{"uin":"MCIHLIA25005V012425","name":"ProHealth Prime Insurance","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425","insurer":{"slug":"manipal-cigna-health-insurance","name":"Manipal Cigna Health Insurance Company Limited","url":"https://indiainsurances.com/insurer/manipal-cigna-health-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"ManipalCigna ProHealth Prime (Protect and Advantage plans) is a one-year indemnity health policy with Base Sum Insured from Rs 3 Lacs (Protect) or Rs 5 Lacs (Advantage) to Rs 100 Lacs, room up to a Single Private AC Room, 60 and 180 days pre and post hospitalisation, and 100% restoration of the Base Sum Insured unlimited times a year. Pre-existing diseases wait 36 months (24 months from Rs 7.5 Lacs), listed conditions 24 months, the cumulative bonus is 25% a year up to 200% irrespective of claims, and treatment in a higher zone than the one paid for carries a 10% or 20% co-pay.","analysis":{"state":"extracted","analysed_at":"2026-10-19 17:10:40.06595+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Protect","Advantage"],"display":"Protect, Advantage","note":"The documents read cover only the Protect and Advantage plans; an Active plan exists under the same UIN but none of these documents describes it. Advantage starts at Rs 5 Lacs and includes Outpatient Expenses; some options (Enhance Plus, Assure, Deductible) are Protect only. The wording's own footer prints the UIN as MCIHLIP27044V032627 (27044, not 27045).","quote":"Plans: Protect | Advantage ... UIN:MCIHLIP27044V032627","sources":[{"clause":null,"heading":"Plans: Protect | Advantage","page":1,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-plans-protect-advantage"},{"clause":null,"heading":"G.IV. Annexure - lII","page":82,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-iv-annexure-lii"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"One year policy tenure, renewable for life.","display":"1 year","note":"From the prospectus; renewal for life is from the policy wording.","quote":"You can buy the policy of one year policy tenure. ... The Policy is ordinarily renewable on mutual consent for life","sources":[{"clause":"8(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/373#c-8-b-11"},{"clause":null,"heading":"F.II.8. Renewal Terms","page":55,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-8-renewal-terms"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Planned hospitalisation: at least 48 hours before admission. Emergency hospitalisation: within 24 hours of admission.","display":"48 hours before a planned admission; within 24 hours of an emergency admission","note":"Hospitalisation over 10 days not intimated within 10 days of admission may attract an extra 10% co-payment; live donor transplants need 7 days' notice, cadaveric within 48 hours; treatment abroad under Freedom within 48 hours. Reimbursement documents within 15 days of discharge.","quote":"Planned Hospitalization, You/the Insured Person will intimate such admission at least 48 hours prior to the planned date of admission. ... Emergency Hospitalization, You /the Insured Person will intimate such admission within 24 hours of such admission. ... If we do not receive intimation within 10 days from the date of admission, we may apply an additional cumulative co-payment of 10% ... For live donor organ transplants, we kindly request that you inform us at least 7 days in advance ... no later than 48 hours from the date and time of admission ... must notify Us either at Our call centre or in writing within 48 hours of such admission ... not later than 15 days from the date of discharge from the Hospital","sources":[{"clause":null,"heading":"G.I.3. Claim Intimation","page":62,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-i-3-claim-intimation"},{"clause":null,"heading":"C. Prolonged Hospitalization extending beyond 10 days","page":60,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-c-prolonged-hospitalization-extending-beyond-10"},{"clause":null,"heading":"D. Organ Transplants","page":61,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-organ-transplants"},{"clause":null,"heading":"G.I.15 Worldwide Emergency Hospitalization with Outpatient Cover","page":69,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-i-15-worldwide-emergency-hospitalization-with"},{"clause":"Excl12(a)(i)","heading":null,"page":64,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-a-i-2"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Claim form duly signed","Copy of photo ID of patient","KYC documents (Photo ID proof, address proof, recent passport size photograph)","Cancelled cheque for NEFT payment","Payment receipt","Hospital Discharge summary","Operation Theatre notes/ ICP papers","Hospital Main Bill","Hospital Break up bill","Investigation reports","Original investigation reports, X Ray, MRI, CT films, HPE, ECG etc.","Doctors reference slip for investigation","Pharmacy bills, prescription and invoices","Copy of FIR/Panchnama / Police Inquest Report (if conducted) in case of Accident"],"display":"Claim form, photo ID, KYC, cancelled cheque, payment receipt, discharge summary, bills, investigation reports, pharmacy bills","note":"Reimbursement list for in-patient claims; other benefits (domiciliary, ambulance, personal accident) have their own lists. Documents within 15 days of discharge; delay condoned for reasons beyond your control.","quote":"• Claim form duly signed • Copy of photo ID of patient • KYC documents (Photo ID proof, address proof, recent passport size photograph) • Cancelled cheque for NEFT payment • Payment receipt ... • Hospital Discharge summary • Operation Theatre notes/ ICP papers • Hospital Main Bill • Hospital Break up bill • Investigation reports • Original investigation reports, X Ray, MRI, CT films, HPE, ECG etc. • Doctors reference slip for investigation • Pharmacy bills, prescription and invoices • Copy of FIR/Panchnama / Police Inquest Report (if conducted) duly attested by the concerned Police Station in case of Accident.","sources":[{"clause":"Excl12(a)(ii)","heading":null,"page":64,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-a-ii-2"},{"clause":"Row 1","heading":"In-patient Hospitalization","page":65,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-row-1-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"Reimbursement claims are settled or rejected within 15 days of the last necessary document; cashless authorisation within 1 hour and final discharge approval within 3 hours.","display":"15 days from submission of necessary documents; cashless: 1 hour, discharge: 3 hours","note":"Delay attracts interest at 2% above the bank rate from the date of documents. Outpatient and Health Maintenance claims: within 5 working days.","quote":"The Company shall settle or reject the claim, as the case may be, within 15 days (other than cashless) from date of submission of necessary claim documents. ... at a rate 2% above the bank rate ... All authorizations will be issued within a period of 1 hour from the receipt of request. ... We shall accept or decline such additional expenses within 3 (Three) hours of receiving the request for final discharge ... We shall settle claims, including its rejection, within 5 (five) working days of the receipt of the document","sources":[{"clause":null,"heading":"F.I.3 Claim Settlement (provision for Penal Interest)","page":49,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-3-claim-settlement-provision-for-penal-inter"},{"clause":"Excl12(a)(v)","heading":null,"page":63,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-a-v"},{"clause":"Excl12(a)(vii)","heading":null,"page":63,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-a-vii"},{"clause":null,"heading":"G.I.12 Outpatient Expenses","page":68,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-i-12-outpatient-expenses"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Pre-existing Disease: 36 months (24 months for Sum Insured Rs 7.5 Lacs and above)","Listed conditions and surgeries: 24 months","Any illness within 30 days of first cover, except accidents","Investigation and evaluation admissions","Surgical treatment of obesity that does not meet the listed conditions","Cosmetic or plastic surgery","Professional hazardous or adventure sports","Alcoholism, drug or substance abuse","Sterility and infertility","Maternity (childbirth, miscarriage, termination)","Dental treatment unless needed due to an accident with at least 24 hours in hospital","Treatment outside India (except Freedom option)","Multi-focal lenses and Femto laser in cataract treatment","Out-patient treatment","Self-injury or attempted suicide"],"display":"Pre-existing disease and listed-condition waiting periods, first 30 days, obesity, cosmetic surgery, maternity, infertility, dental, treatment abroad, OPD and others","note":"Maternity is covered only with the Enhance Plus or Enhance package, infertility only with the Infertility Treatment option, bariatric surgery under its own cover after 36 months. Dental exclusion also applies unless 24 hours hospitalisation.","quote":"Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of the applicable waiting period ... 