Types of Products

Indemnity • It is a contractual agreement in which one party

guarantees compensation for actual or potential losses
Product or damages sustained by another party.

• It is a type of supplemental health plan that gives you a

Fixed Product fixed cash benefit payout in case you experience
specific illnesses covered by your policy

1
Base covers

Inpatient Hospitalization

We will cover Medical Expenses of an Insured Person in case of Medically

Necessary Hospitalization arising from a Disease/ Illness or Injury provided
such Medically Necessary Hospitalization is for more than 24 consecutive
hours

Depending upon the plan opted we will cover expenses up to Single Private room if
sum insured upon is up 5.5 lakhs
More than 5.5 Lakh we will cover up to any category of room except suite and higher

2
Base covers

Pre and Post Hospitalization

• Medical Expenses covered up to the number of days as

per the plan before date of Hospitalization
Pre Hospitalization • Expenses should be prescribed by Dr. and related to
diseases for which insured was hospitalized under inpatient

• Covered up to specific days as per the terms and

conditions post discharge from hospital
Post Hospitalization • Expenses should be prescribed by Dr. and related to
diseases for which insured was hospitalized under inpatient

3
Base covers
Day Care Domiciliary
Ambulance Cover Donor Expenses
Treatment Treatment
• Surgery that requires • Treatment taken at • We will provide for • We will cover In-patient
less than 24 hours home due to below reimbursement of Hospitalization Medical
Hospitalization mentioned conditions reasonable and Expenses towards the
• We have 546 listed day • The condition of the customary expenses up donor for harvesting the
care treatment / patient is such that he/ to limits specified in the organ up to the limits of
procedure she cannot be moved to scheduled that are the Sum Insured
• These treatment / hospital incurred towards • We will not cover
procedure doesn’t • Lack of accommodation transportation expenses towards the
require inpatient due in the hospital • Registered ambulance Donor in respect of:
advance technology is • This is applicable only if • Any pre or post
used the treatment is done at hospitalization Medical
home for a period Expenses
exceeding 3 days • Cost towards donor
• Pre-hospitalization will screening
be covered up to 30 days • Cost directly or indirectly
• Post hospitalization will associated to the
be covered up to 30 days acquisition of the organ

4
Base covers
World Wide Emergency Cover

We will cover Medical Expenses of the Insured Person incurred outside India, up to
limits specified in the scheduled , provided that

The treatment is Medically necessary and has been certified as an emergency by a

Medical Practitioner

The medical expenses payable shall be limited to Inpatient Hospitalization only

and these benefit is available only once in a policy year

Any payment under this benefit will only be made in India, in Indian rupees on a
reimbursement basis and up to sum insured

The payment of any claim under this benefit will be based on the rate of exchange
as on the date of payment to the hospital published by Reserve Bank of India

5
Base covers

Health Maintenance Maternity New Born baby

Restoration Benefit Expenses Expenses

• If the sum insured • Treatment that does not • We will cover Maternity • Medical Expenses
amount gets exhausted require hospitalization Expenses up to limits for towards treatment of
or if it is insufficient and can be carried out in Maternity the New Born Baby
then we will provide an out patient • Expenses related to a while the Insured
100% restoration department will be lawful termination of Person is Hospitalized
• Restoration will be given covered up to limits pregnancy up to as an In-patient for
multiple time in a specific in the maximum 2 deliveries delivery.
policy period scheduled, by way of • The same is paid over • These benefit can be
• On first claim no reimbursement and above the sum availed if maternity
restoration • Use as HMB; can also be insured benefits is availed
• Restoration will not be used to settle Co-pay or • Pre or post natal under the policy
triggered for same Deductible, Non- Maternity Expenses will
person same illness admissible expenses; In be covered within the
addition, utilize up to Maternity Sum Insured
50% of HMB towards under this Benefit
premium from 1st
renewal onwards

6
Base covers

First Year Vaccinations AYUSH Cover

• AYUSH stands for Ayurveda Yoga Unani

• We will cover the charges of Siddha and Homeopathy
vaccination for the new born baby • To avail this benefit insured person
as per National Immunization should take treatment under inpatient
Scheme till the baby completes 1 hospitalization
year (12 months) up to the limits • Hospital should be government
specified in the schedule. recognized AYUSH hospital
Value Added Covers

Expert Guaranteed
Health Opinion Cumulative A guaranteed
Check Up on Critical Bonus increase in sum
Illness If an insured person insured as per the
is diagnosed with plan at the time of
The insured person the covered critical renewal
may avail the illness then he can irrespective of
comprehensive opt for a second whether a claim is
health check up as opinion from our been made in the
per the plan network of medical policy year,
practitioners maximum up to
200% of the sum
insured

