent. With Manipal Cigna ProHealth (Protect), you can choose any type of room, except a suite.
- ICU rent limit: This is the maximum amount your health insurance policy will cover for your ICU stay. Manipal Cigna ProHealth (Protect) does not have a limit on ICU rent - it will be covered up to the sum insured.
- Copayment: A copayment is a portion of the approved claim amount that you must pay from your end. The insurer will pay the rest of the claim. You can opt for an optional copayment of 10% or 20% - depending on your preference. For those 65 years and older, a mandatory copay is imposed.
- Deductible: The deductible is the amount you need to pay from your end before your health insurance kicks in to cover your medical expenses. A deductible limit of Rs 1 / 2 / 3 / 4 / 5 / 7.5 / 10 lakhs is available as an option. Depending on your coverage needs, you can choose the deductible limit that best suits you.
- Limits on surgeries/treatments: In some health insurance policies, certain medical procedures or treatments are covered up to a specific amount. There may be no such limits for other procedures. Manipal Cigna ProHealth (Protect) covers cataract surgery and joint replacement surgery without any limit.
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 (Protect): Waiting Periods & Exclusions
Your health insurance policy may not cover certain illnesses and diseases for a specific period of time, known as the waiting period. You can claim these conditions once this period ends. Types of Waiting Periods
- Initial waiting period: There is a 30-day waiting period for all medical conditions except accidents. As a result, you cannot claim hospitalisation expenses for the first 30 days of your coverage, except in the case of an accident.
- Waiting period for pre-existing diseases: A pre-existing condition is defined as any illness or condition you have had within 48 months of applying for health insurance. Under Manipal Cigna ProHealth (Protect), pre-existing diseases are subject to a 48-month waiting period. The Plan will not cover any expenses related to pre-existing diseases during this time period.
- Waiting period for specific diseases: A waiting period may also be imposed by insurers on specified medical conditions or illnesses, regardless of whether you have had them in the past. The waiting period is determined by the insurer and is not based on your health status. Manipal Cigna ProHealth (Protect) has a 24-month waiting period for specific diseases. As such, customers will have to wait up to 24 months after buying the Manipal Cigna ProHealth (Protect) Plan before being able to claim for these specific medical conditions or illnesses.
Exclusions are certain situations that aren't covered by health insurance. It's important to familiarise yourself with what exclusions are and which situations they apply to, so you can ensure that you have the right level of coverage.
- Standard permanent exclusions: The IRDAI has established a set of 'standard permanent exclusions' that all insurers are required to stick to. These standard permanent exclusions are applied uniformly to all insurance companies and cannot be changed or ignored. Here are some -
- Investigation and evaluation: Hospitalisation for observation or monitoring.
- Rest and rehabilitation: Hospitalisation for bed rest rather than active treatment.
- Obesity or weight control: Weight loss or obesity treatment.
- Change of gender treatment: A treatment aimed at changing the body's characteristics from one sex to another.
- Plastic/cosmetic surgery: Any surgery or procedure designed to alter the appearance or physical characteristics of the body.
- Profession in dangerous or adventure sports: The treatment of injuries caused by professionally participating in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
- Violation of law: Expenses related to treating a person who intentionally breaks the law or tries to violate it.
- Excluded insurers: Healthcare provided by a physician or hospital excluded by the insurer.
- Narcotics: Treatment for addictions such as alcoholism or drug use, etc.
- Treatments for domestic purposes: Treatment at health spas, nursing homes, or similar establishments arranged entirely or partially for domestic usage.
- Dietary supplements, substances bought without a medical prescription: Supplements such as vitamins and minerals that are not prescribed by a physician.
- Refractive error correction: Expenses associated with correcting refractive errors up to 7.5 diopters to improve eyesight.
- Unproven treatments: Unproven surgeries, medical procedures, or treatments.
- Expenses related to birth control, sterility and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
- Additional Exclusions: Insurance companies may impose additional permanent exclusions on specific medical conditions or situations beyond the standard permanent exclusions outlined above. If you have certain diseases or severe health conditions they consider risky, they may not cover you. The Insurance Regulatory and Development Authority of India (IRDAI) allows insurers to apply permanent exclusions to a limited number of illnesses. Diseases and illnesses outside of this list cannot be excluded.
- Non-standard exclusions (Specific exclusions): The insurer may apply specific exclusions beyond the IRDAI’s standard permanent exclusions. The exclusions vary across insurers depending on the policy terms. Here is a list of some top specific exclusions under the Manipal Cigna ProHealth (Protect) -
- Treatment of dental problems other than those caused by accidents.
- Circumcision unless it is necessary to treat a disease or injury.
- Instruments used to treat sleep disorders.
- Expenses associated with screening, consulting, and treating external birth defects.
- Expenses related to organ donor screening and organ transplant surgery. This includes organs that haven’t been harvested from a human body.
- Non-allopathic treatments (except AYUSH inpatient treatments).
- Expenses associated with treatments for nuclear, chemical, or biological weapons-related injuries or illnesses.
- Expenses associated with treating a 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 the past 30 days. This indicates that customers can expect their claims to be processed quickly and efficiently.
- Claim-related complaints: As per our research, ManipalCigna Health Insurance Company Limited has received a relatively low number of complaints related to claims. This suggests that they are relatively efficient in processing claims and providing satisfactory services to their customers.
- Claims incurred ratio: The claims incurred ratio is a metric used to measure the financial strength of an insurance company. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. Manipal Cigna 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%. This indicates that ManipalCigna Health Insurance Company Limited has a satisfactory track record of settling its claims efficiently and in a timely manner.
- Network hospitals: ManipalCigna Health Insurance Company Limited has 8,500+ hospitals on its network. With cashless treatments, you can be sure that you are receiving quality medical care from MandalCigna's network of trusted hospitals without having to worry about upfront bills.
How is the customer service of ManipalCigna Health Insurance Company Limited?
- Policy purchase-related complaints: According to our research, ManipalCigna Health Insurance Company Limited has received 0.01% of complaints related to its after-sales service.
- Response on Toll-Free: Our research shows that ManipalCigna Health Insurance Company Limited's toll-free response time is comparatively slow. So, customers may find it difficult to get their queries addressed quickly and efficiently.
- Response on Twitter: Further, we found that ManipalCigna Health Insurance Company Limited's Twitter response rate is also slow.
About ManipalCigna Health Insurance Company Limited
ManipalCigna Health Insurance, a standalone health insurance company in India, is a joint venture between the Manipal Group and Cigna Corporation. It strives to provide quality services to customers. It offers a variety of insurance products to suit every type of customer's needs including individual health insurance, family floaters, critical illness policy, personal accident cover, group health insurance, and hospital cash policies. Its goal is to ensure that customers receive the best health insurance coverage with an excellent service experience. ManipalCigna Health Insurance Company Limited, founded in 1994, is based in Mumbai, Maharashtra. Mr Prasun Sikdar is the company's CEO and MD.