24 months of continuous coverage from the date of commencement of coverage for Sum Insured ₹ 7.5 Lacs and above ... 36 months of continuous coverage from the date of commencement of coverage for Sum Insured Up to ₹5 Lacs. ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with us. ... Expenses related to the treatment of any illness within 30 days of continuous coverage from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Expenses for cosmetic or plasticsurgery or any treatment to change appearance ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof ... Expenses related to sterility and infertility. ... Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred duringhospitalization) except ectopic pregnancy ... Expense towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period. ... Dental Treatment, orthodontic treatment, dentures or Surgery of any kind unless necessitated due to an Accident and requiring minimum 24 hours Hospitalization. ... Treatment received outside the geographical limits of India other than for coverage under D.III.4.ii Worldwide Emergency Hospitalization with Outpatient Cover under Freedom optional package if opted. ... Expenses related to cataract treatment involving all types of Multi-focal Lenses (including intraocular lenses), Multi-focal Toric Lenses, and Femto Laser-assisted surgeries are not covered. ... Any kind of Out-Patient Treatment expenses including fractures (not requiring any kind of hospitalization). ... Expenses related to an Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide.","sources":[{"clause":null,"heading":"E.I.1 Pre-existing Disease - Code- Excl. 01","page":42,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-1-pre-existing-disease-code-excl-01"},{"clause":null,"heading":"E.I.2 Specified disease/procedure Waiting Period - Code- Excl. 02","page":43,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-2-specified-disease-procedure-waiting-period"},{"clause":null,"heading":"E.I.3 30 days Waiting Period - Code- Excl. 03","page":43,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-3-30-days-waiting-period-code-excl-03"},{"clause":null,"heading":"E.I.4 Investigation & Evaluation- Code- Excl 04","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-4-investigation-evaluation-code-excl-04"},{"clause":null,"heading":"E.I.6 Obesity/ Weight Control: Code- Excl 06","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-6-obesity-weight-control-code-excl-06"},{"clause":null,"heading":"E.I.8 Cosmetic or Plastic Surgery: Code- Excl 08","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-8-cosmetic-or-plastic-surgery-code-excl-08"},{"clause":null,"heading":"E.I.9 Hazardous or Adventure sports: Code- Excl 09","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-9-hazardous-or-adventure-sports-code-excl-09"},{"clause":null,"heading":"E.I.11Excluded Providers: Code- Excl 11","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-11excluded-providers-code-excl-11"},{"clause":null,"heading":"E.I.17Sterility and Infertility: Code- Excl 17","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-17sterility-and-infertility-code-excl-17"},{"clause":null,"heading":"E.I.18Maternity: Code Excl 18","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-18maternity-code-excl-18"},{"clause":null,"heading":"E.II.6 Infertility Treatment Waiting Period","page":46,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-ii-6-infertility-treatment-waiting-period"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First contact ManipalCigna customer care (customercare@manipalcigna.com, toll free 1800-102-4462, any branch); if not satisfied, the Grievance Cell in Goregaon (East), Mumbai, headcustomercare@manipalcigna.com; then the Insurance Ombudsman.","display":"ManipalCigna customer care (customercare@manipalcigna.com, 1800-102-4462), then the Grievance Cell (headcustomercare@manipalcigna.com)","note":"The Ombudsman can be approached if the complaint is open more than 30 days. The CIS gives a four-level ladder: customer care, Grievance Redressal Officer (complaints@manipalcigna.com, 022-61703600), Chief Grievance Redressal Officer (Compliance@manipalcigna.com), Ombudsman. The wording prints the senior citizen address as 'seniorcitizensupport@manipalcignacom' (missing dot).","quote":"you may contact us with the details of the grievance through Our website:www.manipalcigna.com Email: customercare@manipalcigna.com ... Toll Free: 1800-102-4462 ... insured person may contact the grievance officer at, ‘The Grievance Cell, 401/402, 4th Floor, Raheja Titanium, Western Express Highway, Goregaon (East), Mumbai - 400063, Maharashtra, India or Email: headcustomercare@manipalcigna.com. ... You may also approach the Insurance Ombudsman if your complaint is open for more than 30 days from the date of filing the complaint.","sources":[{"clause":null,"heading":"F.I.16. Redressal of Grievance","page":53,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-16-redressal-of-grievance"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Protect: Rs 3, 4, 5, 7.5, 10, 12.5, 15, 20, 25, 30, 40, 50 or 100 Lacs. Advantage: Rs 5, 7.5, 10, 12.5, 15, 20, 25, 30, 40, 50 or 100 Lacs.","display":"Protect: Rs 3 Lacs to Rs 100 Lacs; Advantage: Rs 5 Lacs to Rs 100 Lacs","note":"Base Sum Insured per person (individual) or shared (floater), per policy year.","quote":"Identify your Plan | Protect | Advantage ... ₹3 Lacs, ₹4 Lacs, ₹5 Lacs, ₹7.5 Lacs, ₹10 Lacs, ₹12.5 Lacs, ₹15 Lacs, ₹20 Lacs, ₹25 Lacs, ₹30 Lacs, ₹40 Lacs, ₹50 Lacs, ₹100 Lacs | ₹5 Lacs, ₹7.5 Lacs, ₹10 Lacs, ₹12.5 Lacs, ₹15 Lacs, ₹20 Lacs, ₹25 Lacs, ₹30 Lacs, ₹40 Lacs, ₹50 Lacs, ₹100 Lacs","sources":[{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Accidents are covered from day one. Applies afresh to any increase in sum insured.","quote":"Expenses related to the treatment of any illness within 30 days of continuous coverage from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.","sources":[{"clause":null,"heading":"E.I.3 30 days Waiting Period - Code- Excl. 03","page":43,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-3-30-days-waiting-period-code-excl-03"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months for Sum Insured up to Rs 5 Lacs; 24 months for Rs 7.5 Lacs and above","note":"24 months when the Sum Insured is Rs 7.5 Lacs or more. Applies afresh to any increase in sum insured; reduced by prior continuous cover under portability. A personal waiting period up to 36 months may be applied for declared conditions.","quote":"24 months of continuous coverage from the date of commencement of coverage for Sum Insured ₹ 7.5 Lacs and above ... 36 months of continuous coverage from the date of commencement of coverage for Sum Insured Up to ₹5 Lacs.","sources":[{"clause":null,"heading":"E.I.1 Pre-existing Disease - Code- Excl. 01","page":42,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-1-pre-existing-disease-code-excl-01"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Not applicable to accidents. Other waits: listed mental illnesses 24 months, maternity 36 months (option), bariatric surgery 36 months, infertility 36 months (option). If the condition is pre-existing, the longer PED wait applies.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with us. This exclusion shall not be applicable for claims arising due to an accident.","sources":[{"clause":null,"heading":"E.I.2 Specified disease/procedure Waiting Period - Code- Excl. 02","page":43,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-2-specified-disease-procedure-waiting-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["Cataract","Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus or myomectomy for fibroids unless necessitated by malignancy","Knee Replacement Surgery (other than caused by an Accident)","Non-infectious Arthritis, Gout, Rheumatism, Osteoarthritis and 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","Varicose Veins and Varicose Ulcers","Stones in the urinary uro-genital and biliary systems including calculus diseases and complications thereof","Benign Prostate Hypertrophy, all types of Hydrocele","Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess related to the anal region","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","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","Any surgery of the genito-urinary system unless necessitated by malignancy"],"display":"Cataract, hysterectomy, joint replacement, arthritis, spine disorders, varicose veins, stones, prostate, hernia and piles, ENT, ulcers, cysts, PCOD, genito-urinary surgery","note":"All with a 24 month wait. The listing in the wording ends 'Congenital Internal,' with no noun, as printed.","quote":"i) Cataract, Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus or myomectomy for fibroids unless necessitated by malignancy, ... ii) Knee Replacement Surgery (other than caused by an Accident), Non-infectious Arthritis, Gout, Rheumatism, Osteoarthritis and 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, ... iii) Varicose Veins and Varicose Ulcers, ... iv) Stones in the urinary uro-genital and biliary systems including calculus diseases and complications thereof, ... v) Benign Prostate Hypertrophy, all types of Hydrocele, ... vi) Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess related to the anal region. ... vii) 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. ... viii) 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, ... ix) Any surgery of the genito-urinary system unless necessitated by malignancy.","sources":[{"clause":null,"heading":"E.I.2 Specified disease/procedure Waiting Period - Code- Excl. 02","page":43,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-2-specified-disease-procedure-waiting-period"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"Runs afresh on any increase in sum insured, for the increased amount only.","quote":"After completion of 60 continuous months of coverage (including Portability and Migration) in health insurance policy, no Policy and claim shall be contestable by the Insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":null,"heading":"F.I.12. Moratorium Period","page":52,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-12-moratorium-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The whole policy can be ported to another insurer by applying 30 to 60 days before renewal, with continuity credit for waiting periods, sum insured, bonus and moratorium as per IRDAI rules.