A PRO IN EVERY WAY

ProHealth
Insurance
COMPREHENSIVE HOSPITALIZATION COVERAGE

A comprehensive health insurance

solution for your illness as
well as wellness
 ABOUT US

At ManipalCigna, we're more than a health insurance company. As

your partner in illness and wellness, our mission is to improve the
health, well-being, and peace of mind of those we serve by making
health care Affordable, Predictable and Simple. Our goal is to
provide our customers with easy and lifetime access to quality
healthcare with “no compromises, no surprises” so they can live a
healthier and more secured life.

100 %

Inflation protection guaranteed* More coverage with 100%

Cumulative Bonus up to 200% of Restoration of Sum Insured any
Sum Insured number of times#
*Conditions Apply.

Reduce your renewal premium Worldwide Protection in case of

up to 20% with Healthy Rewards emergency### available on
Points## reimbursement basis

WHAT IS YOUR LIFE STAGE?

Young singles & couples

• ProHealth Protect - cover for the essentials

• ProHealth Accumulate - quality cover when you need it

Planning a family/a family with kids

• ProHealth Plus - base cover when you have/or are planning

kid(s)
• ProHealth Preferred - higher cover when you have/or are
planning kids
• ProHealth Premier - complete cover for all health needs

Singles, Couples & Family - Excluding pregnancy

(Daily Health Needs)

• ProHealth Accumulate - quality cover for your health needs and more

Complete peace of mind

• ProHealth Preferred - cover when you need more of everything

• ProHealth Premier - high-end health solution

YOUR PROHEALTH PLAN COMES LOADED WITH BASIC
COVERS, VALUE ADDED COVERS AND OPTIONAL
COVERS FOR YOU TO CHOOSE.

BASIC COVERS

In-patient Hospitalization: If you are admitted to a hospital for more than 24

hours of illness or injury, we will take care of the room charges, ICU expenses,
nursing charges, doctor fees, surgeon fees, blood, oxygen, operation theatre
charges and other medical expenses.

Also, there will be additional protection with coverage towards Modern

treatment methods, enteral feeding expenses, HIV and related illnesses.

Pre-Hospitalization: We will reimburse medical expenses incurred before the

date of hospitalization.

Post-Hospitalization: We don’t just cover you when you are in the hospital,
but are also with you through the recovery process. Medical expenses
incurred after you are discharged will also be covered.

Day Care Treatment: We will pay for medical expenses if you undergo a
treatment that needs less than 24 hours of hospitalization. We cover 500 plus
listed Day Care procedures.

Domiciliary Treatment: Medical treatment taken at home is also covered in

case your condition is not suitable for hospital transfer or if there is no
hospital bed available.

Ambulance Expenses: We believe that nothing should come between you

and timely treatment. That's why you are covered for transportation
expenses by an ambulance service provider to the hospital.

Donor Expenses: We will cover in-patient hospitalization cost of the donor

for a major organ transplant.

Worldwide Emergency Cover: Emergencies will not necessarily hit you when
in India. We will cover in-patient medical expenses for emergency treatment
outside the country for full Sum Insured on re-imbursement basis once in a
policy year.

Restoration of Sum Insured: You may claim for an illness and God forbid,
there could be multiple unrelated illness/injury that requires you to get
hospitalized.This benefit restores the Sum Insured any number of times under
the policy to additional 100% in a policy year if the balance Sum Insured and
Cumulative Bonus or Cumulative Bonus Booster (if any) is insufficient to
settle a claim (for unrelated illness/injury).

AYUSH Cover: We will cover in-patient medical expenses up to the limit of

Sum Insured toward non-allopathic treatments such as Ayurveda, Yoga &
Naturopathy, Unani, Siddha & Homeopathy for hospitalization arising due to
accident or illness undertaken in a government AYUSH Hospital or teaching
hospitals attached to government recognized AYUSH College or AYUSH
Hospital.
Health Maintenance Benefit: An illness, no matter how small, needs
attention. And we make sure that happens. We will cover costs of doctor
fees, diagnostic tests, drugs, dental treatments and alternative medicines
upto the reimbursement limit under each plan. Fresh coverage will be
available at each policy year.

You can even choose a plan which allows:

- Carry forward of unutilized HMB balance each year on renewal
- Utilization of HMB amount up to 50% towards payment of premium
from 1 st renewal
- Utilization towards payment of deductible or co-pay (if any) and
non-admissible expenses
- Bonus @ 5% on any unutilized HMB at renewal.

