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ManipalCigna ProHealth Prime Plan

ManipalCigna ProHealth Prime was created to address the needs and issues faced by the average citizen in the field of health insurance. It is a comprehensive health insurance program that provides coverage to both individuals and families for hospitalization, ambulance services, in-home care, outpatient care, and much more. 

The plan comes with three variants, namely ProHealth Prime Protect, ProHealth Prime Advantage, and ProHealth Prime Active. It also comes with several value-added covers as well as optional packages, which helps the policyholder to enhance its coverage. Let’s dive deeper into the intricacies of the plan!

Eligibility Of Manipal Cigna Prohealth Prime Plan

Entry Age

For Adults: 18 Years To No Limit

For Children: 91 Days To 25 Years

Policy Term1/2/3 Years
Sum Insured Options (In Rs.)

3/4/5/7.5/10/12.5/15/20/25/30/40/

50/100 Lacs

Policy TypeIndividual/Multi-Individual/Family Floater Options
Premium Payment OptionsSingle/Half-Yearly/Quarterly/Monthly
RenewabilityLifelong

Unique Attributes Of ManipalCigna Prohealth Prime 

Let’s now focus on what the plan covers!

ParametersProHealth Prime ProtectProHealth Prime AdvantageProHealth Prime Active
Pre-Hospitalization60 Days; Up To SI60 Days; Up To SI30 Days; Up To SI
Post-Hospitalization180 Days; Up To SI180 Days; Up To SI60 Days; Up To SI
Room Accommodation

Single Private AC Room

ICU: Up To SI

Single Private AC Room

ICU: Up To SI

  • SI = Rs. 3Lacs: 1% Of Base SI
  • SI >= Rs.5Lacs: Single Private AC Room

ICU: Up to SI

Air Ambulance CoverUp To SI, Subject To A Maximum Of Rs. 10 LacsUp To SI, Subject To A Maximum Of Rs. 10 LacsNot Applicable
Bariatric Surgery CoverUp To SI, Subject To A Maximum Of Rs. 5 LacsUp To SI, Subject To A Maximum Of Rs. 5 LacsNot Applicable
Modern & Advanced Treatments

For Sum Insured < Rs. 5 Lacs: 50% Of Sum Insured

For Sum Insured >= 5 Lacs: Up To Sum Insured

Daycare TreatmentUp To SI
Domiciliary Hospitalization10% Of SI
Road AmbulanceUp To SI
Donor ExpensesUp To SI
AYUSH TreatmentUp To SI
Restoration Of Sum InsuredUnlimited Times For Related/Unrelated Illnesses
Daily Cash For Shared Accommodation

For Sum Insured Up To Rs. 10 Lacs: Rs. 800 Per Day Up To Maximum Of Rs. 5,600.

For Sum Insured > Rs. 10 Lacs: Rs. 1,000 Per Day Up To Maximum Of Rs. 7,000.

Key Benefits Of Manipal Cigna Prohealth Prime

Take a look at some of the attractive benefits of the plan:

  • Enhanced Coverage

The plan offers unrestricted restoration of the sum insured, even for related illnesses, and a guaranteed cumulative bonus of up to 200 percent of the Sum Insured that accrues regardless of claims. The company guarantees a cumulative bonus that increases by 25% of the covered amount annually. 

The bonus will remain with you for the rest of your life as long as you keep renewing your plan; it won’t be lowered if you make a claim in the future or not. Additionally, thanks to the “Unlimited Restoration of the Sum Insured” feature, you will never run out of coverage for any kind of claim, connected or not.

  • Comprehensive Protection

The patient may suffer greatly as a result of the non-medical costs that are typically not reimbursed. Your fears about these costs are allayed by ProHealth Prime, which pays you 100% of the claim amount without making any adjustments for non-medical fees.

Additionally, the plan covers OPD fees to protect you from the costs you pay for physicians’ visits and consultations, diagnostic procedures, and pharmaceutical needs, which can add up to a lot. You can also choose to be admitted in a private room or even a suite without any concerns. 

  • Switch Off Facility

Additionally, you have the choice of stopping your domestic insurance for up to 30 days per year. You might be wondering why someone would ever want to turn off their cover. When they travel abroad, where their insurance is invalid, they would want to do that.

Even when the insurance does give coverage in such circumstances, you must still pay the standard rate. However, not any longer with ManipalCigna. The premium amount may be saved for a maximum of 30 days.

  • Premium Waiver Benefit

If the policyholder is diagnosed with any of the listed critical illnesses or dies in an accident, the plan will waive off the renewal premium for one year. This will minimize the financial burden that may fall on your family after such an incident.

  • Discount From Network Providers

The plan also offers discounts on pharmacy, diagnostics, and health supplements offered through the network providers of the company. This savings on healthcare will follow wherever you go. 

