ManipalCigna ProHealth Prime

Key features

• ✓Three variants — Protect (broad base), Advantage (with cashless OPD), Active (PED-friendly with 90-day waiting on listed chronic conditions)
• ✓Guaranteed 25% NCB per year up to 200% of SI on Protect & Advantage (paid even on claim years)
• ✓Unlimited restoration of sum insured for related and unrelated illnesses (Protect & Advantage)
• ✓Cashless OPD cover (Advantage): ₹20K / ₹30K / ₹50K annually
• ✓All daycare procedures covered up to SI (no list, no cap)
• ✓Pre-hospitalisation 60 days, post-hospitalisation 180 days (Protect & Advantage)
• ✓Air ambulance cover up to ₹10 Lakh
• ✓Bariatric surgery cover up to ₹5 Lakh
• ✓Domiciliary treatment up to 10% of SI
• ✓AYUSH inpatient treatment up to SI
• ✓Wellness rewards programme — up to 20% of base premium
• ✓Premium waiver on critical illness or accidental death of policyholder
• ✓Annual health check-up from year 1
• ✓Travel switch-off benefit — pause cover for up to 30 days while abroad
• ✓Unlimited tele-consultations

What’s included

• ✓In-patient hospitalisation up to sum insured
• ✓Pre-hospitalisation (60 days, 30 for Active)
• ✓Post-hospitalisation (180 days, 60 for Active)
• ✓All daycare procedures
• ✓Domiciliary treatment up to 10% of SI
• ✓AYUSH inpatient treatment up to SI
• ✓Modern treatment / advanced procedures
• ✓Road ambulance
• ✓Air ambulance up to ₹10 Lakh
• ✓Bariatric surgery up to ₹5 Lakh
• ✓Organ donor expenses
• ✓Annual health check-up
• ✓Unlimited tele-consultations
• ✓Domestic second medical opinion
• ✓Cashless OPD (Advantage variant only)
• ✓Convalescence benefit ₹30,000 for stays > 10 days (Active)
• ✓Daily cash for shared accommodation (Active)

What’s excluded

• ✕Maternity and childbirth (unless added via Enhance/Enhance Plus optional package, max ₹1 Lakh)
• ✕Breach of law with criminal intent
• ✕Adventure / hazardous sports injuries
• ✕War, civil war, invasion, and warlike operations
• ✕Nuclear, chemical or biological contamination
• ✕Self-inflicted injury and attempted suicide
• ✕Cosmetic surgery (unless medically necessary)
• ✕Sterility and infertility treatment
• ✕Treatment for alcohol or drug abuse
• ✕Unproven / experimental treatments

Eligibility

Min age

0 years

Max age

99 years

Max entry age

99 years

Covers

Self, Spouse, Children, Parents, Parents-in-law, Siblings, Grandparents, Grandchildren, Extended relations

Policy term

1, 2 or 3 years (7.5% discount for 2-year, 10% discount for 3-year single-premium)

PED waiting period

36 months for SI ≤ ₹5L; 24 months for SI ≥ ₹7.5L (Protect/Advantage). Active variant: 90 days for listed PED (diabetes, hypertension, asthma, dyslipidaemia, obesity); 24 months for others.

Initial waiting

30 days (waived for accidents); specific illnesses 24 months

Co-payment

Base plan has no mandatory co-payment; optional voluntary deductibles (₹10K / ₹25K up to ₹5L) available for premium discount

Room rent

Single Private AC Room (Protect, Advantage, and Active for SI ≥ ₹5L). Active at ₹3L SI: 1% of SI per day. ICU charges up to SI. Optional Any Room upgrade available.

No-claim bonus

Protect & Advantage: Guaranteed 25% of SI per year, max 200% (regardless of claims). Active: 10% per claim-free year, max 100%, with reduction on claims.