LIFETM050025731

Sumit Choudhary
S.O Subhash Chand Choudhary Amar Kala Sadan Shiv Colony Opp.
Panchayat Mahendragarh
Haryana
123001
Mobile No : XXXXXX6063

LIFETM050025731

Dear Sumit Choudhary,

Welcome to ManipalCigna Health Insurance family!

Congratulations and thank you for purchasing ManipalCigna Lifetime Health Insurance Plan.

It is our endeavour to design our products by keeping the evolving needs of our customers in mind. This plan ensures that you have a quality
healthcare financing solution to secure your unique healthcare requirements at every stage of life, and hence put all your medical financing
concerns to rest, for a lifetime.

Here are some of the key benefits of your plan:

1. COMPREHENSIVE COVERAGE

Inpatient Hospitalization in India

For Sum Insured upto INR 2 Crores - Any room category except suite or higher category
For Sum Insured INR 3 Crores - Any room category including suite
Unlimited restoration of Sum Insured for unrelated illnesses to ensure you never run out of cover

2. ASSURANCE OF SUPPORT

Waiver of Premium for one-policy year, upon occurrence of any of the covered contingencies

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
First of its kind, Continuity of benefits on the entire chosen Sum Insured under portability for those with existing base sum insured
(excluding bonuses) of Rs. 10 lacs and above

3. REWARDING RELATIONSHIP

Loyalty discounts on the applicable renewal premium from 4th policy year onwards till life time
Family discounts of 15% on covering 2 or more family members under single individual policy
If you pay renewal premium through NACH or standing instruction (where payment is made either by direct debit of bank account or credit
card) you can avail 3% discount on the renewal premium
Adult (Annual) health check-up from the first policy year onwards

Our policy kit will further help you understand the product benefits in detail and give you more information on how to access our services
seamlessly. Your satisfaction is a priority for us, so we urge you to read the policy terms and conditions carefully so that you are fully aware of the
benefits that you have purchased. In case of any queries or clarifications, please feel free to contact your advisor or reach us at any of our touch
points.

In

1/26
 LIFETM0500257
Cumulative
WORLDWIDE
1 IndiaNo
ZONE3OFFLINEYESPlan
No No
Renewals

KNOW YOUR POLICY REACH US

Policy Number LIFETM050025731
Visit - www.manipalcigna.com
Plan Name India Plan - Domestic Coverage
Plan Type Family Floater
Call us - 1800-102-4462
No of Insured 3 - Insured
Start Date: 26-MAR-2024 Email us - [email protected]
Policy Tenure
End Date: 25-MAR-2025
Nominee Name Neha Choudhary To locate the nearest branch office, visit -
https://www.manipalcigna.com/locate-us
Registered Contact XXXXXX6063
details [email protected] HOW TO SUBMIT CLAIM?
Premium Paymet
Single For hassle free claims experience, we have simplified our
Frequency claims process. Here's how it works,
ManipalCigna Health 360 - Shield,Cumulative Bonus,Worldwide Medical
Add on For Claims Assistance(Within India)
Emergency Hospitalization
Pre Existing Disease Track Claims @
Yes - Refer ‘Insured Persons Details’ section in Policy Schedule
Declared manipalcigna.com/claims/track-claim
OR Download myManipalCigna App
Claims Contact: 040-68178534

Claims Email: [email protected]

For Claims Assistance (outside India)

globalclaims.mchi@europ-
Email:
assistance.in
From USA: 18338768843
From Greece: 0080016122039998
80033883333 /
From Rest of the world:
+912267872036

WAITING PERIOD IN YOUR POLICY*

Particulars Details
Initial Waiting Period 30 days from the inception date of the Policy (Except accident and for renewal policies without break)
M (PED) Waiting period
Pre Existing Disease Covered after 24 months of continuous coverage

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
Specific Waiting Period 24 months since inception of first policy with us
Permanent Exclusions As mentioned in Policy Wording
We offer you a 15 days free-look period. Please read your policy schedule and policy wording for
Free-look Period:
the full terms and conditions relating to the benefits
* For rollover / portability policy continuous coverage will be considered from first policy inception date with us or other insurer (as applicable)
Note: The product is available to all Insured Persons, provided they are Indian resident at inception of the Policy and at subsequent renewals. An individual is
said to be resident of India, if he is in India for a period or periods amounting in all to 182 days or more, in the immediate preceding 365 days.*For details refer
“Area of Cover” section in the Policy Terms and Conditions.**Global coverages under Global Plan are applicable only for the selected Major Illnesses, as
opted.For details on the list of 27 Major Illnesses offered under Global Plan, please refer the Policy Terms and Conditions.

