{"uin":"MCIHLIP27046V062627","name":"ProHealth Select","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627","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 Select is an indemnity health policy in two variants, (A) for affinity partners with sum insured from Rs 0.5 lakh and (B) for agency, broking and direct channels from Rs 2 lakh, up to Rs 25 lakh, for individuals or families. Room rent is capped at 2% of base sum insured up to Rs 3,000, pre-existing diseases wait 36 months, listed illnesses 24 months, and a 5% yearly cumulative bonus up to 100% is given regardless of claims.","analysis":{"state":"extracted","analysed_at":"2026-10-19 17:10:40.392981+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":["ProHealth Select (A)","ProHealth Select (B)"],"display":"ProHealth Select (A) and ProHealth Select (B)","note":"(A) is sold through affinity partners (corporate agents), (B) through agency, broking and direct channels. Several optional covers (voluntary co-pay, health check-up, worldwide emergency cover, disease specific sub-limits, health maintenance benefit) exist only in (A).","quote":"The policy is available under 2 variants as detailed below: ProHealth Select (A) available to Affinity Partners (Corporate Agents) ProHealth Select (B) available to Agency, Broking and Direct Channels","sources":[{"clause":null,"heading":"IX. What are the Benefit Details?","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-ix-what-are-the-benefit-details"}],"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, two or three years.","display":"1, 2 or 3 years","note":"From the prospectus; the wording refers to Policy Periods of two/three years. Instalment premiums are not available for terms over 1 year.","quote":"You can buy the policy for one, two or three continuous years at the option of the Insured.","sources":[{"clause":"Row 1(b)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-row-1-b-3"}],"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 must be notified at least 48 hours before admission; emergency hospitalisation within 24 hours of admission.","display":"48 hours before planned admission; within 24 hours of emergency admission","note":"Worldwide Emergency Cover: within 48 hours of admission abroad. Hospital stays beyond 10 days not intimated within 10 days of admission may attract an extra 10% co-payment. Reimbursement documents are due 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.","sources":[{"clause":null,"heading":"G.I.3. Claim Intimation","page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-g-i-3-claim-intimation"}],"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","Hospital Discharge summary","Operation Theatre notes/ ICP papers","Hospital Main Bill","Hospital Break up bill","Investigation reports","Pharmacy bills, prescription and invoices","Copy of FIR/Panchnama / Police Inquest Report (if conducted) in case of Accident"],"display":"Claim form, photo ID and KYC, cancelled cheque, discharge summary, hospital bills, investigation reports, pharmacy bills, FIR in accident cases","note":"Reimbursement claim list for in-patient hospitalisation. Documents are due within 15 days of discharge (cashless claim documents from the hospital within 30 days). Other benefits (pre/post hospitalisation, domiciliary, ambulance, Re-Assurance, Health Maintenance Benefit) have their own extra documents.","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 ... Hospital Discharge summary ... Operation Theatre notes/ ICP papers ... Hospital Main Bill ... Hospital Break up bill ... Investigation reports ... 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)","heading":null,"page":42,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-18"},{"clause":"Row 1","heading":"In-patient Hospitalization","page":42,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-row-1"}],"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":"The insurer settles or rejects a claim within 15 days from submission of the necessary claim documents, with interest at 2% above bank rate for delay. Cashless pre-authorisation within 1 hour and final discharge authorisation within 3 hours of complete documents.","display":"15 days from the last necessary document; cashless approval within 1 hour, discharge within 3 hours","note":"Health Maintenance Benefit claims: within 5 days, not later than 15 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 authorisations will be issued within a period of 1 hour from the receipt of last complete documents. ... We shall accept or decline such additional expenses within 3 (Three) hours of receiving the complete documents for final discharge from Network provider.","sources":[{"clause":null,"heading":"F.I.3 Claim Settlement (provision for Penal Interest)","page":27,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-3-claim-settlement-provision-for-penal-inter"},{"clause":"Excl12(a)(v)","heading":null,"page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-v"},{"clause":"Excl12(a)(vii)","heading":null,"page":41,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-vii"}],"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 diseases until 36 months of continuous coverage (Excl 01)","Listed specified diseases/procedures until 24 months (Excl 02)","Any illness in the first 30 days except accidents (Excl03)","Admission primarily for investigation and evaluation (Excl 04)","Rest cure, rehabilitation and respite care (Excl 05)","Cosmetic or plastic surgery (Excl 08)","Hazardous or adventure sports as a professional (Excl 09)","Alcoholism, drug or substance abuse (Excl 12)","Sterility and infertility (Excl 17)","Maternity: childbirth, miscarriage and termination (Excl 18)","Treatment outside India other than under Worldwide Emergency Cover","Any kind of Out-Patient Treatment expenses","Non-payable items listed in Annexure IV","Multi-focal lenses and Femto laser in cataract treatment","Modern treatments other than those covered"],"display":"Waiting periods (PED 36 months, listed illnesses 24 months, first 30 days), standard exclusions Excl 04 to Excl 18, maternity, OPD, treatment abroad, non-payable items","note":"Excl12 is printed at the end of the Excl 11 clause in the wording.","quote":"E.I.1. Pre-Existing Diseases - Code- Excl 01 ... excluded until the expiry of 36 months of continuous coverage ... E.I.2. Specified disease/procedure waiting period - Code- Excl 02 ... excluded until the expiry of 24 months of continuous coverage ... E.l.3. 30-day waiting period - Code- Excl03 ... E.I.4. Investigation & Evaluation - Code - Excl 04 ... E.I.5. Rest Cure, rehabilitation and respite care - Code - Excl 05 ... E.l.8. Cosmetic or plastic Surgery: Code- Excl 08 ... E.l.9 Hazardous or Adventure sports: Code- Excl 09 ... E.l.12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... E.l.17. Sterility and Infertility: Code - Excl 17 ... E.l.18. Maternity: Code - Excl 18 ... E.II.7 Treatment received outside the geographical limits of India other than for coverage under Worldwide Emergency Cover. ... Any kind of Out-Patient Treatment expenses ... Annexure IV, List I of “Non-Payable Items” ... 