Overview
The ManipalCigna ProHealth Prime Active plan offers coverage for inpatient hospitalization, pre- and post-hospitalization expenses, and AYUSH treatments. It also provides value-added benefits like unlimited teleconsultations, a premium waiver on critical illness or accidental death, and a cumulative bonus to increase the sum insured. A standout is its 100% restoration benefit but only for unrelated illnesses.
Experts Review
Written by Ishita Jain
Editor
The ManipalCigna ProHealth Prime Active plan has a lot going for it in terms of coverage and features. Its restoration benefit is a big plus as it ensures that your coverage is restored to 100% of the sum insured any number of times in a policy year. With this, you can rest easy even if you have multiple hospitalizations. One thing to note is that this only applies for unrelated illnesses or injuries.
What I also like are the value-added covers, such as Premium Waiver Benefit, Domestic Second Opinion and Wellness Program. A key feature is its 90-day waiting period for treatment of pre-existing Asthma, Diabetes, Hypertension, Dyslipidemia, and Obesity, which is significantly less than the standard 24 months.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Special Bonus for being healthy and not claiming insurance, which is a notable gap.
Some coverage if you are forced to hospitalize at home, which could be a drawback for some.
Maternity benefits not offered, which is a key feature.
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
Bad
Co-payment
The policy will only cover 90% of the final bill. The rest is on you. They call this a co-payment.
Customisable
With this add-on, you get the mandatory co-payment waived off.
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
Your insurance cover won’t be fully available in case you are treated for Hernia, Hysterectomy, Benign Prostate Hypertrophy, Stones, Cataract, Total Knee replacement, Breakage of bones and some Modern Treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you are already dealing with Asthma, Diabetes, Hypertension, Dyslipidaemia & Obesity related conditions, then the insurer will cover you after 90 days. However, if you are dealing with other pre-existing diseases including thyroid and cardiovascular problems, then you’ll have to wait 2 years before they start covering these complications.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Consumables Cover
Recommended
With this add-on, you also get extended coverage for generally excluded items like syringes, gloves, PPE kits, etc.
Worldwide Accidental Emergency Hospitalization Cover
With this rider, you get international coverage up to 100% of the sum insured over and above the base cover for accidental emergency hospitalization.
Waiver of Mandatory co-payment
With this add-on, you get the mandatory co-payment waived off.
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
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
Special Bonus for being healthy and not claiming insurance.
Some coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
A
Ananya Joshi
The 100% restoration benefit for unrelated illnesses is fantastic! Gives me great confidence.
D
Diya Kulkarni
Value-added covers like Premium Waiver Benefit are very useful. ManipalCigna thought of everything.
P
Pari Desai
Domestic Second Opinion feature is something I appreciate, good for peace of mind on big decisions.
F
Fatima Bose
Disease-wise sublimits can be a concern for some specific treatments. Had to check carefully.
A
Amaira Aggarwal
The co-pay clause is something to be aware of if you are healthy, makes the plan feel a bit costly.
K
Kiara Pandey
Unlimited teleconsultations are so convenient, especially in these times. Doctor se baat karna easy ho gaya.
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Frequently Asked Questions
Does ProHealth Prime Active 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
- 90 days waiting period for illnesses and conditions arising out of Asthma, Diabetes, Hypertension, Dyslipidaemia & Obesity.
Does ProHealth Prime Active have room rent restrictions?
Does ProHealth Prime Active offer a restoration benefit?
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