Professional Documents
Culture Documents
BASIC COVERS
• In patient Hospitalisation • Ambulance Cover • Health Maintenance Benefit
• Pre-hospitalisation • Donor Expenses • Maternity Expenses
• Post-hospitalisation • Worldwide Emergency Cover • New Born Baby Expenses
• Day care Treatment • Restoration of Sum Insured • First Year Vaccinations
• Domiciliary Treatment • AYUSH Cover
i) In-patient Hospitalisation
We will cover medical expenses in case of medically necessary hospitalisation of an Insured person incurred due to Disease, Illness or injury when
the Insured person is admitted as an in-patient for more than 24 consecutive hours provided that the admission date of the Hospitalisation due to
Illness or Injury is within the Policy Year. The coverage will include reasonable and customary charges towards room rent for accommodation in
a hospital, up to limits specified under the eligible Room Category under the Plan opted, charges for accommodation in Intensive Care Unit and
operation theatre charges, fees of medical practitioner, anaesthetist, qualified nurses, specialists, the cost of diagnostic tests, medicines, drugs and
consumables, blood, oxygen, surgical appliances and prosthetic devices recommended by the attending medical practitioner that are used intra
operatively during a surgical procedure.
Under the Protect and Accumulate Plan coverage is available up to a Single Private Room for Sum Insured Up to `5.5 Lacs.
Under the Protect, Accumulate with Sum Insured `7.5 Lacs and above, Plus, Preferred and Premier Plan accommodation under any Room Category
will be available excluding a suite or higher category.
If the Insured Person is admitted in a room category that is higher than the one that is specified in the Plan opted, then the Insured Person shall bear
a rateable proportion of the total Associated Medical Expenses (including surcharge or taxes thereon) in the proportion of the difference between
the room rent of the entitled room category to the room rent actually incurred.
Under Inpatient Hospitalisation expenses, when availed under Inpatient care, we will cover the expenses towards artificial life maintenance, including
life support machine use, even where such treatment will not result in recovery or restoration of the previous state of health under any circumstances
unless in a vegetative state, as certified by the treating Medical Practitioner.
The following procedures will be covered (wherever medically indicated) either as inpatient or as part of day care treatment in a hospital up to the
Sum Insured, specified in the policy schedule, during the policy period:
a. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
b. Balloon Sinuplasty
c. Deep Brain stimulation
d. Oral chemotherapy
e. Immunotherapy - Monoclonal Antibody to be given as injection
Medical Expenses related to any admission (under In-patient Hospitalisation, Day Care Treatment or Domiciliary Hospitalisation) primarily for enteral
feedings will be covered maximum up to 15 days in a Policy Year, provided it is Medically Necessary and is prescribed by a Medical Practitioner.
Medical Expenses incurred towards Medically Necessary Treatment of the Insured Person for Hospitalisation due to a condition caused by or
associated with Human Immunodeficiency Virus (HIV) or HIV related Illnesses, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS
Related Complex (ARC) and/or any mutant derivative or variations thereof, sexually transmitted diseases (STD) in respect of an Insured Person will
be covered up to the Sum Insured in a Policy Year. The necessity of the Hospitalisation is to be certified by an authorised Medical Practitioner.
v) Domiciliary Treatment
We will cover medical expenses of an Insured person for treatment of a disease, illness or injury taken at home which would otherwise have required
hospitalisation or since the Insured person’s condition did not allow a hospital transfer or a hospital bed was unavailable. This is provided that the
condition would otherwise have been covered for hospitalisation under the Policy and for which treatment is required continues for at least 3 days
and is on the advice of a medical practitioner. Claims for pre-hospitalisation expenses, post-hospitalisation up to 30 days each. We shall not be
liable under this policy for any claim in connection with or in respect of the following:
• Asthma, bronchitis, tonsillitis and upper respiratory tract infection including laryngitis and pharyngitis, cough and cold, influenza,
• Arthritis, gout and rheumatism,
• Chronic nephritis and nephritic syndrome,
• Diarrhoea and all type of dysenteries, including gastroenteritis,
• Diabetes mellitus and insipidus,
• Epilepsy,
• Hypertension,
• Psychiatric or psychosomatic disorders of all kinds,
• Pyrexia of unknown origin.