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 Policy shall not be payable.","sources":[{"clause":null,"heading":"E.I Standard Exclusions E.I.1. Pre-Existing Diseases - Code- Excl 01","page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-i-standard-exclusions-e-i-1-pre-existing-disea"},{"clause":"46(II)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a-4"},{"clause":null,"heading":"E.I.2. Specified disease/procedure waiting period - Code- Excl 02","page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-i-2-specified-disease-procedure-waiting-period"},{"clause":"46(II)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a-5"},{"clause":null,"heading":"E.l.3. 30-day waiting period - Code- Excl03","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-3-30-day-waiting-period-code-excl03"},{"clause":null,"heading":"E.I.4. Investigation & Evaluation - Code - Excl 04","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#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":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-i-5-rest-cure-rehabilitation-and-respite-care"},{"clause":null,"heading":"E.l.8. Cosmetic or plastic Surgery: Code- Excl 08","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-8-cosmetic-or-plastic-surgery-code-excl-08"},{"clause":null,"heading":"E.l.9 Hazardous or Adventure sports: Code- Excl 09","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-9-hazardous-or-adventure-sports-code-excl-09"},{"clause":null,"heading":"E.l.11. Excluded Providers: Code - Excl 11","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-11-excluded-providers-code-excl-11"},{"clause":"Excl12","heading":null,"page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12"},{"clause":null,"heading":"E.l.17. Sterility and Infertility: Code - Excl 17","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-17-sterility-and-infertility-code-excl-17"},{"clause":null,"heading":"E.l.18. Maternity: Code - Excl 18","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-18-maternity-code-excl-18"},{"clause":null,"heading":"E.II. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-ii-specific-exclusions"}],"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":"Contact ManipalCigna first: website, customercare@manipalcigna.com, toll free 1800-102-4462 or 022-61703600, or any branch; if not resolved, the Grievance Cell in Mumbai (headcustomercare@manipalcigna.com); then the Insurance Ombudsman.","display":"ManipalCigna customer care (1800-102-4462, customercare@manipalcigna.com), then its Grievance Cell, then the Ombudsman","note":"Senior citizens: seniorcitizensupport@manipalcigna.com. The CIS gives a 4-level ladder (Health Relationship Managers, Grievance Redressal Officer at complaints@manipalcigna.com, Chief Grievance Redressal Officer, Ombudsman) and prints the level 2 phone number as 022-617036000. The Ombudsman can be approached if a complaint is open more than 30 days.","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 ... Contact No.: 022-61703600 ... 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.","sources":[{"clause":null,"heading":"F. I .13. Redressal of Grievance","page":30,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-13-redressal-of-grievance"},{"clause":null,"heading":"Toll Free","page":30,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-toll-free"},{"clause":null,"heading":"Contact No.","page":30,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-contact-no"},{"clause":null,"heading":"Courier","page":30,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-courier"}],"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":"ProHealth Select (A): Rs 0.50, 1, 2, 3, 4, 5, 7, 10, 15, 20 or 25 lakh. ProHealth Select (B): Rs 2, 3, 4, 5, 7, 10, 15, 20 or 25 lakh.","display":"0.5 to 25 lakh (A); 2 to 25 lakh (B)","note":"From the benefit table (Annexure III) of the policy wording.","quote":"ProHealth Select | (A) | (B) Base Sum Insured (₹ in Lacs) | 0.50, 1, 2, 3, 4, 5, 7, 10, 15, 20, 25 | 2, 3, 4, 5, 7,10,15, 20, 25,","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"}],"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. The wording body says 'within opted period'; the heading and the CIS give 30 days. Applies afresh to any increase in sum insured.","quote":"E.l.3. 30-day waiting period - Code- Excl03 ... Expenses related to the treatment of any illness within opted period of continuous coverage from the first policy commencement date shall be excluded except claims arising due to an accident ... This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.","sources":[{"clause":null,"heading":"E.l.3. 30-day waiting period - Code- Excl03","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-3-30-day-waiting-period-code-excl03"},{"clause":"46(II)(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a-6"},{"clause":"46(II)(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-b-6"}],"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","note":"Applies afresh to any sum insured increase; reduced by prior continuous cover when ported. A personal waiting period of up to 36 months may also be applied to individual insured persons after underwriting.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"46(II)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a-4"}],"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":"If a listed condition is pre-existing, the longer PED waiting period (36 months) 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":"46(II)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a-5"}],"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","Knee Replacement Surgery (other than caused by an Accident)","Non-infectious Arthritis","any internal congenital anomalies","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","Varicose Veins and Varicose Ulcers","Stones in the urinary uro-genital and biliary systems","Benign Prostate Hypertrophy, all types of Hydrocele","Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Haemorrhoids","Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis","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 tumours/skin tumours","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 and spine disorders, varicose veins, stones, BPH and hydrocele, piles, fissure, fistula and hernia, ENT disorders, ulcers, cysts and benign tumours, breast lumps, PCOD, genito-urinary surgery","note":"All 24 months. Accidents are not subject to this waiting period.","quote":"I) Cataract, ... ii) Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus ... iii) Knee Replacement Surgery (other than caused by an Accident),Non-infectious Arthritis, any internal congenital anomalies, 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 ... iv) Varicose Veins and Varicose Ulcers, ... v) Stones in the urinary uro-genital and biliary systems ... vi) Benign Prostate Hypertrophy, all types of Hydrocele, ... vii) Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Haemorrhoids ... viii) Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis ... Surgery on tonsils/Adenoids, Tympanoplasty and any other benign ear, nose and throat disorder or surgery. ... ix) Gastric and duodenal ulcer, any type of Cysts/ Nodules/Polyps/internal tumours/skin tumours, and any type of Breast lumps (unless malignant), Polycystic Ovarian Diseases, ... x) Any surgery of the genito-urinary system unless necessitated by malignancy.","sources":[{"clause":"46(II)(f)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-f-2"}],"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":"Counted afresh from the date of enhancement for any increase in sum insured. Limits, sub-limits, co-payments and deductibles still apply.","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 .17. Moratorium Period","page":31,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-17-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, with all family members, can be ported to another insurer by applying at least 30 days before, but not earlier than 60 days from, the renewal date; continuously covered persons get accrued continuity benefits in waiting periods as per IRDAI guidelines.