ManipalCigna Health Insurance

ManipalCigna ProHealth Prime Advantage

Plain-English breakdown of the plan — every field a shopper actually needs before clicking buy. Compiled from public ManipalCigna brochures and policy wordings. Always confirm against the official PDF below.

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Trust at a glance

ManipalCigna — IRDAI FY 2024-25

Unverified — verify on irdai.gov.in

Claim Settlement Ratio: 89.7%
Incurred Claim Ratio: 63.4%
Complaints / 10,000 claims: 9.1
Network hospitals: 8,500

Source: IRDAI Annual Report FY 2024-25 · UIN 151PolicyPlain earns no commission · numbers shown verbatim

Plan details

Every field, in one place

Sum insured options: ₹3L · ₹5L · ₹7.5L · ₹10L · ₹15L · ₹25L · ₹50L
Pre-existing disease (PED) waiting: 24 months
Pre-existing covered: Covered after PED waiting period
Co-payment: No copay published
Room rent: Single private AC room
Restoration of sum insured: Once per policy year
No Claim Bonus (NCB): 25% per claim-free year
Cashless network: 8,500 hospitals (insurer disclosure)
Free-look cancellation window: 30 days
Premium grace days: 30 days
IRDAI UIN: Not confirmed — verify on irdai.gov.in
Last verified: 2026-06 · third party aggregator

Honesty note: ProHealth Prime has Protect / Active / Advantage tiers; fields reflect Advantage variant.

Indicative premium

Order-of-magnitude only — NOT a quote

Age	Sum insured	Approx annual premium
35	₹10L	~₹14,000/yr
45	₹10L	~₹20,000/yr

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

Cosmetic surgery (non-reconstructive)
Maternity unless waiting period served (typically 24+ months)
Substance abuse, self-inflicted injury
Hazardous activities
Experimental treatments

Known traps

The fine print that decides claim outcomes

PED waiting is 24 months — shorter than 36-month industry standard.
Maternity sub-limit applies regardless of headline SI on most variants.
Modern treatment percentage caps on advanced procedures.
Restoration triggers once per policy year on full SI exhaustion.
Hospital bed-count minimums apply.

How to claim

Cashless vs reimbursement — the steps

1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use ManipalCigna's helpline or app — keep the reference number.
2Cashless: Pre-authorisation form filled by hospital, sent to ManipalCignavia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.

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