2/26
 For & On Behalf of ManipalCigna Health Insurance Company Limited

3/26
ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
 LIFETM0500257
Yes

Yes
Your Health Card:

Yes

POLICY NUMBER : LIFETM050025731

CLAIM 0406-817-8534 [email protected]
VALID FROM : 26-MAR-2024 SERVICE 1800-102-4462 [email protected]

INSURED NAME DOB

www.manipalcigna.com
Sumit Choudhary 08-MAY-1985

ManipalCigna Heath Insurance Company Limited

Neha Choudhary 26-AUG-1986 (Formly known as CignaTTK Health Insurance Company Limited)
CIN: U66000MH2012PLC227948, IRDAI No. 151
Saanika Choudhary 16-JAN-2014

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223

4/26
 ManipalCigna Lifetime Health

POLICY SCHEDULE
LI

Policy Issuing Office: Policy Servicing Office:

ManipalCigna Health Insurance Company Limited (Formerly ManipalCigna Health Insurance Company Limited, 32-B, Pusa
Fami
known as Cigna TTK Health Insurance Company Limited), Road, Rajinder Nagar, Opp. Pillar no. 122 of Metro station,
Reg. Office: 401/ 402, 4th Floor, Raheja Titanium, Western Karol Bagh, New Delhi - 110005 Ph : 011 47554300
Express Highway Goregaon (East), Mumbai - 400 063 Ph :
022-61703600

Intermediary Name: MEERA CHOUDHARY

Code: 1085231-01 Contact Numbers: 8708445529
NO

POLICYHOLDER DETAILS :
Name: Sumit Choudhary Customer ID: 1002135887

Address: S.O Subhash Chand Choudhary Amar Kala Sadan Shiv Colony Opp. Panchayat Mahendragarh 123001 Haryana

Telephone
(R) - (O) - (M) - XXXXXX6063
number(s):
Email ID: [email protected]

POLICY DETAILS :
Plan: India Plan Policy Number: LIFETM050025731

Policy Period: Inception Date: From: 00:01 hrs on 26-MAR-2024 Expiry date: To: 23:59 hrs on 25-MAR-2025 Tenure (in years): 1

Policy Type: Family Floater Portable Case: Yes

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
Premium Payment Mode: Single Policy Category: Renewal_01

Subscribed to
important alert on Yes Migrated case: No
WhatsApp :

Pre-Existing Disease Waiting Period: Covered after 24 months of continuous coverage.

INSURED PERSON'S DETAILS:

Pre-
Name Of The Relationship Completed existing #Sum Cummula
Sr. Date of Date of Customer Occupatio
Insured With Gender Age In Disease/ Deductible Insured^ tive
No. Inception Birth ID n
Person(s) Policyholder years Illnes / 1 Bonus
Condition
Neha 26-AUG- 100213577
1 22-MAR-2023 Wife Female 37 Nil Any Other
Choudhary 1986 0
Saanika 16-JAN- 100213577
2 22-MAR-2023 Daughter Female 10 Nil Any Other
Choudhary 2014 1
Diabetes
mellitus ( 0 5000000 0
SELF- E10-E14
Sumit 08-MAY- 100213588 Private
3 22-MAR-2023 PRIMARY Male 38 ),Epilepsy (
Choudhary 1985 7 Service
MEMBER G40
),Depressio
n ( F32.10 )

#Sum Insured^1 - Domestic Coverage within India due to any illness or injury.
#Sum Insured - Worldwide Medical Emergency Hospitalization - Global coverage for outside India within the opted Area of Cover for Medical
Emergency arising due to any illness/injury.

5/26
ADDRESS OF THE INSURED:
Insured ID Insured Address

S.O SUBHASH CHAND CHOUDHARY AMAR KALA SADAN SHIV COLONY OPP. PANCHAYAT Mahendragarh
1002135887
Haryana 123001

NOMINEE DETAILS:
Nominee Name: Neha Choudhary Relationship with proposer: Wife

CAREGIVER DETAILS:-
Caregiver name : Relationship with proposer :

Mobile number : Email ID :

FAMILY PHYSICIAN DETAILS:-

Family Physician name : NA Address :

Mobile number : Email ID :

PREVIOUS INSURANCE DETAILS:

Break up of
Total Ported
Previous Ported Sum Cumulative
Name of Insured Date of first Previous Type of Sum Insured Waiting period
Policy Insured chosen Bonus from
Person enrollment Insurer Cover from Pevious waived off
Number under Lifetime Previous Policy
Policy
Health
Care Health
NEHA CHOUDHARY 22-MAR-2022 40053268 MEDICLAIM 5000000 5000000 1 YEARS 0
Insurance
Care Health
SAANIKA CHOUDHARY 22-MAR-2022 40053268 MEDICLAIM 5000000 5000000 1 YEARS 0
Insurance
Care Health
SUMIT CHOUDHARY 22-MAR-2022 40053268 MEDICLAIM 5000000 5000000 1 YEARS 0
Insurance

BENEFITS UNDER THE POLICY:

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
India Plan

Cover Name Coverage

For coverage in India (Domestic coverage)

Hospital expenses, for admission longer than 24 hours, up to the full Sum Insured, where hospitalization is in India.
Hospitalisation Expenses - For Sum Insured up to INR 200 Lacs - Covered up to any room except suite or higher category.
- For Sum Insured INR 300 Lacs – Covered up to any room including suite category

Day Care Treatment All Day Care Treatments, availed in India, covered up to full Sum Insured.