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried","note":"Migration to other ManipalCigna products also allowed, applying at least 30 days before renewal.","quote":"The Insured Person will have the option to port the Policy to otherinsurers 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 plan with an Indian General/Health insurer the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI Guidelines on portability.","sources":[{"clause":null,"heading":"F. I .11. Portability","page":30,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-11-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 on grounds of established fraud, non-disclosure or misrepresentation.","quote":"The Policy is ordinarily renewable on mutual consent for life, subject to application of Renewal and realization of Renewal premium.","sources":[{"clause":"Excl12(a)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-5"}],"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. Renewal is not denied because of claims and no loading applies on renewals based on individual claims experience.","display":"No loading for claims","note":"Risk loading based on health status may be applied from the first policy and carried into renewals; premiums can be revised for all with 45 days' notice.","quote":"Renewal shall not be denied on the ground that the insured person had made a claim or claims in the preceding policy years. ... No loading shall apply on renewals based on individual claims experience","sources":[{"clause":null,"heading":"F.l.9Renewal of Policy","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-l-9renewal-of-policy"}],"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 (Excl 04)","Rest Cure, rehabilitation and respite care (Excl 05)","Obesity/ Weight Control (Excl 06)","Change-of-Gender treatments (Excl 07)","Cosmetic or plastic Surgery (Excl 08)","Hazardous or Adventure sports (Excl 09)","Breach of law (Excl 10)","Excluded Providers (Excl 11)","Alcoholism, drug or substance abuse (Excl 12)","Treatments in health hydros, nature cure clinics, spas (Excl 13)","Dietary supplements without prescription (Excl 14)","Refractive Error below 7.5 dioptres (Excl 15)","Unproven Treatments (Excl 16)","Sterility and Infertility (Excl 17)","Maternity (Excl 18)","External Congenital Anomaly","Dental treatment unless due to an accident","Circumcision unless medically necessary","Prostheses and appliances not required intra-operatively","Treatment outside India other than Worldwide Emergency Cover","Nuclear, chemical or biological attack","War and war-like situations","Non-payable items (Annexure IV)","Non-Allopathic treatment other than AYUSH, Hydrotherapy, Acupuncture, Reflexology, Chiropractic","Hospital stay without treatment","Donor screening costs","C.P.A.P., C.P.A.D., oxygen concentrators and external devices","Multi-focal lenses and Femto laser cataract surgery","Modern & Advanced Treatments other than those covered","Out-Patient Treatment","Intentional self-injury or suicide","Stem cell harvesting","Vaccination (except post animal bite)","Hearing aids, spectacles or contact lenses","Alopecia and baldness treatment","Treatment not medically necessary or not of a reasonable charge","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 outside the practitioner's discipline","Artificial life maintenance after certification of a vegetative state"],"display":"Standard exclusions Excl 04 to Excl 18 plus the product's own (dental, OPD, treatment abroad, non-payable items and others)","note":"Excl 07 has an exception for sex reassignment surgery for transgender persons; Excl 08 allows reconstruction after accident, burns or cancer.","quote":"E.I.4. Investigation & Evaluation - Code - Excl 04 ... E.I.5. Rest Cure, rehabilitation and respite care - Code - Excl 05 ... E.l.6. Obesity/ Weight Control - Code - Excl 06 ... E.l.7. Change-of-Gender treatments: Code- Excl 07 ... E.l.8. Cosmetic or plastic Surgery: Code- Excl 08 ... E.l.9 Hazardous or Adventure sports: Code- Excl 09 ... E.l.10. Breach of law: Code - Excl 10 ... E.l.11. Excluded Providers: Code - Excl 11 ... E.l.12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Treatments received in heath hydros, nature cure clinics, spas ... (Code - Excl 13) ... Dietary supplements and substances that can be purchased without prescription ... (Code - Excl 14) ... E.l.15. Refractive Error: Code - Excl 15 ... refractive error less than 7.5 dioptres ... E.l.16. Unproven Treatments: Code - Excl 16 ... E.l.17. Sterility and Infertility: Code - Excl 17 ... E.l.18. Maternity: Code - Excl 18 ... E.II.3 External Congenital Anomaly ... Dental treatment, orthodontic treatment, dentures or surgery of any kind unless necessitated due to an accident ... Circumcision unless necessary for treatment of an illness or injury ... Prostheses, corrective devices and medical appliances, which are not required intra-operatively ... E.II.7 Treatment received outside the geographical limits of India other than for coverage under Worldwide Emergency Cover. ... nuclear, chemical or biological attack ... war or war-like situation ... Annexure IV, List I of “Non-Payable Items” ... Any form of Non-Allopathic treatment (except AYUSH Cover), Hydrotherapy, Acupuncture, Reflexology or Chiropractic treatment. ... Any stay in Hospital without undertaking any treatment ... Costs of donor screening ... (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 ... Multi-focal Lenses (including intraocular lenses), Multi-focal Toric Lenses, and Femto Laser-assisted surgeries ... Expenses related to any Modern & Advanced Treatments other than those covered under this Policy shall not be payable. ... Any kind of Out-Patient Treatment expenses ... intentional self-injury or attempted suicide or suicide ... Stem cell harvesting ... Vaccination including inoculation and immunisations (except post animal bite treatment) ... hearing aids, spectacles or contact lenses ... alopecia, baldness ... Any treatment or part of a treatment that is not of a reasonable charge and not Medically Necessary. ... Drugs or treatments which are not supported by a prescription. ... Any permanent exclusion applied on any medical or physical condition or treatment of an Insured Person as specifically mentioned in the Policy Schedule ... Treatment at a healthcare facility which is NOT a Hospital or Day Care Centre or AYUSH Hospital. ... Treatment rendered by a Medical Practitioner which is outside his discipline ... artificial life maintenance, including life support, after the patient has been certified to be in a vegetative state","sources":[{"clause":null,"heading":"E.I.4. Investigation & Evaluation - Code - Excl 