ManipalCigna is a standalone health insurance service provider based in Mumbai. The company has its presence all over the country with regional offices in different locations across the country. ManipalCigna was established as a partnership between U.S.-based insurance firm, Manipal Corporation and Indian conglomerate, TTK Group. Cigna is the first Fortune 500 company from the United States to enter the Indian market. The company has a strong lineup of insurance products that provide coverage for people at a reasonable price.
ManipalCigna Health Insurance Plans
Some of the top health insurance plans offered by ManipalCigna can be listed as follows:
ManipalCigna ProHealth: This is a comprehensive health insurance cover available for both individuals as well as families. Multiple variants of this policy (Plus, Accumulate, Premier, etc.) are available based on the type of coverage offered and the sum insured options available. The maximum possible sum insured available under the ‘Premier’ variant of this policy is Rs.1 crore.
ManipalCigna ProHealth Select: This is a value-added health insurance coverage plan offered by ManipalCigna. This policy comes with flexible benefits with sum insured options ranging from Rs.50,000 to Rs.25 lakh. In addition to health insurance coverage, this policy also offers value-added benefits like sum insured restoration, voluntary co-payment, AYUSH coverage, etc. Policyholders can also enhance their coverage by subscribing to various add-on covers.
ManipalCigna Lifestyle Protection - Critical Care: This is a critical illness plan that helps policyholders maintain their lifestyle even after the diagnosis of a life-threatening disease. It provides coverage for up to 30 critical illnesses, and it pays a lump-sum benefit upon the first diagnosis of any of the illness. Moreover, this provides access to various Online Wellness programs that help a patient cope up with the disease.
ManipalCigna Lifestyle Protection - Accident Care: This policy provides benefit following the death or disability of the insured person. Lump-sum benefit up to the extent of the sum insured amount is paid to the insured or his/her family following various eventualities such as death or permanent total disability. This cover also comes with various rider options to enhance the benefits available for policyholders.
ManipalCigna ProHealth Cash: Hospital admission often comes with various expenses including cost of travelling, food, and items of personal comfort. A regular health insurance plan will not provide coverage for these expenses. This policy provides a fixed daily cash allowance during the time of hospital stay of the insured. The money obtained from this policy can be used for any purpose and there is no need to provide any proof of how the money is spent.
ManipalCigna Global Health Group Policy: This group health insurance cover is mainly intended for today’s corporate workforce that travels the world for occupational purposes. Employers can use this policy to provide coverage to their employees and their dependents for all medical expenses incurred in India and abroad.
These are some of the covers available in ManipalCigna’s lineup for policyholders. Some of these policies come in different variants depending upon the level of coverage required for policyholders. With a long lineup of health insurance policies, ManipalCigna caters to the needs of everyone including individuals, families, and groups.
Significance of ManipalCigna Network Hospitals
Policyholders who have subscribed to ManipalCigna Health Insurance can get medical treatment in both network hospitals as well as non-network hospitals. When it comes to network hospitals, policyholders have the option of choosing between cashless treatment facility and reimbursement claim. ManipalCigna has tie-ups with over 4,100 medical and diagnostic facilities in different parts of the country. Customers can benefit from these facilities during the time of a medical emergency.
Network hospitals of insurance service providers are typically located in major cities and towns rather than rural areas. In case of medical emergency, policyholders in rural areas can visit the network facilities in their nearby localities or their district capitals. The network facilities of ManipalCigna are well spread out across the country to ensure reach accessibility to people in various remote locations. The cashless treatments offered in network hospitals are highly beneficial for low-income households that cannot arrange money immediately during a medical emergency.
Types of Claims Executed at ManipalCigna Network Hospitals
As noted earlier, network hospitals that have tie-ups with ManipalCigna can be used for both cashless and reimbursement claims. In certain cases, policyholders may not have the time to make a cashless treatment request. In those situations, reimbursement claims are likely to come in handy.
Cashless Treatment: In case of cashless treatment, the insured has to make a request to the company during an event of hospitalisation. The company will verify the details and approve or reject the request based on its validity. For all approved claims, the settlement process happens directly between the insurer and the network facility.
