ManipalCigna ProHealth Prime Advantage Plan: Key Benefits and Coverage
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ManipalCigna ProHealth Prime Advantage

Comprehensive health insurance covers OPD expenses such as consultatio ...Read More

Up to 1 Cr
Sum insured
1
No. of plans
77+
Pan India presence
98%
Claim settlement ratio
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🛡️ IRDAI Approved
⭐ 4.4/5 · 2,708 reviews
🏥 15,000+ hospitals
📊 1.76 solvency ratio
✅ 98% claim settlement

About ManipalCigna ProHealth Prime Advantage

A quick read on what this ManipalCigna Health Insurance plan covers and why it might be a fit for you.

Buying health insurance that provides 360-degree coverage against medical emergencies for you and your family is essential today. ManipalCigna ProHealth Prime Advantage is a plan that covers OPD expenses such as consultation, diagnosis, and pharmacy. Additionally, the plan offers the freedom to choose any room category during hospitalization, covers cashless non-medical expenses, and provides annual health check-ups from the first policy year, irrespective of previous claims.

The ManipalCigna Prime Advantage plan is a variant under the ManipalCigna ProHealth Prime health plans. The other two variants are Prime Protect and Prime Active.

Relationships covered:

For Individual plans: Self, Spouse, Children, Parents, Parents-in-law, Son-in-law, Daughter-in-law, Grandparents, Grandchildren, Uncle, Aunt, Nephew, Niece, Brother, Sister

For Family Floater plans: Self, spouse, children, and parents. A floater cover can insure a maximum of 2 adults and 3 children under a single policy.

The ManipalCigna ProHealth Prime Advantage plan offers policyholders enhanced OPD coverage and zero deductions for non-medical expenses (e.g., nursing, consultation, diagnosis, drugs). Key features of this plan include:

  • Unlimited restoration of the sum insured, up to 100% of the base Sum Insured (SI).
  • Option to switch off the policy for up to 30 days while traveling abroad, with a discount on premium renewal.
  • One-year premium waiver if diagnosed with a critical illness or in case of accidental disability.
  • Freedom to choose any room category, including suites, during hospitalization.

Features of ManipalCigna ProHealth Prime Advantage Plan

This comprehensive health plan offers additional major benefits:

  • Better Care

    Annual health check-ups from the 1st policy year and wellness programs. Earn rewards up to 20% of the base premium on renewal by meeting pre-defined walking step limits.

  • Base Covers

    In-patient, out-patient, pre and post-hospitalization, modern treatment, road ambulance, donor expenses, air ambulance, bariatric surgery, daycare procedures, domiciliary treatment, daily cash benefit for shared room accommodation, AYUSH treatment, and more.

  • Value-Added Covers

    Enhanced health support including domestic second opinion for up to 36 critical illnesses, unlimited teleconsultations, up to 200% cumulative bonus on SI, switch-off premium benefits, and wellness tracking.

  • Optional Covers

    Benefits include coverage for non-medical expenses up to SI, personal accident cover (twice the plan's SI, up to INR 50 Lakh, for accidental death/disability/PPD), a deductible option (aggregate of all claims in a policy year), cumulative bonus booster, infertility treatment cover, and a critical illness add-on cover.

  • Optional Packages

    A bundle of additional benefits to extend support beyond the base plan's coverage. Options available with the Prime Advantage health plan:
Package options Coverage benefits
Enhance Maternity expenses, newborn cover, 1-year vaccination charges, necessary medical termination of pregnancy (covered up to two pregnancies in a lifetime, applicable at 10% SI on each delivery, up to INR 1 Lakh).
Newborn care coverage for delivery complications, post-partum health support, and baby's healthcare up to 91 days from delivery.
Freedom to opt for any room category, including suites or private rooms.
Freedom (for Indian residents only) Choice of best rooms for comfort during hospitalization and treatment.
Worldwide emergency hospitalization with out-patient coverage for emergency treatment outside India.

Plan at a glance

Eligibility, sum insured options and policy mechanics — pulled straight from the policy wording.

Entry age
Children: 91 days to 25 years, Adults: 18 years to no limit
Plan type
Individual and Family Health Insurance
Sum insured options
₹5 L, ₹10 L, ₹25 L, ₹50 L, ₹1 L
Waiting period
30 days
Renewability
Lifelong
Policy term
1/2/3 years

*Initial Waiting Period is the time period between the issuance of the policy and the time it starts actively. During this period, a policyholder has to wait to avail of the benefits offered under a health insurance plan.

Pros & cons

A quick honest summary — the strengths and the trade-offs.

Pros

  • Bariatric surgery
  • Maternity coverage
  • Newborn baby cover
  • Daily cash benefits

Cons

  • Compassionate travel
  • Copayment unavailable
  • Sub-limits not applicable

What's covered

Every CMS-driven coverage flag from the plan wording — only items with a published value render below.