04","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#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":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-i-5-rest-cure-rehabilitation-and-respite-care"},{"clause":null,"heading":"E.l.6. Obesity/ Weight Control - Code - Excl 06","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-6-obesity-weight-control-code-excl-06"},{"clause":null,"heading":"E.l.7. Change-of-Gender treatments: Code- Excl 07","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-7-change-of-gender-treatments-code-excl-07"},{"clause":null,"heading":"E.l.8. Cosmetic or plastic Surgery: Code- Excl 08","page":23,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-8-cosmetic-or-plastic-surgery-code-excl-08"},{"clause":null,"heading":"E.l.9 Hazardous or Adventure sports: Code- Excl 09","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-9-hazardous-or-adventure-sports-code-excl-09"},{"clause":null,"heading":"E.l.10. Breach of law: Code - Excl 10","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-10-breach-of-law-code-excl-10"},{"clause":null,"heading":"E.l.11. Excluded Providers: Code - Excl 11","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-11-excluded-providers-code-excl-11"},{"clause":"Excl12","heading":null,"page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12"},{"clause":null,"heading":"E.l.15. Refractive Error: Code - Excl 15","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-15-refractive-error-code-excl-15"},{"clause":null,"heading":"E.l.16. Unproven Treatments: Code - Excl 16","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-16-unproven-treatments-code-excl-16"},{"clause":null,"heading":"E.l.17. Sterility and Infertility: Code - Excl 17","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-17-sterility-and-infertility-code-excl-17"},{"clause":null,"heading":"E.l.18. Maternity: Code - Excl 18","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-18-maternity-code-excl-18"},{"clause":null,"heading":"E.II. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-ii-specific-exclusions"}],"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":"Policyholder can cancel with 7 days' written notice. 1-year policy: proportionate refund for unexpired days if no claim, no refund if a claim was made. Longer policies: proportionate refund if no claim in the current policy year; if a claim was made in the current year, refund of premium for the remaining complete policy years. No refund if the insurer cancels for misrepresentation, non-disclosure or fraud.","display":"Pro-rata for unexpired days if no claim; no refund on a 1-year policy after a claim","note":"A claim in an earlier policy year of a multi-year policy still gets a proportionate refund.","quote":"The policyholder may cancel this policy by giving 7 days written notice ... A. Policy Tenure of 1 Year: 1. 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. ... 2. If a claim has been made during the Policy period, no refund will be given to the Policyholder. ... B. If Policy Tenure is more than 1 years: 1. If no claim has been made in the policy year, a proportionate refund of the premium on cancellation will be issued based on the number of unexpired days. ... 2. If a claim has been made in the current policy year, the premium for the remaining complete policy year(s) will be refunded on cancellation. ... There would be no refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud","sources":[{"clause":null,"heading":"F.I.6.Cancellation","page":28,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-6-cancellation"}],"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. Treatment abroad is covered only under the optional Worldwide Emergency Cover (ProHealth Select (A)), for emergency in-patient care, paid in India in rupees.","display":"India only (worldwide emergency cover optional in (A))","note":"AYUSH treatment outside India is excluded.","quote":"The geographical scope of this policy applies to events within India other than for Worldwide Emergency Cover and which are specifically covered in the Schedule. However, all admitted or payable claims shall be settled in India in Indian rupees. ... D.lll.7. Worldwide Emergency Cover (Applicable only for ProHealth Select (A)):","sources":[{"clause":null,"heading":"F.lI.7. Geography","page":32,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-li-7-geography"},{"clause":"46(II)(d)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-d"}],"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 porting/migration. Refund less proportionate risk premium, medical examination and stamp duty costs, within 7 days of 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","sources":[{"clause":null,"heading":"F.I.5Free Look period","page":27,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-5free-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":"15 days for monthly instalments.","quote":"in no case later than the Grace Period of 30 days from the expiry of the Policy for, Single and Yearly mode of payment. ... 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.I.7. Grace Period","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-7-grace-period"}],"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 91 days for children and 18 years for adults; no maximum entry age.","display":"91 days (children), 18 years (adults); no upper limit","note":"From the prospectus. Children 91 days to 5 years only if a parent is covered; 6 to 18 years only if a parent is the proposer; dependent children up to 23 years on 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":"V. What are Features of the Policy?","page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-v-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","Yearly","Half yearly","Quarterly","Monthly"],"display":"Single, yearly, half-yearly, quarterly, monthly","note":"Loading of 5.50% monthly, 3.50% quarterly, 2.50% half-yearly. Instalments only for 1-year policies.","quote":"Premium can be paid on Single, Yearly, Half yearly, Quarterly and Monthly basis.","sources":[{"clause":null,"heading":"F.Il.10. Premium calculation","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-il-10-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":["Deductible (annual aggregate)","Voluntary Co-Pay (ProHealth Select (A) only)","Cumulative Bonus Booster","Removal of Room Rent Limit","Re-Assurance","Health Check Up (ProHealth Select (A) only)","Worldwide Emergency Cover (ProHealth Select (A) only)","Disease Specific Sub limit (ProHealth Select (A) only)","Health Maintenance Benefit (ProHealth Select (A) only)","ManipalCigna Critical Illness Add-on cover","ManipalCigna Health 360 add-on"],"display":"Deductible, voluntary co-pay, bonus booster, room rent limit removal, Re-Assurance, health check-up, worldwide emergency cover, disease sub-limits, health maintenance benefit; Critical Illness and Health 360 add-ons","note":"Voluntary co-pay and deductible cannot be taken together. The Disease Specific Sub-limit option reduces cover (caps named treatments). Critical Illness and Health 360 are separate add-on products.","quote":"D.lll.1. Deductible: ... D.lll.2. Voluntary Co-Pay (Applicable only for ProHealth Select (A)) ... D.lll.3. Cumulative Bonus Booster ... D.lll.4. Removal of Room Rent Limit ... D.llI.5. Re-Assurance ... D.lll.6.Health Check Up (Applicable only for ProHealth