8
Optional Covers

• We will provide for a waiver on waiting period for Maternity

Reduction in Maternity Expenses from 48 months to 24 months

Waiting Period

• 10% or 20% as per plan selected will be payable by the

customer on every claim
Voluntary Co-Payment

9
Optional Covers

• We also provide an option to avail Hospital Daily Cash Benefit for

each 24 hrs. hospitalization, max. for 30 days in a Policy year
Hospital Daily Cash Benefit

• Guaranteed 25% increase in SI, max. upto 200%

Cumulative Bonus Booster

10
Add on Rider

Critical Illness Rider

We provide for a lump-sum amount up to the base Sum
Insured opted on diagnosis of covered 11 listed critical
illnesses like first heart attack, major organ transplant, etc.
under the Critical Illness Add on cover.

90 days waiting period

30 days survival period

11
PROHEALTH INSURANCE

12
 ProHealth – Base Cover
Sr No Identify your Plan Protect PLUS Preferred Premier Accumulate
2.5 Lacs 4.5 Lacs 15 Lacs 5.5 Lacs
3.5 Lacs 5.5 Lacs 30 Lacs 10 Lacs
7.5 Lacs 7.5 Lacs 50 Lacs 15 Lacs
25 Lacs
10 Lacs 10 Lacs
30 Lacs
15 Lacs 15 lacs
50 Lacs
1 Sum Assured 20 Lacs 20 Lacs 100 Lacs
25 Lacs 25 lacs
30 Lacs 30 Lacs
50 Lacs 50 Lacs

Covered up to Single Private

Covered up to Single Private room till 5.5, more
In-patient Covered up to any Room Category room till 5.5, more than 5.5
2 than 5.5 covered up to any room except Suite
Hospitalization except Suite and higher covered up to any room except
and higher
Suite and higher
3 Pre - Hospitalization Covered up to 60 days post discharge from hospital

Covered up to 90 of
Covered up to 90 days post
4 Post - Hospitalization days post discharge Covered up to 180 days post discharge
discharge from hospital
from hospital

5 Day Care Treatment Covered up to the limit of Sum Insured Opted 13

Product Features- Basic Benefits (Contd)….
Sr .No Identify your Plan Protect Plus Preferred Premier Accumulate

Domiciliary Treatment Covered up to the limit of Sum Insured Opted, Pre- hospitalization- 30 days, Post-
6
(Treatment at Home) hospitalization- 30 days

Ambulance Cover Up to `3000 per

Up to `2000 per Actual expenses paid per Up to `2000 per
7 (Reimbursement of Ambulance hospitalization
hospitalization event hospitalization event hospitalization event
Expenses) event

Donor Expenses (Hospitalization

8 Expenses of the donor providing Covered up to full Sum Insured
the organ)
Worldwide Emergency Cover
10 Covered up to full Sum Insured once in a policy year
(Outside India)

Available multiple
times in a
Restoration of Sum Insured (When
Available multiple times in a policy year for unrelated Not policy year for
11 opted Sum Insured is insufficient
illness Available unrelated illnesses
due to claims)
in addition to the
Sum Insured opted

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Product Features- Basic Benefits (Contd)….
SR .No Identify your Plan Protect Plus Preferred Premier Accumulate
Option to
choose from –
5000
10000
Health Maintenance
` 15000,
Benefits (Treatment that
Covered up to Covered up to ` 20000
does not require Covered
12 Covered `15000 `15000 Can also be used
hospitalization and can up to `500
up to ` 2000 per policy year per policy year to pay for Co-pay
be carried out in an Out
or Deductible. In
Patient Department )
addition, utilize up to
50% of HMB towards
premium from 1st
renewal onward
Covered upto Covered up to ` Covered up to `
`15,000 for 50,000 for 100,000 for
normal delivery normal delivery and normal delivery
and `25,000 `100,000 and `200,000
13 Maternity Expenses Not Available Not Available
for C- Section for C-Section per for C-Section per
per event after event after a event after a
a Waiting Period waiting Period of 48 waiting Period of
of 48 months months 48 months
15
Product Features- Basic Benefits (Contd)….

