Disorders of Renewals PROHLN050038

1 No -
ProHealth
ZONE1ONLINE NO
No No

Amol Digambar Pawar

Flatno101 Renukaheights Near
Lonavalamunicipalwatertank
Bhangarwadi Lonawala Pune
Pune
Maharashtra - 410401
Mobile No : XXXXXX7189

PROHLN050038891

Dear Amol Digambar Pawar,

Thank you for choosing us as your trusted health insurance partner. We have highlighted some important points regarding your policy that
you should keep in mind, so please read it carefully.

KNOW YOUR POLICY Reach us for Claims Assistance

Name of Your Plan ProHealth - Protect For hassle free claims experience, we have simplified our
claims process. Here's how it works,
Policy Number PROHLN050038891
Download “myManipalCigna
Contact Number XXXXXX7189 App” from App store or Play
Real-time
E Mail ID XXXAP@[Link] store or visit
claims status
Cover Start Date 14-AUG-2024 [Link]
claims/track-claim
Cover End Date 13-AUG-2025
Claims
Plan Type Family Floater 0406-817-8534
Helpline No.
Policy Term 1 Year
Claims Email
Ported Policy No manipalcigna@[Link]
ID
Zone Zone I - Avail treatment all over India without any co-pay
PED Declared Yes - Please refer details in Policy Schedule Reach us for Service Assistance
[Link] or
Visit : Download our “myManipalCigna
App” from App Store or Play Store
Call us : 1800-102-4462

Email us : customercare@[Link]

To locate the nearest branch office, visit -

[Link]

WAITING PERIOD IN YOUR POLICY*

Particulars Details
Initial Waiting Period 30 days (Except accident and for renewal policies without break)
Pre Existing Disease (PED) Waiting period Covered after 36 months of continuous coverage
Specific Waiting Period 24 months since inception of first policy with us
Permanent Exclusions As mentioned in Policy Wording
* for rollover / portability cases continuous coverage will be considered from first policy inception date with us or other insurer (as applicable)

Please read your policy schedule and policy wordings for detailed terms and conditions relating to the benefits. To download policy wordings, visit
[Link]

In case of any queries or clarifications, please feel free to contact your advisor or reach us at any of our touch points.
Thank you for choosing us as your partner in illness and wellness. Assuring you of our best services at all times.

Yours Sincerely,
ManipalCigna Health Insurance Company Limited

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 1/17

For and On Behalf of ManipalCIgna Health Insurance Company Ltd.

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 2/17

 PROHLN050038
Yes

Yes
Your Policy Kit Includes:

v The Policy Schedule: Presents the details of policy, such as level of protection, the premium payable for the cover, date of
Yes commencement, persons covered, specific conditions related to your plan and any special terms that apply to the policy.

v The Policy Contract: Details the terms and conditions, definitions and exclusions of the policy.

v The Personalized Health Card: Membership card that will help you access our services 24 hours a day, 7 days a week.

v Premium Receipt: Receipt issued for the premium paid by you.

This kit will help you understand your policy in detail and give you more information on how to access our services easily.

We request you to read the policy terms and conditions carefully so that you are fully aware of your policy benefits.

Your Health Card:

POLICY NUMBER : PROHLN050038891

INSURED NAME DOB

Amol Digambar Pawar 02-DEC-1976

Shravani Amol Pawar 08-AUG-2006

Tejaswini Amol Pawar 14-DEC-1979

Claims 0406-817-8534
Claims manipalcigna@[Link]
Service 1800-102-4462 customercare@[Link]

ProHealth - Protect

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 3/17

 PR ManipalCigna ProHealth Insurance
NO

POLICY SCHEDULE
Fami
Policy Issuing Office: Policy Servicing Office:

ManipalCigna Health Insurance Company Limited (Formerly ManipalCigna Health Insurance Company Limited (Formerly
known as Cigna TTK Health Insurance Company Limited), known as Cigna TTK Health Insurance Company Limited),
Reg. Office: 401/ 402, 4th Floor, Raheja Titanium, Western Reg. Office: 401/ 402, 4th Floor, Raheja Titanium, Western
Express Highway Goregaon (East), Mumbai - 400 063 Ph : Express Highway Goregaon (East), Mumbai - 400 063 Ph :
022-61703600 022-61703600

Intermediary Name: NJ Insurance Brokers Pvt. Ltd.

