ManipalCigna Sarvah (Pratham) is a health insurance policy provided by ManipalCigna Health Insurance. An insurance policy for health serves as a protective cover for your medical requirements as well as savings, enabling you and your family to enjoy a secure and contented life. The ManipalCigna Sarvah (Pratham) product has an array of features, benefits, and add-ons with the aim of fulfilling your and your family's medical needs.

This affordable health insurance plan offers the option to waive the waiting period for listed pre-existing conditions, provides an additional 100% of the sum insured on the first claim, and ensures a guaranteed bonus of up to 10 times the sum insured.

However, the plan has certain limitations. It only covers hospitalisation related to four major illnesses: cancer, heart conditions, stroke, and organ transplant. This means claims for any hospitalisation, not related to these listed conditions, will not be covered. Another drawback is the absence of a monthly premium payment option. Additionally, based on our research, the insurer has received a higher number of complaints related to claim settlement and policy purchase.

Let’s now explore the features and benefits offered by the ManipalCigna Sarvah (Pratham) Plan in more detail.

What are the Benefits Offered by the ManipalCigna Sarvah (Pratham) Plan?

Below are the key product benefits that highlight what the ManipalCigna Sarvah (Pratham) Plan brings to the table:

Inpatient hospitalisation coverage: The plan covers hospitalisation expenses when you are hospitalised for more than 24 hours. Room rent, nursing, medication as prescribed, doctor's consultation fee, ICU, and other medical charges you incur during your hospital stay are all covered by the plan. The policy protects you from shouldering the economic cost of these expenses. But hospital costs are covered only if they are for cancer, heart disease, stroke, or organ/bone marrow transplant.
Pre-hospitalisation expenses coverage: Prior to your hospital admission, you might require medical tests, investigations, X-rays, CT scans, and other tests. These are referred to as pre-hospitalisation costs. This policy insures such costs for 90 days, up to the sum insured. However, they are insured only if directly associated with the disease that resulted in your hospitalisation, and only if the inpatient claim is sanctioned.
Post-hospitalisation expenses coverage: After discharge, you might have follow-up visits, tests, or medical check-ups. These are considered post-hospitalisation expenses. The plan covers them for 180 days, up to the sum insured. Like pre-hospitalisation, these are covered only if they relate to the illness you were admitted for, and only if your inpatient claim is approved.
Daycare treatment coverage: Daycare treatments are medical procedures or surgeries that once required extended hospital stays but can now be completed in under 24 hours, thanks to advances in medical technology. The ManipalCigna Sarvah (Pratham) plan covers all daycare treatments up to the sum insured, so you don’t have to worry about the expenses involved.
Domiciliary treatment coverage: Domiciliary treatment refers to receiving medical care at home for a serious illness or injury when hospitalisation isn’t possible, either due to the patient’s condition or unavailability of hospital beds. Under the ManipalCigna Sarvah (Pratham) plan, all domiciliary treatment expenses are covered up to the sum insured. Pre- and post-hospitalisation expenses under domiciliary treatment are covered for 30 days only. Rheumatic heart disease is not covered under domiciliary treatment.
Organ donor coverage: This plan also covers organ donor expenses when the insured is the recipient. It pays for the cost of harvesting the organ, up to the sum insured. Pre- and post-hospitalisation expenses for organ donor procedures are covered for 30 days only. Under Organ Donation, donor screening expenses will be covered once in a policy year, provided the transplant is successful. Complications arising due to organ harvesting, occurring during hospitalisation or within 30 days from the donor’s discharge, will also be covered separately, over and above the total limit of coverage.
Modern treatment coverage: Advanced and technologically complex medical procedures are covered under this plan without any financial limit, provided they are medically necessary and fall under inpatient care or listed procedures. However, the plan covers only 6 modern treatments, while 12 procedures are mandated by IRDAI.
Non-medical expenses coverage: The ManipalCigna Sarvah (Pratham) plan also covers non-medical expenses, with no monetary limit, up to the sum insured. This is available as an add-on at an extra cost. It includes consumables used during treatment, such as nebulisation kits, gloves, oxygen masks, and other essential supplies.
No Claim Bonus: Provided you do not claim anything throughout the policy period, the insurer provides a No Claim Bonus (NCB). In this plan, you get an up to 1000% bonus. For every claim-free year, you receive a 100% annual bonus, helping you build your overall cover over time. If you make a claim, the bonus you’ve earned will not be reduced. The No Claim Bonus benefit applies regardless of the number of claims made under the expiring policy.
Super No Claim Bonus: The Super No Claim Bonus is an extended version of the standard NCB and works in a similar way. However, the ManipalCigna Sarvah (Pratham) plan does not offer this benefit.
Restoration benefit: The restoration benefit reinstates your sum insured once it has been used up during a policy year. With this plan, the benefit allows for unlimited refills within the same policy year. It is triggered by the partial exhaustion of the sum insured and no claim bonus and is available for subsequent claims. This applies to both related and unrelated illnesses, ensuring continued coverage even after the original amount is used up. However, it is important to note that this benefit is available as an add-on at an extra cost.