Maternity Expenses: We will cover expenses for the delivery/medically

necessary termination of pregnancy (maximum up to 2 events) during the
lifetime of an insured between 18 to 45 years after a waiting period of 48
months.

New Born Baby Expenses: Until the baby is 90 days old, we will cover
medical expenses incurred towards the treatment of the child within
maternity expenses limit.

First Year Vaccination: We will also pay for vaccination charges for your
baby till he/she completes 12 months.

VALUE ADDED COVERS

Healthy Rewards: We want you to always stay healthy. You can earn reward
points equal to 1% of premium paid. In addition, you can accumulate points
maximum up to 19% of last premium paid by opting for our Wellness
Programs. The accumulated points can be redeemed against premium
from 1st renewal of policy, or reimbursed under Health Maintenance Benefit
anytime in the policy year, or as discount in fees when availing services of
our network partners.

Health Check-up: Most of us take our health for granted. No more. For
insured aged above 18 years, we will provide a Health Check-up facility at
our Network Providers irrespective of the claim status.

Expert Opinion on Critical Illnesses: Take a second opinion on listed

critical illnesses from experts at no extra cost.

Cumulative Bonus: We will provide a guaranteed additional Sum Insured as

Bonus under all plans at the time of renewal, irrespective of claim in the
expiring policy. Cumulative Bonus will accumulate maximum up to 200% of
Sum Insured.
 OPTIONAL COVERS
Deductible: We provide an option to select a Deductible as per the plan. The
deductible amount will apply on the sum of all admissible claims in that year.
This means that from your claims (should any be arising), you choose to pay
the deductible amount either out of your own pocket, or with the aid of an
existing Health Insurance policy.

You can also go for Waiver of Deductible within or after 48 months of

continuous coverage by paying additional premium as applicable on renewal.

Hospital Daily Cash: Provides a fixed daily cash benefit for seach continuous
and completed 24 hours of hospitalization that will help you take care of out of
pocket expenses. The benefit will be available up to 30 days per Policy Year.

Reduction in Maternity Waiting: You have the option to reduce the maternity
waiting period from 48 to 24 months.

Voluntary Co-pay: This option (when exercised), would mean that you choose
to pay the first 10/20% of the claim and the balance would be covered by your
plan.

Waiver of Mandatory Co-pay: You have the option to remove the mandatory
co-pay applicable for persons aged 65 years and above.

Cumulative Bonus Booster: You have an option to increase policy Sum Insured
with 25% Cumulative Bonus every year irrespective of the claim. Maximum
accumulation is up to 200% of Sum Insured. This benefit is available in place of
Cumulative Bonus.

ADD ON COVER:
Critical Illness Add-on Cover: We will pay a lump sum benefit up to your opted
Sum Insured, in case of first diagnosis of the covered critical illnesses.

MANIPALCIGNA HEALTH 360

SHIELD: Covers your listed non-medical expenses and durable medical Equipment

ADVANCE: Covers ‘Any room’ category, suite or higher category, unlimited

restoration of Sum Insured even for related illnesses/injuries & Air Ambulance,
over and above base Sum Insured