Code: 1608589-01 Contact Numbers: 2614025000
POLICYHOLDER DETAILS:
Name: Amol Digambar Pawar

Customer ID: 1001447480

ProHealth - Protect

Address: Flatno101 Renukaheights Near Lonavalamunicipalwatertank Pune Bhangarwadi Lonawala Pune 410401 Maharashtra

Telephone number(s): (R) - (O) - (M) - XXXXXX7189

Email
ID:
[Link]

4
Subscribed to important alert on WhatsApp:

POLICY DETAILS:
Plan: ProHealth - Protect

Policy Number: PROHLN050038891

Renewals

Policy Period: Inception Date: From: 00:00 hrs on 14-AUG-2024 Expiry date: To: 24:00 hrs on 13-AUG-2025 Tenure (in years): 1

Policy Type: Family Floater Zone of Cover: ZONE1

Portable Case: No Migrated case: No Policy Category: Renewal_04

Premium Payment Mode: Single Pre- Existing Disease waiting period: Covered after 36 months of continuous coverage

INSURED PERSON'S DETAILS:

Healthy
Pre- Rewards
Cumulative
Name Of Relationship Completed existing Points Points
Sr. Date of Date of Customer Sum Bonus
The Insured With Gender Age (In Disease/ Occupation Earned Earned
No. Inception Birth ID Insured Amount
Person(s) Policyholder years) Illness/ through through
Earned
Condition Premium Wellness
Paid Programs
Amol SELF- Disorders
14-AUG- 02-DEC- 10014474 Private
1 Digambar PRIMARY Male 47 of thyroid
2020 1976 80 Service
Pawar MEMBER gland
Shravani 14-AUG- 08-AUG- 10014474
2 Daughter Female 18 Nil Any Other 550000 110000 263.0
1001447480

Amol Pawar 2020 2006 81

Disorders
Tejaswini 14-AUG- 14-DEC- 10014474
3 Wife Female 44 of thyroid Any Other
Amol Pawar 2020 1979 82
gland

ADDRESS OF THE INSURED:

Insured ID Insured Address

1001447480 FLATNO101 RENUKAHEIGHTS NEAR LONAVALAMUNICIPALWATERTANK Pune Maharashtra 410401

NOMINEE DETAILS:
Nominee Name: Tejaswini Amol Pawar Relationship with proposer: Wife

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 4/17

 CAREGIVER DETAILS:-
Caregiver name : Relationship with proposer :

Mobile number : Email ID :

FAMILY PHYSICIAN DETAILS:-

1001447480

Family Physician name : Address :

Mobile number : Email ID :

BENEFITS UNDER THE POLICY:

ProHealth - Protect

Base covers

For Sum Insured up to 5.5 Lacs -Covered up to Single Private Room ; For Sum Insured 7.5 Lacs and Above -
In-patient Hospitalization
Covered up to any Room Category except Suite or higher category

Pre – Hospitalizatio Medical Expenses Covered up to 60 days before date of hospitalisation

Post – Hospitalization Medical Expenses Covered up to 90 days post discharge from hospital

Day Care Treatment Covered up to the limit of Sum Insured opted

Domiciliary Treatment Covered up to the limit of Sum Insured opted

Ambulance Cover Up to Rs. 2000 per hospitalization event

Donor Expenses Covered upto full Sum Insured

Worldwide Emergency Cover Covered upto full Sum Insured once in a policy year

Restoration Of Sum Insured Multiple Restoration is available in a Policy Year for unrelated illnesses in addition to the Sum Insured opted

Ayush Covered up to full Sum Insured

Health Maintenance Benefit Covered up to 500 per policy year

Value Added Covers

Health Check-Up Available once every 3rd Policy year to all insured persons who have completed 18years of Age

Expert Opinion on Critical illness Available once during the Policy Year

Cumulative Bonus A guaranteed 5% Increase in Sum Insured per policy year, maximum up to 200% of Sum Insured.

Reward Points equivalent to 1% of paid premium, to be earned each year. Rewards can also be earned for
enrolling and completing Our Array of Wellness [Link] earned Reward Points can be used against
payable premium (including Taxes) from 1st Renewal of the [Link] they can be redeemed for equivalent value
Healthy Rewards
of Health Maintenance Benefits any time during the policy OR as equivalent value while availing services through
our Network
Providers as defined in the policy.

IN THE EVENT OF A CLAIM:

HealthLine No: Call (Toll Free): 0406-817-8534
Medi Assist Insurance TPA Pvt. Ltd. Tower D, 4th Floor, IBC Knowledge
Address for correspondence :- Park, 4/1 Bannerghatta Road, Bengaluru – 560029 OR Nearest Fax Number : 1800-425-9559
ManipalCigna Health Insurance Branch.
E-mail ID: manipalcigna@[Link]

YOUR PREMIUM DETAILS:

Additional
Basic Add on Discounts Goods & Service GST Total
Loading
Premium (Rs.) Premium (Rs.) (if applicable) Tax (Rs.) Cess (Rs.) Premium (Rs.)
(if applicable)
22312.00 0.00 0.00 0.00 4016.16 0.0 26328.16

*Note: Only applicable Loadings and Discounts will be displayed as per policy.