Please note: The limitations and conditions mentioned above apply to a sum insured of Rs. 10 lakhs.

ManipalCigna Sarvah (Pratham): Financial Limits

Room rent limit: The room rent limit is the maximum amount your insurance plan will cover for your hospital room charges. As long as you stay within this limit, you won’t have to pay anything extra. But if the room you choose costs more than your eligible limit, a proportionate deduction will apply. Under the ManipalCigna Sarvah (Pratham) plan, there is no room rent limit, and this benefit is available as an add-on.
ICU rent limit: The ICU rent limit refers to the maximum amount the insurer will pay for your stay in the Intensive Care Unit. With the ManipalCigna Sarvah (Pratham) plan, there is no limit on ICU rent. ICU charges are covered in full, up to the total sum insured.
Copayment: Copayment means you pay a fixed percentage of the claim amount from your own pocket, and the insurer pays the remaining balance. In the ManipalCigna Sarvah (Pratham) plan, copayment options of 10%, 20%, or 30% are available.
Deductible: A deductible is the amount you pay by yourself before the insurer starts covering your medical bills. The ManipalCigna Sarvah (Pratham) plan offers multiple deductible options, available as an optional feature.
Limits on surgeries/treatments: This refers to the maximum coverage allowed for certain medical procedures. Some health plans apply limits in this area. Under the ManipalCigna Sarvah (Pratham) plan, cataract treatments and joint replacement surgeries are covered up to the full sum insured.

Please note: The above financial limits apply to a 30-year-old individual with a sum insured of Rs. 10 lakhs.

ManipalCigna Sarvah (Pratham): Waiting Periods & Exclusions

👉 Waiting period

The waiting period is the time after purchasing a health insurance policy during which certain diseases or treatments are not covered. You can claim these conditions only after the waiting period is over.

Here are the key types of waiting periods:

Initial waiting period: For all diseases, except those resulting from accidents, there is a first waiting period of 30 days. During this period, you are not able to lodge a claim for hospitalisation except in the case of an accident.
Waiting period for pre-existing illnesses: A pre-existing condition is any condition or health disorder you had 36 months before you took up the policy. Under the ManipalCigna Sarvah (Pratham) policy, there is a waiting period of 36 months for pre-existing ailments, except for ailments such as asthma, diabetes, obesity, high blood pressure, and dyslipidemia.
Waiting period for specific diseases: Other than pre-existing conditions, insurers also have a waiting period for a list of certain diseases, irrespective of your health record. In ManipalCigna Sarvah (Pratham), this waiting period is 36 months for listed specific diseases.

👉 Exclusions

Exclusions are individual cases or circumstances that are not included in a health insurance policy. The following are some of the typical exclusions:

