Manipal Cigna ProHealth Group Policy

This plan has come up with a sack full of benefits and facilities. Some of the important mentions are as below.

In-patient Hospitalisation Expenses Cover:

The company will pay the Reasonable and Customary Charges for the following Medical Expenses of an Insured Person in case of Medically Necessary Treatment taken during Hospitalisation provided that the admission date of the Hospitalisation due to Illness or Injury is within the Policy Year, such as Room charges up to the category/limit, Charges for accommodation in ICU/CCU/HDU, Operation theatre cost, Medical Practitioner fees, Specialist fee, Surgeon’s fee, Anaesthetist fee, Radiologist fee, etc.

Road Ambulance Cover:

The company will, on a reimbursement basis, pay the Reasonable and Customary Charges up to the limits specified in the Policy Schedule that are incurred during the Policy Year towards transportation of an Insured Person by a registered healthcare or Ambulance service provider to a hospital for treatment of an Illness or Injury covered under the Base Cover in case of an Emergency, necessitating the Insured Person’s admission to the Hospital.

Day Care Treatment Cover:

It will pay for the Medical Expenses incurred during the Policy Year for an Insured Person in case of Day Care Treatment or Surgery undertaken for the Illness/condition covered under Base Cover that requires less than 24 hours of Hospitalisation due to advancement in technology and which is undertaken in a hospital/nursing home / Day Care Centre on the recommendation of a Medical Practitioner. Any Treatment in an Out-Patient department (OPD) is not covered under this Benefit.

Domiciliary Hospitalisation Cover:

The policy will pay the Medical Expenses incurred on the Domiciliary Hospitalisation of an Insured Person during the Policy Year, subject to the following conditions:

• The Domiciliary Hospitalization continues for at least 3 consecutive days, in which case We will make payment under this Benefit in respect of Medical Expenses incurred from the first day of Domiciliary Hospitalization.

• The treating Medical Practitioner confirms in writing that the Insured Person’s condition was such that the Insured Person could not be transferred to a hospital or the hospital bed was not available.

• If a claim has been accepted under this Benefit, Post-hospitalization Medical Expenses shall not be payable.

Donor Expenses Cover:

This policy will cover In-patient Hospitalisation Medical Expenses incurred during the Policy Year towards the donor for harvesting the organ up to the limits specified in the Policy Schedule, provided that:

• The organ donor is any person by the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules.

• The company has admitted a claim towards In-patient Hospitalization under the Base Cover, and it is related to the same condition.

• The organ donated is for the use of the Insured Person who has been asked to undergo an organ transplant on Medical Advice.

Optional Cover:

There are multiple optional covers available with this policy that can be purchased by paying a little extra premium amount. Some of the important mentions are – choice of personal accident, critical illness, Daily Cash benefits (Inpatient, ICU, Accidental, Worldwide Emergency, Convalescence, Companion and Chemo & Radiotherapy), etc.