Overview
The Manipal Cigna ProHealth Accumulate plan is a comprehensive health insurance policy offering sum insured options from ₹5.5 lakhs to ₹50 lakhs. It provides coverage for in-hospitalization, outpatient consultations under Health Maintenance Benefit, and worldwide emergency medical treatment. The plan features unlimited restoration of sum insured for unrelated illnesses, and a guaranteed cumulative bonus 5% increase in Base SI up to 200% of the sum insured irrespective of claims made.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Manipal Cigna ProHealth Accumulate plan stands out for combining health coverage with a savings-oriented approach through its Health Maintenance Benefit (HMB), which allows policyholders to accumulate unused benefits and use them to offset premiums or co-payments. This feature is unique among Manipal Cigna’s ProHealth variants and adds a financial cushion beyond standard coverage.
The plan offers outpatient consultation coverage [with option to choose from - `5000, `10000, `15000, `20000 Per Policy Year] and worldwide emergency treatment [Covered up to full Sum Insured once in a Policy Year], enhancing its appeal for those seeking comprehensive care. Unlimited restoration [for unrelated illnesses] of sum insured and a cumulative bonus booster of 5% increase up to 200% irrespective of claims, provides strong inflation protection, and rewards generously.
Unlike the Plus, Preferred, and Premier variants, it lacks maternity coverage and offers a longer waiting period of three years for pre-existing conditions, compared to the Preferred and Premier variants, which may be a drawback for some buyers. Post-hospitalization coverage is limited to 90 days, shorter than the 180 days offered by higher-tier plans.
Room rent is covered for a single private room up to ₹5.5L SI. For ₹7.5L & above, all room types are allowed, except for suites or higher categories. Although the plan doesn’t have any disease-specific sub-limits, a mandatory co-pay of 20% is applicable on all claims for insured individuals aged 65 years and above, regardless of their entry age. This co-pay can be waived by opting for the Waiver of Mandatory Co-pay cover.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Offers ManipalCigna Health 360 Advance, which makes this policy stand out.
Cons
Maternity benefits not offered, which is a notable gap.
Manipal Cigna
Key Insights
Founded
2014
Manipal Cigna was established 11 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
91% claims settled in 30 Days
Manipal Cigna settles 91% of all claims it receives demonstrating strong credibility.
Network Hospitals
8,500+
Manipal Cigna maintains a moderate network of 8,500 hospitals, offering reasonable coverage across key locations.
Complaints
24 complaints per 10,000 claims registered
Manipal Cigna experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
ManipalCigna Health 360 Advance
STANDOUT
Extended coverage with no room restriction, unlimited restoration of sum insured even for same illness along with air ambulance coverage.
Co-payment
If you bought this policy, you have to pay 20% of the bill every time you make a claim after you turn 65. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
Customisable
Choose a co-payment between 10% and 20% to reduce premiums.
Customisable
Waives off 20% of the co-payment if purchased at the age of 65 years or above.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Add-ons
ManipalCigna Health 360 Shield
Recommended
Covers list of 68 non-medical items as per list I upto ₹1,00,000.
Cumulative Bonus Booster
Recommended
Additional bonus of 25% up to a maximum of 200%, irrespective of any claim in the previous year.
Waiver of Mandatory Co-payment
Recommended
Waives off 20% of the co-payment if purchased at the age of 65 years or above.
ManipalCigna Health 360 OPD cover
Get coverage for outpatient and e-consultations i.e. doctor visits along with coverage for prescribed diagnostics and pharmacy based on the option taken.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹1000 to 3000 for up to 30 days.
Co-payment
Choose a co-payment between 10% and 20% to reduce premiums.
Aggregate Deductible
Choose deductible between ₹50,000 and ₹10,00,000 and get a discount on premiums.
ManipalCigna Health 360 Advance
Get extended coverage with no room restriction, unlimited restoration of sum insured even for same illness along with air ambulance coverage.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract and other disorders of lens and retina
Hysterectomy for menorrhagia, fibromyoma, prolapse of uterus, or myomectomy for fibroids (unless necessitated by malignancy)
Surgery of hernia
Surgery of hydrocele
Benign ear, nose, and throat (ENT) disorders and surgeries (including tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
Maternity benefits not offered.
Customer Reviews
A
Arjun Kapoor
The Health Maintenance Benefit (HMB) is a unique and fantastic feature! Can use it for premiums.
P
Parineeti Chopra
Unlimited restoration of sum insured gives great peace of mind.
S
Sidharth Malhotra
Guaranteed cumulative bonus booster up to 200% as an add-on is excellent for long-term value.
A
Ananya Panday
Manipal Cigna's claim settlement ratio had a slight dip, worth keeping an eye on.
S
Sara Ali Khan
The HMB sounds good, but need to understand how easily it can be accessed and used.
K
Kriti S (new)
Combines health coverage with a savings element through HMB. Very innovative!
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Frequently Asked Questions
Does ProHealth Accumulate have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does ProHealth Accumulate have room rent restrictions?
Does ProHealth Accumulate offer a restoration benefit?
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