9041883189 ManipalCigna Agent in Ludhiana , Jalandhar

Manipal Cigna

BENEFITS UNDER THE POLICY

BASIC COVERS

  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:

  1. 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.
  2. Intensive Care Unit charges for accommodation in ICU ,
  3. Operation theatre charges,
  4. Fees of Medical Practitioner/ Surgeon ,
  5. Anaesthetist,
  6. Qualified Nurses,
  7. Specialists,
  8. Cost of diagnostic tests,
  9. Medicines,
  10. 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.

All Claims under this benefit can be made as per the process defined under

Section VII 5.

II.4. Day Care Treatment:

We will cover payment of Medical Expenses of an Insured Person in case of Medically Necessary Day Care Treatment or Surgery that requires less than 24 hours Hospitalization due to advancement in technology and which is undertaken in a Hospital / nursing home/Day Care Centre on the recommendation of a Medical Practitioner. Any treatment in an outpatient department/OPD is not covered. For list of Day Care Treatments refer Annexure II of the Policy.

Coverage will also include pre-post hospitalisation expenses as available under the Plan opted.

All Claims under this benefit can be made as per the process defined under

Section VII 4 & 5.

II.5. Domiciliary Treatment:

We will cover Medical Expenses of an Insured Person which are towards a Disease/Illness or Injury which in the normal course would otherwise have been covered for Hospitalisation under the policy but is taken at home    on the advice of the attending Medical Practitioner, under the following circumstances:

  1. The condition of the Insured Person does not allow a Hospital transfer; or
  2. A Hospital bed was unavailable;

Provided that, the treatment of the Insured Person continues for at least   3 days, in which case the reasonable cost of any Medically Necessary treatment for the entire period shall be payable.

  1. We will pay for Pre-hospitalisation, Post-hospitalisation Medical Expenses up to 30 days each.
  2. We shall not be liable under this Policy for any Claim in connection with or in respect of the following:
    1. Asthma, bronchitis, tonsillitis and upper respiratory tract infection

including laryngitis and pharyngitis, cough and cold, influenza,

  1. Arthritis, gout and rheumatism,
    1. Chronic nephritis and nephritic syndrome,
    1. Diarrhoea and all type of dysenteries, including gastroenteritis,
    1. Diabetes mellitus and Insipidus,
    1. Epilepsy,
    1. Hypertension,
    1. Psychiatric or psychosomatic disorders of all kinds,
    1. Pyrexia of unknown origin.

All Claims under this benefit can be made as per the process defined under

Section VII 5.

II.6. Ambulance Cover:

  1. We will provide for reimbursement of Reasonable and Customary expenses up to limits specified in the Schedule that are incurred towards transportation of an Insured Person by a registered healthcare or Ambulance service provider to a Hospital for treatment of an Illness or Injury covered under the Policy in case of an Emergency, necessitating the Insured Person’s admission to the Hospital. The necessity of use of an Ambulance must be certified by the treating Medical Practitioner.
  2. Reasonable and Customary expenses shall include:
  3. Costs towards transferring the Insured Person from one Hospital to another Hospital or diagnostic centre for advanced diagnostic treatment where such facility is not available at the existing Hospital; or
  4. When the Insured Person requires to be moved to a better Hospital facility due to lack of super speciality treatment in the existing Hospital.

To know more, Call / sms / Whatsapp at 7015143936