Hospitalization

  • Room rent Covered
  • ICU charges Covered
  • Pre-hospitalization Covered
  • Post-hospitalization Covered
  • Domiciliary hospitalization Covered
  • Day-care treatment Covered
  • OPD charges Covered
  • Covid-19 treatment Covered
  • Cataract Covered

Bonuses & restoration

  • No-claim bonus Covered
  • Automatic restoration of SI Covered
  • Daily hospital cash Covered

Family & special care

  • Maternity cover Covered
  • New-born baby cover Covered
  • IVF treatment Covered
  • AYUSH treatment Covered
  • Organ donor expenses Covered

Modern & preventive care

  • Modern treatment Covered
  • Road ambulance Covered
  • Air ambulance Covered
  • E-consultation Covered
  • Health check-up Covered
  • Second medical opinion Covered
  • Vaccination Covered

Conditions & global

  • Co-payment Not covered
  • Sub-limits Covered
  • Compassionate travel Not covered
  • Global coverage Covered

Waiting periods for this plan vary by condition:

  • For specified diseases: 24 months
  • For pre-existing diseases: 36 months for Sum Insured up to INR 5 Lakh; 24 months for Sum Insured INR 7.5 Lakh and above.
  • Bariatric surgery & Maternity treatment: 36 months
  • ManipalCigna Critical Illness add-on cover: Initial waiting period - 90 days; Survival period - 30 days.

How to Claim ManipalCigna Prime Advantage?

To avail of claim settlement services, follow these steps:

  • Visit the official website of ManipalCigna Health Insurance.
  • Click on the 'Claim' button in the header, then navigate to 'Raise a claim' > 'Proceed to raise a claim'.
  • For claim intimation, fill out the pre-authorized form on the official website with your date of birth and policy number, then 'Submit'.
  • You can call the toll-free number 1800-102-4462 or email [email protected] for claim settlement procedure information.
  • Reach out to PolicyX.com for further assistance.

ManipalCigna Health Insurance Network Hospital List

ManipalCigna Health Insurance Network Hospitals are present in 31 states nationwide. With a wide network of hospitals, ManipalCigna Health Insurance ensures that you are medically secured, irrespective of the city you reside in.

Delhi Mumbai Bengaluru Chennai Kolkata Hyderabad Pune Ahmedabad Jaipur Lucknow

Know More About Network Hospitals →

Inclusions & exclusions

What the plan pays for, and what it doesn't.

Inclusions

  • Here are the detailed benefits of the ManipalCigna Prime Advantage Health Insurance Plan:
  • Your plan's coverage restores its sum insured value up to 100% upon exhaustion of any claim made in the policy year. This safeguards you and your family in case of related or unrelated illnesses. Unlimited restoration is applicable only after the second claim and onwards.
  • Policyholders can switch off their health insurance for up to 30 days if they are traveling abroad.
  • Policyholders can avail of a one-year premium waiver if diagnosed with any critical illness listed in the policy schedule or in case of death. This provides peace of mind regarding future medical and financial protection for their family.
  • The plan provides access to advanced medical treatments such as mental illness, medically necessary bariatric surgery (up to SI, maximum INR 5 Lakh), HIV/AIDS, and STDs.
  • All premiums paid towards the ManipalCigna Prime Advantage Plan are eligible for tax benefits under Section 80D of the Income Tax Act, 1961.

Exclusions

  • This policy schedule lists the following exclusions:
  • Hazardous/adventure sports, nuclear wars, defensive attacks.
  • Breach of law, alcoholism, drug, or substance abuse.
  • Unproven/experimental treatments.
  • Suicide or attempted suicide.

Who can buy this plan

Eligibility criteria pulled straight from the policy wording.

  • Entry age: 18 years to no max limit
  • SI: 5 L to 1 Cr
  • Policy term: 1/2/3 years
  • Initial waiting period: 30 days

Other features & benefits

  • Air ambulance cover
  • OPD available
  • Domiciliary hospitalization

ManipalCigna ProHealth Prime Advantage Plan: FAQs

The 6 most-asked questions about ManipalCigna ProHealth Prime Advantage, answered.

Base health plan ManipalCigna Prime Advantage has multiple coverage benefits including - in-patient, out-patient, pre and post-hospitalisations, modern treatment, road ambulance, donor expenses, air ambulance, bariatric surgery, daycare procedures, domiciliary treatment, daily cash benefit on shared room accommodation, AYUSH treatment, and others.
You are eligible to buy value-added covers, optional packages, optional covers, critical illness rider add-ons, and much more with your base Prime Advantage health plan by ManipalCigna.
Yes, daycare procedures are covered up to the sum insured under this plan.
If you have the Prime Advantage plan, you can avail of health reward benefits which reflect on the renewal premium of your policy. If the policyholder walks from 6,000 to 10,000+ steps daily for up to 120 to 240 and above days, they are eligible to get up to 5% to 20% discounts on the premium renewal.
Yes. Lump sum payment up to 100% of the Sum Insured, if opted is covered under the add-on ManipalCigna Critical Illness cover.
Waiting periods for this plan vary from coverage to coverage, like:- For specified diseases- 24 months For pre-existing disease- For sum insured up to INR 5L is 36 months; For sum insured INR 7.5L and above is 24 Months Bariatric surgery & Maternity treatment- 36 months ManipalCigna Critical Illness add-on cover- Initial waiting period - 90 days and survival period- 30 Days

Conclusion

A feature-rich health plan with strong restoration, wellness, maternity, and global coverage benefit

Explore ManipalCigna Health Insurance

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Written and reviewed by

PolicyX content is researched in-house and reviewed by an IRDAI-certified insurance specialist before publication.

Written by Simran Nirala — Health & Term Insurance Reviewed by Anchita Bhattacharyya — Health, Term & Life Insurance
Last updated: 20 Mar 2024 · Originally published: 25 Oct 2024

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