ManipalCigna ProHealth Prime (Protect) is a health insurance policy that is offered by ManipalCigna Health Insurance.

With its affordable price and unique features/benefits, this plan is perfect for anyone looking for comprehensive protection. Besides hospitalisation expenses, it covers maternity expenses, infertility treatment expenses, consumable items, etc. Plus, the plan gives you multiple options so you can get discounts on your premiums. However, the plan doesn't provide the monthly premium payment option. Furthemore, the insurer has received a higher number of complaints related to claim settlement as well as policy purchase. This shows that the insurer has a poor track record in terms of both purchase and claims service experience.

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

Inpatient hospitalisation coverage: ManipalCigna ProHealth Prime (Protect) Plan covers the expenses associated with inpatient hospitalisation. These are costs incurred when you are admitted in the hospital for more than 24 hours such as medical consultation charges, medicines, ICU charges, and other related expenses.
Pre-hospitalisation coverage: Pre-hospitalisation expenses are charges incurred before hospitalisation, like expenses related to consultations, tests, checkups, etc. The insurer will cover these charges only if they are related to the medical condition that led to the hospitalisation and if they are approved as part of the inpatient hospitalisation coverage. The ManipalCigna ProHealth Prime (Protect) Plan covers pre-hospitalisation charges for 60 days before hospitalisation up to the sum insured.
Post-hospitalisation coverage: Medical expenses incurred after you are discharged from the hospital are referred to as post-hospitalisation expenses. Such expenses include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related costs. For these expenses to be covered, they must be related to the medical condition that led to the hospitalisation, and be approved as part of inpatient hospitalisation coverage. ManipalCigna ProHealth Prime (Protect) Plan covers post-hospitalisation expenses for 180 days after hospitalisation up to the sum insured.
Daycare treatment coverage: Daycare treatments refer to medical procedures or surgeries that used to require a prolonged hospital stay but can now be completed within 24 hours due to advancements in medical technology. ManipalCigna ProHealth Prime (Protect) Plan provides coverage for all such treatments without any limit, which means that the costs will be covered up to the sum insured.
Domiciliary treatment coverage: Domiciliary treatments are medical treatments for illnesses or injuries that require urgent medical attention at the hospital but are carried out at home due to the severity of a patient’s condition or if no hospital beds are available nearby. Under the ManipalCigna ProHealth Prime (Protect) Plan, the expenses incurred for domiciliary treatments(except for 8 specific illnesses) will be covered up to 10% of the sum insured. Please note that the pre-hospitalisation costs associated with domiciliary treatments are covered for 30 days instead of 60 days and the post-hospitalisation costs associated with domiciliary treatments are covered for 30 days instead of 180 days.
Organ donor coverage: ManipalCigna ProHealth Prime (Protect) Plan provides coverage for organ donor expenses associated with in-patient hospitalisation, up to the sum insured - where you are the organ recipient.
Modern treatment coverage: With the advent of technology, healthcare is progressing rapidly, and new modern treatments are being developed. These treatments, such as stem cell therapy, radio surgeries, etc. aim to treat diseases that were previously considered untreatable. ManipalCigna ProHealth Prime (Protect) Plan covers the costs of such modern treatments up to the sum insured.
Non-medical expenses coverage: In addition to medical expenses, the ManipalCigna ProHealth Prime (Protect) Plan provides coverage for non-medical expenses, such as gloves, oxygen masks, and other similar items - if you opt for an add-on. These expenses will be covered up to the sum insured, relieving you of the financial strain.
No Claim Bonus: If you do not make any claims during a policy year, ManipalCigna ProHealth Prime (Protect) Plan provides a No-Claim Bonus of 25% of the sum insured - regardless of whether any claims are made or not. This plan does not reduce the accumulated bonus even if a claim is filed during a policy year. Moreover, it allows you to accumulate a maximum bonus of 200% of the sum insured.
Super No Claim Bonus: A Super No Claim Bonus is an upgraded version of the No Claim Bonus and works just like it. ManipalCigna ProHealth Prime (Protect) Plan offers a 50% of the sum insured as a Super No Claim Bonus. You can keep your accumulated bonus intact even if you make claims. And, the maximum bonus you can accumulate under this plan is 200% of the sum insured. You can avail of this benefit if opt for an add-on.
Restoration Benefit: The refill benefit is a useful feature that restores your sum insured after it has been used up during a policy year. The ManipalCigna ProHealth Prime (Protect) Plan offers this benefit for related and unrelated illnesses, which activates when the sum insured and the No Claim Bonus (if any) are partially used up in a policy year. You can avail of this benefit unlimited times in a policy year for subsequent claims.