Pre - hospitalization Medical Expenses incurred in India, covered up to 60 days preceding the date of Hospitalization and up to the full Sum Insured.

Medical Expenses incurred in India, covered up to 180 days immediately after discharge from the hospital and up to full Sum
Post - hospitalization
Insured.

Inpatient Hospitalisation for

Covered up to full Sum Insured for treatment availed in India
AYUSH

Road Ambulance Cover Expense incurred on availing Road Ambulance services in India, up to full Sum Insured.

Donor Expenses Covered up to full Sum Insured for expenses incurred in India.

Domiciliary Expenses Covered up to 10% of Sum Insured for expenses incurred in India.

Available once in a policy year to all Insured Persons who have completed 18 years of Age at the inception of the Policy Year.
Adult Health Check-up
Health check-up will be conducted at our Network in India, as per the list specified under the Policy.

Robotic and Cyber Knife

Covered up to full Sum Insured for treatment availed in India.
Surgery

Modern and Advanced

Covered up to full Sum Insured for treatment availed in India.
Treatments

HIV/AIDS and STD Cover Covered up to full Sum Insured for expenses incurred in India.

Mental Care Cover Covered up to full Sum Insured for treatment availed in India.

6/26
 Multiple Restoration is available in a Policy Year, for unrelated illnesses, in addition to the Sum Insured opted. The restored amount
Restoration of Sum Insured
will be available for claim towards expenses covered in India only.

Renewal Premium for one Policy Year will be paid by Us, if the Proposer is diagnosed with any of the listed Critical Illnesses or in
Premium Waiver Benefit case of Accidental Death, Permanent Total Disablement, Permanent Partial Disablement of the Proposer, provided the Proposer is
also an Insured Person in the same Policy.

Add On Cover
ManipalCigna Health 360 - Shield Coverage for listed Non-medical items and Durable Medical equipment within the base policy Sum Insured

ManipalCigna Lifetime Plus - Cumulative Guaranteed Cumulative Bonus of 15% of Sum Insured1, which is applicable for coverages within India, at the end
Bonus of the Policy Year if the Policy is renewed with us without any break. There is no maximum limit on accumulation.

Coverage for medical expenses worldwide (within selected area of cover) in case of medical emergency leading to
ManipalCigna Lifetime Plus - Worldwide
inpatient hospitalization or day care. Coverage also includes, Global Post Hospitalization, Global Road & Air
Medical Emergency Hospitalization
Ambulance

Area of Cover option (for coverage outside

WORLDWIDE
India)

Coverage under Worldwide Medical Emergency Hospitalization

Covers hospital expenses for admission longer than 24 hours for emergency treatment availed outside India,
Global Hospitalization
within the selected Area of Cover.

Covers Day Care Treatment Day Care Treatments for emergency availed outside India, within the selected Area of
Global Day Care Treatment
Cover.

Covers expenses incurred on availing Road Ambulance, in case of an emergency outside India within the selected
Global Road Ambulance Cover
Area of Cover.

Cover is available up to the full Sum Insured up to 30 days post discharge from the hospital for emergency
Global Post Hospitalization
treatment availed outside India within the selected Area of Cover.

Covers expenses incurred on availing Air Ambulance, in case of an emergency outside India within the selected
Air Ambulance
Area of Cover

IN THE EVENT OF A CLAIM:

Address for correspondence for Medi Assist Insurance TPA Pvt. Ltd. Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bengaluru -
Hospitalisation expenses :- 560029 OR Nearest ManipalCigna Health Insurance Branch.

24*7 HealthLine No: Call (Toll Free): 0406-817-8534 E-mail ID: [email protected]

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
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)
21735.00 2934.23 0.00 0.00 4440.46 0.0 29109.69

PAN No.: AAECC7904J

The stamp duty of Rs. 1 paid vide receipt no, LOA/ENF-1/CSD/26/2023/07/12/2023to30/11/2028/5071 dated 12-DEC-2023 . Government Notification Revenue and
Forest Department No. Mudrank 2004/4125/CR/690/M-1, dated 31/12/2004

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 [email protected] 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
[email protected] or call at +91 2261703600.