Select (A)): ... D.lll.7. Worldwide Emergency Cover (Applicable only for ProHealth Select (A)): ... D.Ill.8. Disease Specific Sub limit (Applicable only for ProHealth Select (A)) ... D.lll.9 Health Maintenance Benefit (Applicable only for ProHealth Select (A)) ... D.IV.1 ManipalCigna Critical Illness Add-on cover ... D.IV.2 ManipalCigna Health 360","sources":[{"clause":null,"heading":"D.lll. OPTIONAL COVERS","page":14,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-optional-covers"},{"clause":"46(I)(d)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-d-6"},{"clause":null,"heading":"D.lll.3. Cumulative Bonus Booster","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-3-cumulative-bonus-booster"},{"clause":null,"heading":"D.lll.4. Removal of Room Rent Limit","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-4-removal-of-room-rent-limit"},{"clause":null,"heading":"D.llI.5. Re-Assurance","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lli-5-re-assurance"},{"clause":"46(II)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii"},{"clause":"46(II)(d)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-d"},{"clause":null,"heading":"D.Ill.8. Disease Specific Sub limit (Applicable only for ProHealth Select (A))","page":20,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-ill-8-disease-specific-sub-limit-applicable-on"},{"clause":null,"heading":"D.lll.9 Health Maintenance Benefit (Applicable only for ProHealth Select (A))","page":21,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-9-health-maintenance-benefit-applicable-on"},{"clause":null,"heading":"D.IV Rider/Add On Benefit D.IV.1 ManipalCigna Critical Illness Add-on cover","page":21,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-iv-rider-add-on-benefit-d-iv-1-manipalcigna-cr"},{"clause":null,"heading":"D.IV.2 ManipalCigna Health 360","page":21,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-iv-2-manipalcigna-health-360"}],"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":"Not for single or yearly premiums: claims arising during the grace period are not paid. For instalment premiums (half-yearly, quarterly, monthly), cover continues during the grace period.","display":"No for single/yearly payment; yes for instalment payment","note":"Renewal clause also says 'Coverage is not available during the grace period.'","quote":"We will not be liable to pay for any claim arising out of an Injury/ Accident/ Condition that occurred 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.I.7. Grace Period","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-i-7-grace-period"}],"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 2% of Base Sum Insured for a hospital room, up to a maximum of Rs 3,000. With the optional Removal of Room Rent Limit, up to a Single Private AC Room.","display":"2% of base sum insured, max ₹3,000","note":"Proportionate deduction of associated medical expenses if a costlier room is taken (not for ICU).","quote":"Covered up to 2% of Base Sum Insured for a Hospital Room, up to a max of ₹3,000 ... We will provide for an option to remove the Room Rent limit applicable on the Inpatient Hospitalization and upgrade to a Single Private AC Room.","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"},{"clause":null,"heading":"D.lll.4. Removal of Room Rent Limit","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-4-removal-of-room-rent-limit"}],"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":"No room category by default: room rent is a rupee limit (2% of base sum insured, max Rs 3,000). With the optional Removal of Room Rent Limit, a Single Private AC Room.","display":"Rupee limit by default; Single Private AC Room if the option is bought","note":"Single Private AC Room means the most economical air-conditioned single room in the hospital. The CIS says 'Single Private Room'.","quote":"Covered up to 2% of Base Sum Insured for a Hospital Room, up to a max of ₹3,000 ... We will provide for an option to remove the Room Rent limit applicable on the Inpatient Hospitalization and upgrade to a Single Private AC Room.","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"},{"clause":null,"heading":"D.lll.4. Removal of Room Rent Limit","page":16,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-4-removal-of-room-rent-limit"}],"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":"Up to 4% of Base Sum Insured for ICU, up to a maximum of Rs 7,000.","display":"4% of base sum insured, max ₹7,000","note":null,"quote":"Up to 4% of Base Sum Insured for ICU up to a max of ₹7,000","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"}],"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 a room above the eligible category is chosen, associated medical expenses (nursing, operation theatre, doctor, surgeon, anaesthetist, specialist fees) are reduced in the same proportion; pharmacy, consumables, implants and diagnostics are not, and it does not apply to ICU.","display":"Yes, except ICU, pharmacy, implants and diagnostics","note":"Applies only in hospitals that follow differential billing 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. ... The proportionate deduction will apply to “Associated Medical Expenses” shall include - Nursing Charges, Operation Theatre Charges, Fees of Medical Practitioner/Surgeon/ Anesthetist/ Specialist excluding cost of pharmacy and consumables, cost of implants and medical devices, cost of diagnostics ... It shall not be applicable for Hospitalization in ICU.","sources":[{"clause":"46(I)(k)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-k"}],"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":"No general co-pay. Zone co-pay: a person paying Zone II premium bears 10% of each claim when treated in Zone I; Zone III premium bears 10% in Zone II and 20% in Zone I (not for accident hospitalisation). Optional voluntary co-pay of 10% or 20% in ProHealth Select (A).","display":"None by default; 10% or 20% if treated in a costlier zone than the premium zone","note":"The zone co-pay rules are printed under 'Zone Discount (Only for ProHealth Select (B))'. Optional voluntary co-pay (A only): 10% or 20%. Extra 10% co-pay may apply if a stay beyond 10 days is not intimated within 10 days of admission; extra 20% for non-network organ transplants without intimation or biopsy.","quote":"Persons paying Zone I premium can avail treatment all over India without any co-pay. ... Availing treatment in Zone I will have to bear 10% of each and every claim. ... Availing treatment in Zone II will have to bear 10% of each and every claim. iii) 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 an Accident. ... We will only indemnify 90% or 80% of any amount that We assess","sources":[{"clause":"Excl12(a)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-8"},{"clause":"Excl12(b)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-b-8"},{"clause":"Excl12(c)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-c-5"},{"clause":"46(I)(d)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-d-6"}],"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 annual aggregate deductible is chosen (Rs 1, 2, 3, 4 or 5 lakh, not higher than the sum insured).","display":"None unless opted","note":"Optional deductible: Rs 1, 2, 3, 4 or 5 lakh, aggregate per policy year, for both (A) and (B). Cannot be combined