MANIPALCIGNA PROHEALTH PRIME

CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY

This document provides key information about your policy. You are also advised to go
through your policy document.

Policy
SI Description
Title Clause
No. (Please refer the Policy Clause Number in next column)
Number
Name of
1 Insurance ManipalCigna ProHealth Prime - Advantage
Product/Policy
2 Policy Number xxxxxxxx
• Both indemnity and Benefit (Where the policy has
elements of both)
Type of
Indemnity - Where insured losses are covered up to Sum
3 Insurance
Insured under the policy.
Product/Policy
Benefit - Where the Insurance Policy pays a fixed amount
under the policy on the occurrence of a covered event.

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
• Individual Sum Insured - Where each insured member has
a separate sum insured the policy,
Insured Name Sum Insured (in A)
<Insured Name 1> xxxxx
<Insured Name 2> xxxxx
<Insured Name 3> xxxxx

Or
• Floater Sum Insured - Where all members under the policy
have a single sum insured limit which may be utilized by any
or all members.
Sum Insured Insured Name Sum Insured (in A)
(Basis) <Insured Name 1>
4
(Along with
amount) <Insured Name 2> xxxxx
<Insured Name 3>

Sum Insured under Outpatient Expenses

• Individual Sum Insured - Where each insured member has a
separate sum insured the policy),
Insured Name Sum Insured (in A)
<Insured Name 1> xxxxx
<Insured Name 2> xxxxx
<Insured Name 3> xxxxx

Or
 • Floater Sum Insured - Where all members under the policy
have a single sum insured limit which may be utilized by any
or all members,
Insured Name Sum Insured (in A)
<Insured Name 1>
<Insured Name 2> xxxxx
<Insured Name 3>

1. In-patient Hospitalization (When you are hospitalized)

• Room Rent: Covered up to Single Private AC Room D.I.1
• For ICU - Covered up to Sum Insured
This benefit shall also offer the below covers up to the limits
mentioned:
a. Listed Modern and Advanced Treatments:
For Sum Insured < A5 Lacs: Up to 50% of Sum Insured
For Sum Insured >= A5 Lacs: Up to Sum Insured
b. HIV/AIDS & STD: Up to Sum Insured
c. Mental Illness: Up to Sum Insured
For below mentioned ICD Codes: Waiting Period of 24 months

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
shall apply.
ICD 10
DISEASES
CODES
F05 Delirium due to known physiological condition
Other mental disorders due to known physiological
F06
condition
Personality and behavioural disorders due to known
F07
physiological condition
Policy F10 Alcohol related disorders
Coverages
5 F20 Schizophrenia
(What the policy
covers?) F23 Brief psychotic disorders
F25 Schizoaffective disorders
Unspecified psychosis not due to a substance or
F29
known physiological condition
F31 Bipolar disorder
F32 Depressive episode
F39 Unspecified mood [affective] disorder
F40 Phobic Anxiety disorders
F41 Other Anxiety disorders
F42 Obsessive-compulsive disorder
F44 Dissociative and conversion disorders
F45 Somatoform disorders
F48 Other nonpsychotic mental disorders
F60 Specific personality disorders
F84 Pervasive developmental disorders
F90 Attention-deficit hyperactivity disorders
F99 Mental disorder, not otherwise specified
2. Pre - hospitalization
Medical Expenses Covered up to 60 days before the date D.I.2
of hospitalization; Covered upto the Sum Insured
3. Post - hospitalization
Medical Expenses Covered up to 180 days post discharge D.I.3
from the hospital; Covered upto the Sum Insured
4. Day Care Treatment D.I.4
Covered up to the Sum Insured
5. Domiciliary Hospitalization (Treatment at Home) D.I.5
Covered up to 10% of the Sum Insured
Pre and Post Hospitalization Expenses: 30 days each
6. Road Ambulance (Reimbursement of Ambulance
Expenses) D.I.6
Covered up to the Sum Insured
7. Donor Expenses (Hospitalization Expenses of the D.I.7
donor providing the organ)
Covered up to the Sum Insured
• Pre & Post Hospitalization expenses (Up to 30 days each)
of the donor
• Cost towards donor screening once in a Policy year for
successful transplant