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

ManipalCigna ProHealth Prime (Protect): Financial Limits

Room rent limit: It is a certain limit up to which your insurer will cover for the hospital room you stay in during your hospitalisation. If you select a room that falls within the limit of the plan, then you need not pay any additional expenses. However, if the room exceeds the eligibility limit, a proportionate deduction will apply. This means that you will be responsible for paying a proportionate share of the entire bill, not just the difference in the room rent. ManipalCigna ProHealth Prime (Protect) Plan provides the flexibility to select any type of room without restrictions.
ICU rent limit: It is the maximum amount your insurer will pay for your stay in the intensive care unit (ICU) of a hospital. ManipalCigna ProHealth Prime (Protect) Plan covers ICU charges without any limit - if you opt for an add-on.
Co-payment: Co-payment is a portion of the approved claim amount that you are required to pay yourself. Once you make the payment, the insurance company will cover the remaining expenses. ManipalCigna ProHealth Prime (Protect) plan does not include co-payment.
Deductible: A deductible is a certain amount that you must pay from your end before your health insurance policy kicks in to provide coverage. The ManipalCigna ProHealth Prime (Protect) Plan does not include a deductible.
Limits on surgeries/treatments: Health insurance policy covers certain medical procedures or treatments up to a certain limit. Some policies may have limits on the amount they will cover for certain procedures, while others may not. The ManipalCigna ProHealth Prime (Protect) Plan covers the entire cost of major surgeries like joint replacement surgery and cataract treatment up to the sum insured 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.

ManipalCigna ProHealth Prime Protect: Waiting Periods & Exclusions

👉Waiting period

Certain illnesses and diseases may not be covered for a specific period right after buying your health insurance policy. This duration is known as the waiting period. Once the waiting period is over, you can file claims for these conditions. Here are some of the types of waiting period -

Initial waiting period: The first 30 days after purchasing a health insurance policy, except for accidents, is considered as an initial waiting period. During this time, you will not be able to make claims for hospitalisation expenses, except in the case of an accident.
Waiting period for pre-existing diseases: Pre-existing disease is a medical condition/disease that you have experienced in the past 48 months before obtaining a health insurance policy. The ManipalCigna ProHealth Prime (Protect) Plan includes a waiting period of 24 months for pre-existing diseases. During this period, you will not be covered for medical expenses related to a pre-existing disease.
Waiting period for specific diseases: Insurance providers maintain a list of specific medical conditions that are subject to a waiting period, irrespective of whether you have experienced those conditions previously or not. This waiting period is determined by the insurance provider and is independent of your current health status. The ManipalCigna ProHealth Prime (Protect) Plan has a waiting period of 24 months for specific diseases.