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried","note":"Migration to another ManipalCigna product: apply at least 30 days before renewal.","quote":"The insured person will have the option to port 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 the accrued continuity benefits to the extent of the Sum Insured, No Claim Bonus, specific waiting periods, waiting period for pre-existing disease, moratorium period etc.as per IRDAI guidelines on portability.","sources":[{"clause":null,"heading":"F.I.9. Portability","page":51,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-9-portability"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes, renewable for life","note":"Renewal can be refused only for fraud, misrepresentation or non-disclosure. With the Freedom package the insured must be an Indian resident at renewal.","quote":"The Policy is ordinarily renewable on mutual consent for life, subject to application of Renewal and realization of Renewal premium.","sources":[{"clause":null,"heading":"F.II.8. Renewal Terms","page":55,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-8-renewal-terms"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. The policy says no loading applies on renewal based on individual claims experience.","display":"No claim-based loading at renewal","note":"A 1% No Claim Discount on renewal applies if no claim was made. Risk loading for health status can apply from the first policy.","quote":"v) No loading shall apply on renewals based on individual claims experience. ... Renewal premium will not alter based on individual claims experience. ... The insured shall be eligible for 1% discount on the renewal premium if no claim has been made during the expiring policy tenure ... These loadings will be applied from inception date of the first Policy including subsequent Renewal(s) with Us. There will be no loadings based on individual claims experience.","sources":[{"clause":"Excl12(d)(v)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-d-v"},{"clause":null,"heading":"F.II.8. Renewal Terms","page":55,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-8-renewal-terms"},{"clause":null,"heading":"F.II.10. Discounts under the Policy","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-10-discounts-under-the-policy"},{"clause":null,"heading":"F.II.11 Loadings & Special Conditions","page":58,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-11-loadings-special-conditions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Investigation & Evaluation","Rest Cure, rehabilitation and respite care","Obesity/ Weight Control (surgery not meeting the listed conditions)","Change-of-Gender treatments","Cosmetic or Plastic Surgery","Hazardous or Adventure sports","Breach of law","Excluded Providers","Alcoholism, drug or substance abuse or any addictive condition","Treatments in health hydros, nature cure clinics, spas","Dietary supplements and substances that can be purchased without prescription","Refractive error less than 7.5 diopters","Unproven Treatments","Sterility and Infertility (unless the Infertility Treatment cover is bought)","Maternity (unless the Enhance Plus or Enhance package is bought)","Dental treatment unless necessitated due to an Accident with 24 hours hospitalisation","Circumcision unless necessary for treatment","Instruments for sleep apnoea (C.P.A.P.), C.P.A.D., oxygen concentrator, infusion pump or other external devices","External Congenital Anomaly","Prostheses, corrective devices and medical appliances not required intra operatively","Hospital stay without treatment","Treatment outside India (except under the Freedom package)","Donor screening or transplant costs for organs not harvested from a human body","Non-Allopathic treatment (except AYUSH), Hydrotherapy, Acupuncture, Reflexology or Chiropractic treatment","Nuclear, chemical or biological attack and radiation","War, hostilities, rebellion and riots","Non-medical expenses (Annexure III List I), unless the Non-Medical Items cover is bought","Cataract treatment with multi-focal lenses or femto laser surgery","Modern & Advanced Treatments other than those covered","Out-Patient Treatment expenses including fractures not requiring hospitalisation","Intentional self-injury, attempted suicide or suicide","Stem cell harvesting","Vaccination (except post animal bite treatment)","Hearing aids, spectacles or contact lenses","Alopecia and baldness treatment","Treatment that is not of a reasonable charge and not Medically Necessary","Drugs or treatments not supported by a prescription","Permanent exclusions named in the Policy Schedule","Treatment at a facility that is not a Hospital, Day Care Centre or AYUSH Hospital","Treatment by a Medical Practitioner outside his discipline","Artificial life maintenance after certification of a vegetative state","Treatments or medicines not approved by CDSCO, FDA, or used off-label"],"display":"Standard IRDAI exclusions (investigation, rest cure, obesity, gender change, cosmetic, adventure sports, breach of law, excluded providers, substance abuse, spas, supplements, refractive error under 7.5 diopters, unproven treatment, infertility, maternity) plus the product's own list (dental, external devices, treatment abroad, OPD, self-injury, premium cataract lenses, unapproved or off-label drugs and others)","note":"Bariatric surgery is covered under D.I.11 (after 36 months) despite the obesity exclusion. Infertility, maternity and non-medical items can be bought back (E.III). The CIS heading reference reads 'E.I.4 to E.I.18 and E.II.7 to E.II.32'.","quote":"E.I.4 Investigation & Evaluation- Code- Excl 04 ... E.I.5 Rest Cure, rehabilitation and respite care- Code- Excl 05 ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... E.I.7 Change-of-Gender treatments: Code- Excl 07 ... E.I.8 Cosmetic or Plastic Surgery: Code- Excl 08 ... E.I.9 Hazardous or Adventure sports: Code- Excl 09 ... E.I.10Breach of law: Code- Excl 10 ... E.I.11Excluded Providers: Code- Excl 11 ... E.I.12. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... Dietary supplements and substances that can be purchased without prescription ... Expenses related to the treatmen for correction of eye sight due to refractive error less than 7.5 diopters ... E.I.16Unproven Treatments: Code- Excl 16 ... E.I.17Sterility and Infertility: Code- Excl 17 ... E.I.18Maternity: Code Excl 18 ... E.III. Exclusion which can be opted for cover by payment of additional premium ... E.II.7 Dental Treatment, orthodontic treatment, dentures or Surgery of any kind unless necessitated due to an Accident and requiring minimum 24 hours Hospitalization. ... E.II.8 Circumcision unless necessary for treatment of a disease, illness or injury ... E.II.9 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. ... E.II.10 External Congenital Anomaly or defects ... E.II.11 Prostheses, corrective devices and medical appliances, which are not required intra operatively ... E.II.12 Any stay in Hospital without undertaking any treatment ... E.II.13 Treatment received outside the geographical limits of India other than for coverage under D.III.4.ii Worldwide Emergency Hospitalization with Outpatient Cover under Freedom optional package if opted. ... E.II.15 Any form of Non-Allopathic treatment (except AYUSH Treatment), Hydrotherapy, Acupuncture, Reflexology or Chiropractic treatment. ... E.II.16 All Illness/expenses caused by ionizing radiation or contamination by radioactivity ... nuclear, chemical or biological attack ... foreign invasion, act of foreign enemies, hostilities, warlike operations ... civil war, public defense, rebellion, revolution, insurrection, military or usurped power, active participation in riots ... E.II.18 All non-medical expenses ... E.II.21 Expenses related to cataract treatment involving all types of Multi-focal Lenses (including intraocular lenses), Multi-focal Toric