Special Condition:

7/26
Sumit Choudhary - Life time waiting period is applicable for Epilepsy (G40). The above mentioned waiting period is from the date of inception of policy for MR
SUMIT CHOUDHARY.

In witness, where of this Policy has been signed at Mumbai on 26-MAR-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 Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223

8/26
 Premium Certificate

For the purpose of deduction under section 80D of Income Tax Act, 1961 and any amendments made thereafter*.

This is to certify that MR. SUMIT CHOUDHARY has paid the premium of

₹29,109.69 (in words) Twenty Nine Thousand One Hundred and Nine and Sixty Nine paise only for the period

26/03/2024 to 25/03/2025 towards Premium for Health Insurance policy for term of One Year policy.

Policy
Number LIFETM050025731

Receipt Receipt Payment

R003145919 Date 26/03/2024 29,109.69 DIRECTDEBIT
Number Amount Mode

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
* Note:
1. For your eligibility and deductions please refer to provisions of Income Tax Act, 1961 as modified and/or consult your tax
consultant.
2. Any amount paid in cash towards premium will not qualify for tax benefits.
3. In case of dishonour of premium instrument, the policy will be deemed cancelled ab initio.
4. Deduction under section 80D shall not be allowed if the premium is paid by third party (other than proposed/insured) under
this policy.
5. This certificate must be surrendered to us in case of cancellation of Policy or for issuance of fresh certificate in case of any
alteration in the insurance affecting the premium.

Yours Sincerely,
ManipalCigna Health Insurance Company Limited

(Formerly known as CignaTTK Health Insurance Company Limited)

‘This is a system generated communication and does not require signature’.

Date: 27/03/2024
Location: Mumbai

ManipalCigna Lifetime Health MCIHLIP21559V012021 LIFETM050025731

Stamp Duty has been paid vide receipt no LOA No.CSD/111/2023/28/08/2023 to 28/08/2028/3581 dated 28th August 2023
9/26
 LIF ManipalCigna Lifetime Health
CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

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 to applicable Clause Number in next column) Number
Name of Insurance ManipalCigna Lifetime Health - India Plan
1 Family Floater
Product/Policy
2 Policy Number LIFETM050025731
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)

Neha Choudhary
Saanika Choudhary 5000000
Sumit Choudhary

5 Policy Coverage 1. Hospitalization Expenses D.II.1

(What the policy Hospital expenses, for admission longer than 24 hours, up to the full
covers?) Sum Insured, where hospitalization is in India.
- For Sum Insured up to INR 200 Lacs - Covered up to any room
except suite or higher category.
- For Sum Insured INR 300 Lacs - Covered up to any room including
suite category.
2. Day Care Treatment D.II.2

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
All Day Care Treatments, availed in India, covered up to the full Sum
Insured.
3. Pre - hospitalization D.II.3
Medical Expenses incurred in India, covered up to 60 days preceding
the date of Hospitalization and up to the full Sum Insured.
4. Post - hospitalization D.II.4
Medical Expenses incurred in India, covered up to 180 days
immediately after discharge from the hospital and up to full Sum
Insured.
5. Inpatient Hospitalization for AYUSH D.II.5
Up to full Sum Insured, for treatment availed in India.
6. Road Ambulance Cover D.II.6
Expense incurred on availing Road Ambulance services in India, up to
full Sum Insured.
7. Donor Expenses D.II.7
Up to full Sum Insured, for expenses incurred in India.
8. Domiciliary Expenses D.II.8
Up to 10% of Sum Insured, for expenses incurred in India.
9. Adult Health Check-up D.II.9
Available once in a Policy Year to all Insured Persons who have
completed 18 years of Age or more at the inception of the Policy Year.
Health check-up will be conducted at our Network in India, as per the
list specified under the Policy.
10. Robotic and Cyber Knife Surgery D.II.10
Up to full Sum Insured, for treatment availed in India.
D.II.11
10/26
 11. Modern and Advanced Treatments
Up to full Sum Insured, for treatment availed in India. For complete list
of Modern and Advanced Treatments, please refer policy wordings.
12. HIV/AIDS and STD Cover D.II.12
Expenses incurred in India up to full Sum Insured
13. Mental Care Cover D.II.13
Up to full Sum Insured, for treatment availed in India.
14. Restoration of Sum Insured D.II.14
Multiple Restoration is available in a Policy Year, for unrelated
illnesses, in addition to the Sum Insured opted. The restored amount
will be available for claim towards expenses covered in India only.
15. Premium Waiver Benefit D.II.15
Renewal Premium for one Policy Year will be paid by Us, if the
Proposer is diagnosed with any of the listed Critical Illnesses or in
case of Accidental Death, Permanent Total Disablement, Permanent
Partial Disablement of the Proposer, provided the Proposer is also an
Insured Person in the same Policy.