Identify your
Sr. No Protect Plus Preferred Premier Accumulate
Plan

Covered for the Covered for the

Covered for the inpatient
New Born Baby inpatient hospitalisation inpatient hospitalisation
Not Available hospitalisation expenses Not Available
14 Expenses expenses expenses
of a new born up to the
of a new born up to the of a new born up to the
limit provided under
limit provided under limit provided under
Maternity Expenses
Maternity Expenses Maternity Expenses
Covered as per national Covered as per national
Covered as per national
immunization immunization programme
First Year immunization
Not Available programme Not Available
15 Vaccinations programme
over and above over and above Maternity
over and above
Maternity Sum Insured Sum Insured
Maternity Sum Insured

In patient
In patient treatment
treatment In patient treatment In patient treatment In patient treatment covered up to
16 AYUSH Cover
covered up to covered up to SI covered up to SI covered up to SI SI
SI Not Available

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Product Features-Value Added Cover
This section lists the additional value added benefits that are available along with the plan
Sr.No Identify your Plan Protect Plus Preferred Premier Accumulate

Available once every Available once every

3rd Policy year to all Available at each policy year (excluding the first year), 3rd Policy year to all
1 Health Check-Up insured persons who to all insured persons who have completed 18 years insured persons who
have completed 18 of Age have completed 18
years of age years of age
Expert Opinion on Critical
2 Available once during the Policy Year
illness (by a Specialist)
Guaranteed 10% Guaranteed Guaranteed 5%
Guaranteed 5% Guaranteed
Increase in SI, 10% Increase in Increase in Sum
Increase in Sum 10% Increase in
3 Cumulative Bonus maximum up to SI, maximum up Insured, maximum up
Insured, maximum up SI, maximum up
200% to 200% to 200%
to 200% to 200%
Earn up to 20% of premium paid
Reward Points equivalent to 1% of paid premium, to be earned each year.
Rewards can also be earned for enrolling and completing Our Array of Wellness Programs.
4 Healthy Rewards These earned Reward Points can be used to get a discount in premium from the 2nd Annual
Premium OR they can be redeemed for equivalent value of Health Maintenance Benefits
any time during the policy. OR As equivalent value while availing services through our
Network Providers as defined in the policy 17
Product Features-Optional Covers
This section lists the available optional covers under your plan and the limits under each of these options

Sr.No. Identify your Plan Protect Plus Preferred Premier Accumulate

Deductible*
(Please select the Sum
1/ 2 / 3 / 4 /5 / 1/ 2 / 3 / 4 /5 / 0.5 / 1/ 2 / 3 / 4 /5 /
1 Insured and Deductible Not Available Not Available
7.5 / 10 Lakhs 7.5 / 10 Lakhs 7.5 / 10 Lakhs
on the Policy. Deductible is
claim will be payable in the policy

Reduction in Maternity waiting period Reduced from 48 to 24

2 Not Available Not Available
Maternity Waiting months

Voluntary Co-Payment*
(The cost sharing percentage that
10% or 20%
you have opted will apply on each 10% or 20% voluntary
voluntary
3 claim.) co-payment for each and every Not Available
each and every on the
If you have opted for a claim as opted on the Policy
Policy
Deductible, Voluntary
Co-payment does not apply

18
Product Features-Optional Covers (Contd)….
Identify your
Sr .No Protect Plus Preferred Premier Accumulate
Plan

Waiver of
4 Mandatory Waiver of Mandatory co-payment of 20% for Insured Persons aged 65 years and above
Co-payment

Guaranteed 25%
Increase in Sum
Cumulative
5 Guaranteed 25% Increase in Sum Insured, maximum up to 200% Not Available Insured, maximum
Bonus Booster
up to 200%

19
Product Features-Add On Cover (Rider)
Identify your
Protect Plus Preferred Premier Accumulate
Plan

Lump sum payment of Lump sum payment of Lump sum payment Lump sum payment
an additional 100% of an additional 100% of of an additional of an additional
Critical Illness Not Available
opted opted 100% of opted 100% of Sum
Sum Insured Sum Insured Sum Insured Insured Opted

20
Waiting Period
This sections lists the applicable period (days/ months) before you can make a claim for the listed diseases/treatments

a. First 30 days from the Policy start date, for all illnesses except accidents.

b. 90 days waiting period will be applicable for listed Critical Illness where Critical Illness Add on cover has been opted.

c. Two Year Waiting Period will be applicable for specific illnesses.

d. A 48 months of waiting period will be applicable for Maternity, New Born and First year Vaccination expenses (Except here
Reduction in Maternity Waiting is opted)
e. A Personal waiting period may apply to individuals depending upon declarations on the proposal form and existing health
conditions. Please refer to the "Special Conditions" Column on your Policy
A 48 months waiting period will be applicable for any Pre-existing disease, for Protect and Accumulate plan and
36/24/24 month Waiting period for Plus, Preferred & Premier Plan respectively.

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How to claim
 In the event of a hospitalization, the insured person must notify us within 48 hrs.

 Claim form duly filled and signed

 Documents required: original or attested copy of prescriptions, bills, test, final bill, discharge summary

 Photo ID proof: Pan card, voter ID card, passport, Aadhar card or driving license (any one out of this)

 Account details: Cancel cheque of proposer on which name, account number and IFSC code needs to be pre printed

 Insured person needs to submit all these documents to the nearest ManipalCigna branch

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