7015143936 Manipal Cigna Health Insurance Chandigarh

ManipalCigna ProHealth Insurance Policy Terms and Conditions

I PREAMBLE & OPERATING CLAUSE

This is a legal contract between You and Us subject to the receipt of full
premium, Disclosure to Information Norm including the information provided
by You in the Proposal Form and the terms, conditions and exclusions of
this Policy.

If any Claim arising as a result of a Disease/Illness or Injury that occurred
during the Policy Period becomes payable, then We shall pay the Benefits
in accordance with terms, conditions and exclusions of the Policy subject
to availability of Sum Insured and Cumulative Bonus (if any). All limits
mentioned in the Policy Schedule are applicable for each Policy Year of
coverage.

BENEFITS UNDER THE POLICY

II BASIC COVERS

II.1. Inpatient Hospitalization:
We will cover Medical Expenses of an Insured Person in case of Medically
Necessary Hospitalization arising from a Disease/ Illness or Injury provided
such Medically Necessary Hospitalization is for more than 24 consecutive
hours provided that the admission date of the Hospitalisation due to Illness
or Injury is within the Policy Year. We will pay Medical Expenses as shown
in the Schedule for:
a. Reasonable and Customary Charges for Room Rent for
accommodation in Hospital room up to Category as per Plan opted
and specified in the Schedule to this Policy.
b. Intensive Care Unit charges for accommodation in ICU ,
c. Operation theatre charges,
d. Fees of Medical Practitioner/ Surgeon ,
e. Anaesthetist,
f. Qualified Nurses,
g. Specialists,
h. Cost of diagnostic tests,
i. Medicines,
j. Drugs and consumables, blood, oxygen, surgical appliances and
prosthetic devices recommended by the attending Medical Practitioner
and that are used intra operatively during a Surgical Procedure.
Room category coverage for Sum Insured under each plan will be up to
limit specified in the Policy Schedule.
If the Insured Person is admitted in a room category that is higher than the
one that is specified in the Schedule to this Policy then the Policyholder/
Insured Person shall bear a ratable proportion of the total Associated
Medical Expenses (including surcharge or taxes thereon) in the proportion
of the difference between the room rent of the entitled room category to the
room rent actually incurred.
All Claims under this benefit can be made as per the process defined under
Section VII 4 & 5.

II.2. Pre – hospitalization:
We will, on a reimbursement basis cover Medical Expenses of an Insured
Person which are incurred due to a Disease/ Illness or Injury that occurs
during the Policy Year immediately prior to the Insured Person’s date of
Hospitalisation up to limits specified in the Schedule, provided that a Claim
has been admitted under In-patient Benefit under Section II.1 and is related
to the same illness/condition.
All Claims under this benefit can be made as per the process defined under
Section VII 5.

II.3. Post – hospitalization:
We will, on a reimbursement basis cover Medical Expenses of an Insured
Person which are incurred due to a Disease/ Illness or Injury that occurs
during the Policy Year immediately post discharge of the Insured Person
from the Hospital up to limits specified in the Schedule, provided that a
Claim has been admitted under In-patient Benefit under Section II.1 and is
related to the same illness/condition.

Ask any Question on Health Insurance .... We will reply for sure.