PAN No.: AAECC7904J

The stamp duty of Rs. 1 paid vide receipt no, LOA/ENF-1/CSD/64/2024/01/03/2024 to30/03/2029/1566 dated 01-MAR-2024 . Government Notification Revenue
and Forest Department No. Mudrank 2004/4125/CR/690/M-1, dated 31/12/2004

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 5/17

 NOTE:

Basic premium is inclusive of opted Add on's and after adjustment of premium discounts, wherever applicable.

In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of whether a separate communication is sent or
not.

This Policy has been issued based on the information provided by you on the proposal form. Attached with this Policy Schedule are the Policy Terms & Conditions
and Annexures. Please ensure that these documents have been received, read and understood. If any of these documents have not been received, please contact
our Customer Service at the below mentioned details at the earliest. In case you find any discrepancy in the same, please contact us immediately.

You may write to us at customercare@[Link] Or call us at HealthLine No. (Toll Free): 1800-102-4462 or at +91 2261703600.
For any grievance related to the policy you may write to The Grievance Officer at the policy issuing office address mentioned above or email at
headcustomercare@[Link] or call at +91 2261703600.

In witness, where of this Policy has been signed at Mumbai on 12-JUL-2024

For and on behalf of ManipalCigna Health Insurance Company Limited

Authorised Signatory

ManipalCigna Health Insurance Company Limited

(Formerly known as Cigna TTK Health Insurance Company Limited)

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 6/17

 No

Fami
P ManipalCigna ProHealth Insurance
CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY
YES
ProH
This document provides key information about your policy. You are also advised to go through your policy document.

SI Title Description Policy Clause

No. (Please refer the Policy Clause Number in next column) Number
1 Name of Insurance ManipalCigna ProHealth Insurance - Protect
Family Floater
Product/Policy
2 Policy Number PROHLN050038891
3 Type of Insurance • Both indemnity and Benefit (Where the policy has elements of both)
Product/Policy Indemnity - Where insured losses are covered up to Sum Insured
under the policy
Benefit - Where the Insurance Policy pays a fixed amount under the
policy on the occurrence of a covered event
4 Sum Insured (Basis) • Floater Sum Insured - Where all members under the policy have a
(Along with amount) single sum insured limit which may be utilized by any or all members,

Insured Name Sum Insured (in Rs)