In case the Restored Sum Insured is not utilised in a policy year, it shall not be carried forward to subsequent policy year. Any restored Sum Insured
will not be used to calculate the Cumulative Bonus or Cumulative Bonus Booster. For Individual policies restored Sum Insured will be available on
individual basis whereas in case of a floater it will be available on floater basis.
For any single Claim during a Policy Year the maximum Claim amount payable shall be sum of:
a. The Sum Insured
b. Cumulative Bonus (if earned) or Cumulative Bonus Booster (if opted & earned)
During a Policy Year, the aggregate Claim amount payable, subject to admissibility of the Claim, shall not exceed the sum of:
x) AYUSH Cover
We will pay the Medical Expenses incurred during the Policy Year in case of Medically Necessary Treatment taken during In-patient Hospitalisation
for AYUSH Treatment for an Illness or Injury that occurs during the Policy Year, provided that:
The Insured Person has undergone treatment in an AYUSH Hospital where AYUSH Hospital is a healthcare facility wherein medical/ surgical/ para-
surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising any of the following:
i) Central or State Government AYUSH Hospital; or
ii) Teaching hospitals attached to AYUSH College recognized by Central Government / Central Council of Indian Medicine and Central Council of
Homeopathy; or
iii) AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered with the local
authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH Medical Practitioner and must comply with all the
following criterion:
a) Having at least five in-patient beds;
b) Having qualified AYUSH Medical Practitioner in charge round the clock;
c) Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out;
d) Maintaining daily record of the patients and making them accessible to the insurance company’s authorized representative.
The following exclusions will be applicable in addition to the other Policy exclusions:
Facilities and services availed for pleasure or rejuvenation or as a preventive aid, like beauty treatments, Panchakarma, purification, detoxification
and rejuvenation
Accumulate i. Diagnostic tests, preventive tests, drugs, Non- i. Fresh limits will be available as per the Plan under the
Medical expenses (as defined under Annexure IV of new Policy Year
the policy), prosthetics, medical aids (spectacles and ii. Any unutilised Health Maintenance Benefit limit
contact lenses, hearing aids, crutches, wheel chair, shall not lapse at the end of the Policy Year and can
walker, walking stick, lumbo-sacral belt), crutches continue to be carried forward each year as long as
and wheel chair prescribed by the specialist Medical the Policy is renewed with Us in accordance with the
Practitioner up to the limits specified in the Schedule. Renewal Terms under the Policy.
ii. Towards Dental Treatments and AYUSH Forms iii. In case of expiry of the policy any unutilized Health
of Medicines wherever prescribed by a Medical Maintenance Benefit limit shall be available for a
Practitioner as an Out-Patient. claim up to a period of 12 months from the date of
iii. Towards payment of the deductible/ co-pay/ Non- expiry of the Policy.
Medical expenses (as defined under Annexure iv. In case of utilisation of Health Maintenance Benefit
IV of the policy) of a claim wherever opted and post expiry of the policy year, the cumulative bonus
applicable including any cashless facility in case of a shall be suitably adjusted basis revised Health
Hospitalisation or Day Care Claim. Maintenance Benefit balance for the previous policy
iv. Towards payment of renewal premium (inclusive year.
of taxes): Up to 50 % of the accumulated Health
Maintenance Benefit can be utilised for payment
against premium from first renewal of the policy.
Subject to renewal of the policy in Accumulate Plan.
Insured can use Our application or contact Us for scheduling an appointment for availing services covered under this benefit at our Network provider.
All Waiting Periods and Permanent Exclusions including Co-pay’s applicable on the Policy shall not apply to this section.
i) Health Check Up
We will provide for a comprehensive Health Check-Up as listed in the eligibility table below, to all Insured Persons who are 18 years of age. Heath
Check Ups will be available irrespective of their claim status under the policy and will be arranged by Us at Our network providers. The coverage
under this benefit will not be available on reimbursement basis.
For Protect & Accumulate plan –available once every 3rd Policy year.
For Plus, Preferred and Premier Plan –available once each year, excluding the first policy year.
