Star Health Cardiac Care Platinum vs Manipal Cigna ProHealth Protect
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Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Cardiac Care Platinum is sold by Star Health and ProHealth Protect is sold by Manipal Cigna. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are built for very different use cases. Cardiac Care Platinum is built for people suffering from heart ailments. ProHealth Protect is built for International. And that means you're comparing very different products here. So analysis will be tainted by this distinction.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That's something you'll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let's start with Cardiac Care Platinum. The product comes from Star Health's stable:
Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.
The company also boasts a network of over 14,000+ hospitals and a decent claim settlement ratio of 89%.
ProHealth Protect meanwhile comes from Manipal Cigna's stable:
ManipalCigna Health Insurance Company is a collaborative partnership between Manipal Group and Cigna and together they have over 200 years of expertise in the healthcare business. And while the company has shown some potential recently, it still only corners a small part of the Indian market.
Also, they have a settlement ratio of 90% with more than 14,000+ network hospitals in tow.
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Star Health Cardiac Care Platinum vs Manipal Cigna ProHealth Protect
Compare Insurances Insurance Parameters Recommended Not Recommended | Star Health Cardiac Care Platinum | Manipal Cigna ProHealth Protect |
|---|---|---|
| Network hospitals | 14000 | 14000 |
| Claim settlement ratio (avg. of last 3 years) | 89% | 90% |
| Co-payment | No | 20% (if purchased after turning 65) |
| Room rent | Single Private room | Single Private room |
| Disease sub-limit | Yes | No |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 60/180 days |
| No claim bonus | 10% per year (up to 100%) | 5% per year (up to 200%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (unlimited no. of times for different illness) |
| Health check-up | Once every year | Once every 3 years |
| Maternity | ||
| Out Patient Department | Up to ₹2,500 | Up to ₹500 (Annually) |
| Day care |
Insurer Comparison
Star Health settles 89% of the claims it receives, while Manipal Cigna settles 90%. Ditto looks for a claim settlement ratio of 90% and above. Manipal Cigna clears that comfortably, while Star Health sits just short of it, which is worth weighing alongside the rest of the comparison.
What is the Claim Settlement Ratio (CSR)?
The Claim Settlement Ratio tells you what percentage of health insurance claims an insurer settled during a given year, out of the total claims it received. A CSR of 93% means the insurer paid out 93 claims for every 100 filed. Ditto uses a 3-year average to smooth out year-on-year fluctuations, and recommends insurers at 90% or above — anything below 85% is a red flag.
Incurred Claims Ratio
Star Health pays out ₹67 in claims for every ₹100 it collects as premium. Manipal Cigna pays out ₹82. Both sit inside the 55%-85% band Ditto considers healthy — high enough to show claims are actually being paid, low enough to be sustainable.
What is the Incurred Claims Ratio (ICR)?
The Incurred Claims Ratio tells you how much of every rupee collected as premium was paid back to customers as claims. An ICR of 70% means the insurer paid out ₹70 in claims for every ₹100 of premium collected. Unlike CSR, a very high ICR is not necessarily good — it can point to an unsustainable payout rate and future premium hikes, while a very low ICR can indicate an insurer that is overly restrictive in settling claims. Ditto looks for an ICR between 55% and 85%.
For every 10,000 claims processed, Star Health received 54 complaints and Manipal Cigna received 18. Fewer complaints usually mean smoother claim processing and better servicing, so Manipal Cigna has the edge on this metric. Ditto looks for under 20 complaints per 10,000 claims from general insurers, and under 40 from standalone health insurers, since their claims are more complex.
What is the complaint volume?
Complaint volume shows how many customers formally complained per 10,000 claims processed. Fewer complaints generally mean smoother claim processing and better customer support. General insurers and Standalone Health Insurers (SAHIs) are judged against different baselines because SAHIs handle only health claims, which are more complex — Ditto looks for below 20 complaints for general insurers and below 40 for standalone health insurers.
Star Health has 14,000 network hospitals and Manipal Cigna has 14,000. Both are past the 10,000-hospital mark Ditto recommends. A bigger network makes it easier to find cashless treatment near you, but it counts for little if your preferred hospitals are not on the list — so check that before you decide.
What are network hospitals?
Network hospitals are the hospitals an insurer has tied up with, where it settles bills directly so you get cashless treatment instead of paying out of pocket and claiming reimbursement later. The larger the network, the easier it is to find cashless treatment near you. Ditto recommends a network of 10,000+ hospitals, but a large network matters little if your preferred hospitals are not on it — always check.
Track Record
Star Health has been operating since 2006 (20 years) and Manipal Cigna since 2014 (12 years). Both have the 10+ years of history Ditto looks for, which means there is enough data to judge how they behave at scale rather than just early on.
Why does the insurer’s track record matter?
India’s insurance sector was privatised in 2000, so most private players have been operating for 20-25 years. A company with just 3-4 years of data gives you very little to judge it on — numbers can look excellent early on and deteriorate sharply as the insurer scales. Ditto considers 10+ years ideal, and under 5 years a reason to proceed with caution.
Feature Comparison
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Cardiac Care Platinum doesn’t impose a co-payment clause whereas ProHealth Protect requires you to co-pay a part of the bill 20% if you purchase after turning 65
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Cardiac Care Platinum lets you stay in a single private room and ProHealth Protect also lets you stay in a single private room. Nothing fancy.
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Cardiac Care Platinum imposes disease-wise sub-limits on cardio vascular conditions, cataracts, modern treatments whereas ProHealth Protect doesn’t impose a disease wise sub-limit.
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Cardiac Care Platinum imposes a 3 year waiting period on pre-existing diseases and ProHealth Protect will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Cardiac Care Platinum covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, ProHealth Protect covers expenses incurred 60 days before hospitalization and expenses incurred 180 after hospitalization, although there may be different sub-limits
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Cardiac Care Platinum offers a no-claim bonus of 10% whereas ProHealth Protect offers a no-claim bonus of 5%. And the no-claim bonus may be capped at different levels too.
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Cardiac Care Platinum doesn’t offer domiciliary protection whereas ProHealth Protect offers domiciliary cover.
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Cardiac Care Platinum covers Ayush procedures and ProHealth Protect also extends coverage for Ayush treatments.
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, neither Cardiac Care Platinum offers maternity cover nor does ProHealth Protect.
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Cardiac Care Platinum offers OPD coverage, and ProHealth Protect also offers OPD coverage, although the sub-limits may be different.
Final Conclusion
Since this isn't a fair comparison, to begin with, we will only tell you this much. If you want something specifically for people suffering from heart ailments you can go for Cardiac Care Platinum. However, if you are looking to cover International, then you may want to consider ProHealth Protect.
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