ManipalCigna Prime Senior Plan

Let’s Delve Into The Specifics Of The ManipalCigna Prime Senior Plan!

The ManipalCigna Prime Senior is a health insurance policy by ManipalCigna Health Insurance Company Limited designed specifically for seniors. This plan provides financial assistance during medical emergencies in their golden years. With this plan, you can be assured that your elderly family members will receive necessary medical care without the stress of unexpected expenses. The policy is available in two variants: Classic and Elite.
 

Who is Eligible To Buy The ManipalCigna Prime Senior Plan?

• Minimum Age to Join: 56 years
• Maximum Age to Join: 75 years
   

Benefits And Limits Of The ManipalCigna Prime Senior Plan

The ManipalCigna Prime Senior Plan not only takes care of inpatient hospitalisation costs that are incurred when you get hospitalised for more than 24 hours, including room and boarding charges, fees for medical practitioners, prescribed medicines and drugs, ICU charges, etc., but also covers various other expenses. Here's a brief overview of the other expenses covered under the plan –

• Pre- & Post-Hospitalisation Expenses
  If your doctor needs to run tests before or after your hospital stay, you do not have to fret. This is because the ManipalCigna Prime Senior Plan has got you covered. It provides coverage for both pre- and post-hospitalisation expenses up to the sum insured. The duration of coverage for these expenses depends on the variant you select –

You should keep in mind that your insurance provider will cover these costs only if they are related to the medical condition for which you are hospitalised. And your claim for them must be approved as part of inpatient hospitalisation coverage.

• Daycare Treatment Coverage

A daycare treatment denotes those medical surgeries or procedures that needed a long hospitalisation but can now be performed in less than a day because of medical progress. The ManipalCigna Prime Senior Plan covers all daycare procedures without any limit, so your expenses will be paid for up to the sum insured.

• Domiciliary Treatment Coverage
  Domiciliary treatments are medical care for illnesses or injuries that need urgent attention in a hospital but are given at home because the patient is too sick or injured to travel safely to a hospital, or because there are no hospital beds nearby. The ManipalCigna Prime Senior Plan will pay for domiciliary treatment costs (excluding certain listed illnesses) up to the sum insured. You should also note that it covers costs for both pre- and post-hospitalisation for 30 days each.
   
• Organ Donor Coverage
  With the ManipalCigna Prime Senior Plan, if you are the recipient of an organ transplant, the insurer covers the organ donor expenses. This includes coverage for the inpatient costs that are related to organ transplant, up to the maximum sum insured you have chosen for your policy. There is also coverage for the donor’s pre- and post-hospitalisation expenses for 30 days each. Additionally, the coverage includes the cost of screening the donor once per year, and any complications from the organ donation process during their hospital stay or up to 30 days after they get discharged.
   
• Modern Treatment Coverage
  Healthcare is a field that is advancing fast with new technologies, making available treatments that seemed impossible before. The ManipalCigna Prime Senior Plan is here to support you by covering the costs of these modern treatments, up to the sum insured.
   
• Non-Medical Expenses
  With the ManipalCigna Prime Senior Plan, you do not just get coverage for medical costs; you are also covered for non-medical expenses if you choose an add-on. These non-medical expenses include the cost of consumables like gloves, nebulization kits, oxygen masks, etc., – essential items you need for treatment. These items can be very expensive, and their costs can add up quickly. The plan covers these expenses up to the sum insured, easing the financial load associated with such necessities.
   
• Cumulative Bonus (No Claim Bonus)
  With the ManipalCigna Prime Senior Classic Plan, for every year you don't make a claim, the insurer rewards you with a bonus of 10% of the base sum insured. This bonus can accumulate up to 100% of the base sum insured. Even if you make a claim later on, your accumulated bonus stays untouched. The ManipalCigna Prime Senior Elite Plan offers a guaranteed bonus of 10% of the base sum insured, regardless of your claims history up to a maximum of 100%.
   
• Restoration Benefit
  The restoration benefit is a helpful feature in the ManipalCigna Prime Senior Plan that replenishes your sum insured if you use it up during the policy year. This benefit works for both unrelated and related illnesses. It gets triggered when you have used up part of your sum insured and No Claim Bonus. You can use this benefit as many times as needed in a year, and it applies to subsequent claims. You should just remember, for the Classic variant, you will need to pay an extra premium and choose a sum insured of Rs. 5 lakhs or more to access this benefit (but it is available as an inbuilt feature in all sum insured options with the Elite plan).
   
• Room Rent Limit
  The maximum amount your insurer covers for the room you stay in is called the room rent limit. If you pick a room within your plan's limit, you will not incur any extra expenses. But, if you go for a room with a higher rent than allowed, then you will have to face a deduction based on the proportion, and not just the rent difference. ManipalCigna Prime Senior Plan has a room rent limit of up to a single private AC room. It is important to note that if you end up in a higher category room for any reason, there will not be a proportionate deduction, unlike other plans. You will only pay the difference in the room rent. Also, if you choose an add-on, you are free to pick any room you want – shared, single, deluxe, or any available room.
   

Additional Key Features Of The ManipalCigna Prime Senior Plan

• OPD Coverage
  Seniors often need regular check-ups and tests to keep track of their health. Having outpatient coverage encourages you to stay proactive about your health. This optional benefit pays for routine doctor visits, tests, and medicines up to a certain limit, without you having to pay upfront, i.e., on a cashless basis. This focus on early detection helps seniors catch health problems early, leading to a better quality of life.