👉Exclusions

Exclusions are certain situations that will not be covered by your health insurance policy. These include:

Standard Permanent Exclusions: All insurance companies must enforce the list of ‘standard permanent exclusions’ established by IRDAI. These include -

Investigation and evaluation: Hospital admission for monitoring or observation.
Plastic/Cosmetic surgery: Treatment or surgery that’s intended to modify body characteristics or appearance.
Rest, rehabilitation, and respite care: Admission to a facility for bed rest without any active treatment.
Obesity/weight control: Treatment or surgery related to weight control or obesity.
Gender reassignment: Treatments meant for altering the body’s characteristics to match the opposite sex.
Excluded providers: Treatment from medical practitioners or hospitals that are excluded by the insurance company.
Narcotics: Treatment for addiction to substances such as alcohol, drugs, etc.
Treatments in establishments arranged for domestic purposes: Expenses incurred for treatments undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
Profession in hazardous or adventure sports: Treatment expenses incurred due to participating in adventurous activities such as river rafting, skydiving, scuba diving, etc. as a professional.
Breach of law: Expenses incurred for treating a person who has committed or attempted to commit a criminal act.
Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
Refractive error: Expenses that are associated with correcting refractive errors up to 7.5 diopters to improve eyesight.
Unproven treatments: Surgeries, medical procedures, treatments, etc. that are not proven to be efficient.
Expenses related to birth control, sterility 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 permanent exclusions: Insurance companies can apply specific exclusions for certain medical conditions or situations in addition to the standard permanent exclusions. If you have a severe medical condition or a particular disease that is considered risky by the insurer, they may permanently exclude it from your policy. It is worth noting that IRDAI has a list of illnesses for which insurance companies can impose permanent exclusions. They are not permitted to exclude any illness or disease that are not on this list.
Non-standard exclusions (Specific exclusions): These are specific exclusions apart from the standard permanent exclusions listed by IRDAI. These exclusions may vary across insurers and depend on the terms and conditions of the policy. Here are some specific exclusions under ManipalCigna ProHealth Prime (Protect) plan -

All dental treatments, unless necessary due to an accident.
Circumcision, unless it is necessary for treating a disease or injury.
Instruments that are used in the treatment of sleep disorders.
Expenses related to screening, consulting, or treating external birth defects.
Expenses related to organ transplant surgeries.
Any non-allopathic treatment, except AYUSH in-patient treatments.
Injury or illness caused due to nuclear, chemical, or biological attacks or weapons.
Injury or disease caused due to war, invasion, act of a foreign enemy, warlike operations, etc.

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

Speed of claims: ManipalCigna Health Insurance Company has settled 99.15% of claims in less than 30 days. This shows their commitment to providing quick and efficient service to customers.
Claim-related complaints: According to our research, it appears that ManipalCigna Health Insurance Company has received a higher number of complaints for claims, as compared to other insurers, accounting to 0.29%.
Claims incurred ratio: The claims incurred ratio reflects the financial performance of the company. It represents the total number of claims incurred by the insurance company compared to the total premiums they collected in a given financial year. ManipalCigna Health Insurance Company has a claims incurred ratio of 65.08%.
Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by the insurer compared to the total number of claims received in a financial year. ManipalCigna Health Insurance Company has a claim settlement ratio of 77.78%.
Network hospitals: ManipalCigna Health Insurance Company has a network of 8,500+ hospitals that offers a vast range of healthcare providers across various locations. This network of hospitals allows you to receive cashless treatments - alleviating your financial burden.

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

Policy purchase-related complaints: As per our research, ManipalCigna Health Insurance Company has received a higher number of complaints for their after-sales service, as compared to other insurers, accounting to 0.01%.
Response on Toll-Free: According to our research, ManipalCigna Health Insurance Company’s response on the toll-free is slow, as compared to other insurers.
Response on Twitter: As per our research, ManipalCigna Health Insurance Company’s response on Twitter is also slow, when compared to other insurance companies.

About ManipalCigna Health Insurance Company Limited

ManipalCigna Health Insurance Company is an Indian health insurance firm that operates independently, and is a joint venture between the Manipal Group and Cigna Corporation. It offers a broad spectrum of products to cater to the varying needs of customers, including family floater, individual health insurance, personal accident insurance, critical illness insurance, group health insurance, hospital cash policies, and more. It was established in 1994 and is headquartered in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Prasun Sikdar.

Manipal Cigna ProHealth Prime (Protect)