Sum Insured Age List of tests
Protect, Plus &
Accumulate Plan
Sum Insured
`2.5 Lacs, >18 years Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT
`3.5 Lacs,
`4.5 Lacs,
`5.5 Lacs,
Protect, Plus & 18 to 40 years Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT,
Accumulate Plan GGT
Sum Insured
`7.5 Lacs, > 40 years (For Females Only) Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT,
`10 Lacs GGT, TSH
> 40 years (For Males Only) Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT,
GGT
Protect, Plus & 18 to 40 years (For Females Only) Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT,
Accumulate Plan GGT, TSH
Sum Insured
`15 Lacs and Above 18 to 40 years (For Males Only) Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile,
SGOT, GGT
> 40 years (For Females only) Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT,
TSH, TMT
> 40 years (For Males only) Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT,
TMT
Preferred & Premier 18 to 40 years (For Females Only) Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT,
Plan GGT, TSH, Pap smear, Mammogram
Sum Insured `15 Lacs
and Above 18 to 40 years (For Males Only) Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile,
SGOT, GGT, PSA
> 40 years (For Females only) Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT,
TSH, TMT, Pap smear, Mammogram, Uric acid, USG Abdomen & Pelvis
> 40 years (For Males only) Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT,
TMT, PSA, Uric acid, USG Abdomen & Pelvis
Full explanation of Tests is provided here: Vitals - Height, Weight, Blood Pressure, Pulse, BMI, Chest Circumference & Abdominal Girth, FBS
– Fasting Blood Sugar, GGT – Gamma-Glutamyl Transpeptidase, ECG – Electrocardiogram, CBC-ESR – Complete Blood Count-Erythrocyte
Sedimentation Rate, SGPT – Test Serum Glutamic Pyruvate Transaminase, SGOT – Serum Glutamic Oxaloacetic Transaminase, TSH – Thyroid
Stimulating Hormone, TMT – Tread Mill Test, PSA – Prostate Specific Antigen
ManipalCigna ProHealth Insurance | Prospectus | UIN: MCIHLIP415V042021 | October 2020
(c) Coverage under this value added cover will not be available on reimbursement basis. All Claims under this benefit can be made as per the
process defined under Section VII of Policy Terms and Conditions.
Reward Points, wherever offered under any specific Sponsored Program will be the same for all customers.
Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in the following ways –
- Against payable premium (including Taxes) from 1st Renewal of the Policy.
- Equivalent value of Health Maintenance Benefit anytime during the Policy.
- As equivalent value while availing services through any of Our Network Providers as defined in the Policy.
Refer Annexure for Healthy Reward Process for details of delivery mechanism.
The following optional covers shall be available under the Policy and shall apply to all Insured Persons under a single policy without any individual
selection.
Rider/Add On Benefit: Along with this Product You can also avail the ManipalCigna Critical Illness- Add On Cover. Please ask for the
Prospectus and Proposal Form of the same at the time of purchase. All terms and conditions of applicable rider including medical check-up requirement
will apply.
i) Eligibility
The minimum entry age under this policy is 91 days for children and 18 years for adults. There is no limit for entry under this policy.
Coverage for children:
a. Children from 91 days to 18 years will only be covered if one of the parents is the proposer.
b. Children up to 23 years can be covered under the floater
c. Children beyond 23 years can be covered under an individual policy.
Renewals will be available for lifetime.
vii) Premiums
The Premium charged on the Policy will depend on the Plan, Sum Insured, Policy Tenure, Age, Policy Type, Gender, Zone of Cover, Optional
Covers and Add On Benefits opted. Additionally, the health status of the individual will also be considered.
For premium calculation of floater policies, age of eldest member would be considered
For detailed premium chart please refer Annexure “Rate Chart” attached along with this document.
For the purpose of calculating premium, the country has been divided into 3 Zones. Identification of Zone will be based on the City-Location of the
correspondence address of the proposed Insured persons and premiums will be calculated accordingly.