Optional Packages
This section lists the optional packages, available under the product and
limits for each of these options.
Please note:Any cover under a package (Health+, Women+ or Global+)
cannot be opted on a standalone basis, however, can only be opted as a
package. Selection of this package is allowed at Policy level only.
I. Health+ (Applicable only if opted)
· Each benefit is available on Individual Basis.
· Sum Insured/ limits specified under Health+ is over and above that of
Base Plan (India Plan, as opted).
1. Air Ambulance Cover D.III.1.i
Expenses incurred on availing Air Ambulance services in India, in
case of an Emergency. Cover is available up to INR 10 Lacs and
maximum one event per Policy Year.
2. Medical Devices and Non-Medical Items D.III.1.ii
Expenses towards medical devices and non - medical items (listed

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
under the policy) incurred in India. The cover is available up to INR 2
Lacs and once in 3 Policy Years. One or more claims of Medically
Prescribed medical device/s will be payable if that is related to one
Hospitalization
3. Domestic Second Opinion D.III.1.iii
Medical second opinion available in India, for Major Illnesses (listed
under the Policy). Opinion can be sought once during a Policy Year
for one illness and multiple times for different Major Illness/es.
4. Bariatric Surgery Cover D.III.1.iv
Expenses incurred in India towards Bariatric Surgery is covered up to
INR 5 Lacs under below conditions.
i. BMI of at least 32.5 with co-morbidities or
ii. BMI equivalent to 37 and above without any co-morbidity
A waiting period of 2 years, since inception of the benefit under the
Policy, shall be applicable.

5. Convalescence Benefit D.III.1.v

On consecutive Hospitalization for 10 days or more in India, an
amount of INR 50,000 will be paid as a lumpsum.
6. Major Illness Hospi Cash D.III.1.vi
A daily cash benefit of INR 2,500 is paid on every completed 24 hours
of Hospitalization of an Insured Person, provided the Hospitalization is
towards treatment of a Major Illness (as specified in the Policy) in
India.
The benefit is payable maximum up to 10 days per Hospitalization.

11/26
 7. Chemotherapy and Radiotherapy Cash D.III.1.vii
The benefit is payable maximum up to 12 sittings per Policy Year.
8. Accidental Hospi Cash D.III.1.viii
A daily cash benefit of INR 2,500 is paid on every completed 24 hours
of Hospitalization of an Insured Person in India, provided the
Hospitalization is towards treatment of an Injury due to an Accident.
The benefit is payable maximum up to 10 days per Hospitalization.
9. Domestic Concierge Services D.III.1.ix
For Hospitalization in India, assistance services shall be offered to the
Insured Person, subject to event being covered under the Policy. The
benefit is available once in a Policy Year.
10. Tele-Consultations D.III.1.x
Medical consultations will be available at Our Network in India through
tele/chat mode.
II. Women+ (Applicable only if opted)
· Available to female of age 12 years and above.
· Each benefit is available on Individual Basis.
· Sum Insured/ limits specified under the Women+ is over and above
that of Base Plan (India Plan, as opted).
1. Breast Cancer Screening D.III.2.i
Mammogram test, once in Policy Year for each Insured Person
covered under this benefit, at Our Network in India.
2. Cervical Cancer Screening D.III.2.ii
PAP Smear test, once in a Policy Year for each Insured Person
covered under this benefit, at Our Network in India.
3. Cervical Cancer Vaccination D.III.2.iii
Cervical cancer vaccination availed in India with a per dose limit of
INR 2,500, for each Insured Person covered under this benefit.
4. Ovarian Cancer Screening D.III.2.iv
Ultrasound and CA-125 test, once in a Policy Year for each Insured
Person covered under this benefit, at Our Network in India.
5. Osteoporosis Screening D.III.2.vi
DEXA Scan, once in a Policy Year for each Insured Person covered
under this benefit, at Our Network in India.