Amol Digambar Pawar
Shravani Amol Pawar 550000
Tejaswini Amol Pawar

5 Policy Coverage
(What the policy 1. Inpatient Hospitalisation (When you are hospitalised) D.I.1
covers?) 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
2. Pre-hospitalisation D.I.2
Medical Expenses Covered up to 60 days before date of
hospitalisation
3. Post - hospitalisation D.I.3
Medical Expenses Covered up to 90 days post discharge from
hospital
4. Day Care Treatment D.I.4
Covered up to the limit of Sum Insured opted
5. Domiciliary Treatment (Treatment at Home) D.I.5
Covered up to the limit of Sum Insured opted
6. Ambulance Cover (Reimbursement of Ambulance Expenses) D.I.6
Up to ₹ 2000 paid per hospitalisation event
7. Donor Expenses (Hospitalisation Expenses of the donor D.I.7
providing the organ)
Covered up to full Sum Insured
8. Worldwide Emergency Cover (Outside India) D.I.8
Covered up to full Sum Insured once in a Policy Year
9. Restoration of Sum Insured (When opted Sum Insured is D.I.9
insufficient due to claims)
Multiple Restoration is available in a Policy Year for unrelated
illnesses in addition to the Sum Insured opted
10. AYUSH Cover D.I.10
Covered up to full Sum Insured
11. Health Maintenance Benefit (Treatment that does not require D.I.11
hospitalisation and can be carried out in an Out-Patient
Department)
Covered up to ₹ 500 per policy year
Value Added Covers
This section lists the additional value added benefits that are
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 7/17
 available along with your plan
12. Health Check-Up [Link].1
Available once every 3rd Policy year to all insured persons who have
completed 18 years of Age
13. Expert Opinion on Critical illness (By a Specialist) [Link].2
Available once during the Policy Year
14. Cumulative Bonus [Link].3
A guaranteed 5% Increase in Sum Insured per policy year, maximum
up to 200% of Sum Insured.
15. Healthy Rewards [Link].4
Reward Points equivalent to 1% of paid premium, to be earned each
year. Rewards can also be earned for enrolling and completing Our
Array of Wellness Programs. These earned Reward Points can be
used against payable premium (including Taxes) from 1st Renewal of
the Policy. or they can be redeemed for equivalent value of Health
Maintenance Benefits any time during the policy or as equivalent
value while availing services through our Network Providers as
defined in the policy.
Optional Covers (Applicable only if opted)
This section lists the available optional covers under your plan and
the limits under each of these options
1. Hospital Daily Cash Benefit [Link].1
₹ 1000 for each continuous and completed 24 Hours of
Hospitalisation during the Policy Year up to a maximum of 30 days in
a policy year.
2. Deductible [Link].2
(Please select the Sum Insured and Deductible amount as you
have opted on the Policy. Deductible is the amount beyond
which a claim will be payable in the Policy)
₹ 1/ 2/ 3/ 4/ 5/ 7.5 /10 Lacs
3. Waiver of Deductible [Link].2
Available
4. Voluntary Co-pay (The cost sharing percentage that you have [Link].4
opted will apply on each claim.)
If you have opted for a Deductible, Voluntary Co-payment does
not apply
10% or 20% Voluntary Co-payment for each and every claim as opted
5. Waiver of Mandatory Co-pay [Link].5
Waiver of Mandatory co-payment of 20% for Insured Persons aged 65
years and above
6. Cumulative Bonus booster [Link].6
A guaranteed 25% increase in Sum Insured per policy year, maximum
up to 200% of Sum Insured
Add on cover (Applicable only if opted)
This section lists the Add on cover available under your plan
1. ManipalCigna Critical Illness Add-on (UIN: Add on policy
MCIHLIP21128V022021): wordings
Lump sum payment of Sum Insured, upon diagnosis of a Critical
Illness listed under Add on policy wordings.
2. ManipalCigna Health 360 Add-on (UIN: MCIHLIA23023V012223):
a. ManipalCigna Health 360-Shield:
Coverage for listed Non-medical items up to base policy Sum
Insured and Durable Medical Equipment up to maximum of
Rs.1 Lac
b. ManipalCigna Health 360 - Advance:
Coverage for ‘Any room’ category and unlimited restoration
of Sum Insured within the base policy Sum Insured. It also
provides Air Ambulance cover up to Sum Insured opted under the
base policy subject to a maximum of Rs.10 Lacs, over and above
the base policy Sum Insured.
c. ManipalCigna Health 360 - OPD:
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 8/17
 Package 1: Get cover for doctor consultations on cashless basis
within the OPD Sum Insured
Package 2: Get coverage for doctor consultations and prescribed
diagnostics on cashless basis within the OPD Sum Insured.
Package 3: Get coverage for doctor consultations, prescribed
diagnostics and pharmacy on cashless basis within the OPD Sum
Insured. Pharmacy limit is 20% of the OPD Sum Insured.
3. ManipalCigna Prime Plus (UIN: MCIHLIA25005V012425):
a. Room Rent Modification
The Insured Person shall be eligible to modify the room type
category eligibility under the Policy to Twin Sharing AC room;
ICU Up to Sum Insured.
b. Supreme Bonus
Guaranteed Cumulative Bonus of 100% of Base Sum Insured
each policy year; subject to a maximum of 800% of the Base
Sum Insured.
c. Deductible
Option to opt from Rs. 10,000 and Rs. 25,000 on aggregate basis
6 Exclusions (What 1. Investigation & Evaluation- Code- Excl. 04 E.I.4 to E.I.18
the policy does not 2. Rest Cure, rehabilitation and respite care- Code- Excl. 05 and
cover) 3. Obesity/ Weight Control: Code- Excl. 06 [Link].4 to [Link].17
4. Change-of-Gender treatments: Code- Excl. 07
5. Cosmetic or plastic Surgery: Code- Excl. 08
6. Hazardous or Adventure sports: Code- Excl. 09
7. Breach of law: Code- Excl. 10
8. Excluded Providers: Code- Excl. 11
9. Treatment for, Alcoholism, drug or substance abuse or any addictive
condition and consequences a thereof. Code- Excl. 12
10. Treatments received in heath hydros, nature cure clinics, spas or
similar establishments s. Code- Excl. 13
11. Dietary supplements and substances that can be purchased without
prescription. Code- Excl. 14
12. Refractive Error: Code- Excl. 15
13. Unproven Treatments: Code- Excl. 16
14. Sterility and Infertility: Code- Excl. 17
15. Maternity: Code Excl 18
16. Dental Treatment, orthodontic treatment, dentures or Surgery of any
kind unless necessitated due to an Accident and requiring minimum
24 hours Hospitalization. Treatment related to gum disease or tooth
disease or damage unless related to irreversible bone disease
involving the jaw which cannot be treated in any other way, unless
specifically covered under the Policy.
17. Circumcision unless necessary for treatment of a disease, illness or
injury not excluded hereunder or due to an accident.
18. Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.)
and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and
Oxygen Concentrator for Bronchial Asthmatic condition, Infusion