Zone Classification
Zone I: Mumbai, Thane & Navi Mumbai, Gujarat and Delhi & NCR
x) Portability
The Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. If such person is presently
covered and has been continuously covered without any lapses under any health insurance plan with an Indian General/Health insurer as per
Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under:
i. The waiting periods specified in Section V of the policy terms and conditions shall be reduced by the number of continuous preceding
years of coverage of the Insured Person under the previous health insurance Policy.
ii. Portability benefit will be offered to the extent of sum of previous sum insured and accrued bonus (as part of the base sum insured), portability
benefit shall not apply to any other additional increased Sum Insured.
For Detailed Guidelines on Portability, kindly refer IRDAI Guidelines Ref No: IRDAI/HLT/REG/CIR/003/01/2020 and Schedule 1 of IRDAI(Health
Insurance) Regulations 2016 for the Portability norms.
All benefits under the Policy will terminate on successful porting of the Policy other than any Health Maintenance Benefit under Accumulate Plan
which will be available for a claim up to a period of 12 months from the date of expiry of such policy.
xiii) Cancellations
In case You are not satisfied with the policy or our services, You can request for a cancellation of the policy by giving 15 days’ notice in writing. We
shall refund the premium for the unexpired term as per the short period scale mentioned below.
Premium shall be refunded as per table below if no claim has been registered/ made under the policy and full premium has been received.
You further understand and agree that We may cancel the Policy by giving 15 days’ notice in writing by Registered Post Acknowledgment Due /
recorded delivery to Your last known address on grounds of misrepresentation, moral hazard, fraud or non-disclosure of material fact without any
refund of premium.
Cover may end immediately for all Insured Persons, if there is non-cooperation by You/ Insured person, with refund of premium on pro rata basis
after deducting Our expenses, by giving 15 days’ notice in writing by Registered Post Acknowledgment Due / recorded delivery to Your last known
address.
An individual policy with a single insured shall automatically terminate in case of Your death or if You are no longer a resident of India. In case
of an Individual Policy with multiple Insured Persons and in case of a floater, the Policy shall continue to be in force for the remaining members
of the family up to the expiry of current Policy Period. The Policy may be Renewed on an application by another adult Insured Person under the
Policy whenever such is due. In case, the Insured Person is minor, the Policy shall be renewed only through any one of his/her natural guardian or
guardian appointed by Court. All relevant particulars in respect of such person (including his/her relationship with You) must be given to Us along
with the Application.
All coverages and benefits including any earned Healthy Reward Points under the Policy shall automatically lapse upon cancellation of the Policy.
Wherever a Policy under the Accumulate Plan is cancelled, any unclaimed Health Maintenance Benefit will be active on the Policy and available
for a claim over the next 12 month period. You may convert any available Healthy Reward Points in to Health Maintenance Benefit before initiating
the cancellation of the Policy.
xiv) Endorsements
The Policy will allow the following endorsements during the term of the Policy. Any request for endorsement must be made by You in writing. Any
endorsement would be effective from the date of the request as received from You, or the date of receipt of premium, whichever is later other than
for change in Date of Birth or Gender which will be with effect from inception.
Up to 45 NO TEST
Protect, Plus 2.5L, 3.5L, 4.5 L,
Tests shall be based on Medical declarations by the Insured and
Preferred & 5.5L,7.5 L, 10 L, 15L, 46-55
underwriting evaluation.
Accumulate Plan 20L, 25L, 30L, 50L
>55 SET 14- MER, CBC-ESR, FBS, Lipid Profile, Sr. Creatinine, ECG
Up to 18 SET 1 – MER
Premier & Preferred
>50L
Plan >18 SET 14- MER, CBC-ESR, FBS, Lipid Profile, Sr. Creatinine, ECG
The above list of Medical Tests and age criteria may be modified after due approval from the Head of Underwriting.
Full explanation of Tests is provided here: MER – Medical Examination Report, FBS – Fasting Blood Sugar, ECG – Electrocardiogram, CBC-ESR
– Complete Blood Count-Erythrocyte Sedimentation Rate.
xvii) Migration:
The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the company by applying for
migration of the policy at least 30 days before the policy renewal date as per IRDAI guidelines on Migration. If such person is presently covered and
has been continuously covered without any lapses under any health insurance product/plan offered by the company, the Insured Person will get the
accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.
We shall not be liable to make any payment for any claim caused by, based on, arising out of or howsoever attributable to any of the following. All waiting
periods shall be applicable individually for each Insured Person and claims shall be assessed accordingly.
