ManipalCigna ProHealth Prime Insurance: Details & Review

Created on 28 Apr 2022

Wraps up in 7 Min

Read by 3.8k people

Updated on 01 Apr 2023

We all have been weathered by this harsh world in ways we did not deserve. We all have been scathed to the extent where we found it almost impossible to jump back to normal. We all have been bathed in miseries that seemed to have no ends. 

While we call this ‘life’, there are some things, people and tools that could aid you to go on with this ‘life’ a little smoother and unruffled. Today, we are here to help you with a tool of one such kind. 💁‍♀️

The human species is amazing and confusing, both at the same time, with the highest level of structural complexity. God forbid, but anything could happen to us anytime. And it does. The instances we hear today of unnatural deaths do not hold count with us. But so do the instances of common illnesses. Both these situations ensure the occurrence of one thing- drainage of resources, health, financial, and otherwise.

There surely should be a way to get out of it with the least possible harm incurred, no?

Yes. Health Insurances. Not here to pitch a product, but yes, this deserves a pitch. 

ManipalCigna ProHealth Prime Plan

The health insurance business in India is vast. The promises and perils are vaster. Choosing the right plan that not only promises comprehensiveness but is actually comprehensive is what you need in this uncertain time and this uncertain life; one that does not leave you hanging high and dry in a health crisis. 🥺

This one product came out of the need to cover the health insurance issues that no companies covered or even paid heed to. The issues, you ask? Oh, we’ll get into that nice and slow later. 

ManipalCigna ProHealth Prime transpired to cater to the requirements and problems that a common citizen suffers from in the health insurance domain. Anyone who buys an insurance policy buys it for one reason - to address claim-related things. 

Suppose you get hospitalized for whatever reason. You have an insurance policy that says it covers hospitalization costs. But does it really? 🤔 No, it does not. When a person gets hospitalized, there is approximately 10 to 12% of the bill value that does not get covered and the patient has to pay for all the miscellaneous things like hand gloves, syringes, etc. that the policy does not cover. 

So there is this health insurance that we came across- ManipalCigna ProHealth Prime, which launched a few days ago and found it to be the perfect fit to meet the above-mentioned needs. 

Let us dive a little deeper into the intricacies of the plan.

Problems no insurance companies have addressed yet.

Let’s talk about the ‘issues’ we mentioned above. It is essential to understand the problems before we look into the solutions that are served to us on a silver plate. There are 3 major problems that need to be addressed by health insurance companies, but it hasn’t been done YET. These are:

Problem 1: OPD expenses are largely not covered😐
Approximately 60% of the health care expenses are out-of-pocket expenses that are not covered by most health insurance policies. These out-of-pocket expenses are called OPD expenses that you incur. Expenses like doctor consultations, health check-ups, dental issues, diagnostics and pharmacy requirements constitute this. People with chronic illnesses need to visit doctors and get tests done quite frequently. These expenses add up to a lot but go unnoticed by your health insurance provider. 

Problem 2: 100% of the expenses are not paid by insurance companies😒 
There are some expenses that are termed non-payables or non-medical. Expenses incurred on gloves, food charges (other than patient’s diet provided by the hospital), attendant charges, expenses related to a birth certificate, medical certificate, medical records, spacer, thermometer, nebulizer kit, urine bag, etc.

Problem 3: Bariatric surgeries are largely not covered😟
When a person's BMI goes beyond a level that is life-threatening, the doctors recommend some kind of surgery. Bariatric surgeries are surgical procedures done on a patient to aid in weight loss. These procedures are done on people for whom weight loss through diet and exercise has proven to be ineffective and excessive weight is causing them health issues. Most health insurances exclude bariatric surgeries from their cover. 


Unique features of ManipalCigna ProHealth Prime

Now let’s take a look at how ManipalCigna ProHealth Prime solved these problems. It basically says yes to everything! 

1. Comprehensiveness:🤩
We talked about the non-medical expenses, which are largely not covered and how it can be a real pain for the patient. ProHealth Prime relieves you from the worries of such expenses and provides you 100% of the claim amount without any deductions towards the non-medical items.

In addition, ManipalCigna ProHealth Prime insurance covers OPD fees to guard you against the expenses you incur on doctors and consultations, diagnostics and pharmacy requirements, which sum up to a lot is also covered under this plan.

Also, with 'Any room category', you can choose to be admitted in a private room or even a suite or above without any worry. You just choose and the rest is taken care of. 