pump or any other external devices used during or after treatment.
19. External Congenital Anomaly or defects or any complications or
conditions arising therefrom.
20. Prostheses, corrective devices and medical appliances, which are
not required intra-operatively for the disease/ illness/ injury for which
the Insured Person was Hospitalised.
21. Any stay in Hospital without undertaking any treatment or any other
purpose other than for receiving eligible treatment of a type that
normally requires a stay in the hospital
22. Treatment received outside India other than for coverage under
World Wide Emergency Cover, Expert Opinion on Critical Illnesses.
23. Costs of donor screening or costs incurred in an organ transplant
surgery involving organs not harvested from a human body.
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 9/17
 24. Any form of Non-Allopathic treatment (except AYUSH In-patient
Treatment), Hydrotherapy, Acupuncture, Reflexology, Chiropractic
treatment or any other form of indigenous system of medicine.
25. All Illness/expenses caused by ionizing radiation or contamination by
radioactivity from any nuclear fuel (explosive or hazardous form) or
from any nuclear waste from the combustion of nuclear fuel nuclear,
chemical or biological attack or in any other sequence to the loss.
26. All expenses caused by or arising from or attributable to foreign
invasion, act of foreign enemies, hostilities, warlike operations
(whether war be declared or not or while performing duties in the
armed forces of any country), participation in any naval, military or
air-force operation, civil war, public defense, rebellion, revolution,
insurrection, military or usurped power, active participation in riots,
confiscation or nationalization or requisition of or destruction of or
damage to property by or under the order of any government or local
authority.
27. All non-medical expenses including convenience items for personal
comfort not consistent with or incidental to the diagnosis and
treatment of the disease/illness/injury for which the Insured Person
was hospitalized - belts, collars, splints, slings, braces, stockings of
any kind, diabetic footwear, thermometer and any medical equipment
that is subsequently used at home except when they form part of
room expenses, procedure charges and cost of [Link]
complete list of Non-medical expenses, please refer to the Annexure
IV List - I “Items for which Coverage is not available in the Policy”
28. Any deductible amount or percentage of admissible claim under co-
pay if applicable and as specified in the Schedule to this Policy.
29. Existing diseases disclosed by the Insured Person (limited to the
extent of the ICD codes mentioned in line with Chapter IV, Guidelines
on Standardization of Exclusions in Health Insurance Contracts,
2019), provided the same is applied at the underwriting and
consented by You/ Insured Person.
7 Waiting Period a. Initial Waiting Period: 30 days for all illnesses (not applicable in case E.I.3
· Time period of continuous renewal or accidents).
b. Specific Waiting Period (Not Applicable for claims arising due to E.I.2
during which specified
accident):
disease/treatment are
not covered. 24 Months for following diseases:
i. Cataract,
· It is counted from ii. Hysterectomy for Menorrhagia or Fibromyoma or prolapse of
the beginning of the
Uterus unless necessitated by malignancy myomectomy for
policy coverage
fibroids,
iii. Knee Replacement Surgery (other than caused by an Accident),
Non-infectious Arthritis, Gout, Rheumatism, Oestoarthritis and
Osteoposrosis, Joint Replacement Surgery (other than caused
by Accident), Prolapse of Intervertibral discs(other than caused
by Accident), all Vertibrae Disorders, including but not limited to
Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal,
iv. Varicose Veins and Varicose Ulcers,
v. Stones in the urinary uro-genital and biliary systems including
calculus diseases,
vi. Benign Prostate Hypertrophy, all types of Hydrocele,
vii. Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus,
Hemorrhoids and any abscess related to the anal region.
viii. Chronic Suppurative Otitis Media (CSOM), Deviated Nasal
Septum, Sinusitis and related disorders, Surgery on
tonsils/Adenoids, Tympanoplasty and any other benign ear, nose
and throat disorder or surgery.
ix. Gastric and duodenal ulcer, any type of
Cysts/Nodules/Polyps/internal tumors/skin tumors, and any type
of Breast lumps (unless malignant), Polycystic Ovarian
Diseases,
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 10/17
 x. Any surgery of the genito-urinary system unless necessitated by
malignancy.
c. Pre-existing Disease: Covered after 36 Months E.I.1
d. Personal Waiting period: A special Waiting Period not exceeding 36 [Link].2
months, may be applied to individual Insured Persons for the list of
acceptable Medical Ailments listed under Underwriting Manual of the
Product, depending upon declarations on the proposal form and
existing health conditions. Such waiting periods shall be specifically
stated in the Schedule and will be applied only after receiving Your
specific consent.
8 Financial limits of 1. The policy will pay only up to the limits specified hereunder for the
coverage following diseases/procedures:
Not Applicable
· Sub-limit (it is pre-
defined limit and the 2. In case of claim, this policy requires you to share the following sub
insurance company limits: Expense exceeding Sub-limits D.I.1
will not pay any
amount in excess of · Room/ICU Charges
this limit - For Sum Insured up to ₹ 5.5 Lacs - Covered up to Single
Private Room
· Co-payment (it is a - For Sum Insured ₹ 7.5 Lacs and Above - Covered up to any
specified Room Category except Suite or higher category
amount/percentage · For the following specified disease
of admissible claim - No sublimit on any disease.
amount to be paid by [Link].10 & [Link].6
3. Co-Payment 0 %
policyholder/
insured). *Zonal Co-Payment
Identification of Zone will be based on the location-City of the
· Deductible (It is proposed Insured Persons.
specified amount: - a) Persons paying Zone I premium can avail treatment all over
up to which and India without any Co-pay
insurance company b) Persons paying Zone II premium
will not pay any
claim, and - which
will be deducted from i. Can avail treatment in Zone II and Zone III without any Co-
total claim amount (if pay
claim amount is ii. Availing treatment in Zone I will have to bear 10% of each
more than specified and every claim.
amount) c) Person paying Zone III premium
· Any other limit (as i. Can avail treatment in Zone III, without any Co-pay
applicable)
ii. Availing treatment in Zone II will have to bear 10% of each
and every claim.
iii. Availing treatment in Zone I will have to bear 20% of each
and every claim.
Aforesaid Co-payments for claims occurring outside of the Zone
will not apply in case of Hospitalization due to Accident.