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
6. Gynaecological Consultations D.III.2.vi
15 outpatient gynecological related consultations in a Policy Year for
each Insured Person covered under this benefit, at Our Network in
India.
7. Psychiatric and Psychological Consultations D.III.2.vii
5 psychiatric consultations and psychotherapy sessions in a Policy
Year for each Insured Person covered under this benefit, at Our
Network in India.
Add on cover (Rider) (Applicable only if opted)
1. Critical Illness Add on (UIN: MCIHLIP21128V022021):
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 Add on policy
Insured and Durable Medical Equipment up to maximum of Rs.1 wordings
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
Package 1: Get cover for doctor consultations on cashless basis
within the OPD Sum Insured Package
12/26
 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 Lifetime Plus Add-on (UIN: MCIHLIA24148V012324):
a) ManipalCigna Lifetime Plus - Maternity Expenses
Coverage up to Rs 1 Lac towards expenses for delivery,
treatment of the new born baby and first year vaccinations to new
born. Available up to 2 deliveries in the lifetime and even
medically necessary termination of pregnancy is covered. In
addition coverage for expenses of the eligible Insured Person if
hospitalized on the advice of the Medical Practitioner for Infertility
Treatments up to maximum of Rs.2.5 lacs which is over and
above the maternity Sum Insured if selected as an optional cover.
b) ManipalCigna Lifetime Plus - Surrogacy Cover
Coverage towards the medical expenses up to Rs. 1 Lac for a
Surrogate Mother, in case of a medically necessary
hospitalization for complication arising out of pregnancy & post-
partum delivery.
c) ManipalCigna Lifetime Plus - Oocyte Donor Cover
Coverage towards the medical expenses up to Rs. 1 Lac for an
Oocyte Donor, in case of a medically necessary hospitalization
for any complication arising due to Oocyte retrieval of donor.
d) ManipalCigna Lifetime Plus - Cumulative Bonus
Guaranteed Cumulative Bonus of 15% of Sum Insured1, which is
applicable for coverages within India, at the end of the Policy
Year if the Policy is renewed with us without any break. There is
no maximum limit on accumulation.
e) ManipalCigna Lifetime Plus - Worldwide Medical Emergency
Hospitalization
Coverage for medical expenses worldwide (within selected area
of cover) in case of medical emergency leading to inpatient
hospitalization or day care. Coverage also includes, Global Post
Hospitalization, Global Road & Air Ambulance.

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
6 Exclusions (What 1. Investigation & Evaluation- Code- Excl 04
the policy does not 2. Rest Cure, rehabilitation and respite care- Code- Excl 05
cover) 3. Obesity/ Weight Control: Code- Excl 06
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- Excl10
8. Excluded Providers: Code- Excl 11
9. Treatment for, Alcoholism, drug or substance abuse or any addictive
condition and consequences thereof. Code- Excl 12
10. Treatments received in heath hydros, nature cure clinics, spas or
similar establishments Code- Excl13
11. Dietary supplements and substances that can be purchased without E.I.4 to E.I.18
prescription, including but not limited to Vitamins, minerals and And
organic substances. Code- Excl 14 E.II.2 to E.II.11
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. External Congenital Anomaly or defects or any complications or
conditions arising therefrom
17. Circumcision unless necessary for Treatment of an Illness or Injury
not excluded hereunder or due to an Accident.
18. Prostheses, corrective devices and/or Medical Appliances, which are
not required intra- operatively for the Illness/ Injury for which the
Insured Person was Hospitalised, unless opted.
19. Treatment received outside India.
13/26
 20. All 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.
21. All expenses caused by or arising from war or war-like situation 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.
22. Annexure III, list I of “Non-Payable Items”.
23. Any form of Non-Allopathic Treatment, except Inpatient for AYUSH.
24. Existing diseases disclosed by the Insured Person (Limited to the
extent of 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.
25. Any stay in Hospital without undertaking any treatment
7 Waiting Period a. Initial Waiting Period: 30 days for all illnesses (not applicable in E.I.1 to E.I.3,
· Time period case of continuous renewal or accidents). E.II.1
during which and
specified D.III.1.iv
b. Specific Waiting Period (Not Applicable on claim arising due to
disease/treatment accidents):
are not covered. 24 Months for following diseases:
· It is counted from i. Cataract,
the beginning of the ii. Hysterectomy for Menorrhagia or Fibromyoma or prolapse of
policy coverage Uterus unless necessitated by malignancy myomectomy for
fibroids,
iii. Knee Replacement Surgery (other than caused by an Accident),
Non-infectious Arthritis, Gout, Rheumatism, Osteoarthritis and

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
Osteoporosis, Joint Replacement Surgery (other than caused by
Accident), Prolapse of Intervertebral discs(other than caused by
Accident), all Vertebrae 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,

x. Any surgery of the genito-urinary system unless necessitated by

malignancy.
c. Pre-existing Disease: Covered after 24 Months

14/26
 d. Personal Waiting Period: A special Waiting Period not exceeding 48
months, may be applied to individual Insured Persons for the list of
acceptable Medical Ailments listed under the 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.
e. Bariatric Surgery Cover: Covered after 24 months
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 2. In case of claim, this policy requires you to share the following sub
pre-defined limit limits: Expense exceeding Sub-limits -
and the
insurance For India Cover only
company will not
pay any amount
· Room/ICU Charges beyond- No Limit
o For Sum Insured up to INR 200 Lacs - Covered up to any
in excess of this D.II.1
room
limit
except suite or higher category.
o For Sum Insured INR 300 Lacs - Covered up to any room
including suite category.
· For the following specified disease
o No sublimit on any disease.
· Co-payment (it is
a specified 3. Co-Payment - Not Applicable
amount/percenta
ge of admissible
claim amount to 4. Deductible
be paid by
policyholder/ Deductible of Rs. 0 per policy year on aggregate basis.
insured).

