Overview
The ManipalCigna ProHealth Prime Advantage Plan is a premium health insurance that offers extensive coverage for hospitalization, outpatient expenses, and modern treatments. It comes with unlimited restoration of the sum insured, and add-ons like maternity benefits, mental health coverage, and a Supreme Bonus of up to 800%. Other added perks like OPD coverage, non-medical expense waivers, and advanced treatment options, the plan is ideal for individuals and families seeking comprehensive healthcare protection with flexibility.
Experts' Review
Written by Nikhil Nair
Senior Writer
The ManipalCigna ProHealth Prime Advantage Plan is truly packed with features that cater to a wide range of healthcare needs. One of its standout benefits is the unlimited restoration of the sum insured, which ensures you’re never left without coverage (even for related illnesses). This is a huge plus for anyone concerned about exhausting their coverage with multiple claims in a year.
The Supreme Bonus is a game-changer as it allows your sum insured to grow by up to 800% over time, which can be a fantastic way to keep pace with rising medical costs. Other highlights include comprehensive OPD coverage and maternity benefits that make it an excellent choice for growing families. It also provides non-medical expense waiver and coverage for modern treatments like robotic surgeries and mental health care, which are features that showcase the plan’s focus on addressing modern healthcare needs.
However, the plan does come with standard waiting periods—24 months for specific diseases and 36 months for any pre-existing conditions for a cover amount of ₹5 lakhs. The latter can be reduced to 24 months by purchasing plans with sum insured higher than ₹5 lakhs.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap. Need to opt add-on for maternity cover.
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
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
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.
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 - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Consumables Cover
Recommended
Covers list of 68 non-medical items as per list I
Cumulative Bonus Booster
Recommended
Additional bonus of 50% up to a maximum of 200%, irrespective of any claim in the previous year.
Critical Illness
Lump sum payout in the event you are diagnosed with critical illnesses outlined in the policy document.
Personal Accident cover
Paid out as a lump sum of 200% of sum insured for Accidental Death, Permanent Partial Disability up to a limit of ₹5000000.
Enhance
Coverage for maternity expenses i.e. childbirth and newborn expenses. However the coverage is limited to 10% of the cover, max up to ₹1L. Along with this, the room category is upgraded to no limit.
Freedom Package
Coverage for both in-patient and out-patient emergency hospitalizations outside India on reimburement basis only with room category upgraded to no limit. But remember, this add-on is available only for Indian Residents.
Infertility Treatment
Along with Enhance Plus add-on, you get coverage for infertility treatments like IUI or IVF upto ₹2.5L over & above the maternity limit for cover amount of 7.5L and above.
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
V
Vimal Sharma
The 'Prime Advantage' really lives up to its name with comprehensive benefits.
V
Vinay Verma
Coverage for non-medical expenses is a big plus. Those small costs add up!
V
Vinod Gupta
Unlimited restoration of sum insured gives great peace of mind for multiple claims.
A
Amrita Joshi
Domiciliary treatments are only covered upto 10% of sum insured, which is quite low
A
Aaliya Khan
ManipalCigna’s claim settlement ratio dropped slightly below 90% recently, which is a bit of a concern.
Y
Yusuf Patel
Wellness program with rewards is a nice touch to encourage healthy living.
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Frequently Asked Questions
Does ProHealth Prime Advantage 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 for a cover amount of 5L and a 2-year for the cover amount above 5L.
Does ProHealth Prime Advantage have room rent restrictions?
Does ProHealth Prime Advantage offer a restoration benefit?
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