Lenses, and Femto Laser-assisted surgeries are not covered. ... Expenses related to any Modern & Advanced Treatments other than those covered under this ... E.II.23 Any kind of Out-Patient Treatment expenses including fractures (not requiring any kind of hospitalization). ... E.II.24 Expenses related to an Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide. ... E.II.25 Stem cell harvesting. E.II.26 Vaccination including inoculation and immunisations (except post animal bite treatment). E.II.27 Expenses related to the provision or fitting of hearing aids, spectacles or contact lenses. ... E.II.28 Any treatment and associated expenses for alopecia, baldness ... E.II.29 Any treatment or part of a treatment that is not of a reasonable charge and not Medically Necessary. E.II.30 Drugs or treatments which are not supported by a prescription. E.II.31 Any permanent exclusion applied on any medical or physical condition or treatment of an Insured Person as specifically mentioned in the Policy Schedule ... E.II.32 Treatment at a healthcare facility which is NOT a Hospital or Day Care Centre or AYUSH Hospital. E.II.33 Treatment rendered by a Medical Practitioner which is outside his discipline ... E.II.34 Expenses incurred towards artificial life maintenance, including life support, after the patient has been certified to be in a vegetative state ... Any treatment, medicine not approved by CDSCO, FDA and other appropriate authorities in India shall not be covered under the policy. ... Treatments or medications used outside their approved purpose (often called “off-label” or extra usage) shall not be covered ... E.II.14 Costs of donor screening or costs incurred in an organ transplant surgery involving organs not harvested from a human body","sources":[{"clause":null,"heading":"E.I.4 Investigation & Evaluation- Code- Excl 04","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-4-investigation-evaluation-code-excl-04"},{"clause":null,"heading":"E.I.5 Rest Cure, rehabilitation and respite care- Code- Excl 05","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-5-rest-cure-rehabilitation-and-respite-care"},{"clause":null,"heading":"E.I.6 Obesity/ Weight Control: Code- Excl 06","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-6-obesity-weight-control-code-excl-06"},{"clause":null,"heading":"E.I.7 Change-of-Gender treatments: Code- Excl 07","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-7-change-of-gender-treatments-code-excl-07"},{"clause":null,"heading":"E.I.8 Cosmetic or Plastic Surgery: Code- Excl 08","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-8-cosmetic-or-plastic-surgery-code-excl-08"},{"clause":null,"heading":"E.I.9 Hazardous or Adventure sports: Code- Excl 09","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-9-hazardous-or-adventure-sports-code-excl-09"},{"clause":null,"heading":"E.I.10Breach of law: Code- Excl 10","page":44,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-10breach-of-law-code-excl-10"},{"clause":null,"heading":"E.I.11Excluded Providers: Code- Excl 11","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-11excluded-providers-code-excl-11"},{"clause":"Excl12","heading":null,"page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12"},{"clause":null,"heading":"E.I.15Refractive Error: Code- Excl 15","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-15refractive-error-code-excl-15"},{"clause":null,"heading":"E.I.16Unproven Treatments: Code- Excl 16","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-16unproven-treatments-code-excl-16"},{"clause":null,"heading":"E.I.17Sterility and Infertility: Code- Excl 17","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-17sterility-and-infertility-code-excl-17"},{"clause":null,"heading":"E.I.18Maternity: Code Excl 18","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-18maternity-code-excl-18"},{"clause":null,"heading":"E.II.6 Infertility Treatment Waiting Period","page":46,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-ii-6-infertility-treatment-waiting-period"},{"clause":null,"heading":"A. Medical Protocols","page":59,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-a-medical-protocols"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"You can cancel with 7 days' written notice. If no claim has been made, the premium is refunded in proportion to the unexpired days; if a claim has been made, there is no refund.","display":"Pro-rata refund for unexpired days if no claim; no refund after a claim","note":"The insurer may cancel for misrepresentation, non-disclosure or fraud on 15 days' notice with no refund.","quote":"The policyholder may cancel this policy by giving 7 days written notice at any time during the term ... If no claim has been made during the policy period, a proportionate refund of the premium will be issued based on the number of unexpired days. ... If a claim has been made during the Policy period, no refund will be given to the Policyholder.","sources":[{"clause":"Excl12(d)(i)","heading":null,"page":50,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-d-i"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only, except the optional Freedom package's Worldwide Emergency Hospitalization with Outpatient Cover. Claims are settled in India in rupees.","display":"India; worldwide emergencies only with the Freedom option","note":"Air ambulance cover is for transport within India.","quote":"The geographical scope of this policy applies to events within India other than for D.III.4.ii Worldwide Emergency Hospitalization with Outpatient Cover under Freedom optional package (if opted) and which are specifically covered in the Policy Schedule. However all admitted or payable claims shall be settled in India in Indian rupees. ... transfer between healthcare facilities within India by an Air Ambulance","sources":[{"clause":null,"heading":"F.II.5. Geography","page":54,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-5-geography"},{"clause":null,"heading":"D.I.10 Air Ambulance Cover","page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-10-air-ambulance-cover"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"New individual policies only, not renewals or ported policies. Refund less proportionate risk premium, medical examination and stamp duty costs, within 7 days of the request.","quote":"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.","sources":[{"clause":null,"heading":"F.I.15. Free Look period","page":53,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-15-free-look-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Instalment premiums: 30 days for half-yearly and quarterly, 15 days for monthly mode.","quote":"in no case later than the Grace Period of 30 days from the expiry of the Policy. ... Grace Period of 30 days would be given for Half-yearly and Quarterly mode of payment and grace period of 15 days for monthly mode of payment","sources":[{"clause":null,"heading":"F.II.7. Grace Period","page":55,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-7-grace-period"},{"clause":null,"heading":"F.I.13. Premium Payment in Instalments (Wherever applicable)","page":52,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-13-premium-payment-in-instalments-wherever-a"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Minimum entry age is 91 days for children and 18 years for adults; there is no maximum entry age.","display":"91 days (children), 18 years (adults); no upper limit","note":"From the prospectus. Children from 91 days to 17 years are covered only if a parent is the proposer; children up to 25 years can be in a floater.","quote":"The minimum entry age under this policy is 91 days for children and 18 years for adults. There is no limit for entry under this policy.","sources":[{"clause":null,"heading":"Vi. What are Features of the Policy?","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/373#c-vi-what-are-features-of-the-policy"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Single","Half yearly","Quarterly","Monthly"],"display":"Single (annual), half-yearly, quarterly or monthly","note":"Loading on premium: monthly 5.50%, quarterly 3.50%, half-yearly 2.50%. The prospectus lists 'Single, Yearly, Half yearly, Quarterly and Monthly'. Instalments only for a one-year tenure.","quote":"Premium can be paid on Single, Half yearly, Quarterly and Monthly basis.","sources":[{"clause":null,"heading":"F.II.9. Premium calculation","page":56,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-9-premium-calculation"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Enhance Plus package (Protect plan): maternity and new born, room upgrade, Health Maintenance Benefit","Assure package (Protect, Rs 3, 4 and 5 Lacs): room limit, disease sub-limits","Enhance package (Advantage plan): maternity and new born, room upgrade","Freedom package: room upgrade, Worldwide Emergency Hospitalization with Outpatient Cover","Non-Medical Items","Deductible","Infertility Treatment","Personal Accident Cover","Cumulative Bonus Booster","ManipalCigna Critical Illness Add-on cover","ManipalCigna Prime Plus add-on"],"display":"Enhance Plus, Assure, Enhance, Freedom packages; Non-Medical