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
· Deductible (It is
specified
amount: - up to
which and
insurance
company will not
pay any claim,
and - which will
be deducted
from total claim
amount (if claim
amount is more
than specified
amount)
Any other limit
(as applicable)
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:

To know the process for our cashless and reimbursement claims visit

https://www.manipalcigna.com/claims

Turn Around Time (TAT) for claim settlement

i. TAT for pre-authorization of cashless facility - within 4 hours from the
last complete document.

15/26
 ii. TAT for cashless final bill settlement - within 4 hours from the last
complete document
Web links for the followings:
i. Network hospital details - https://www.manipalcigna.com/locate-us
ii. Helpline Number - https://www.manipalcigna.com/claims
iii. Hospital which are blacklisted or from where no claims will be
accepted by insurer -https://www.manipalcigna.com/locate-us
iv. Link for downloading claim form -
https://www.manipalcigna.com/downloads/claims
10 Policy Servicing For hassle free policy servicing customer can manage their policy by
clicking on https://eservicing.manipalcigna.com/login F.I.15
or Download myManipalCigna App from Playstore or appstore
11 Grievances/Compla Level 1
ints Health Relationship Managers
Call our toll-free number 1800-102-4462 between 9:00 AM to 9:00 PM.
Email us at [email protected]
For Senior Citizen Assistance [email protected]
LEVEL 2
Senior Manager - Grievance Cell
Call us on 022-61703600 between 10 am to 6 Pm (Monday to Friday)
Email us at [email protected]

LEVEL 3
Grievance Redressal Officer
Call us on 022-61703603 between 10 am to 6 Pm (Monday to Friday) G.II
Email us at [email protected]
For Senior Citizen Assistance [email protected]

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
https://www.cioins.co.in/Ombudsman

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
Note: You may also approach the Insurance ombudsman if your
complaint is open for more than 30 days at any of the above levels

16/26
12 Things to Free Look Cancellations: The Free Look period shall be applicable on F.I.7
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 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. 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
[email protected] 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.11

grounds of fraud, misrepresentation by the insured person.

Migration: The Insured Person will have the option to migrate the Policy F.I.9
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 [email protected] 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

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
assistance

Portability: The Insured Person will have the option to port the Policy to F.I.13
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 [email protected] 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

17/26
 Change in Sum Insured: It will be allowed at the time of Renewal of the F.II.14.f
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 eight continuous years under the F.I.4
policy no look back would be applied. This period of eight years is called
as moratorium period. The moratorium would be applicable for the sums
insured of the first policy and subsequently completion of 8 continuous
years 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.
· 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 https://eservicing.manipalcigna.com/document-
vault

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
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).

18/26
 Annexure to CIS - Benefit Illustration
Indian Plan
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, Optional Cover, Premium payment mode and Add
On Benefits opted. Additionally the health status of the individual will also be considered.

2A
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (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 (�)

20 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 `13,835 NA `13,835 `50,00,000

18 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 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 is `17,362.1 when they are covered under a single is `13,835.
`20,426 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Premium or Floater Premium Sum Insured
(�) (�) (�) if any after Insured (�) Consolidated Discount, after (�)
discount (�) premium for if any discount
all members (�)
of family (�)
30 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 `13,835 NA `13,835 `50,00,000

25 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 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 is `17,362.1 when they are covered under a single is `13,835.
`20,426 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

19/26
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum Insured
(�) (�) (�) if any after (�) Consolidated Discount, after (�)
discount premium for if any discount
(�) all members (�)
of family (�)

40 `10,931 `50,00,000 `10,931 `1,639.65 `9,291.35 `50,00,000 `16,167 NA `16,167 `50,00,000

35 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 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 `17,972.4 when they are covered under a single is `16,167.
is `21,114 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum Insured
(�) (�) (�) if any after (�) Consolidated Discount, after (�)
discount (�) premium for if any discount
all members (�)
of family (�)
50 `17,256 `50,00,000 `17,256 `2,588.40 `14,667.60 `50,00,000 `29,564 NA `12,761 `50,00,000

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
45 `10,931 `50,00,000 `10,931 `1,639.65 `9,291.35 `50,00,000 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 `23,958.95 when they are covered under a single is `29,564.
is `28,187 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (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 (�)

60 `28,831 `50,00,000 `28,831 `4,324.65 `24,506.35 `50,00,000 `49,815 NA `49,815 `5,00,000

55 `21,756 `50,00,000 `21,756 `3,263.40 `18,492.60 `50,00,000 NA

20/26
 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 `42,998.95 when they are covered under a single is `49,815.
is `50,587 when each policy. Sum Insured of `5,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `5,00,000.
Sum Insured available
for each individual is
`5,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (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 (�)