2. Enhanced coverage:😍
Guaranteed Cumulative Bonus up to 200% of Sum Insured, which accrue irrespective of claims and unlimited restoration of Sum Insured even for related illnesses.
What does it mean? Well, ManipalCigna promises a guaranteed cumulative bonus which grows at 25% of the sum insured every year. It grows on a guaranteed basis irrespective of whether you make any claim or not. 

Once accrued, the bonus will not get reduced whether you make any claim or not in future and will stay with you throughout your life as long as you continue renewing your plan. Also, with the ‘Unlimited Restoration of the sum insured’ feature, you would never face any shortage of sum insured for any type of claim, whether it is related or unrelated.

3. Pay as you use: 😏
You also get the option of switching off your domestic cover up to 30 days in a year. Now, you might wonder why would anyone ever want to switch off their cover? They would want to do that when they travel abroad, where the insurance is not applicable. 

In such cases, even when the insurance does provide cover, you still have to pay the regular premium. But, not with ManipalCigna anymore. You have the option to save the premium amount for maximum of 30 days. 

4. By your side: 🤗
In a case where the premium payer is diagnosed with CI or in case of an accidental death, 1-year renewal premium is waived off, so that the financial burden that falls on the family after such an incident, is minimized to the last bit possible. 

5. Maternity cover and includes IVF/IUI treatments:👩‍👦
ManipalCigna ProHealth Prime also solves pre-natal problems. Pregnancy and related complications are covered under maternity limit in the Protect plan. In addition to this, IVF and IUI are over and above the maternity limit and covered upto 2.5 L. 

6. Specialized plan for the ones suffering from Diabetes, Hypertension, Dyslipidemia, Asthma or Obesity:‍👦
ManipalCigna ProHealth Prime Active is a specialized plan for the ones currently suffering from Diabetes, Hypertension, Dyslipidemia, Asthma or Obesity and are largely without any cover today.

And not just this, the cover starts from 91st day onwards which sets them free from long waiting periods. In a nutshell, anybody who suffers from any of the 5 PEDs (Diabetes, Hypertension, Dyslipidemia, Asthma or Obesity) will have a waiting period of 90 days only. Along with it comes the Condition Management Program to ensure you do not encounter any health surprises and have complete control on your chronic condition.

Key eligibility and applicability for ManipalCigna ProHealth Prime

The eligibility and applicability criteria are pretty basic. Let’s check them out as well.

  • Entry Age Limit: For Children: 91 days to 17 years
  • Entry Age Limit: For Adults- 18 years to any age limit (70 years under ProHealth Prime Active)
  • Sum Insured options: Up to Rs1 crore (ProHealth Prime Active : Up to Rs15 Lacs)
  • Policy Type: Individual, Floater and Multi-Individual Options
  • Premium Payment Options: Single/ Half-yearly/ Quarterly/ Monthly
  • Age band and Zone-based pricing
  • Lifetime Renewals

Base, Value-added and Optional Covers

The base cover includes the following things:

Inpatient Hospitalization, Pre-Hospitalization, Post-Hospitalization, Day-care Treatment, Domiciliary Treatment, Road Ambulance, Donor Expenses, Restoration of Sum Insured, AYUSH Cover (treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy) , Convalescence Benefit (available only in ProHealth Prime Active), Daily Cash for Shared Accommodation.

The value-added cover offers the following benefits:

Health Check-up, Domestic Second Opinion, Tele-Consultation, Cumulative Bonus, Wellness Program, Discount from Network Providers, Premium Waiver Benefit, Switch off Benefit (not available in ProHealth Prime Active)

Finally, the optional cover offers the following benefits:

Non-medical items, Personal Accident Cover (only with ProHealth Prime Protect and Advantage), Cumulative Bonus Booster (only with ProHealth Prime Protect and Advantage), Critical Illness Add-on (only with ProHealth Prime Protect and Advantage), Deductible options (only with ProHealth Prime Protect), World-wide Accidental Emergency Hospitalization Cover (only with ProHealth Prime Active)

While the pros speak for themselves and may seem enough for any health insurance to cover, you still have the option of customizing your plan according to your specific needs. 

The Bottom Line

To end this, I would like to emphasize on the point that saying, “mujhe kuch nahi hoga” would not make you cool. What actually would make you cool is having health insurance and protecting yourself and your family from the uncertainties of life. 

Till we meet again. Stay healthy, stay invested. 

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Rishika Mukherjee

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Mukherjee is an avid reader and loves to write as much as read. She is the youngest of all but handles chores like a 50-year-old woman. She takes a lot on her plate and somehow, eerily manages to get the job done. As Hazel Grace stated, she could read a good author's grocery list, and so would Miss Mukherjee. 

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