Items, Deductible, Infertility, Personal Accident, Cumulative Bonus Booster; Critical Illness and Prime Plus add-ons","note":"Only one optional package can be chosen. Deductible is not available with Assure and is shown as not available for Advantage in the benefit table. Prime Plus offers room rent modification, Surplus Benefit, Supreme Bonus, Premium Management Cover, Women Care and deductibles of Rs 50,000 to 5,00,000. Infertility Treatment needs the Enhance Plus or Enhance package and Sum Insured Rs 7.5 Lacs or more; Cumulative Bonus Booster is for Sum Insured Rs 5 Lacs or more.","quote":"D.III.1 Enhance Plus (Applicable for Protect Plan) ... D.III.1.i Maternity & New Born Hospitalization Expenses ... D.III.1.ii Room Accommodation Upgrade ... D.III.1.iii Health Maintenance Benefit ... D.III.2 Assure (Applicable for Sum Insured ₹ 3Lacs, ₹ 4 Lacs and ₹ 5 Lacs under Protect Plan) ... D.III.2.i Room Accommodation Limit ... D.III.2.ii Disease Specific Sub-limits ... D.III.3 Enhance (Applicable for Advantage Plan) ... D.III.3.ii Room Accommodation Upgrade ... D.III.4 Freedom ... D.III.4.ii Worldwide Emergency Hospitalization with Outpatient Cover ... D.IV.1 Non-Medical Items ... D.IV.2 Deductible ... D.IV.3 Infertility Treatment ... D.IV.4 Personal Accident Cover ... D.IV.5 Cumulative Bonus Booster ... D.V.1 ManipalCigna Critical Illness Add-on cover ... D.V.2 ManipalCigna Prime Plus ... D.III.1 ‘Enhance Plus’ or D.III.3 ‘Enhance’ Optional Package is opted and Sum Insured opted under the Policy and mentioned in Policy Schedule is ₹7.5 lacs and above ... This benefit is applicable for Sum Insured opted for ₹5 lacs and above.","sources":[{"clause":null,"heading":"D.III.1 Enhance Plus","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-enhance-plus"},{"clause":null,"heading":"D.III.1.i Maternity & New Born Hospitalization Expenses A. Maternity Expenses","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-i-maternity-new-born-hospitalization-exp"},{"clause":null,"heading":"D.III.1.ii Room Accommodation Upgrade","page":35,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-ii-room-accommodation-upgrade"},{"clause":null,"heading":"D.III.1.iii Health Maintenance Benefit","page":35,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-iii-health-maintenance-benefit"},{"clause":null,"heading":"D.III.2 Assure","page":35,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-2-assure"},{"clause":null,"heading":"D.III.2.i Room Accommodation Limit","page":35,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-2-i-room-accommodation-limit"},{"clause":null,"heading":"D.III.2.ii Disease Specific Sub-limits","page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-2-ii-disease-specific-sub-limits"},{"clause":null,"heading":"D.III.3 Enhance","page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-3-enhance"},{"clause":null,"heading":"D.III.3.i Maternity & New Born Hospitalization Expenses A. Maternity Expenses","page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-3-i-maternity-new-born-hospitalization-exp"},{"clause":null,"heading":"D.III.3.ii Room Accommodation Upgrade","page":38,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-3-ii-room-accommodation-upgrade"},{"clause":null,"heading":"D.III.4 Freedom","page":38,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-4-freedom"},{"clause":null,"heading":"D.III.4.ii Worldwide Emergency Hospitalization with Outpatient Cover","page":38,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-4-ii-worldwide-emergency-hospitalization-w"},{"clause":null,"heading":"D.IV.1 Non-Medical Items","page":39,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-1-non-medical-items"},{"clause":null,"heading":"D.IV.2 Deductible","page":39,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-2-deductible"},{"clause":null,"heading":"D.IV.3 Infertility Treatment","page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-3-infertility-treatment"},{"clause":null,"heading":"D.IV.4 Personal Accident Cover","page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-4-personal-accident-cover"},{"clause":null,"heading":"D.IV.5 Cumulative Bonus Booster","page":41,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-5-cumulative-bonus-booster"},{"clause":null,"heading":"D.V Add on Cover D.V.1 ManipalCigna Critical Illness Add-on cover","page":41,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-v-add-on-cover-d-v-1-manipalcigna-critical-ill"},{"clause":null,"heading":"D.V.2 ManipalCigna Prime Plus","page":41,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-v-2-manipalcigna-prime-plus"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"No. Claims arising during the grace period are not paid; renewal within it keeps continuity.","display":"Not covered during the grace period","note":"For instalment premiums the wording says coverage is available during the instalment grace period (a contradiction inside the wording).","quote":"We will not be liable to pay for any claim arising out of an Injury/ Accident/ Condition that occurred during the Grace Period. ... Coverage is not available during the grace period. ... If the premium is paid in instalments during the Policy Period, coverage will be available during such Grace Period.","sources":[{"clause":null,"heading":"F.II.7. Grace Period","page":55,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-7-grace-period"},{"clause":"Excl12(d)(iv)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-excl12-d-iv"},{"clause":null,"heading":"F.I.13. Premium Payment in Instalments (Wherever applicable)","page":52,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-i-13-premium-payment-in-instalments-wherever-a"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Up to a Single Private AC Room, subject to the Sum Insured.","display":"Up to Single Private AC Room","note":"Enhance Plus, Enhance and Freedom packages upgrade to any room. The Assure package (Protect, Rs 3 to 5 Lacs) limits room rent to 1% of Base Sum Insured per day. Prime Plus add-on allows any room or twin sharing.","quote":"Room category coverage under each plan will be covered up to Single Private AC Room or as specified in the Policy Schedule, subject to maximum of Sum Insured Opted.","sources":[{"clause":"48(j)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-j"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"cross-checked","value":"Single Private AC Room in the base cover; any room category with the Enhance Plus, Enhance or Freedom package.","display":"Single Private AC Room (any room with Enhance Plus, Enhance or Freedom)","note":"Assure package: room rent capped at 1% of Base Sum Insured per day instead.","quote":"Room category coverage under each plan will be covered up to Single Private AC Room or as specified in the Policy Schedule ... We will upgrade the Room category coverage under Section D.I.1 In-patient hospitalization up to ‘Any Room Category’ subject to maximum of Sum Insured Opted and as specified in the Policy Schedule.","sources":[{"clause":"48(j)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-j"},{"clause":null,"heading":"D.III.1.ii Room Accommodation Upgrade","page":35,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-ii-room-accommodation-upgrade"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU is covered up to the Sum Insured.","display":"Up to Sum Insured","note":"Assure package: ICU capped at 2% of Base Sum Insured per day. The CIS says 'For ICU - At actuals'.","quote":"For ICU accommodation, we will cover up to Sum Insured opted or as specified in the Policy Schedule.","sources":[{"clause":"48(j)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-j"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If you take a room above your eligible category, associated medical expenses are reduced in proportion to the eligible room rent; pharmacy, consumables, implants, devices, diagnostics and ICU charges are not reduced.","display":"Yes, on associated medical expenses (not pharmacy, implants, diagnostics or ICU)","note":"Applies only in hospitals that bill differently by room category.","quote":"If you choose a hospital room that is higher than your eligible room category, you will need to pay a proportionate share of the associated medical expenses. ... Such associated medical expenses do not include Cost of pharmacy and consumables, Cost of implants and medical devices and Cost of diagnostics. Proportionate deduction shall not be applicable to ‘ICU charges’.","sources":[{"clause":null,"heading":"Proportionate Deduction Clause","page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-proportionate-deduction-clause"},{"clause":null,"heading":"C.II Specific Definitions","page":8,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-c-ii-specific-definitions"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"Zonal co-pay only: Zone I premium payers have none; Zone II payers bear 10% of each claim treated in Zone I; Zone III payers bear 10% in Zone II and 20% in Zone I; not applied to accident hospitalisation.","display":"None in your own zone; 10% or 20% if treated in a higher zone","note":"Zone I premium can be chosen in Zone II or III for a higher premium. Extra 10% co-pay may apply if a stay over 10 days is not intimated within 10 days; extra 20% for non-network organ transplants without intimation or biopsy. The CIS co-payment line is a blank 'Xxxx %'.","quote":"a) Persons paying Zone I premium can avail treatment all over India without any Co-pay.