If these diseases are pre-existing at the time of proposal or subsequently found to be pre-existing then they will have to be covered after the pre-
exiting disease waiting period of (24 months for Preferred, Premier Plan/ 36 months for Plus, Accumulate Plan/ 48 months for Protect Plans).
vi. 90 day waiting period for Critical Illness Add On Cover (if opted):
Any critical illness contracted and/or the disease incepts or manifests during the first 90 days from the Inception Date of the policy will not be covered
under the critical illness benefit wherever opted.
9. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- Excl 12
10. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private
beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. Code-
Excl 13
11. Dietary supplements and substances that can be purchased without prescription, including but not
limited to Vitamins, minerals and organic substances unless prescribed by a Medical Practitioner as part of hospitalisation claim or day care
procedure. Code- Excl 14
16. Dental Treatment, orthodontic treatment, dentures or Surgery of any kind unless necessitated due to an Accident and requiring minimum 24 hours
Hospitalisation. Treatment related to gum disease or tooth disease or damage unless related to irreversible bone disease involving the jaw which
cannot be treated in any other way, unless specifically covered under the Policy.
17. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder or due to an accident.
18. Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen
Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment.
19. External Congenital Anomaly or defects or any complications or conditions arising therefrom.
20. Prostheses, corrective devices and medical appliances, which are not required intra-operatively for the disease/ illness/ injury for which the Insured
Person was hospitalised.
21. Any stay in Hospital without undertaking any treatment or any other purpose other than for receiving eligible treatment of a type that normally
requires a stay in the hospital.
22. Treatment received outside India other than for coverage under World Wide Emergency Cover, Expert Opinion on Critical Illnesses.
23. Costs of donor screening or costs incurred in an organ transplant surgery involving organs not harvested from a human body.
24. Any form of Non-Allopathic treatment (except AYUSH In-patient Treatment), Hydrotherapy, Acupuncture, Reflexology, Chiropractic treatment or any
other form of indigenous system of medicine.
25. All Illness/expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any
nuclear waste from the combustion of nuclear fuel nuclear, chemical or biological attack or in any other sequence to the loss..
26. All expenses caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations
(whether war be declared or not or while performing duties in the armed forces of any country), participation in any naval, military or air-force
operation, civil war, public defense, rebellion, revolution, insurrection, military or usurped power, active participation in riots, confiscation or
nationalization or requisition of or destruction of or damage to property by or under the order of any government or local authority.
27. All non-medical expenses including convenience items for personal comfort not consistent with or incidental to the diagnosis and treatment of the
disease/illness/injury for which the Insured Person was hospitalized - belts, collars, splints, slings, braces, stockings of any kind, diabetic footwear,
thermometer and any medical equipment that is subsequently used at home except when they form part of room expenses, procedure charges and
ManipalCigna ProHealth Insurance | Prospectus | UIN: MCIHLIP415V042021 | October 2020
cost of treatment.
For complete list of Non-medical expenses, Please refer to the Annexure IV List – I “Items for which Coverage is not available in the Policy”
. 28. Any deductible amount or percentage of admissible claim under co-pay if applicable and as specified in the Schedule to this Policy.
29. Existing diseases disclosed by the Insured Person ((limited to the extent of the ICD codes mentioned in line with Chapter IV, Guidelines on
Standardization of Exclusions in Health Insurance Contracts, 2019), provided the same is applied at the underwriting and consented by You/
Insured Person.
Step 1: The product brochure, policy benefits, exclusions and premium details must be thoroughly understood and discussed with Our advisor/ Company
representative, before buying the policy.
Step 2: Once the benefits of the policy are understood, the Proposal Form must be filled, wherein details of the prospective Insured Persons including
medical information must be provided as accurately as possible.
Step 3: The proposal form with the required documents have to be submitted along with the premium.
Step 4: If You are required to undergo medicals tests as per the chosen Sum Insured and Age band, we would arrange the medical check-up’s at Our
network of diagnostic centres.
Step 5: Based on the above information we will process Your proposal for Insurance and a policy kit containing the Benefit Schedule, Policy Terms and
associated documents will be sent to you.