with the voluntary co-pay.","quote":"The following Optional Covers shall be available under this Policy only if specifically opted for ... An Annual Aggregate Deductible is the amount you agree to pay on your own, once, each policy year before your policy starts paying for covered claims. ... Deductible - ₹1/2/3/4/5 Lacs in all combinations provided the Deductible is not higher than the Sum Insured opted","sources":[{"clause":null,"heading":"D.lll. OPTIONAL COVERS","page":14,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-lll-optional-covers"},{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"}],"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":"conflicting","value":["No disease-specific rupee sub-limit in the base cover; HIV/AIDS & STD covered up to Sum Insured","Admissions primarily for enteral feedings: up to 15 days in a Policy Year"],"display":"None in the base cover unless the optional Disease Specific Sub Limit is chosen (ProHealth Select (A))","note":"CIS says: 'Medical Expenses on HIV/AIDS-up to the Sum Insured with a maximum limit of ₹5 Lacs', although it also says 'Not Applicable' for disease limits; the wording covers HIV/AIDS and STD with no cap and the prospectus says 'Up to Sum Insured'. Optional Disease Specific Sub Limit (ProHealth Select (A) only, not available in (B)), per surgery or medical management per policy year, Options 1/2/3: cataract per eye 7,500 / 15,000 / 22,500; hernia per side 12,500 / 25,000 / 37,500; any joint replacement 40,000 / 60,000 / 80,000; cancer 40,000 / 60,000 / 80,000; and ten other named ailments.","quote":"ii) HIV/AIDS & STD: Up to Sum Insured ... primarily for enteral feedings will be covered, up to 15 days in a Policy Year ... You may choose to opt for Disease Specific Sub Limit on an optional basis under the ProHealth Select (A). ... Medical Expenses on HIV/AIDS-up to the Sum Insured with a maximum limit of ₹5 Lacs","sources":[{"clause":null,"heading":"Basic Covers","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-basic-covers"},{"clause":"46(I)(k)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-k"},{"clause":null,"heading":"D.Ill.8. Disease Specific Sub limit (Applicable only for ProHealth Select (A))","page":20,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-ill-8-disease-specific-sub-limit-applicable-on"},{"clause":"Row 1(b)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/377#c-row-1-b-2"}],"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":"Up to sum insured. 30 days for domiciliary treatment.","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":"46(I)(k)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-k"}],"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":"conflicting","value":{"unit":"days","amount":180},"display":"180 days","note":"CIS says: 'up to 90 days immediately post discharge'. The wording's benefit clause (D.I.3) says 180 days but its own benefit table (Annexure III) says 'Post - Hospitalization | 90 days'; the prospectus likewise says 180 days in its benefit text and 90 days in its benefit table. The CIS states that the policy document prevails in case of conflict. 30 days for domiciliary treatment.","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. ... Post - Hospitalization | 90 days ... Cover Medical Expenses of an Insured Person which are incurred due to an Illness or Injury up to 90 days immediately post discharge of the Insured Person","sources":[{"clause":"46(I)(k)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-k"},{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"},{"clause":"3","heading":"Post-hospitalization","page":2,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/377#c-3"}],"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 Medically Necessary day care treatments in the list (Annexure II, 171 procedures) are covered up to the sum insured; OPD treatment is not covered under this benefit.","display":"171 listed procedures, up to sum insured","note":"Includes pre and post hospitalisation expenses.","quote":"Day Care Treatment | 171 procedures, Covered up to Sum Insured ... For list of Day Care treatments covered under this policy, please refer Annexure II of the policy.","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"},{"clause":"46(I)(e)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-e-2"}],"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 the sum insured, when the patient's condition does not allow a hospital transfer or no hospital bed is available, and treatment lasts at least 3 days.","display":"Yes, up to sum insured (min 3 days)","note":"Pre and post hospitalisation up to 30 days each. Excludes asthma, bronchitis, arthritis, diabetes, epilepsy, hypertension, diarrhoea, chronic nephritis, pyrexia of unknown origin and others.","quote":"We will reimburse Medical Expenses of an Insured Person, up to the Sum Insured, for an Illness or Injury which in the normal course would have required Hospitalization but is taken at home on the advice of the attending Medical Practitioner, under the following circumstances: ... The condition of the Insured Person does not allow a Hospital transfer; or ... A Hospital bed is unavailable; Provided that, the treatment of the Insured Person continues for at least 3 days","sources":[{"clause":"46(I)(e)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-e-2"}],"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 (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy) in an AYUSH hospital is covered up to the sum insured.","display":"Yes, up to sum insured","note":"Excludes rejuvenation, Panchakarma and similar, and treatment outside India.","quote":"We will indemnify In-patient hospitalization expenses up to the limits of Sum Insured, for an Insured Person towards non-allopathic treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy for Hospitalization arising due to Accident or Illness provided such treatment is taken in an AYUSH hospital.","sources":[{"clause":null,"heading":"D.l.9. AYUSH Cover","page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-d-l-9-ayush-cover"}],"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":"Listed Modern and Advanced Treatments are covered up to the sum insured when taken as in-patient or day care treatment: uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy (monoclonal antibody as injection), intra vitreal injections, stereotactic radio surgeries, bronchial thermoplasty, vaporisation of the prostate, IONM, and stem cell therapy for haematological conditions.","display":"Listed treatments covered up to sum insured","note":"Robotic surgery is not in the list; Modern and Advanced Treatments other than those covered are excluded (E.II.18).","quote":"The following Modern and Advanced Treatment methods will be indemnified (wherever medically indicated) when availed under In-patient Hospitalization or as a Day Care Treatment ... a) Uterine Artery Embolization and HIFU (High intensity focused ultrasound) ... b) Balloon Sinuplasty ... c) Deep Brain stimulation ... d) Oral chemotherapy ... e) Immunotherapy - Monoclonal Antibody to be given as injection ... f) Intra vitreal injections ... g) Stereotactic radio surgeries ... h) Bronchial Thermoplasty ... i) Vaporisation of the prostate (Green laser treatment or holmium laser treatment) ... j) IONM ( Intra Operative Neuro