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
• Complications arising during hospitalization or up to 30
days from date of discharge – Covered Up to 25% of Sum
Insured subject to maximum of Rs.2 Lacs, Over and above
Sum Insured.
We will not cover expenses towards the Donor in respect
of cost associated to the acquisition of the organ.
8. Restoration of Sum Insured (When opted Sum Insured D.I.8
is insufficient due to claims)
Multiple Restoration is available in a Policy Year for all
illnesses whether unrelated or same, in addition to the Sum
Insured
Applicable for below covers only
D.I.1 - In-patient Hospitalization (Except for Bariatric Surgery)
D.I.2 - Pre - hospitalization
D.I.3 - Post - hospitalization
D.I.4 - Day Care Treatment
D.I.6 - Road Ambulance
D.I.7 - Donor Expenses
D.I.9 - AYUSH Treatment
D.IV.1 - Non-Medical Items
Restoration shall not get triggered for the 1st claim
The maximum liability under a single claim shall not be
more than Base Sum Insured + Cumulative Bonus +
Restored Sum Insured
9. AYUSH Treatment D.I.9
Covered up to the Sum Insured
10. Air Ambulance Cover D.I.10
Covered up to Sum Insured subject to maximum of A10
Lacs in addition to the Sum Insured for expenses incurred
on Air Ambulance
11. Bariatric Surgery Cover D.I.11
Covered up to the Sum Insured subject to maximum of
A5 Lacs
Waiting Period of 36 months shall apply for Bariatric
Surgery
12. Outpatient Expenses D.I.12
Option to choose from - A20,000, A30,000, Rs.50,000
Per Policy Year Can be used to pay for Consultations and
Diagnostics including Dental and Vision: Up to 100% of the
Sum Insured opted for Outpatient expenses.
Up to 20% of the Outpatient Limit can be used for
Pharmacy (Drugs and Medicines prescribed by Network
Medical Practitioners).
This benefit is available only on cashless basis from the
Network providers of ManipalCigna Health Insurance
Company Limited.
Any unutilized amount under this benefit shall not be carried
forward to subsequent Policy Year.
13. Daily Cash for Shared Accommodation D.I.13
Daily Cash benefit for occupying shared accommodation
during In-patient Hospitalization, shall be covered as
below:-
a. For Sum Insured up to A10 Lacs: A800 per day up to
maximum of A5,600
b. For Sum Insured above A10 Lacs: A1,000 per day up to
maximum of A7,000

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
Payable for each continuous and completed 24 Hours of
Hospitalization during the Policy Year.
This benefit gets triggered post 48 hours of In-patient
Hospitalization and shall be payable from 1st day onwards.

Value Added Covers

This section lists the additional value added benefits that
are available along with your plan
14. Health Check Up D.II.1
Available each Policy Year (including the first year), to all Adult
Insured Persons who have completed 18 years of Age.
• For Sum Insured up to A5 Lacs: Package 1 subject to a
maximum of up to A1,000 per adult member.
• For Sum Insured above A5 Lacs and up to A10 Lacs:
Package 2 subject to a maximum of up to A2,500 per
adult member.
• For Sum Insured above A10 Lacs: Package 3 subject to
maximum of up to A5,000 per adult member.
Annually from 1st year onwards. This benefit will not be
available during the free look period of the Policy.
The packages shall be offered on cashless basis only.
However, the eligible insured may avail any health check from
the MCHI Network of Health Check Up Center upto the limit
specified D.II.2
15. Domestic Second Opinion
Available for 36 listed Critical Illness/es
16. Tele-Consultation D.II.3
Unlimited Tele-consultation during the Policy Year
17. Cumulative Bonus D.II.4
A guaranteed bonus of 25% of Sum Insured for every
completed Policy Year irrespective of claims, subject to a
maximum accumulation up to 200% of the Sum Insured
 D.II.5
18. Switch Off Benefit
The Policy can be Switched Off, after one year, any time
during the Policy Year in case you/ Insured Person travel out of
India, for a period maximum up to 30 days in a Policy Year.
This benefit shall not be available for the last 90 days of the
Policy Year.
Premium discount shall be calculated on pro-rated basis if
Policy is switched off due to Insured Person (in individual
Policy) or all Insured Persons (under floater Policy) travelling
out of India and this discount shall be adjusted in the renewal
premium falling due immediately after the expiring Policy
Period.
The Policy will reactivate the cover on the requested date of
Switch On as intimated to Us by You/ Insured Person.
The option to Switch Off the cover shall be available only once
in a Policy Year and upto a maximum of 30 days at a stretch.
This shall not deactivate the following cover, if opted:
i. Worldwide Emergency Hospitalization with Outpatient
Cover under Freedom optional package
ii. Personal Accident Cover

