Overview
The ManipalCigna ProHealth Prime Senior Elite Plan, like its Classic counterpart, is specifically designed for senior citizens aged 56 to 75 years. It emphasizes comprehensive coverage with no mandatory pre-policy medical check-up, access to modern treatments, and mental illness coverage. It also offers enhanced coverage for donor expenses and enhanced control with unlimited restoration of the sum insured. Above all, the plan is designed to provide robust financial support for seniors' healthcare needs.
Experts' Review
Written by Nikhil Nair
Senior Writer
ManipalCigna ProHealth Prime Senior Elite Plan is a decent plan for seniors, who often have specific healthcare requirements. The fact that there's no mandatory pre-policy medical check-up is a significant advantage as it streamlines the process of getting a policy for seniors who usually have to jump through hoops only to get a rejected application.
Unlike the Senior Classic plan, coverage with the Senior Elite plan is more all-rounded for donor expenses, and there is unlimited restoration of the sum insured. Other key features include access to modern treatments and coverage for mental illnesses, which are essential but often overlooked. This policy also offers unlimited tele-consultations, making it easy for senior policyholders to get the care they need in the comfort of their homes.
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.
Doctor consultations are not covered, which could be a drawback for some.
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 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
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 24 months 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 - 60 days before you are hospitalized and 90 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.
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 24 months to 90 days.
Co-payment Modifier
Modifies the co-payment from 20% to either 0%, 10% or 30%
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
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
R
Ramesh
Designed specifically for seniors, covers our needs.
S
Shanta
No mandatory pre-policy medical check-up is a big help.
A
Alok
Access to modern treatments is important.
V
Vimala
Are there any sub-limits for senior-specific ailments?
N
Nirmala
Premiums might be high for an elite plan.
G
Gayatri
Provides peace of mind for senior years.
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Frequently Asked Questions
Does ProHealth Prime Senior Elite 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 Elite have room rent restrictions?
Does ProHealth Prime Senior Elite offer a restoration benefit?
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