Monitoring) ... k) Stem cell therapy - Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered. ... Listed Modern and Advanced Treatment: up to Sum Insured","sources":[{"clause":"46(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i"},{"clause":"46(I)(a)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-a"},{"clause":"46(I)(b)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-b"},{"clause":"46(I)(c)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-c"},{"clause":"46(I)(d)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-d"},{"clause":"46(I)(e)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-e"},{"clause":"46(I)(f)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-f"},{"clause":"46(I)(g)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-g"},{"clause":"46(I)(h)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-h"},{"clause":"46(I)(i)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-i"},{"clause":"46(I)(j)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-j"},{"clause":"46(I)(k)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-k"},{"clause":null,"heading":"Basic Covers","page":29,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-basic-covers"}],"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. The donor's in-patient hospitalisation expenses for harvesting the organ are covered up to the sum insured, if the insured's transplant claim is admitted; donor pre/post hospitalisation, screening and acquisition costs are not covered.","display":"Yes, up to sum insured","note":"Live donor transplants should be intimated 7 days in advance.","quote":"We will cover In-patient Hospitalization Medical Expenses towards the donor (in accordance with Section D.I.1 above) for harvesting the organ up to the limits of the Sum Insured ... We will not cover expenses towards the Donor in respect of: i) Any Pre or Post - hospitalization Medical Expenses, ii) Cost towards donor screening, iii) Cost directly or indirectly associated to the acquisition of the organ","sources":[{"clause":"46(I)(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-a-5"},{"clause":"46(I)(d)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-d-3"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance in an emergency is covered up to Rs 2,000 per hospitalisation event.","display":"Up to ₹2,000 per hospitalisation","note":"Includes transfer to another hospital or to a diagnostic centre and back. Air ambulance is not mentioned.","quote":"Ambulance Cover | Covered upto ₹2000 per Hospitalization event ... Ambulance means a road vehicle","sources":[{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"},{"clause":null,"heading":"C.II Specific Definitions","page":6,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-c-ii-specific-definitions"}],"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":"Yes. 100% of the base sum insured is restored once in a policy year when base sum insured and bonus are used up; it cannot be used for the same illness already claimed in that year or for the first claim, and is not available on the Rs 0.5 and 1 lakh sum insured under ProHealth Select (A).","display":"100% once a year, unrelated illnesses only","note":"Not carried forward to the next year; on a floater, available on a floater basis.","quote":"We will provide for a 100% restoration of opted Base Sum Insured once in a Policy Year ... The Restored amount shall not be available for claims towards an Illness / Injury (including its complications) for which a claim has been paid in the current Policy Year for the same Insured Person. ... shall not apply to the first claim in the Policy Year. ... Restoration shall not apply to Worldwide Emergency Cover and for ₹0.5 & 1 Lac Sum Insured under ProHealth Select (A).","sources":[{"clause":"46(I)(d)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-d-3"},{"clause":"46(I)(b)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-b-6"},{"clause":"46(I)(c)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-c-4"},{"clause":"46(I)(j)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-j-2"}],"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":"Cumulative Bonus of 5% of base sum insured each policy year, up to 100%, given irrespective of claims (not reduced after a claim). A Cumulative Bonus Booster can be bought for faster or higher bonus.","display":"5% a year, up to 100%, regardless of claims","note":"Booster options (extra premium): 10%, 25% or 50% a year up to 100%, or 10% a year up to 200%. Lost if not renewed within the grace period.","quote":"A bonus of 5% of your Base Sum Insured will be provided at the end of every Policy Year ... Bonus shall be provided irrespective of claims made in the expiring policy year ... Cumulative Bonus can be accumulated upto a maximum of 100% of your Base Sum Insured","sources":[{"clause":"46(I)(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-a-7"},{"clause":"46(I)(c)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-c-5"},{"clause":"46(I)(f)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-i-f-3"}],"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 covered: items in the non-payable list (Annexure IV, List I), such as gloves and masks, are excluded. A separate add-on covers listed non-medical items.","display":"Not covered (non-payable list applies)","note":"Drugs and consumables used intra-operatively during surgery are payable. ManipalCigna Health 360 Shield add-on: 'Coverage for listed Non-medical items up to base policy Sum Insured'.","quote":"For complete list of non-medical items, please refer to the Annexure IV, List I of “Non-Payable Items” ... List I - Items for which Coverage is not available in the Policy ... GLOVES ... MASK","sources":[{"clause":null,"heading":"E.II. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-ii-specific-exclusions"},{"clause":null,"heading":"G.IV. Annexure - lV","page":60,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-g-iv-annexure-lv"}],"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 covered. Childbirth expenses (including caesarean) and miscarriage or termination are excluded (Excl 18), except ectopic pregnancy.","display":"Not covered","note":null,"quote":"E.l.18. Maternity: Code - Excl 18 ... Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy;","sources":[{"clause":null,"heading":"E.l.18. Maternity: Code - Excl 18","page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-l-18-maternity-code-excl-18"},{"clause":"Excl12(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-2"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"Not stated. Children can be insured from 91 days of age, and a newborn can be added by endorsement for extra premium; no cover from birth is described.