We shall process the proposals with speed and efficiency and the decision on the proposal thereof, shall be communicated in writing to You within a
reasonable period but not exceeding 15 days from the date of receipt of proposals or any requirements called for by Us.
Where a proposal deposit is refundable to a prospect under any circumstances, the same shall be refunded within 15 days from the date of underwriting
decision on the proposal.
Upon assessment if there is any change in terms or premium is loaded then We will inform You about any revised terms through a counter offer letter. We will issue
the Policy only once you accept the counter offer. Where You do not agree to the counter offer we will cancel your proposal and refund any premium collected.
b) Claim Process
In case of an Illness or an injury please notify Us either at the call centre or in writing:
The following details are to be provided to Us at the time of intimation of Claim:
• Policy Number
• Name of the Policyholder
• Name of the Insured Person in whose relation the Claim is being lodged
• Nature of Illness / Injury
• Name and address of the attending Medical Practitioner and Hospital
• Date of Admission
• Any other information as requested by Us
For a Cashless Claim -
In case of planned hospitalisation - at least 3 days prior to the planned date of admission.
In case of Emergency Hospitalisation - within 48 hours of such admission.
Cashless facility is available only at Our Network Hospital. The latest/updated list of network of hospitals will be available on our website. You can avail
Cashless facility at the time of admission into any Network Hospital, by presenting the health card as provided Us with this Policy, along with a valid photo
identification proof (Voter ID card / Driving License / Passport / PAN Card / any other identity proof as approved by Us).
For a Reimbursement Claim -
The following claim documents should reach us not later than 15 days from the date of discharge from Hospital –
o Claim Form Duly Signed
o Original pre-authorisation request
o Copy of pre-authorisation approval letter (s)
o Copy of Photo ID of Patient Verified by the Hospital
o Original Discharge/Death Summary
o Operation Theatre Notes(if any)
o Original Hospital Main Bill and break up Bill
o Original Investigation Reports, X Ray, MRI, CT Films, HPE
o Doctors Reference Slips for Investigaions/Pharmacy
o Original Pharmacy Bills
The policy is available under 5 Plans as detailed below: ManipalCigna ProHealth Insurance (Plan Benefit Structure)
Description
Title Please refer to the Plan and Sum Insured you have opted to understand the available benefits under
your plan in brief
Your Coverage
Identify your Plan Protect Plus Preferred Premier Accumulate
Details:
Basic Cover ` 2.5 Lacs `4.5 Lacs, `15 Lacs, `100 Lacs `5.5 Lacs,
` 3.5 Lacs `5.5 Lacs, `30 Lacs, `7.5 Lacs,
This section lists ` 4.5 Lacs, `7.5 Lacs, `50 Lacs `10 Lacs,
the Basic benefits ` 5.5 Lacs, `10 Lacs, `15 Lacs,
available on your ` 7.5 Lacs, `15 Lacs, `20 Lacs,
plan Identify your Opted
Sum Insured ` 10 Lacs, `20 Lacs, `25 Lacs,
` 15 Lacs, `25 Lacs, `30 Lacs,
` 20 Lacs, `30 Lacs, `50 Lacs
` 25 Lacs, `50 Lacs
` 30 Lacs,
` 50 Lacs
A guaranteed 25%
increase in Sum Insured
Cumulative Bonus A guaranteed 25% increase in Sum Insured per policy year,
Not Available per policy year, maximum
Booster maximum up to 200% of Sum Insured
up to 200% of Sum
Insured
Add on cover
(Rider)
Lump sum payment of an
This section lists Lump sum payment of an additional 100% of Sum Insured
Critical Illness Not Available additional 100% of Sum
the Add on cover Opted
Insured Opted
available under your
plan
Disclaimer:
This is only a summary of the product features. The actual benefits available shall be described in the policy, and will be subject to the policy terms, conditions
and exclusions.
For more details on risk factors, terms and conditions read the sales brochure and speak to Your advisor before concluding a sale.
1. No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take or renew or continue an insurance in respect of any kind
of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on
the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance
with the published prospectuses or tables of the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
Annexure:
Illustration of Benefits
Rate Charts