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
iii. ManipalCigna Critical Illness Add-on Cover
19. Wellness Program
Rewards can be earned maximum up to 20% of expiring base
Premium (excluding premium for optional covers, Rider and D.II.6
taxes), by completing activities specified under Our Healthy
Life Management Program.
These earned Reward Points can be used against payable
Renewal premium (excluding Premium for optional covers,
Rider and taxes) as discount from 1st Renewal of the Policy.
Carry forward of earned Reward Points shall not be allowed.
20. Discount from Network Providers
Discount on Pharmacy, Diagnostics and Health Supplements
offered by the Network Providers of ManipalCigna Health D.II.7
Insurance Company Limited
21. Premium Waiver Benefit
Waives off one year Policy Premium (including premium for
optional covers, rider and taxes) upon occurrence of any of the D.II.8
listed contingencies (Accidental death/ listed Critical Illnesses)
to the Policyholder who is also an Insured Person in the Policy.

Optional Packages (Applicable only if opted)

This section lists the available optional packages under
your plan and the limits under each of these options.
The limits specified under these optional packages shall
override the applicable limits mentioned as part of base
cover for the respective coverages.
1. Enhance
A. Maternity & New Born Hospitalization Expenses
a. Maternity Cover (up to maximum 2 deliveries or
terminations) -
Covered up to 10% of Sum Insured Opted subject to a D.III.3.i.A
maximum of A1 Lac in addition to the Sum Insured opted
b. New Born Baby -
Coverage for the In-patient hospitalization expenses of a D.III.3.i.B
new born up to the limit provided under Maternity Expenses
c. First Year Vaccination
Covered as per national immunization program, up to the D.III.3.i.C
limit provided under Maternity Expenses
B. Room Accommodation upgrade
The Insured Person shall be eligible to upgrade the D.III.3.ii
room type category eligibility under the Policy to “Any Room
Category” in a Hospital.

2. Freedom (Applicable to Indian Residents only)

A. Room Accommodation upgrade
The Insured Person shall be eligible to upgrade the D.III.4.i
room type category eligibility under the Policy to “Any Room
Category” in a Hospital.
B. Worldwide Emergency Hospitalization with Outpatient
Cover
Covered up to Sum Insured opted for Emergency In-patient D.III.4.ii
Hospitalization or Emergency Outpatient outside India.

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
Any claim payable under this benefit is over and above the
Sum Insured.

Optional Covers (Available if opted)

This section lists the available optional covers under your
plan and the limits under each of these options
1. Non-Medical Items
Non-Medical items covered up to the Sum Insured opted in D.IV.1
case of In-patient Hospitalization and/or Day Care
Treatment.
2. Infertility Treatment
Infertility Cover (Available if D.III.3 ‘Enhance’ optional
package is opted and for Sum Insured A7.5 Lacs and
above)
Covered for Infertility Expenses up to A2.5 Lacs in addition
to Maternity Sum Insured under Maternity Cover. D.IV.3
Maximum upto 2 successful procedures shall be covered
during the lifetime of the eligible Insured person and the
coverage shall terminate thereafter.
Waiting period of 36 months shall apply for this cover.
The cover shall cease upon the eligible Insured Person
attaining 60 years of age.
3. Personal Accident Cover
Lump sum benefit equal to two times of Sum Insured
subject to a maximum of A50 Lacs in case of Accidental D.IV.4
Death or Permanent Total Disablement of Insured Member
due to accident.
4. Cumulative Bonus Booster
A guaranteed bonus of 50% increase in Sum Insured for
every Policy Year irrespective of claims, subject to a
maximum accumulation up to 200% of the Sum Insured D.IV.5
This benefit is applicable for Sum Insured of A5 Lacs and
above.
Opting for this Benefit will replace the Cumulative Bonus in
the Base Cover.
Add on cover(Rider) (Applicable only if opted)
This section lists the Add on cover available under your
plan
1. ManipalCigna 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 Prime Plus (UIN: MCIHLIA25005V012425)
Rider 1: Room Rent Modification
The Insured Person shall be eligible to modify the room type
category eligibility under the Policy as follows:
Option 1: Any room; ICU Up to Sum Insured
Option 2: Twin Sharing AC room; ICU Up to Sum Insured