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention mental illness treatment.","quote":null,"sources":[],"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":"None unless the optional Health Check Up is chosen (ProHealth Select (A) only): once a year for each insured person aged 18 or above, at network providers, cashless only, tests by sum insured and age.","display":"None unless opted (yearly check-up option in (A))","note":"Not available in ProHealth Select (B). Healthy Rewards also give points for a health check-up.","quote":"D.lll.6.Health Check Up (Applicable only for ProHealth Select (A)): ... We will provide for Health check-up for each and every Insured Persons who is 18 years or above at the start of a Policy Year. ... Health Check-Ups will be available once each year.","sources":[{"clause":"46(II)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii"},{"clause":"46(II)(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-46-ii-a"}],"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":"Not covered: out-patient treatment expenses are excluded. Optional Health Maintenance Benefit (ProHealth Select (A)) reimburses out-patient costs up to Rs 500 or 1,000; a separate OPD add-on covers consultations.","display":"Not covered (optional ₹500 or 1,000 benefit in (A))","note":"Health Maintenance Benefit covers diagnostics, drugs, dental and alternative medicine prescribed out-patient, once a policy year.","quote":"E.II.19 Any kind of Out-Patient Treatment expenses including fractures (not requiring any kind of hospitalization) ... Health Maintenance Benefit | Covered up to ₹500 or 1000 as opted","sources":[{"clause":null,"heading":"E.II. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-e-ii-specific-exclusions"},{"clause":null,"heading":"Operation of bone and joints","page":57,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-operation-of-bone-and-joints"}],"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 zone (Zone 1: Mumbai, Thane, Navi Mumbai, Delhi NCR; Zone 2: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata, Gujarat; Zone 3: rest of India). Treatment in a higher zone than the premium zone carries a 10% or 20% co-pay, except accidents.","display":"Yes, 3 zones; co-pay if treated in a costlier zone","note":"ProHealth Select (B) offers a zone discount of 8% (Zone 2) and 16% (Zone 3). A higher or lower zone can be chosen for the matching premium.","quote":"The Premium charged on the Policy will depend on the Sum Insured, Policy Tenure, Age, Zone ... Zone 1 | Mumbai, Thane, Navi Mumbai, Delhi and NCR ... Zone 2 | Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata, Gujarat ... Zone 3 | Rest of India ... Availing treatment in Zone I 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.","sources":[{"clause":null,"heading":"F.Il.10. Premium calculation","page":33,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-f-il-10-premium-calculation"},{"clause":null,"heading":"Zone Classification","page":34,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-zone-classification"},{"clause":"Excl12(b)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-b-8"},{"clause":"Excl12(c)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-c-5"}],"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 common empanelment hospitals) on showing the health card and photo ID; planned admissions need pre-authorisation 48 hours ahead.","display":"Yes, at network hospitals","note":"Worldwide Emergency Cover is reimbursement, cashless only case by case.","quote":"Cashless facility is available only at our Network Hospital. The Insured Person can avail Cashless facility at the time of admission into any Network Hospital, by presenting the health card as provided by Us with this Policy, along with a valid photo identification proof ... The Insured Person should at least 48 hours prior to admission to the Hospital approach the Network Provider for Hospitalization for medical treatment.","sources":[{"clause":null,"heading":"G.I.4. Cashless Facility","page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-g-i-4-cashless-facility"},{"clause":"Excl12(a)(i)","heading":null,"page":40,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-excl12-a-i"}],"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":"A TPA (service partner) is used for network access and to facilitate cashless and reimbursement claim processing, but all customer contact (intimation, submission, settlement, disputes) is with ManipalCigna.","display":"Insurer, with a TPA for network access and processing","note":null,"quote":"Cashless and Reimbursement Claim processing and access to network hospitals is through Our service partner ... A TPA will be used for Network Access and 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":39,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#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":"Up to 2 adults and 3 dependent children (up to 23 years) or dependent parents.","quote":"In case of Family Floater policies, a common Base Sum Insured shall be available on a floating basis amongst all the Insured Persons. ... A floater cover can cover a maximum of 2 adults and 3 dependent children under a single policy.","sources":[{"clause":null,"heading":"C.II Specific Definitions","page":6,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375#c-c-ii-specific-definitions"},{"clause":"Row 1(b)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376#c-row-1-b-3"}],"law":[]}],"documents":[{"kind":"wording","label":"ProHealth Select Terms & Conditions","pages":63,"fetched_at":"2026-10-19 17:10:40.166332+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/Prohealth Select - Policy Wordings/90631095-1127-600b-c1e3-0afc293bf3de?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/375"},{"kind":"prospectus","label":"ProHealth Select Prospectus","pages":31,"fetched_at":"2026-10-19 17:10:40.166332+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/ProHealth Select- Prospectus/a8efbe03-05b0-40ac-aaa3-ecff7541ccce?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/376"},{"kind":"cis","label":"ProHealth Select Select (A) CIS","pages":14,"fetched_at":"2026-10-19 17:10:40.166332+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - Prohealth Select A - CIS/27ecd5bb-85f5-1049-ca6d-92b6d5284228?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/377"},{"kind":"cis","label":"ProHealth Select Select (B) CIS","pages":12,"fetched_at":"2026-10-17 19:49:55+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/Prohealth Select B - CIS/023ffc75-15f6-2c5f-d7c0-9168ca5f7cbe?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/12724"},{"kind":"benefit-illustration","label":"ProHealth Select Annexure to Prospectus - Benefit illustration","pages":4,"fetched_at":"2026-10-17 19:48:50+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/ProHealth Select- Annexure to Prospectus/f65da15b-f356-c4f5-f623-783cc6810623?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/12693"},{"kind":"benefit-illustration","label":"ProHealth Select Annexure to CIS(Select A) - Benefit Illustration","pages":2,"fetched_at":"2026-10-17 19:48:57+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/MCHI - ProHealth Select A - Annexure to CIS/0877334a-c90e-3c53-c1cc-da2ba73f26e8?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/12697"},{"kind":"benefit-illustration","label":"ProHealth Select Annexure to CIS(Select B) - Benefit Illustration","pages":2,"fetched_at":"2026-10-17 19:49:03+00","source_url":"https://www.manipalcigna.com/documents/10140644/0/ProHealth Select B- Annexure to CIS/abbd24d2-4d84-b0c3-5f84-196c96b8a8b8?t=28","url":"https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627/document/12700"}],"versions":[],"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 Select (UIN MCIHLIP27046V062627), IndiaInsurances, https://indiainsurances.com/policy/manipal-cigna-health-insurance/prohealth-select-mcihlip27046v062627"}