65 `36,713 `50,00,000 `36,713 `5,506.95 `31,206.05 `50,00,000 `63,289 NA `63,289 `50,00,000

60 `28,831 `50,00,000 `28,831 `4,324.65 `24,506.35 `50,00,000 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 `55,712.4 when they are covered under a single is `63,289.
is `65,544 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
separately (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 (�)

70 `39,960 `50,00,000 `39,960 `5,994 `33,966 `50,00,000 `68,893 NA `68,893 `50,00,000

65 `36,713 `50,00,000 `36,713 `5,506.95 `31,206.05 `50,00,000 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 `65,712.05 when they are covered under a single is `68,893.
is `76,673 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

21/26
 2A+ 2C
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum Insured
(�) (�) (�) if any after (�) Consolidated Discount, after (�)
discount premium for if any discount
(�) all members (�)
of family (�)
20 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 `24,165 NA `24,165 `50,00,000

19 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

1 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 NA

1 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 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 `28,350.9 when they are covered under a single is `24,165.
is `33,354 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
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 (�)

30 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 `24,165 NA `24,165 `50,00,000

25 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

3 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 NA

2 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 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 `28,350.9 when they are covered under a single is `24,165.
is `33,354 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

22/26
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum Insured
(�) (�) (�) if any after (�) Consolidated Discount, after (�)
discount (�) premium for if any discount
all members (�)
of family (�)

40 `10,931 `50,00,000 `10,931 `1,639.65 `9,291.35 `50,00,000 `27,300 NA `27,300 `50,00,000

35 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

5 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 NA

4 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 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 `28,961.20 when they are covered under a single is `27,300.
is `34,072 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, Premium Sum Insured Premium or Floater Premium Sum Insured
(�) (�) (�) if any after (�) Consolidated Discount, after (�)
discount premium for if any discount

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
(�) all members (�)
of family (�)

50 `17,256 `50,00,000 `17,256 `2,588.40 `14,667.60 `50,00,000 `41,665 NA `41,665 `50,00,000

45 `10,931 `50,00,000 `10,931 `1,639.65 `9,291.35 `50,00,000 NA

15 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 NA

10 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 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 `34,947.75 when they are covered under a single is `41,665.
is `41,115 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

23/26
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (at a single
point in time)
Premium Sum Insured Premium Discount, if Premium Sum Insured Premium or Floater Premium Sum
(�) (�) (�) any after (�) Consolidated Discount, after Insured (�)
discount premium for if any discount
(�) all members (�)
of family (�)
60 `28,831 `50,00,000 `28,831 `4,324.65 `24,506.35 `50,00,000 `63,893 NA `63,893 `50,00,000

55 `21,756 `50,00,000 `21,756 `3,263.40 `18,492.60 `50,00,000 NA

20 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

15 `6,464 `50,00,000 `6,464 `969.60 `5,494.40 `50,00,000 NA

Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater
members of the family `57,174.40 when they are covered under a single basis is `63,893.
is `67,264 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (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

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
(�) all members (�)
of family (�)

65 `36,713 `50,00,000 `36,713 `5,506.95 `31,206.05 `50,00,000 `77,593 NA `77,593 `50,00,000

60 `28,831 `50,00,000 `28,831 `4,324.65 `24,506.35 `50,00,000 NA

23 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

20 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater
members of the family `73,074.50 when they are covered under a single basis is `77,593.
is `85,970 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

24/26
Age Coverage opted Coverage opted on Individual basis covering Coverage opted on family floater basis with
of the on Individual basis multiple members of the family under a single overall sum insured (Only one sum insured is
members covering each policy (Sum Insured is available for each available for entire family)
insured member of the family member of the family)
separately (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 (�)

70 `39,960 `50,00,000 `39,960 `5,994 `33,966 `50,00,000 `83,482 NA `83,482 `50,00,000

60 `36,713 `50,00,000 `36,713 `5,506.95 `31,206.05 `50,00,000 NA

23 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

20 `10,213 `50,00,000 `10,213 `1,531.95 `8,681.05 `50,00,000 NA

Total Premium for all Total Premium for all members of the family is Total Premium when policy is opted on floater
members of the family `82,534.15 when they are covered under a single basis is `83,482.
is `97,099 when each policy. Sum Insured of `50,00,000 available for the entire
member is covered Sum Insured available for each family member is family.
separately. `50,00,000.
Sum Insured available
for each individual is
`50,00,000.

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223

ManipalCigna Lifetime Health UIN: MCIHLIP21559V012021

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.

25/26
 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)

ManipalCigna Lifetime Health | UIN: MCIHLIP21559V012021 ManipalCigna Health 360 | UIN: MCIHLIA23023V012223
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 address-www.manipalcigna.com | 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 |
26/26