Rider 2: Surplus Benefit

Add on
Additional 100% of Sum Insured, available from day 1 for 1st
policy
claim only, in each policy year.
wordings
Rider 3: Supreme Bonus
Guaranteed Cumulative Bonus of 100% of Base Sum

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
Insured each policy year; subject to a maximum of 800% of
the Base Sum Insured.

Rider 4: Premium Management Cover

Once opted below benefits shall not be available in base product.
1. Air Ambulance Cover
2. Bariatric Surgery Cover
3. Daily Cash for Shared Accommodation
4. Health Check Up
5. Domestic Second Opinion
6. Tele Consultation
7. Premium Waiver Benefit
 1.Investigation & Evaluation - Code - Excl. 04
2.Rest Cure, rehabilitation and respite care - Code - Excl. 05
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 - Excl. 10
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 or private beds registered
as a nursing home attached to such establishments or
where admission is arranged wholly or partly for domestic
reasons. Code - Excl. 13
11. Dietary supplements and substances that can be purchased
without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a
Medical Practitioner as part of hospitalization claim or day
care procedure. Code - Excl. 14

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
12. Refractive Error: Code - Excl. 15
Exclusions
13. Unproven Treatments: Code - Excl. 16 E.I.4 to
(What the
6 14. Sterility and Infertility: Code - Excl. 17 E.I.18
policy does not
15. Maternity: Code - Excl. 18 and
cover)
16. External Congenital Anomaly or defects or any E.II.7 to
complications or conditions arising therefrom. E.II.21
17. 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.
18. Circumcision unless necessary for treatment of a disease,
illness or injury not excluded hereunder or due to an
accident.
19. 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.
20. Prostheses, corrective devices and medical appliances,
which are not required intra-operatively for the disease/
illness/ injury for which the Insured Person was
Hospitalized.
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 D.III.4.ii Worldwide Emergency Hospitalization with
Outpatient Cover under Freedom optional package if
opted.
23. Costs of donor screening or costs incurred in an organ
transplant surgery involving organs not harvested from
a human body subject to conditions mentioned in D.I.7
‘Organ Donor’.
24. Any form of Non-Allopathic treatment (except AYUSH
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

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
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 treatment. For complete list of Non-medical expenses,
please refer to the Annexure III 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 Policy
Schedule.
29. Pre-existing condition disclosed by the Insured Person will
be reviewed according to the company’s underwriting
policy.
 30. Expenses incurred towards the use of multi-focal lenses
and Femto Laser-assisted surgeries for the treatment of
cataract.
Note:
a. Femto laser surgeries refer to advanced medical
procedures utilizing femtosecond laser technology for
precision-based treatment, commonly used in ophthalmic
surgeries such as Lasik or cataract removal.
b. Multi-focal lenses include intraocular lenses designed to
provide vision correction at multiple distances, such as
bifocal, trifocal, and progressive lenses with a seamless
transition between distances or any other type of premium
intraocular lenses.
a. Initial Waiting Period: 30 days for all illnesses (not
applicable on in case of continuous renewal or accidents) E.I.3
b. Specific Waiting Period (Not Applicable on claim arising
due to accidents):
24 Months for following diseases:
a. Cataract,