\nb) Persons paying Zone II premium\ni) Can avail treatment in Zone II and Zone III without any Co-pay.\nii) Availing treatment in Zone I will have to bear 10% of each and every claim.\nc) Person paying Zone III premium\ni) Can avail treatment in Zone III, without any Co-pay.\nii) Availing treatment in Zone II will have to bear 10% of each and every claim.\niii) Availing treatment in Zone I will have to bear 20% of each and every claim. ... Aforesaid Co-payments for claims occurring outside of the Zone will not apply in case of Hospitalization due to Accident. ... If we do not receive intimation within 10 days from the date of admission, we may apply an additional cumulative co-payment of 10% ... an additional 20% co-payment may be applicable on the admissible claim amount","sources":[{"clause":null,"heading":"F.II.9. Premium calculation","page":56,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-9-premium-calculation"},{"clause":null,"heading":"C. Prolonged Hospitalization extending beyond 10 days","page":60,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-c-prolonged-hospitalization-extending-beyond-10"},{"clause":null,"heading":"D. Organ Transplants","page":61,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-organ-transplants"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"None unless the optional deductible of Rs 10,000 or Rs 25,000 is chosen.","display":"None unless opted","note":"Optional aggregate deductible of Rs 10,000 or Rs 25,000 a year; not with the Assure package and shown as not available for Advantage. The Prime Plus add-on offers Rs 50,000 to Rs 5,00,000.","quote":"You can opt for a Deductible of ₹ 10,000 or ₹ 25,000 in the Policy. Wherever a Deductible is selected such amount will be applied for each Policy Year on the annual aggregate of all Claims in that Policy Year other than for claims under fixed benefit covers and Health Check Ups.","sources":[{"clause":null,"heading":"D.IV.2 Deductible","page":39,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-2-deductible"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Listed Modern and Advanced Treatments: up to 50% of Sum Insured when Base Sum Insured is below Rs 5 Lacs","Bariatric surgery: up to Base Sum Insured or Rs 5 Lacs, whichever is lower"],"display":"Modern treatments up to 50% of Sum Insured (Base Sum Insured below Rs 5 Lacs); bariatric surgery up to Rs 5 Lacs","note":"No other disease-wise caps in the base cover; the Protect CIS says 'For the following disease - Not Applicable'. The CIS words the modern treatment cap as 50% of Base Sum Insured. Optional Assure package (Protect, Rs 3 to 5 Lacs) only: hernia, hysterectomy, BPH and renal stone surgery Rs 50,000 (Rs 3 and 4 Lacs) or Rs 65,000 (Rs 5 Lacs); cataract per eye Rs 20,000 or 30,000; knee replacement per knee Rs 80,000 or 1,00,000; fractures Rs 2,00,000 or 2,50,000; modern treatments 10% of Base Sum Insured.","quote":"Listed Modern and Advanced Treatments: For Base Sum Insured <₹5 Lacs: Up to 50% of Sum Insured For Base Sum Insured >=₹5 Lacs: Up to Sum Insured ... D.I.11 Bariatric Surgery Cover ... Benefit under this cover is payable Up to the opted Base Sum Insured or ₹5Lacs whichever is lower ... For the following disease - Not Applicable","sources":[{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"},{"clause":null,"heading":"D.I.11 Bariatric Surgery Cover","page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-11-bariatric-surgery-cover"},{"clause":"48(b)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-b-10"},{"clause":"5(f)(x)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/374#c-5-f-x"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Also after a day care claim. 30 days for domiciliary treatment and the organ donor.","quote":"We will reimburse Pre-hospitalization Medical Expenses, upto the Sum Insured, incurred during the 60 days immediately prior to the date the Insured was admitted in the Hospital.","sources":[{"clause":null,"heading":"D.I.2 Pre-hospitalization","page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-2-pre-hospitalization"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":180},"display":"180 days","note":"30 days for domiciliary treatment and the organ donor. The prospectus benefit table misprints it as '180 days before date of hospitalization'.","quote":"We will reimburse Post-hospitalization Medical Expenses, upto the Sum Insured, incurred during the 180 days immediately post the date the Insured was discharged from the Hospital.","sources":[{"clause":null,"heading":"D.I.3 Post-hospitalization","page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-3-post-hospitalization"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All day care treatments are covered up to the Sum Insured; out-patient treatment is not.","display":"All day care treatments, up to Sum Insured","note":"'All' is from the CIS; the wording covers any medically necessary day care treatment without a list.","quote":"We will indemnify the Medical Expenses incurred for an Insured Person upto the sum Insured in the event of Medically Necessary Day Care Treatment or Surgery that requires less than 24 hours of Hospitalization due to advancement in technology ... All day care treatments covered up to the Sum Insured","sources":[{"clause":null,"heading":"D.I.4 Day Care Treatment","page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-4-day-care-treatment"},{"clause":"1(c)","heading":"Mental Illness","page":2,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/374#c-1-c"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Yes, up to 10% of the Sum Insured when the patient cannot be moved or no bed is available, for at least 3 days; pre and post costs 30 days each; some illnesses excluded.","display":"Yes, up to 10% of Sum Insured","note":"Excludes asthma, bronchitis, arthritis, chronic nephritis, diarrhoea, diabetes, epilepsy, hypertension, pyrexia of unknown origin and others. No restoration for this benefit.","quote":"We will reimburse the Medical Expenses of an Insured Person, up to the limits specified in the Policy Schedule, for an Illness or Injury that would normally require Hospitalization, but it is instead treated at home on the advice of the attending Medical Practitioner ... The condition of the Insured Person does not allow a Hospital transfer; or ... A Hospital bed was unavailable; Provided that, the treatment of the Insured Person continues for at least 3 days ... Domiciliary Hospitalization (Treatment at Home) | Covered up to 10% of the Sum Insured Pre and Post Hospitalization Expenses: 30 days each","sources":[{"clause":null,"heading":"D.I.5 Domiciliary Hospitalization","page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-5-domiciliary-hospitalization"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient AYUSH treatment in an AYUSH Hospital is covered up to the Sum Insured.","display":"Covered up to Sum Insured (in-patient, AYUSH Hospital)","note":"Excludes pleasure, rejuvenation and preventive treatments such as Panchakarma. The prospectus benefit table prints the air ambulance text against the AYUSH row (rows shifted).","quote":"Medically Necessary Treatment taken during In-patient Hospitalization for AYUSH Treatment ... The Insured Person has undergone treatment in an AYUSH Hospital. ... AYUSH Treatment | Covered up to the Sum Insured","sources":[{"clause":null,"heading":"D.I.9 AYUSH Treatment","page":17,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-9-ayush-treatment"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"cross-checked","value":"Covered as in-patient or day care: up to 50% of Sum Insured if Base Sum Insured is below Rs 5 Lacs, up to the Sum Insured from Rs 5 Lacs.","display":"Up to 50% of Sum Insured below Rs 5 Lacs; up to Sum Insured from Rs 5 Lacs","note":"Listed: uterine artery embolisation and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, prostate vaporisation, IONM, stem cell therapy for haematological conditions. Assure package: 10% of Base Sum Insured.","quote":"The following procedures will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment ... Listed Modern and Advanced Treatments: For Base Sum Insured <₹5 Lacs: Up to 50% of Sum Insured For Base Sum Insured >=₹5 Lacs: Up to Sum Insured","sources":[{"clause":null,"heading":"Coverage for Advanced/Modern Treatment procedures","page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-coverage-for-advanced-modern-treatment-procedure"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes. Donor's in-patient costs for harvesting are covered up to the Sum Insured, with donor pre and post costs 30 days each and screening; complications covered up to 25% of Sum Insured, max Rs 2 Lacs, over and above.","display":"Yes, up to Sum Insured","note":"Organ acquisition cost is not covered. Requires an admitted in-patient claim for the recipient.","quote":"We