Reimbursement Claim: If cashless treatment request is not approved by the company for some reason, the policyholder can still apply for reimbursement claims after discharge from the hospital. For all reimbursement claims, the insured must submit proof for all the expenses incurred. Only those requests with valid documents will be reimbursed by the company.
Procedure for Filing Claims with ManipalCigna
Any claims related to cashless treatment at ManipalCigna can be filed as follows:
- The company must be notified immediately following an eventuality that may lead to a claim. Planned hospitalisations must be informed at least 3 days before the date of hospitalisation. Emergency hospitalisations can be informed within 48 hours from the date of admission.
- Pre-authorisation must be obtained from the company before initiating the cashless treatment facility.
- The network facility’s insurance help desk typically contains the pre-authorisation request form. Policyholders must fill this form and submit it to the concerned personnel along with the policy details.
- The hospital will send the request form to the insurer through fax. Upon receipt of the request, the company will verify the details and contact the hospital for issuing authorisation.
- Following approval from the company, cashless treatment can be obtained in the network hospital.
- During the time of discharge, the final bill will be verified by the insurer and the hospital. Any expenses incurred for inadmissible claims will have to be paid by the insured.
The procedure for filing reimbursement request is as follows:
- Even for reimbursement claims, the insurer must be contacted immediately after the occurrence of an event. Planned hospitalisation must be intimated 3 days in advance, whereas emergency hospitalisations can be notified within 48 hours of hospital admission.
- The claim reimbursement form can be obtained from the insurer’s branch office or it can be downloaded from the official website.
- All claims must be filed within 15 days from the date of discharge from the hospital.
- Along with the duly filled claim form, the insured must also provide proofs including medical bills, discharge summary, diagnostic reports, prescriptions, pharmacy receipts, etc.
- Once these details are submitted, the company will verify the admissibility of the claim. If additional details are required, the company will contact the policyholder and seek additional details.
- Once the verification is done, the company will communicate the acceptance or rejection of the claim to the insured. A suitable reason will be provided if the claim request is rejected.
- After the successful acceptance of the claim, the settlement amount will be paid to the policyholder.
General Exclusions Applicable to ManipalCigna Health Insurance
The company will not provide any reimbursement for the following claims:
- Self-inflicted injuries or injuries attributable to a suicide attempt
- Claims attributable to sexually transmitted diseases, HIV, or AIDS
- Genetic disorders, birth defects, and anomalies
- Claims attributable to mental disorders or psychiatric conditions
- Claims attributable to drug abuse or rehabilitation
- Expenses related to childbirth, pregnancy, or related complications
- Illnesses or injuries attributable to war or warlike activities
- Any kind of cosmetic or aesthetic treatment
- Expenses related to weight management or obesity treatments
- Cost of accessories such as spectacles, contact lenses, or hearing aids
- Non-medical expenses incurred during the time of hospital stay
1. What are the details that must be provided while intimating a claim?
At the time of intimation, policyholders can contact the company’s customer service department and notify about the hospitalisation. During this time, it is necessary to provide the following details to the insurer:
- Policy details (name of the policyholder, policy number, etc.)
- Date of admission
- Name and address of the medical facility
- Name of the attending physician
- Nature of the illness or injury
2. Can I make a claim request during the grace period?
No. Health insurers do not provide any coverage for the claims arising during the grace period. The grace period is just an additional time provided for policyholders to renew their policy after the date of expiry. During this period, the policy remains inactive. The policy becomes active only after the payment of the next premium instalment. Hence, the company will not entertain any claims arising during the inactive period.
3. Can I apply for reimbursement even if my cashless treatment request is rejected?
Yes. Even if the cashless treatment request is rejected, a policyholder may still apply for a reimbursement claim. If the claim is valid, the company will provide settlement for it.
4. How long will the company take to provide settlement in case of reimbursement claims?
Once all the required documents are submitted, the settlement amount will be paid within a maximum of 30 days.
5. What is a worldwide emergency cover?
The worldwide emergency coverage in ManipalCigna health insurance policies provides coverage for emergency treatments taken outside the country. In this case, the compensation is paid only for inpatient hospitalisation claims. The claim amount will be paid only in Indian Rupees at the exchange rate specified by the Reserve Bank of India.