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
b. Hysterectomy for Menorrhagia or Fibromyoma or prolapse
of Uterus or myomectomy for fibroids unless necessitated by
malignancy,
c. Knee Replacement Surgery (other than caused by an
Waiting Period
Accident), Non-infectious Arthritis, Gout, Rheumatism,
• Time period
Osteoarthritis and Osteoporosis, Joint Replacement Surgery
during which
(other than caused by Accident), Prolapse of Intervertebral
specified
discs(other than caused by Accident), all Vertebrae
disease/
Disorders, including but not limited to Spondylitis,
treatment
Spondylosis, Spondylolisthesis, Congenital Internal,
7 are not E.I.2
d. Varicose Veins and Varicose Ulcers,
covered.
e. Stones in the urinary uro-genital and biliary systems
• It is counted
including calculus diseases and complications thereof,
from the
f. Benign Prostate Hypertrophy, all types of Hydrocele,
beginning
g. Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal
of the policy
sinus, Hemorrhoids and any abscess related to the anal
coverage.
region.
h. 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.
i. 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,
j. Any surgery of the genito-urinary system unless
necessitated by malignancy.
c. Pre-existing Disease:
i. Covered after 24 months for Sum Insured 7.5 Lacs and E.I.1
above
ii. Covered after 36 months for Sum Insured up to 5 Lacs.
d. Maternity Waiting Period
Any treatment arising from or traceable to pregnancy, E.II.1
childbirth including caesarean section until 36 months of
continuous coverage has elapsed for the particular Insured
Person since the inception of the first Policy with Us.
However, this exclusion / waiting period will not apply to
Ectopic Pregnancy proved by diagnostic means and certified
to be life threatening by the attending Medical Practitioner.
e. Personal Waiting period: E.II.2
A special Waiting Period not exceeding 36 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

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
periods shall be specifically stated in the Schedule and will
be applied only after receiving Your specific consent.
 f. Mental Illness Cover Waiting Period E.II.4
Covered after 24 months below mentioned ICD Codes
ICD 10
DISEASES
CODES
F05 Delirium due to known physiological condition
Other mental disorders due to known physiological
F06
condition
Personality and behavioural disorders due to
F07
known physiological condition
F10 Alcohol related disorders
F20 Schizophrenia
F23 Brief psychotic disorders
F25 Schizoaffective disorders
Unspecified psychosis not due to a substance or
F29
known physiological condition
F31 Bipolar disorder

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
F32 Depressive episode
F39 Unspecified mood [affective] disorder
F40 Phobic Anxiety disorders
F41 Other Anxiety disorders
F42 Obsessive-compulsive disorder
F44 Dissociative and conversion disorders
F45 Somatoform disorders
F48 Other nonpsychotic mental disorders
F60 Specific personality disorders
F84 Pervasive developmental disorders
F90 Attention-deficit hyperactivity disorders
F99 Mental disorder, not otherwise specified

g. Bariatric Surgery Waiting Period E.II.5

Covered after 36 months
h. Infertility Treatment Waiting Period
Covered after 36 months E.II.6
1. The policy will pay only up to the limits specified hereunder
for the following diseases/procedures:
Financial limits
Listed Modern and Advanced Treatments covered up to
of coverage D.I.1
- For Sum Insured < A5 Lacs: Up to 50% of Sum Insured
• Sub-limit (it is
- For Sum Insured >= A5 Lacs: Up to Sum Insured
pre-defined limit
and the
8 2. In case of claim, this policy requires you to share the
insurance
following sub limits: Expenses exceeding the following Sub-
company will not
limits
pay any amount
• For Room/ICU
in excess of this D.I.1
- Room Rent: Covered up to Single Private A/C Room
limit
- For ICU - Covered up to Sum Insured
• For the following disease - Not Applicable
 • Co-payment
(it is a specified
amount 3. Co- Payment - Xxxx % F.II.9
percentage of *Zonal Co-payment
admissible claim Identification of Zone will be based on the location-City of
amount to be the proposed Insured Persons.
paid by a) Persons paying Zone I premium can avail treatment all over
policyholder / India without any Zonal Co-pay
insured). b) Persons paying Zone II premium
• Deductible (It is i. Can avail treatment in Zone II and Zone III without any
specified Zonal Co-pay
amount: ii. Availing treatment in Zone I will have to bear 10% of each
- up to which and and every claim.
insurance c) Person paying Zone III premium
company will not i. Can avail treatment in Zone III, without any Zonal Co-pay
pay any claim, ii. Availing treatment in Zone II will have to bear 10% of
and each and every claim.
- which will be iii. Availing treatment in Zone I will have to bear 20% of each
deducted from and every claim.
total claim Aforesaid Co-payments for claims occurring outside of the