will indemnify In-patient Hospitalization Medical Expenses towards the donor for harvesting the organ up to the Sum Insured as specified in the Policy Schedule ... Any Pre or Post-hospitalization Medical Expenses, up to 30 days each. ... Complications arising during hospitalization or up to 30 days from date of discharge - Covered up to 25% of SI subject to maximum of Rs,2 Lacs, Over and above Sum Insured.","sources":[{"clause":null,"heading":"D.I.7 Donor Expenses","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-7-donor-expenses"},{"clause":"48(c)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-c-7"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance covered up to the Sum Insured in an emergency; air ambulance within India up to the Base Sum Insured or Rs 10 Lacs, whichever is lower, over and above the Sum Insured.","display":"Road: up to Sum Insured; Air: up to Base Sum Insured or Rs 10 Lacs","note":"Air ambulance return transport home is excluded. Air ambulance is removed if the Prime Plus Premium Management Cover is chosen.","quote":"We will reimburse Reasonable and Customary expenses up to Sum Insured as specified in the Policy Schedule that are incurred towards road transportation of an Insured Person ... transfer between healthcare facilities within India by an Air Ambulance ... Benefit under this cover is payable Up to the opted Base Sum Insured or ₹10Lacs whichever is lower The benefit is payable over and above the Sum Insured.","sources":[{"clause":null,"heading":"D.I.6 Road Ambulance","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-6-road-ambulance"},{"clause":null,"heading":"D.I.10 Air Ambulance Cover","page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-10-air-ambulance-cover"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"100% of Base Sum Insured restored unlimited times a year, for related and unrelated illnesses, but not for the first claim of the year.","display":"100% of Base Sum Insured, unlimited times, same or other illness; not for first claim","note":"Triggers when Base Sum Insured and bonus are insufficient; usable for in-patient, pre/post, day care, road ambulance, donor, AYUSH and non-medical items; unused amount does not carry forward.","quote":"Under restoration benefit, we will provide 100% restoration of the opted Base Sum Insured unlimited times in a Policy Year ... The Restored amount shall available for both related as well as unrelated illnesses and for all Insured members under the policy. ... The Restored amount will will not apply to the first admissible claim in the Policy Year.","sources":[{"clause":null,"heading":"D.I.8 Restoration","page":17,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-i-8-restoration"},{"clause":"48(b)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-b-8"},{"clause":"48(c)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-c-8"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"25% of Base Sum Insured is added each year irrespective of claims, up to 200%.","display":"25% a year, max 200%, irrespective of claims","note":"Optional Cumulative Bonus Booster: 50% a year up to 200% instead. Prime Plus Supreme Bonus: 100% a year up to 800%.","quote":"A bonus of 25% of your Base Sum Insured will be provided at the end of every Policy Year, if the Policy is renewed with Us before the end of the Grace Period. ... Bonus shall be provided irrespective of claims made in the expiring policy year ... Cumulative Bonus can be accumulated upto a maximum of 200% of your Base Sum Insured under the current Policy.","sources":[{"clause":null,"heading":"D.II.4 Cumulative Bonus","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-ii-4-cumulative-bonus"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not in the base cover: non-medical items are excluded. Covered up to the Sum Insured with the optional Non-Medical Items cover.","display":"Only with the optional Non-Medical Items cover","note":"The Non-Medical Items option reduces the Sum Insured when used.","quote":"E.II.18 All non-medical expenses including convenience items for personal comfort ... We will cover the cost of Non-Medical items, listed under Annexure III List 1 of the Policy, incurred towards Medically Necessary Hospitalization of the insured person","sources":[{"clause":null,"heading":"E.II.6 Infertility Treatment Waiting Period","page":46,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-ii-6-infertility-treatment-waiting-period"},{"clause":null,"heading":"D.IV.1 Non-Medical Items","page":39,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iv-1-non-medical-items"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not in the base cover. With Enhance Plus (Protect) or Enhance (Advantage): up to 10% of Base Sum Insured, max Rs 1 Lac, after 36 months, up to 2 deliveries or terminations.","display":"Not in the base cover; with Enhance Plus or Enhance: 10% of Base Sum Insured, max Rs 1 Lac, after 36 months","note":"The Enhance wording gives the limit 'as per Plan opted', the benefit table shows the same 10% max Rs 1 Lac. Ectopic pregnancy is covered under in-patient hospitalisation.","quote":"Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred duringhospitalization) except ectopic pregnancy ... subject to a maximum 2 deliveries or terminations during the lifetime of an Insured Person with Us ... The female adult Insured Person should have been continuously covered under this Policy for at least 36 months before availing this benefit. ... Maternity Sum Insured is 10% of Base Sum Insured Opted subject to a maximum of Rs 1 Lac in addition to the Sum Insured opted. ... (Applicable for Protect Plan) ... (Applicable for Advantage Plan)","sources":[{"clause":null,"heading":"E.I.18Maternity: Code Excl 18","page":45,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-e-i-18maternity-code-excl-18"},{"clause":null,"heading":"D.III.1.i Maternity & New Born Hospitalization Expenses A. Maternity Expenses","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-i-maternity-new-born-hospitalization-exp"},{"clause":null,"heading":"D.III.1 Enhance Plus","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-enhance-plus"},{"clause":null,"heading":"D.III.3 Enhance","page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-3-enhance"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Only with a maternity package: new born treatment during and up to 90 days after birth, and first year vaccinations, within the maternity limit.","display":"Not in the base cover; with Enhance Plus or Enhance: new born treatment up to 90 days, within the maternity limit","note":"Needs an admitted maternity claim. Beyond 90 days the baby must be added for premium.","quote":"Medical Expenses towards treatment of the New Born Baby while the Insured Person is hospitalized as an In-patient for delivery. ... The Reasonable and Customary Charges incurred on the New Born Baby during and post birth up to 90 days from the date of delivery, within the limits specified in the Policy Schedule under Maternity Expenses without payment of any additional premium.","sources":[{"clause":null,"heading":"D.III.1.i Maternity & New Born Hospitalization Expenses A. Maternity Expenses","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-d-iii-1-i-maternity-new-born-hospitalization-exp"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"cross-checked","value":"In-patient mental illness treatment covered up to the Sum Insured; listed ICD conditions need 24 months of continuous cover.","display":"Covered up to Sum Insured; 24 months wait for listed conditions","note":"Listed codes include schizophrenia, bipolar disorder, depressive episode, anxiety disorders and others.","quote":"Indemnification of Medical Expenses upto the Sum Insured incurred for the Medically Necessary treatment taken of the Insured Person for in-patient Hospitalization, arising from or associated with a Mental illness ... For the below-mentioned ICD Codes, the Insured Person should have been continuously covered under this Policy for at least 24 months before availing this benefit.","sources":[{"clause":null,"heading":"Coverage for Mental Illness","page":14,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-coverage-for-mental-illness"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"Yearly health check-up, including the first year, for insured adults 18 and above, cashless at network providers: up to Rs 1000 (Sum Insured up to Rs 5 lacs), Rs 2500 (up to Rs 10 lacs) or Rs 5000 (above Rs 10 lacs) per adult.","display":"Every year incl. first; Rs 1000 / 2500 / 5000 per adult by Sum Insured","note":"Not available during the free look period; over and above the Sum Insured. Removed if Prime Plus Premium Management Cover is chosen.","quote":"is 18 years or above at the start of Policy Year ... This benefit is available once in a policy year including the first policy year. ... For Base Sum Insured Up to ₹5 lacs: Package 1 subject to a maximum of Up to ₹1000 per adult member • For Base Sum Insured above ₹5 lacs and Up to ₹10 lacs: Package 2 subject to a maximum of Up to ₹2500 per adult member • For Base Sum Insured above ₹10 lacs: Package 3 subject to maximum of