Overview
The ManipalCigna ProHealth Prime Protect plan is designed to offer comprehensive health coverage with customizable options. Its key features include the option to modify room rent, a women's care package, a surplus benefit and other flexible add-ons.
Experts' Review
Written by Nikhil Nair
Senior Writer
The ManipalCigna ProHealth Prime Protect plan is built with flexibility at its core. The inclusion of base benefits alongside more targeted features makes it a well-rounded plan.
The first distinct feature I find really appealing for female policyholders is the option to add a Women Care package for mammography, cervical cancer screenings, and PCOS/PCOD diagnostic tests. At the same time, the Surplus Benefit, which gives you an extra 100% of the sum insured for the first claim, is a handy feature.
Now, let's talk about the waiting periods. There's an initial waiting period of 30 days for most illnesses, but the specified disease/procedure waiting period of 24 months is something to keep in mind. Also, there’s a waiting period of 36 months for pre-existing diseases if your sum insured is up to ₹5 Lakhs, but it reduces to 24 months if you opt for a sum insured of ₹7.5 Lakhs or more.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap. Need to opt add-on for maternity cover.
Doctor consultations are not covered, which could be a drawback for some.
Manipal Cigna
Key Insights
Founded
2014
Manipal Cigna was established 11 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
91% claims settled in 30 Days
Manipal Cigna settles 91% of all claims it receives demonstrating strong credibility.
Network Hospitals
8,500+
Manipal Cigna maintains a moderate network of 8,500 hospitals, offering reasonable coverage across key locations.
Complaints
24 complaints per 10,000 claims registered
Manipal Cigna experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Restoration benefit
Even after you claim part of the cover on one occasion, you will be allowed to claim the full cover any number of times repeatedly if you are hospitalized in the future. All in the same year by the way!!!
Add-ons
Consumables Cover
Recommended
Covers list of 68 non-medical items as per list I
Cumulative Bonus Booster
Recommended
Additional bonus of 50% up to a maximum of 200%, irrespective of any claim in the previous year.
Critical Illness
Lump sum payout in the event you are diagnosed with critical illnesses outlined in the policy document.
Freedom Package
Coverage for both in-patient and out-patient emergency hospitalizations outside India on reimburement basis only with room category upgraded to no limit. But remember, this add-on is available only for Indian Residents.
Personal Accident cover
Paid out as a lump sum of 200% of sum insured for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to a limit of ₹5000000.
Enhance Plus
Coverage for maternity expenses i.e. childbirth and newborn expenses. However the coverage is limited to 10% of the cover, max up to ₹1L. Along with this, the room category is upgraded to no limit. Plus, you get Health Maintenance Benefit worth 3k on top of it.
Infertility Treatment
Along with Enhance Plus add-on, you get coverage for infertility treatments like IUI or IVF upto ₹2.5L over & above the maternity limit for cover amount of 7.5L and above.
Assure
Reduces the Single Private room category to 1% of the cover amount per day and ICU limit to 2% of the cover amount per day. It further imposes disease-wise sub-limits on various conditions and caps the modern & Advanced treatments upto 10% of the base cover. Do note that this add-on is only available till 5L base cover in Zone 2 & zone 3 areas only.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract and other disorders of lens and retina
Hysterectomy for menorrhagia, fibromyoma, prolapse of uterus, or myomectomy for fibroids (unless necessitated by malignancy)
Surgery of hernia
Surgery of hydrocele
Benign ear, nose, and throat (ENT) disorders and surgeries (including tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
A
Aarav Sharma
I really like the customizable options in this plan. Being able to modify room rent is a big plus!
V
Vivaan Verma
The Women Care package is a thoughtful addition. Finally, a plan that considers specific needs for women.
A
Aditya Gupta
Surplus Benefit is amazing! That extra 100% sum insured for the first claim gives so much peace of mind.
I
Ishaan Menon
While add-ons are good, they do increase the premium. Wish some features were standard.
V
Vihaan Reddy
The initial 30-day waiting period was a bit inconvenient for a minor issue I had.
R
Reyansh Patel
The reduction in PED waiting period for higher sum insured is a fair deal. Good thinking by ManipalCigna.
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Frequently Asked Questions
Does ProHealth Prime Protect have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy for a cover amount of 5L and a 2-year for the cover amount above 5L.
Does ProHealth Prime Protect have room rent restrictions?
Does ProHealth Prime Protect offer a restoration benefit?
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