The aforesaid Co-payments applicable are in addition to the

Voluntary Co-pay under Section [Link].4 (if opted) and Mandatory
Co-pay.

A mandatory co-payment of 20% will be applicable for insured’s

aged 65 years and above.
4. Deductible
Deductible of Rs. 0 will apply per policy year on aggregate basis.
9 Claims/Claims Details of procedure to be followed for cashless services as well as for
procedure reimbursement of claim including pre and post hospitalisation:
G.I
To know the process for our cashless and reimbursement claims visit

[Link]
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 11/17
 Turn Around Time (TAT) for claim settlement
i. TAT for pre-authorization of cashless facility - within 4 hours from the
last complete document.
ii. TAT for cashless final bill authorization- within 4 hours from the last
complete document
Web links for the followings:
i. Network hospital details - [Link]
ii. Helpline Number - [Link]
iii. Hospital which are blacklisted or from where no claims will be
accepted by insurer -[Link]
iv. Link for downloading claim form -
[Link]
10 Policy Servicing For hassle free policy servicing customer can manage their policy by
clicking on [Link]
or Download myManipalCigna App from Playstore or appstore
11 Grievances/Compla Level 1 F.I.16
ints Health Relationship Managers
Call our toll-free number 1800-102-4462 between 9:00 AM to 9:00 PM.
Email us at headcustomercare@[Link]
For Senior Citizen Assistance Seniorcitizensupport@[Link]

LEVEL 2
Senior Manager - Grievance Cell
Call us on 022-61703600 between 10 am to 6 Pm (Monday to Friday)
Email us at complaints@[Link]

LEVEL 3
Grievance Redressal Officer
Call us on 022-61703603 between 10 am to 6 Pm (Monday to Friday)
Email us at GRO@[Link]
For Senior Citizen Assistance Seniorcitizensupport@[Link]

LEVEL 4
Approach Ombudsman
If the channels above have still not met your expectations, you may
approach the insurance ombudsman, the office Name and address details
applicable for your state can be obtained from
[Link]

Note: You may also approach the Insurance ombudsman if your

complaint is open for more than 30 days at any of the above levels
12 Things to Free Look Cancellations: The Free Look period shall be applicable on F.I.15
remember new individual health insurance policies and not on renewals or
Ported/Migrated policies.
The insured person shall be allowed a free look period of 30 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. Free look is
applicable only, if the insured has not made any claim or opted for any
benefit during the Free Look Period.

To avail:
- Customer can request for cancellation writing to
customercare@[Link] from the registered
email id with us.
OR
- Customer can also visit any MCHI Branch and give a written request.