• Tele-Consultation
  Seniors sometimes find it hard to travel to healthcare centres due to mobility issues. Teleconsultation removes the need for travel, allowing them to get medical advice without leaving home. With the ManipalCigna Prime Senior Plan, you can connect with experienced doctors or specialists through video or chat whenever you need help with routine health issues. This service is available unlimited times in a policy year, giving you the convenience of healthcare from the comfort of your home.
   
• No Financial Limits On Treatments/Diseases
  Many plans for senior citizens often restrict coverage for certain diseases or surgeries/treatments to control claims, considering the higher risk of illness with age. However, with this plan, there are no sub-limits on common treatments like cataract procedures or joint replacements. This means you can claim the full amount up to the sum insured, regardless of the specific illness you are dealing with.
   

Getting To Know The Plan’s Waiting Periods

Upon buying a health insurance policy, there is a timeframe where certain illnesses and conditions are not covered right away. This is called the waiting period. Once this specific timeframe is over, you can start claiming for these conditions. There are various types of waiting periods, including –

• Initial Waiting Period
  All medical conditions, except accidents, come with an initial waiting period of 30 days. This means you cannot claim for hospitalisation during the first 30 days, unless it is due to an accident.
   
• Waiting Period For Pre-Existing Conditions
  A pre-existing disease is any health issue you have had in the 48 months before getting your health insurance policy. With ManipalCigna Prime Senior, there is a waiting period of 24 months for pre-existing conditions. During this time, the policy will not cover expenses related to your pre-existing conditions. However, you can choose to reduce this waiting period to just 90 days by paying an extra fee.
   
• Waiting Period For Specific Diseases
  Insurers create a list of medical conditions or illnesses that have a waiting period, apart from your pre-existing conditions. This waiting period is set out by the insurance company and is not related to your current health conditions. With the ManipalCigna Prime Senior Plan, there is a waiting period limit of 24 months for specific diseases listed by the insurer.
   

Exclusions

These are situations where your health insurance policy will not provide coverage. They include –

• Standard Permanent Exclusions: The IRDAI has set certain 'standard permanent exclusions' that all insurance companies must adhere to and diligently follow. Some of these exclusions include –
  • Observation And Monitoring: Admission to a hospital solely for observation or monitoring.
  • Bed Rest, Rehabilitation, And Respite Care: Admission to a facility for rest without active treatment.
  • Weight Control Or Obesity: Treatment or surgery for managing weight or addressing obesity.
  • Gender Transition Treatment: Procedures to alter the body's characteristics to match the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures to modify body characteristics or appearance.
  • Hazardous Sports Profession: Treatment expenses incurred during professional participation in adventurous activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Legal Violations: Expenses for treating a person involved in a criminal breach of the law.
  • Excluded Providers: Treatment from medical practitioners or hospitals not covered by the insurer.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Domestic Establishment Treatments: Expenses for treatment in health spas, nursing homes, or similar places primarily or partially for domestic reasons.
  • Non-Prescription Supplements: Costs of vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error Correction: Expenses for correcting refractive errors up to 7.5 diopters to improve eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments lacking proven effectiveness.
  • Birth Control, Sterility, Infertility: Expenses related to contraception, sterilisation, artificial insemination, and advanced reproductive technologies (IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.).
  • Maternity Costs: Expenses for pre/post-natal care, hospitalisation related to childbirth, etc.
• Additional Permanent Exclusions: Other than those standard permanent exclusions mentioned earlier, the insurer may add more exclusions for medical conditions or specific situations. If you have certain diseases or severe medical conditions that the insurer sees as risky to cover, they might permanently exclude them from your policy. However, it is important to note that insurers can only exclude illnesses listed by the IRDAI.
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard exclusions set by the IRDAI. These exclusions can differ from one insurance company to another and may hinge on the terms and conditions of your policy. Here are some key specific exclusions under the ManipalCigna Prime Senior Plan –
  • Dental treatment, dentures, orthodontic procedures, or any surgery unless it is a result of an accident requiring a minimum of 24 hours of hospitalisation. Also, treatment for gum disease, tooth disease, or damage, unless related to irreversible bone disease involving the jaw, not treatable in any other way, and specifically covered under the Policy.
  • Circumcision unless it is necessary for treating a disease, illness, or injury not excluded in the policy or due to an accident.
  • Instruments used in treating Sleep Apnea Syndrome (C.P.A.P.), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.), Oxygen Concentrator for Bronchial Asthmatic conditions, infusion pumps, or any other external devices used during or after treatment.
  • External congenital anomalies, defects, or any complications arising from them.
  • Costs related to donor screening or surgeries involving organs not obtained from a human body.
  • Non-allopathic treatments such as hydrotherapy, acupuncture, reflexology, chiropractic treatment, or any other indigenous system of medicine, except for AYUSH Treatment (In-patient Treatment).
  • Illnesses or expenses resulting from contamination by radioactivity from nuclear fuel, ionising radiation, nuclear waste, chemical or biological attacks, or any related causes.
  • Expenses arising from actions of foreign enemies, foreign invasion, warlike operations (whether declared or not, or while serving in the armed forces of any country), hostilities, participation in military, naval, or air-force operations, public defence, civil war, revolution, insurrection, rebellion, military or usurped power, active involvement in riots, or confiscation, requisition, nationalisation, destruction, or damage to property by or under the order of any government or local authority.
     

Summary

Access The ManipalCigna Prime Senior Plan’s Brochure And Policy Documentation

• Brochure:https://www.manipalcigna.com/documents/20124/0/Senior%20Citizen%20_Accordian_Apr23%20(1).pdf/b0267e65-9fb6-1efb-43fe-e16cc30727f4
   
• Policy Wording: https://www.manipalcigna.com/documents/20124/0/Prime_Senior_TnC.pdf/d55d079e-68af-5ce9-dd9b-fb274d506e86

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