Overview
The Manipal Cigna ProHealth Premier plan is a high-end health insurance policy offering a substantial sum insured of ₹1 crore. It features unlimited restoration of sum insured for unrelated illness, guaranteed cumulative bonuses irrespective of claims 10% increase in base SI up to 200%, and access to high-end hospital rooms (except suites). With a relatively low waiting period for pre-existing diseases [24 months] and wellness benefits like annual health check-ups, the plan is tailored for individuals and families seeking premium, all-encompassing health protection.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Manipal Cigna ProHealth Premier plan is designed for those seeking ultra-premium health coverage with a high sum insured of ₹1 crore. Its standout features include outpatient consultation coverage [Covered up to 15000 per policy year under Health Maintenance Benefit], maternity [Covered upto 100,000 for normal delivery and 200,000 for C-Section per event upto 2 deliveries, after a waiting Period of 48 months] and newborn benefits, and worldwide emergency medical cover [Covered up to full Sum Insured once in a Policy Year], which are not universally available in many high-value plans.
The unlimited restoration [for unrelated illness] of the sum insured and guaranteed cumulative bonus 10% increase in base SI up to 200% irrespective of claims, provides strong financial protection and reward generously.
Compared to other ProHealth variants like ProHealth Plus and ProHealth Protect, the Premier plan offers significantly higher coverage limits and more comprehensive benefits, including lower waiting periods for pre-existing diseases [24 months]. However, this comes at a premium cost, with base premiums substantially higher—often 30-40% more than ProHealth Plus—making it a considerable investment.
The plan also grants access to high-end hospital rooms (excluding suites), enhancing comfort during hospitalization. The plan doesn’t have any disease-specific sub-limits; however, 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. Manipal Cigna’s claim settlement ratio [90% avg. of 2021-24] is competitive but slightly behind market leaders, which is a consideration for prospective buyers.
Pros
Offers a wide range of features.
Insurer has a solid track record with great claim and service metrics.
Offers ManipalCigna Health 360 Advance, which makes this policy stand out.
Cons
No significant drawbacks found.
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
Waives off 20% of the co-payment if purchased at the age of 65 years or above.
Room Rent
Shared rooms are okay. Single private rooms are okay. Most rooms are okay unless it’s a suite room — the expensive stuff. Then you’ll have to start splitting 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 just 2 years. It’s probably the best deal you can get to be honest.
Add-ons
ManipalCigna Health 360 Shield
Recommended
Covers list of 68 non-medical items as per list I upto ₹1,00,000.
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.
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.
Maternity Waiting Period Reduction
Reduces the maternity waiting period from 4 years to 2 years.
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.
Customer Reviews
P
Prakash M.
Sum insured up to ₹1 crore offers ultra-premium coverage.
P
Preeti I (new)
Unlimited restoration of sum insured and guaranteed cumulative bonus up to 200% provide strong protection.
R
Rahul M.
Outpatient consultation coverage, maternity, and newborn benefits are all included.
R
Rishi C (new)
Compared to ProHealth Plus, this is even more expensive; ensure the extra benefits justify the cost.
R
Ravi D (new)
This is a very high-end plan, so premiums will be significantly expensive.
R
Ramesh J (new)
Access to high-end hospital rooms (except suites) is standard for such a premium plan.
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Frequently Asked Questions
Does ProHealth Premier 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.
- Maternity and Newborn Waiting Period: There’s a 4-year waiting period before you can make claims related to pregnancy and childbirth.
Does ProHealth Premier have room rent restrictions?
Does ProHealth Premier offer a restoration benefit?
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