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
amount (if claim Zone will not apply in case of Hospitalization due to Accident.
amount is more
than specified 4. Deductible -
amount) Deductible of AXxx per policy year on aggregate basis
• Any other limit
(as applicable)
Details of procedure to be followed for cashless services as
well as for reimbursement of claim including pre and post
hospitalization:
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 1 hours
from the last complete document.
Claims/Claims ii. TAT for cashless final bill settlement - within 3 hours from the
9 G.I
procedure 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
For hassle free policy servicing customer can manage their
Policy
10 policy by clicking on-https://eservicing.manipalcigna.com/login
Servicing
or Download myManipalCigna App from Playstore or appstore
 LEVEL 1
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: Seniorcitizensupport@
ManipalCigna.com

LEVEL 2
Grievance Redressal Officer
Call us on 022-71781389 between 10 am to 6 Pm (Monday to
Friday)
Email us at - [email protected]

LEVEL 3
Chief Grievance Redressal
Call us on 022-71781300 between 10 am to 6 Pm (Monday to
Friday)
Email us at - [email protected]
For Senior Citizen Assistance: Seniorcitizensupport@

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
11 ManipalCigna.com

LEVEL 4
Approach Ombudsman
Grievances/ The office Name and address details applicable for your state
can be obtained from https://www.cioins.co.in/Ombudsman F.I.16
Complaints
Courier: Any of Our Branch office or corporate office during
business hours.
Insured Person may also approach the grievance cell at any of
company’s branches with the details of the grievance. If Insured
Person is not satisfied with the redressal of grievance through one
of the above methods, insured person may contact the grievance
officer at,
‘The Grievance Cell,
ManipalCigna Health Insurance Company Limited,
Techweb center 2nd Floor New Link Rd,
Anand Nagar, Jogeshwari West, Mumbai, Maharashtra 400102,
India or
Email: [email protected].
For updated details of grievance officer, kindly refer link - https://
www.manipalcigna.com/grievance-redressal If Insured person is not
satisfied with the redressal of grievance through above methods,
the Insured Person may also approach the office of Insurance
Ombudsman of the respective area/region for redressal of grievance
as per Insurance Ombudsman Rules 2017. The contact details of
Ombudsman offices attached as Annexure I to this Policy document.
Grievance may also be lodged at IRDAI complaints management
system - https://bimabharosa.irdai.gov.in/

You may also approach the Insurance Ombudsman if your complaint

is open for more than 30 days from the date of filing the complaint
 Free Look Cancellations: The Free Look period shall be
applicable on new individual health insurance policies and not
on renewals or at the time of porting/migrating the policy.
F.I.15
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, If the insured has not made any claim 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 grounds of established fraud, misrepresentation,
non-disclosure by the insured person.
F.I.10

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 |May 2025
Migration: The Insured Person will have the option to migrate
the Policy to other health insurance products/plans offered by
the company by applying for migration of the policy at least 30
F.I.8
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
Things to
person will get the accrued continuity benefits to the extent of
remember
the Sum Insured, No Claim Bonus, Specific Waiting periods,
waiting period for pre-existing diseases, Moratorium period etc.
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
12 - 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

F.I.9
the Policy to other insurers by applying to such insurer to port
the entire policy along with all the members of the family, if
any, at least 30 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 to the extent of the Sum Insured, No Claim Bonus,
Specific Waiting periods, waiting period for pre-existing
diseases, Moratorium period etc. as per IRDAI guidelines on
portability.
 To avail:
- Customer can share for portability 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
assistance
Change in Sum Insured: It will be allowed at the time of
F.II.8 g
Renewal of the 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 coverage (including Portability and Migration) in health F.I.12
insurance policy, no Policy and claim shall be contestable by
the Insurer on grounds of non-disclosure, misrepresentation,
except on grounds of established fraud. This period of 60

ManipalCigna ProHealth Prime | Advantage | Customer Information Sheet | UIN: MCIHLIP26036V022526 | May 2025
continuous 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. The policies would
however be subject to all limits, sub limits, co-payments,
deductibles as per the policy contract.
Disclosure of Information
a. The Policy shall be null and void, and all premium paid
thereon shall be forfeited to the Company in the event of
any misrepresentation or mis-description of any material
fact by the policyholder.
Your b. The Policy shall be null and void, and all premium paid
13 F.I.1
Obligations thereon shall be forfeited to the Company in the event of
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
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).