OPD: Coverage for consultation, prescribed diagnostics and pharmacy. Option

to choose any one package from the 3 package options

MORE DETAILS ABOUT YOUR PROHEALTH

INSURANCE
• Premium: Premium will depend on the plan, Sum Insured, policy tenure, age,
policy type, gender, zone of cover, optional covers and add-on benefit opted.
To calculate premium, the country is divided into three zones.
This zone based pricing enables you to pay as per the healthcare costs
prevailing in your city. For details on premium, please refer to premium
booklet.
• Mandatory Co-pay: A co-pay of 20% will apply on all claims for insured aged
65 years and above.
• PREMIUM PAYMENT MODE: Option to choose premium payment mode from
Monthly^, Quarterly, Half yearly, Yearly, Single.
Premium loading will be applied If Monthly, Quarterly, Half Yearly payment
mode is chosen.
Premium payment mode % Loading on premium
Monthly 5.50
Quarterly 3.50
Half yearly 2.50
^2 months premium to be paid in advance and instalment/renewal premium payment through NACH or standing instruction
(where payment is made either by direct debit of ban k accountor credit card).
DISCOUNTS:
- Family Discount of 25% for Protect and Plus Plans and 10% for Preferred,
Premier and Accumulate Plans covering 2 and more family members
under the same individual policy.
- Long-term Discount 7.5% on opting for a 2 year and 10% on opting for a
3 year single policy term.
- Co-pay Discount of 7.5% for opting 10% Co-pay and 15% for opting a 20%
Co-pay on the Policy in case of Protect and Plus Plan.
A discount of 5% for opting 10% Co-pay and 10% for opting 20% Co-pay
on the Policy in case of Accumulate Plan.
• Renewals: Lifetime renewals available.
• Grace Period: Grace Period of 30 is allowed for Single, Yearly, Half-yearly
and Quarterly mode of payment. Grace period of 15 days is allowed for
Monthly mode of payment.
• Free-look: A period of 15 days from date of receipt of the policy
document to review the terms and conditions of the policy and to return
the same if not acceptable. In case of no claim, you are eligible for
a. Refund of the premium paid less any expenses incurred by the Company
on medical examination and the stamp duty charges or;
b. Where the risk has already commenced and the option of return of the
policy is exercised a deduction towards the proportionate risk premium
for period of cover or;
c. Where only a part of the insurance coverage has commenced, such
proportionate premium commensurate with the insurance coverage
during such period.
• Tax Benefit: Income Tax deduction available under Sec 80D, Income Tax
Act 1961 (as amended).
• Cancellation: Request can be placed during the policy. Premium refund
will be on short period basis.No refund will be processed for cancellation
of policies with Premium Payment Mode as Half-yearly, Quarterly or
Monthly.

WAITING PERIOD:
• First 30 days waiting period is applicable for all illnesses other than
accidents.
• 24 months waiting period is applicable on specific ailments.
• Pre-existing diseases will not be covered for 24 months in Preferred &
Premier plans; 36 months in Accumulate & Plus plans and 48 months in
Protect plan.
• First 90 days waiting period and 30 days survival period is applicable to
Critical Illness Add-on Cover (if opted).

KEY EXCLUSIONS

WE WILL NOT COVER ANY COSTS TOWARDS

• Breach of Law • Contamination from Nuclear fuel or radiation
• Suicide or drug abuse • Foreign invasion or civil war

WHO IS ELIGIBLE FOR THESE PLANS?

• Min Entry Age: Child - 91 days, Adult - 18 years

• Max Entry Age: No limit
• Cover Type: Individual and Family Floater
• Policy Period: 1, 2 and 3 years
 A PLAN FOR EVERY ONE OF YOUR HEALTH NEEDS
Coverage ProHealth ProHealth ProHealth ProHealth ProHealth
Benefits at a Protect Plus Preferred Premier Accumulate
Glance
Sum Insured (SI) 2.5, 3.5, 4.5, 5.5, 7.5, 10, 4.5, 5.5, 7.5, 10, 15, 5.5, 7.5, 10, 15, 20,
(figures in ₹ in Lacs) 20, 25, 30, 50 15, 30, 50 100
15, 20, 25, 30, 50 25, 30, 50
Covered up to Single Covered up to Single
Private Room for Private Room for SI up
In-patient SI up to 5.5 Lacs & any
Any hospital room except Suite to 5.5 Lacs & any
Hospitalization hospital room except hospital room except
suite and higher for SI suite and higher for SI
above 5.5 lacs above 5.5 Lacs
Pre - Hospitalization Up to 60 days
Post - Hospitalization Up to 90 days Up to 180 days Up to 90 days
Day Care treatment 500 plus listed Day Care treatments covered up to Sur Insured
Domiciliary Treatment Treatment at home covered up to Sum Insured
Ambulance Cover Up to ₹ 2000 per Up to ₹ 3000 Actual expenses per Up to ₹ 2000 per
Road Ambulance per event event
event event
Donor Expenses Covered up to Sum Insured
Worldwide Emergency Cover Covered up to full Sum Insured once in a Policy Year
Basic Restoration Of Sum Multiple Restoration is available in a Policy Year for unrelated illnesses, injury in addition to the
Insured Sum Insured opted
AYUSH Cover In-patient hospitalization covered up to Sum Insured
Option –
Health Maintenance Up to ₹ 500 Up to ₹ 2000 Up to ₹ 15000 ₹ 5000, ₹ 10000,
Benefit ₹ 15000, ₹ 20000
₹50,000 ₹ 1 lac for
₹15,000 for normal for normal; normal;
Maternity Expenses^ ㄨ ₹25,000 for C- Section ₹ 1 lac for ₹ 2 lacs for ㄨ
(Per event) C-section C-section
(per event) (per event)
New Born Baby Expenses^ ㄨ Covered within maternity expenses ㄨ
First Year Vaccinations^ ㄨ Covered over & above maternity expenses ㄨ
Health Check-Up (for all Available once
insured aged 18 years & Available once every Available each policy year every 3rd policy
above) 3rd policy year (excluding the first year) year
Expert Opinion on Critical Available once during the Policy Year
illness
Value Cumulative Bonus Guaranteed 5%,
Guaranteed 10%, Max - 200% Guaranteed 5%,
Added (% increase in Sum Insured) Max - 200% Max - 200%
Earn points equivalent to 1% of premium paid and additional points max. up to 19% from
Healthy Rewards 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.
Hospital Daily Cash Benefit
(for each 24 hours ₹1000 ₹2000 ₹3000 ₹3000 ₹1000
hospitalization)
Deductible* ₹ 1/2/3/4/5/7.5/10 Lacs ₹50,000, 1/2/3/4/
ㄨ ㄨ 5/7.5/10 Lacs
Reduction in Maternity Maternity waiting period Reduced from ㄨ
Waiting ㄨ 48 months to 24 months
Voluntary Co-Payment* 10% or 20% as opted ㄨ ㄨ 10% or 20% as opted
Optional Waiver of Mandatory Co-pay**
Guaranteed 25%,
Cumulative Bonus Booster Guaranteed 25%, Max - 200% ㄨ
Max - 200%
For SI ₹ 4.5 Lacs & Reduce Reduce
above: Pre-existing Pre-existing
Reduction in Pre-existing Reduce Pre-existing diseases ㄨ ㄨ diseases waiting
diseases waiting period diseases waiting waiting period period to 24
period to 24 months to 24 months months
Critical Illness Add On Cover
(lumpsum additional 100% of ㄨ
Add-on SI opted)
ManipalCigna Health
360 (OPD, Shield,
Advance)

