Overview
The ManipalCigna ProHealth Prime Senior Classic Plan is designed specifically for senior citizens to purchase between the ages of 56 and 75 with lifelong renewability. The plan focuses on ease of access with no mandatory pre-policy medical check-up and offers optional covers like any room upgrade (from the inbuilt Single Pvt A/C room) and reduction in PED waiting period to just 90 days.
Experts' Review
Written by Nikhil Nair
Senior Writer
As the name suggests, the ManipalCigna ProHealth Prime Senior Classic is geared toward seniors, which is great because they often have unique healthcare needs. The fact that there's unlimited restoration and a consumables coverage add-on is a big plus. There are also no disease-wise sub-limits and only a 2 year-waiting period for pre-existing diseases, which is a huge plus.
I appreciate that there is coverage for mental illnesses along with modern and advanced treatments. The plan also covers AYUSH treatments, which is a great feature that broadens the scope of care for senior individuals. There's also coverage for air and road ambulance costs, which are both really important for this specific age group.
A couple of things to note are the co-payment of 20% per claim and room rent restrictions. The upside is that you can modify & do away with these with add-ons.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, 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 80% of the final bill. The rest is on you. They call this a 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.
Customisable
Changes the room type from Single Private Room to ₹3,000/day and reduce the premiums to be paid.
Customisable
Change Single Private Room to Any room.
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.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 2 years to 90 days.
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
Health 360 Shield
Recommended
Covers list of 68 non-medical items as per list I upto ₹1,00,000.
Automatic Restoration
Recommended
Restores the cover unlimited times up to 100% of the sum insured for any illness.
Any Room Upgrade
Recommended
Change Single Private Room to Any room.
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 2 years to 90 days.
Co-payment Modifier
Modifies the co-payment from 20% to either 0%, 10% or 30%
Premium Management
Changes the room type from Single Private Room to ₹3,000/day and reduce the premiums to be paid.
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.
Tumors, cysts, polyps including benign breast lumps
Polycystic ovarian disease
Fibromyoma
Adenomyosis
Endometriosis
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to 90 days for all diseases.
What's missing in the policy
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered.
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does ProHealth Prime Senior Classic 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.
Does ProHealth Prime Senior Classic have room rent restrictions?
Does ProHealth Prime Senior Classic offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.