Standard Permanent Exclusions: According to the regulations of the Insurance Regulatory and Development Authority of India (IRDAI), all health insurers are supposed to adhere to a standardised list of standard permanent exclusions. Some of these are:
- Investigation and evaluation: Hospitalisations undertaken merely for monitoring or observation.
- Rest, rehabilitation, and respite care: Admission for rest or recovery without active medical treatment.
- Obesity/weight control: Surgeries, treatments, or procedures intended for weight reduction.
- Gender reassignment: Medical interventions that seek to transform body characteristics to match a different gender identity.
- Plastic/Cosmetic surgery: Procedures or treatments undertaken to alter or improve physical appearance.
- Profession in adventure sports: Injuries incurred while working professionally for such activities as river rafting, mountaineering, scuba diving, etc.
- Breach of law: Medical treatment of injuries sustained while committing or attempting to commit a criminal offense.
- Excluded providers: Services received from hospitals or doctors are not included in your insurance coverage.
- Narcotics: Treatment or rehabilitation for alcohol, drug, or related substance dependence.
- Treatments in set-ups organised for domestic use: Service received in nursing homes, spas, or any setup organized mainly for domestic or non-medical purposes.
- Prescription-free dietary supplements: Vitamins, minerals, or dietary supplements not prescribed by a registered medical practitioner.
- Refractive error: Costs incurred for the correction of refractive errors up to 7.5 diopters for the improvement of vision.
- Unproven treatment: Medical treatment or procedures that have not been shown to be effective.
- Sterilisation, conception, and infertility expenses: Costs incurred for sterilisation, contraceptives, artificial insemination, or higher fertility treatments such as IVF, GIFT, ZIFT, ICSI, and gestational surrogacy.
- Maternity charges: Fees for prenatal care, postnatal care, and giving birth.
Additional Permanent Exclusions: In addition to the standard list, insurers may also apply additional permanent exclusions for certain diseases or conditions they consider too risky to cover. These exclusions must be selected from the specific list approved by the IRDAI. Insurers are not permitted to permanently exclude any illness or condition that is not included in this approved list.
Non-standard exclusions (Specific exclusions): Non-standard exclusions go beyond the standard permanent exclusions defined by IRDAI. These exclusions vary by insurer and are based on the specific terms and conditions of the policy. Here are some of the specific exclusions mentioned under the ManipalCigna Sarvah (Pratham) plan:
- Dental treatment, except when required due to an accident
- Circumcision, unless necessary due to an accident or for treating a disease
- Devices used for treating sleep disorders
- Expenses related to external birth defects
- Expenses associated with organ donor screening or organ transplant surgery involving organs not harvested from a human body
- Any non-allopathic treatment (except for AYUSH treatments), including hydrotherapy, acupuncture, and similar procedures

What can you expect in terms of Claims Experience if you buy from Manipal Cigna Health Insurance?

Speed of claims: Manipal Cigna Health Insurance has settled 99.14% of claims in less than 30 days, ensuring rapid and convenient claims service for its insureds.
Claim-related complaints: Nevertheless, according to our study, the percentage of complaints on overall claims is 0.26%, which is higher compared to other insurance companies. This indicates there might be discrepancies in the claim settlement process.
Claims incurred ratio: The claims incurred ratio refers to the claims paid as compared to the premium received in a given fiscal year. In Manipal Cigna Health Insurance's case, this is 63.78%, indicating how effectively the company is settling claims against its revenues.
Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by the insurer as compared to the total number of claims received by them in a financial year. Manipal Cigna Health Insurance is reported to have settled 87.68% of all claims it has received.
Network hospitals: Manipal Cigna Health Insurance offers customers access to an extensive network of more than 15,000 hospitals. This big network allows customers to get cashless treatment at different places without any issues.

How is the Customer Service of Manipal Cigna Health Insurance?

Policy purchase complaints: Our research shows that Manipal Cigna Health Insurance has a complaint ratio of 0.01% for its after-sales service, which is significantly higher than other insurance companies.
Response on Toll-Free: Based on our research, the response time on toll-free for Manipal Cigna Health Insurance is average when compared with other insurers.
Twitter response time: According to our studies, Manipal Cigna Health Insurance's Twitter response time is slow in comparison to other insurance providers.

About Manipal Cigna Health Insurance

A joint venture between Manipal Group and Cigna Corporation formed ManipalCigna Health Insurance, an independent health insurance provider in India. ManipalCigna Health Insurance offers individual health insurance, family floater plans, cover for critical illnesses, personal accident covers, group health cover, and hospital cash covers, among others to meet the diverse needs of customers. It was founded in 2012 and has its main office in Mumbai, Maharashtra.