Up to ₹5000 per adult member","sources":[{"clause":"48(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-a-12"},{"clause":"48(d)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-48-d-7"},{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Advantage plan only: Outpatient Expenses of Rs 20,000, Rs 30,000 or Rs 50,000 a year for consultations and diagnostics (up to 20% for pharmacy), cashless at network only. Not available on Protect.","display":"Advantage only: Rs 20,000 / 30,000 / 50,000 a year, cashless network","note":"Protect plan: out-patient care only through the Enhance Plus Health Maintenance Benefit (Rs 3000 a year). Dental and vision treatment not covered under OPD.","quote":"Outpatient Expenses | Not Available | Option to choose from - ₹20,000, ₹30,000, ₹50,000 Per policy Year ... Up to 20% of the Outpatient Limit can be used for Pharmacy ... This benefit is available only on cashless basis from the Network providers of ManipalCigna Health Insurance Company Limited.","sources":[{"clause":null,"heading":"Ombudsman","page":72,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-ombudsman"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Yes. Premium depends on the zone of the proposer's city (three zones); treatment in a higher zone than the one paid for brings a 10% or 20% co-pay, except accidents.","display":"Yes, three zones; 10% or 20% co-pay for higher-zone treatment","note":"Zone I covers Delhi NCR, Mumbai, Thane, Ahmedabad, Surat, Hyderabad, Kolkata and others; Zone II includes Chennai, Bangalore, Pune; Zone III the rest. Zone I can be chosen for a higher premium.","quote":"Premium will be calculated based on the Sum Insured opted, Age, gender, risk classification and Zone of Cover. ... Availing treatment in Zone II will have to bear 10% of each and every claim. ... Availing treatment in Zone I will have to bear 20% of each and every claim. ... Aforesaid Co-payments for claims occurring outside of the Zone will not apply in case of Hospitalization due to Accident.","sources":[{"clause":null,"heading":"F.II.9. Premium calculation","page":56,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-f-ii-9-premium-calculation"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Yes, at network hospitals and hospitals under the Insurance Council's common empanelment, on showing the health card and photo ID.","display":"Yes, at network and common-empanelment hospitals","note":"Not for Daily Cash or the Freedom worldwide cover. Planned admissions need 48 hours' notice.","quote":"Cashless facility is available only at our Network Hospital or Common empanelment of hospital/healthcare providers as specified by Insurance Council.","sources":[{"clause":null,"heading":"G.I.4. Cashless Facility","page":62,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-i-4-cashless-facility"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"Claims are processed through ManipalCigna's service partner/TPA, but all customer contact is with ManipalCigna.","display":"Service partner/TPA; customer contact with ManipalCigna","note":null,"quote":"Cashless and Reimbursement Claim processing and access to network hospitals is through our service partner/TPA ... Wherever a TPA is used, the TPA will only work to facilitate claim processing. All customer contact points will be with Us including claim intimation, submission, settlement and dispute resolutions.","sources":[{"clause":null,"heading":"G. Other terms and conditions G.I. Claim process & management G.I.1. Condition Preceding","page":61,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-g-other-terms-and-conditions-g-i-claim-process-m"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Prospectus: a floater can cover a maximum of 2 adults and 3 children. Individual and multi-individual policies also available.","quote":"In case of Family Floater policies, a common Base Sum Insured shall be available on a floating basis amongst all the Insured Persons.","sources":[{"clause":null,"heading":"C.II Specific Definitions","page":8,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372#c-c-ii-specific-definitions"}],"law":[]}],"documents":[{"kind":"wording","label":"ProHealth Prime Insurance Terms & Conditions- Protect & Advantage Plan","pages":85,"fetched_at":"2026-10-19 17:10:39.762911+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Tnc - Protect & Advantage/034ce3d4-d80b-4bce-0027-e7d995e7843c?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/372"},{"kind":"wording","label":"ProHealth Prime Insurance Terms & Conditions- Active Plan","pages":69,"fetched_at":"2026-10-17 19:48:31+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Tnc - Active/463104cd-3ddb-5260-c3b0-b2dddecd40f9?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12683"},{"kind":"wording","label":"ProHealth Prime Insurance Prime Plus TnC","pages":7,"fetched_at":"2026-10-17 19:48:37+00","source_url":"https://www.manipalcigna.com/documents/20124/0/Prime-Plus-TnC-WithUIN/079c88eb-ced5-3ef3-b42c-04e14eaaba76?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12685"},{"kind":"prospectus","label":"ProHealth Prime Insurance Prospectus- Protect & Advantage Plan","pages":51,"fetched_at":"2026-10-19 17:10:39.762911+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Prospectus - Protect & Advantage/3843eced-143d-e5d4-252b-78f9c292a8d3?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/373"},{"kind":"prospectus","label":"ProHealth Prime Insurance Prospectus- Active","pages":43,"fetched_at":"2026-10-17 19:48:40+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - 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ProHealth Prime - CIS - Protect/c0cbce3e-1d38-b5d2-e783-c0a90835371d?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/374"},{"kind":"cis","label":"ProHealth Prime Insurance Active CIS","pages":18,"fetched_at":"2026-10-17 19:48:33+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - CIS - Active/99eab315-133a-3d67-20cc-8a228c417771?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12684"},{"kind":"cis","label":"ProHealth Prime Insurance Advantage CIS","pages":22,"fetched_at":"2026-10-17 19:48:39+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - CIS - Advantage/48d5e571-d8b0-664c-6383-5d4da6dcdce0?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12687"},{"kind":"cis","label":"ProHealth Prime Insurance Annexure to CIS Protect","pages":8,"fetched_at":"2026-10-17 19:48:52+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Annexure to CIS - Protect/3df13bf3-475d-9e5d-bdfa-8ebabbae6a1f?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12694"},{"kind":"cis","label":"ProHealth Prime Insurance Annexure to CIS Advantage","pages":7,"fetched_at":"2026-10-17 19:48:58+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Annexure to CIS - Advantage/9abd05a6-3680-d332-1856-f404d5520c41?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12699"},{"kind":"cis","label":"ProHealth Prime Insurance Annexure to CIS Active","pages":7,"fetched_at":"2026-10-17 19:49:04+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Annexure to CIS - Active/db10358d-c9c5-7f99-6bd6-c7e893a575e7?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12701"},{"kind":"brochure","label":"ProHealth Prime Insurance Protect & Advantage Leaflet","pages":3,"fetched_at":"2026-10-17 19:49:14+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Onepager - Protect and Advantage/18f9c76f-45b6-794e-a41c-ef5baed6e856?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12704"},{"kind":"brochure","label":"ProHealth Prime Insurance Protect & Advantage Accordion","pages":11,"fetched_at":"2026-10-17 19:49:07+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Protect and Advantage - Accordion/139efe3a-c385-5f58-1912-599ec97f9da4?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12706"},{"kind":"brochure","label":"ProHealth Prime Insurance Active Leaflet","pages":2,"fetched_at":"2026-10-17 19:49:26+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealthPrime - Onepager - Onepager/5697d725-e270-48e3-9c7b-8811d02fa295?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12709"},{"kind":"brochure","label":"ProHealth Prime Insurance Active Accordion","pages":7,"fetched_at":"2026-10-17 19:49:20+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Prime - Active - Accordion/7f546e0a-15ac-0daf-0033-6708ebb19ce1?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425/document/12719"}],"versions":[{"uin":"MCIHLIP27045V032627","version":null,"approved_on":null},{"uin":"MCIHLIA25005V012425","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Manipal Cigna Health Insurance official website","url":"https://www.manipalcigna.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims","url":"https://claim.manipalcigna.com/claims/","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.manipalcigna.com/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renew online","url":"https://online.manipalcigna.com/erenewal/renew?source=NWEB","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"ProHealth Prime Insurance (UIN MCIHLIA25005V012425), IndiaInsurances, https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-prime-insurance-mcihlia25005v012425"}