*Voluntary Co-pay & Deductible cannot be opted under the same plan. ^Waiting Period of 48 months applies.
**A Mandatory Co-pay of 20% will apply on all claims for insured whose age at the time of buying a policy is 65 years or above, which can be waived with the optional cover.
RELATIONSHIPS COVERED:
• Individual Plan: Self, spouse, children, parents, siblings, parents-in-law,
grandparents and grandchildren, son-in-law and daughter-in-law, uncle,
aunt, nephew and neice.
• Floater Plan: Self, spouse, children and parents. A floater cover can insure
a maximum of 2 adults and 3 children under a single policy.

THE KEY PILLARS UNDERLYING OUR SERVICES ARE:

Claims Handling: Our claims processing service is fast and accurate.
You can rely on our claims service associate for easy, efficient and
hassle-free claims.
Prevention and Well-being: We are proactive in identifying your health
risks and helping you in their management. We go beyond paying claims by
bringing to our customers, lifestyle programs that help them live healthier
and happier lives.

Prohibition of Rebates (under section 41 of Insurance Act, 1938, as amended):

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or
renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate
of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall
any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be
allowed in accordance with the published prospectuses or tables of the insurer. Any person making default
in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh
rupees.

Dedicated Assistance Services

For any questions or queries, you can contact us at:

1800-102-4462 [email protected]

Unlimited restoration available for unrelated illness, injury.

#

Maximum rewards that can be earned in a single policy period will be limited to 20% of premium paid in the
##

Policy.
###
Worldwide Emergency Cover available up to full Sum Insured once in a Policy Year.

Disclaimer:
ManipalCigna Health Insurance Company Limited (Formerly known as CignaTTK Health
Insurance Company Limited) | CIN: U66000MH2012PLC227948 | IRDAI Reg. No.: 151 |
Regd. Office: 401/ 402, 4th Floor, Raheja Titanium, Off Western Express Highway,
Goregaon East, Mumbai – 400 063 | For more details on risk factors, terms and conditions,
please read the sales brochure/ sales document available on our website (Download
section) before concluding a sale | Trade Name / Trade Logo belongs to MEMG
International India Private Limited and Cigna Intellectual Property Inc. and is being used by
ManipalCigna Health Insurance Company Limited under license | Tax benefits are subject
to changes in tax laws | ManipalCigna ProHealth Insurance UIN: MCIHLIP24011V072324 |
ManipalCigna Critical Illness Add On Cover UIN: MCIHLIP21128V022021 | ManipalCigna
Health 360 UIN: MCIHLIA23023V012223 | Toll free: 1800-102-4462 | Website:
www.manipalcigna.com | ARN: ADV/1067/Apr/2022-23.