Policy Renewal: The policy shall ordinarily be renewable except on F.I.10

grounds of established fraud or non-disclosure or misrepresentation by the

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 12/17

 insured person.

Migration: The Insured Person will have the option to migrate the Policy F.I.8
to other health insurance products/plans offered by the company by
applying for migration of the policy at least 30 days before the policy
renewal date as per IRDAI guidelines on Migration. If such person is
presently covered and has been continuously covered without any lapses
under any health insurance product/plan offered by the company, the
insured person will get the accrued continuity benefits in waiting periods
as per IRDAI guidelines on migration.

To avail:
- Customer can share for migration of the policy 30 days prior to the
renewal date by writing to customercare@[Link] from
an email registered with us
OR
- Visit nearest ManipalCigna Branch and submit a written request
OR
- Contact the intermediary/agent assigned to the customer for
assistance

Portability: The Insured Person will have the option to port the Policy to F.I.9
other insurers by applying to such insurer to port the entire policy along
with all the members of the family, if any, at least 45 days before, but not
earlier than 60 days from the policy renewal date as per IRDAI guidelines
related to portability. If such person is presently covered and has been
continuously covered without any lapses under any health insurance
policy with an Indian General/Health insurer, the proposed Insured Person
will get all the accrued continuity benefits in waiting periods as per IRDAI
guidelines on portability.

To avail:
- Customer can share for portability of the policy 45 days prior to the
renewal date by writing to customercare@[Link] from
an email registered with us
OR
- Visit nearest ManipalCigna Branch and submit a written request
OR
- Contact the intermediary/agent assigned to the customer for
assistance

Change in Sum Insured: It will be allowed at the time of Renewal of the [Link].9.h
Policy. You can submit a request for the changes by filling the proposal
form before the expiry of the Policy. We reserve Our right to carry out
underwriting in relation to acceptance of request for change of Sum
Insured

Moratorium Period: After completion of 60 continuous months of F.I.12

coverage(including portability and migration) under the policy no look back
would be applied. This period of 60 continous months is called as
moratorium period. The moratorium would be applicable for the sums
insured of the first policy and subsequently completion of 60 continuous
months would be applicable from date of enhancement of sums insured
only on the enhanced limits. After the expiry of Moratorium Period no
health insurance claim under this policy shall be contestable except for
proven fraud and permanent exclusions specified in the policy contract.

13 Your Obligations · Please disclose all Pre-existing disease/s or condition/s before buying a F.I.1
Policy.

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 13/17

 · The Policy shall be null and void and all premium paid thereon shall be
forfeited to the Company in the event of misrepresentation, mis-
description or non-disclosure of any material fact by the policyholder.
(“Material facts” for the purpose of this policy shall mean all relevant
information sought by the company in the proposal form and other
connected documents to enable it to take informed decision in the context
of underwriting the risk)

Declaration by the Policy Holder;

I have read the above and confirm having noted the details.
Place:
Date: (Signature of Policyholder)

Note:
i. Insured/policyholder can get the product related document at [Link]
ii. In case of any conflict, the terms conditions mentioned in the policy document shall prevail.
(Benefits and exclusion are applicable as per the plan chosen, please refer the policy schedule for the applicable benefits).

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 14/17

 Annexure to Customer Information Sheet - Benefit Illustration
ProHealth Protect
Notes:
• All the premiums are excluding taxes
• All the premiums mentioned below are for illustration purpose only. The Premium charged on the Policy will depend
on the Plan, Sum Insured opted, Policy Tenure, Age, Policy Type, Gender, Zone of Cover, Optional Covers and Add
On Benefits opted. Additionally the health status of the individual will also be considered.
• Zone 1 rates are considered
• Premium rates are rounded off to the nearest integer value
• The premium rates are for the mandatory base covers in each variant
• The Gender considered for 1st and 3rd members in the tables below is Female and that for 2nd and 4th members it is
Male.

2A+2C
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple member of the family under a single overall Sum Insured (Only one Sum Insured is
Insured covering each member policy (Sum insured is available for each available for the entire family)
Member of the family separately member of the family)
(at a single point in
time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum
(�) (�) (�) if any (�) after (�) consolidated discount, after Insured (�)
discount premium for if any discount
(�) all members (�)
of family (�)
18 a6,784 a5,50,000 a6,784 a1,696 a5,088 a5,50,000 a22,761 NA a22,761 a5,50,000
21 a7,665 a5,50,000 a7,665 a1,916 a5,749 a5,50,000 NA
39 a8,994 a5,50,000 a8,994 a2,248 a6,746 a5,50,000 NA
45 a12,369 a5,50,000 a12,369 a3,092 a9,277 a5,50,000 NA
Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater basis
members of the family a26,860, when they are covered under a single a22,761.
is a35,812, when each policy. Sum insured of a5.5 Lacs is available for the entire
member is covered Sum insured available for each individual is a5.5 family
separately. Lacs.
Sum insured available
for each individual is a5.5
Lacs.