  • Annual Health Checkup

All the insured adults will be eligible for annual health checkups under the plan. This is applicable from 1st year onwards and primarily aims to take the utmost care of the insured’s health both in illness and wellness.

  • Wellness Programs

The plan enables you to earn appealing prizes for completing the predetermined number of wellness steps in a day, up to 20% of your base premium. You can use these reward points to get your renewal premium discounted.

  • Maternity Cover & IVF/IUI Treatments

Prenatal issues are also resolved by ManipalCigna ProHealth Prime. The plan’s maternity limit covers complications associated with pregnancy as well as any linked events. Additionally, IVF and IUI are covered up to Rs. 2.5 lakhs over and above the maternity limit.

  • Disease-Specific Coverage

For those who currently have diabetes, hypertension, dyslipidemia, asthma, or obesity and are primarily uninsured, ManipalCigna ProHealth Prime offers customized coverage. Additionally, they are free from lengthy waiting periods because the coverage begins on the 91st day.

Optional Packages Under Manipalcigna Prohealth Prime

The plan offers the following as optional covers to the policyholder:

Plan OptionCovers
Enhance Plus
  • Maternity, New Born & One Year Vaccination Expense
  • New Born Expenses
  • Room Accommodation
  • Health Maintenance Benefit
Assure
  • Room Accommodation Limit
  • Disease-Specific Sub-Limit
  • Modern & Advanced Treatments
Enhance
  • Maternity, New Born & One Year Vaccination Expense
  • New Born Expenses
  • Room Accommodation
Freedom
  • Room Accommodation
  • Worldwide Emergency Hospitalization With Outpatient Cover

What’s Not Covered Under Manipalcigna Prohealth Prime Plan?

The plan excludes the following coverages:

  • Breach of law
  • Hazardous or adventurous sports
  • Foreign invasion or civil war
  • Contamination from nuclear fuel or radiation

Premium Calculation Of Manipalcigna Prohealth Prime

Before you purchase the Manipal Cigna Prohealth Prime plan, it is important to have an estimate of the premium amount you need to pay. Therefore, we have illustrated premium amounts with respect to different ages, gender, and various other criteria.

NameAgeGenderSum InsuredPolicy DurationPremium Amount
Avantika Mishra29 YearsFemaleRs. 7.5 Lakhs1 YearRs. 10,210
Rohit Roy27 YearsMaleRs. 10 Lakhs2 YearsRs. 20,188
Dimple Singh36 YearsFemaleRs. 50 Lakhs3 YearsRs. 34,826
Vicky Singh49 YearsMaleRs. 75 Lakhs2 YearsRs. 39,523

How To Claim For Manipalcigna Prohealth Prime Plan?

The company follows the below-mentioned claim processes:

CASHLESS CLAIM PROCESS:

  1. Claim Intimation: Firstly, you need to inform the TPA desk about the hospitalization. For planned hospitalization, report to the hospital TPA desk 48 hours before hospitalization; and for emergency hospitalization, report to the hospital TPA desk within 24 hours of hospitalization.
  1. Submission Of Pre-Authorization Forms & Medical Records: Now your hospital TPA will submit the pre-authorization form and medical records to your insurance company.
  1. Submission Of Necessary Documents: Various relevant documents, such as discharge summary and final bill, need to be submitted to the hospital TPA, who will then share them with the insurance company.
  1. Claim Settlement: Once the insurance company verifies every detail and document, it gives final approval to the claim amount.

REIMBURSEMENT PROCESS:

  1. Downloading Claim Form: You can download the claim form from the company’s website and prepare all the original documents mentioned in the claim form.
  1. Submission Of Documents: Now submit all the relevant documents to the nearby branch office of ManipalCigna for the claim process.
  1. Claim Settlement: Once your documents are verified by the company, the reimbursement amount will be transferred to your registered bank account directly.

Frequently Asked Questions

The plan offers the following discounts to the policyholder:

  • Family Discount: 20%
  • Standing Instruction Discount: 3%
  • Long-Term Discount: Up To 10%
  • Wellness Discount: Up To 20%

For an individual plan, you can cover yourself, your spouse, parents, children, siblings, grandparents, parents-in-law, grandchildren, son-in-law, uncle, aunt, daughter-in-law, nephew, and niece. Whereas, for the family floater option, you can cover yourself, your spouse, parents, and children. Maximum coverage under a floater cover is for 2 adults and 3 kids only.

No. The facility of annual health checkups is only available for insured adults.

The plan offers 6 optional covers to the policyholder:

  1. Coverage for non-medical items
  2. Personal accident cover
  3. Deductible
  4. Infertility treatment
  5. Cumulative bonus booster
  6. Critical illness add-on cover

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