Coverage Benefits at a Glance | ProHealth Protect | ProHealth Plus | ProHealth Preferred | ProHealth Premier | ProHealth Accumulate |
Basic Cover | |||||
Sum Insured (SI) (figures in ₹ in Lacs) | 2.5, 3.5, 4.5, 5.5, 7.5, 10, 15, 20, 25, 30, 50 | 4.5, 5.5, 7.5, 10, 15, 20, 25, 30, 50 | 15, 30, 50 | 100 | 5.5, 7.5, 10, 15, 20, 25, 30, 50 |
In-patient Hospitalization | For Sum Insured up to `5.5 Lacs - Covered up to Single Private Room For Sum Insured `7.5 Lacs and Above - Covered up to any Room Category except Suite or higher category |
Any hospital room except Suite | For Sum Insured up to `5.5 Lacs- Covered up to Single Private Room For Sum Insured `7.5 Lacs and Above - Covered up to any Room Category except Suite or higher category |
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Pre Hospitalisation | Up to 60 days | ||||
Post Hospitalisation | Up to 90 days | Up to 180 days | Up to 90 days | ||
Day-care Treatment | 500 plus listed Day Care treatments covered up to Sum Insured | ||||
Domiciliary Treatment | Treatment at home covered up to Sum Insured | ||||
Ambulance Expenses | Up to ₹ 2000 per event | Up to ₹ 3000 per event | Actual expenses per event | Up to ₹ 2000 per event | |
Donor Expenses | Covered up to Sum Insured | ||||
Worldwide Emergency Cover | Covered up to full Sum Insured once in a Policy Year | ||||
Restoration of Sum Insured | Multiple Restoration is available in a Policy Year for unrelated illnesses, injury in addition to the Sum Insured opted | ||||
AYUSH Cover | In-patient hospitalization covered up to Sum Insured | ||||
Health Maintenance Benefit | Up to ₹500 | Up to ₹2000 | Up to ₹15000 | Option ₹5000, ₹10,000,₹15,000,₹20,000 | |
Maternity Expenses^ | NA | ₹ 15000 for normal; ₹ 25000 for C-section (per event) after a Waiting Period of 48 months | ₹ 50000 for normal; ₹ 1 lac for C-section (per event) after a Waiting Period of 48 months | ₹ 1 lac for normal; ₹ 2 lacs for C-section (per event) after a Waiting Period of 48 months | NA |
New Born Baby Expenses^ | NA | Covered within maternity expenses | NA | ||
First Year Vaccinations^ | NA | Covered over & above maternity expenses | NA | ||
Value Added | |||||
Health Check-Up (for all insured aged 18 years & above) | Available once every 3rd policy year | Available each policy year(excluding the fi rst year) | Available once every 3rd Policy year to all insured persons who have completed 18 years of Age | ||
Available once every 3rd Policy year to all insured persons who have completed 18 years of Age | Available once during the Policy Year | ||||
Cumulative Bonus (% increase in Sum Insured) | Guaranteed 5%, Max - 200% | Guaranteed 10%, Max - 200% | Guaranteed 5%, Max - 200% | ||
Healthy Rewards | Earn points equivalent to 1% of premium paid and additional points max. up to 19% from our wellness programs. Redeem earned points against renewal premium or as Health Maintenance Benefi t anytime or as equivalent value while availing services through our Network Providers | ||||
Optional | |||||
Hospital Daily Cash Benefit (for each 24 hours hospitalization) | ₹ 1000 | ₹ 2000 | ₹ 3000 | ₹ 3000 | ₹ 1000 |
Deductible* | ₹ 1/2/3/4/5/7.5/10 Lacs | NA | NA | ₹ 50,000, 1/2/3/4/5/7.5/10 Lacs | |
Reduction in Maternity Waiting | Maternity waiting period Reduced from 48 months to 24 months | ||||
Voluntary Co-Payment* | 10% or 20% as opted | NA | NA | 10% or 20% as opted | |
Waiver of Mandatory Co-pay | Available | Available | Available | Available | Available |
Cumulative Bonus Booster | Guaranteed 25%, Max - 200% | NA | Guaranteed 25%, Max - 200% | ||
Add-on | |||||
Critical Illness# (lumpsum additional 100% of SI opted) | Available | Lump sum payment of an additional 100% of Sum Insured Opted | NA | Lump sum payment of an additional 100% of Sum Insured Opted |
Medical check-up depends upon the disease declared, age of insured person and Sum Insured. Pre-policy medical check-up typically has Medical Examination Report by the Physician, few blood & Urine tests & ECG. Additional test like TMT, 2D echo, Sonography etc can also be part of the PPC check up list depending on the health status, Sum insured and age of the customer.
Pre-existing waiting period for ManipalCigna ProHealth Insurance Plan is 48/36/24 months (as per plan). That means, your pre-existing diseases declared at the time of policy purchase will be covered after 4/3/2 years subject to continuous renewals.
A compulsory co-payment of 20% is applicable on all claims for Insured Persons aged 65 years and above irrespective of the age of entry in to the Policy. Co-pay will be applied on the admissible claim amount. For persons who have opted for a Waiver of Mandatory Co-pay the same will not apply. In case the Insured has selected the Voluntary co-pay under Optional Cover and/or chooses to avail treatment outside his Zone of Cover, then the co-pay percentages will apply in conjunction
Review ManipalCigna ProHealth insurance brochure to understand coverage details.
Review ManipalCigna ProHealth insurance policy wordings which explains the terms and conditions.
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