2A
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple member of the family under a single overall Sum Insured (Only one Sum Insured is
Insured covering each policy (Sum insured is available for each available for the entire family)
Member member of the family member of the family)
separately (at a single
point in time)
Premium Sum Premium Discount, Premium Sum Premium or Floater Premium Sum
(�) Insured (�) (�) if any (�) after Insured (�) consolidated discount, after Insured (�)
discount premium for if any discount
(�) all members (�)
of family (�)
55 a18,754 a5,50,000 a18,754 a4,688 a14,066 a5,50,000 a51,441 NA a51,441 a5,50,000
63 a35,696 a5,50,000 a35,696 a8,924 a26,772 a5,50,000 NA
Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater basis
members of the family a40,838, when they are covered under a single a51,441.
is a54,450, when each policy. Sum insured of a5.5 Lacs is available for the entire
member is covered Sum insured available for each individual is a5.5 family
separately. Lacs.
Sum insured available
for each individual is
a5.5 Lacs.

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 15/17

 Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple member of the family under a single overall Sum Insured (Only one Sum Insured is
Insured covering each policy (Sum insured is available for each available for the entire family)
Member member of the family member of the family)
separately (at a single
point in time)
Premium Sum Premium Discount, Premium Sum Premium or Floater Premium Sum
(�) Insured (�) (�) if any (�) after Insured (�) consolidated discount, after Insured (�)
discount premium for if any discount
(�) all members (�)
of family (�)
65 a30,442 a5,50,000 30,442 7,610 22,832 5,50,000 `68,349 NA `68,349 `5,50,000
70 a47,367 a5,50,000 47,367 11,842 35,525 5,50,000 NA
Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater basis
members of the family a58,357, when they are covered under a single a68,349.
is a77,809, when each policy Sum insured of a5.5 Lacs is available for the entire
member is covered Sum insured available for each individual is a5.5 family
separately. Lacs.
Sum insured available
for each individual is
a5.5 Lacs.

ManipalCigna ProHealth Insurance UIN: MCIHLIP24011V072324

Note: Premium rates specified in the above illustration shall be standard premium rates without
considering any loading. Also, the premium rates shall be exclusive of
taxes applicable.

ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 16/17

 CLAIMS PROCESS

PRE-AUTHORIZATION REIMBURSEMENT

1 Customer requires
hospitalisation.

1 At the time of hospitalization,

customer calls Claims
customer care 040-68178534.
Planned Hospitalistion- 3 days
Emergency- within 48hrs

2 Customer calls Claims

customer care 040-68178534.

Planned Hospitalisation- 3 days

2 ManipalCigna registers
claim intimation in system.

3 ManipalCigna Customer
care team provides
required information.

3 Customer receives
notification on email
and SMS.

4 Customer gets admitted and

Hospital sends documents to
ManipalCigna.

4 Customer submits claim

documents to Medi Assist TPA Head
office within 15 days of discharge.

5 5
Claim team registers the Claim assessment
pre-auth and is done. (Approved/
acknowledgement is Rejected/ Additional
sent to customer, hospital Information)
and advisor.

6 6
Final decision is ManipalCigna releases payment
communicated to to the customer on approval.
customer, hospital & Email/SMS/ Mail notification is
advisor after pre- sent to customer- on claim
authorisation rejected/Add Info or for any
assessment. additional information.

7 Email/SMS notification is sent

and customer is called in case
of claim rejection or for any
addition information.
7 ManipalCigna Customer service
team updates the customer on
the status.

8 ManipalCigna Customer
service team collects
Feedback.

8 ManipalCigna Customer
service team collects
Feedback.

Know Your Customer Help us remain as your trusted service partner by ensuring we have a copy of all your documents.
A Color passport size photograph not older than 6 months A Original Cancelled cheque A Copy of PAN card and address proof for claims over 1 lakh

Medi Assist Insurance TPA Pvt. Ltd.

Head Office: Tower D,4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road Bengaluru – 560029

ManipalCigna Health Insurance Company Limited (Formerly known as CignaTTK Health Insurance Company Limited) | CIN: U66000MH2012PLC227948 |
IRDAI Reg. No. 151 | Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number
– 1800-102-4462 | Website [Link] | 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 | Apr2019 onwards |
ManipalCigna ProHealth Insurance | UIN: MCIHLIP24011V072324 17/17