Health Insurance

Cigna TTK ProHealth Insurance

Product FAQs
1. What is Health Insurance?
A: Insurance coverage that pays for medical and surgical expenses
that are incurred by the insured person during the treatment of a
disease or injury. Health insurance can either reimburse the
insured for expenses incurred from illness or injury or pay the
care provider directly.
5. Can I increase/decrease the Sum Insured or change the plan
in my policy?
A: Alterations like increase or decrease in Sum Insured, change in
plan will be allowed at the time of Renewal of Policy. However,
any such change request will be subject to underwriting decision
or requirement of medical tests on a case to case basis.

2. Why to choose CignaTTK ProHealth plan? 6. How do I decide on an appropriate cover amount?

A: Unexpected illnesses wipe out all your savings. CignaTTK offers A: You can choose from 4 plan types (Protect/Plus/Preferred/ Premier)
a health insurance plan that provides below benefits in one policy.
Protect 2.5 , 3.5 , 4.5 Lacs
Basic Value Added Optional Add on
Covers Covers Covers Cover Plus 4.5 , 5.5 , 7.5, 10 Lacs

a. In patient a. Health a. Deductible* a. Critical Preferred 15, 30, 50 Lacs

Hospitalization Check-Up Illness
cover Add on Premier 1 Cr

b. Pre/Post b. Expert b. Reduction 7. Does it cover Senior Citizens?

Hospitalization Opinion in Maternity
A: Yes, the Minimum age at entry is:
cover on CI Waiting
91 days (for Children); 18 years (for adult)
c. Day Care c. Cumulative c. Voluntary
treatment Bonus Co-pay* Maximum age at entry:
d. Domiciliary d. Healthy *Voluntary 23 years (for children under a floater); Lifetime (for adults)
treatment Rewards Co-pay and
Deductible 8. Is there any tax benefit?
cannot be
taken under a A: Yes. Premium paid under the Policy shall be eligible for income
single plan. tax deduction benefit under Sec 80 D of the Income Tax Act and
any amendments thereon.
e. Ambulance
Cover 9. What do you mean by in-patient and out-patient Treatment?

f. Donor expenses A: When an insured is hospitalized and stays in hospital for more
than 24 hours solely for receiving treatment it is termed as in-
g. Worldwide patient treatment.
Emergency Cover
Out-patient treatment is when insured visits a clinic/hospital or a
h. Restoration of consultation room for diagnosis and treatment based on the
Sum Insured advice of medical practitioner. In out-patient hospitalization
patient is not admitted under a day care or as an in-patient.
i. Maternity
Expenses & New 10. What is Day Care Procedure?
Born Baby
Expenses A: It refers to any medical treatment and/or surgical procedure
which are:
j. First Year
Vaccinations i. Undertaken under general/local anesthesia in a hospital/day
care center with less than 24 hours stay due to technological
3. Can I buy ProHealth online? advancement, and

A: You can buy ProHealth Online by visiting our website ii. Which would have otherwise required hospitalization of more
www.cignattkinsurance.in than 24 hours.

4. What coverages do I get? *Treatment normally taken on an out-patient basis is not included
in the scope of this definition.
A: Under this policy, coverages are divided into Basic, Value added,
Optional and Add-on. 11. What are Pre & Post Hospitalization expenses?

The Basic and Value Added covers as detailed in (Q2) will be A: Pre-hospitalization expenses are medical expenses incurred
available as per the plan and SI chosen. immediately before the insured is hospitalized provided that:

The optional covers and Critical illness add-on can be opted by i. Such hospitalization expenses are incurred for the same
paying additional premium. condition for which the insured

Person's hospitalization was required
ii. And an in-patient hospitalization claim is admissible for that
hospitalization by CignaTTK Health Insurance.
Post-hospitalization medical expenses include expenses
incurred immediately after the insured is discharged from the
hospital provided that:
i. Such medical expenses are incurred for the same condition for
which the insured's Hospitalization was required
ii. An in-patient hospitalization claim is admissible for that
hospitalization by CignaTTK Health Insurance.
12. Are all the systems of medicine covered under this
insurance plan?
A: Any form of Non-Allopathic treatment, Naturopathy,
hydrotherapy, Ayurvedic, Homeopathy, Acupuncture,
Reflexology, Chiropractic treatment or any other form of
indigenous system of medicine are permanently excluded under
this policy. However you can cover AYUSH treatments under
Health Maintenance Benefit provided it is prescribed by a
Certified Medical Practitioner.
13. What is Domiciliary Hospitalization?
A: It means medical treatment for an illness/disease/injury which
normally would require care and treatment at a hospital but is
actually taken while confined at home because:
• The condition of the patient is such that he/she cannot be moved
to a hospital, or
• The patient takes treatment at home under the care of a medical
practitioner on account of non-availability of room in a hospital.
14. What is meant by Zone based premium?
A: For calculating premium the country has been divided into 3
zones. Zone will be identified based on the location city of the
insured person and premium will be calculated accordingly.
Zone I: Mumbai, Thane / Navi Mumbai and Delhi NCR
Zone II: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana,
Kolkata, Gujarat
Zone III: Rest of India excluding the locations mentioned under
Zone I & Zone II
(a) Persons paying Zone I premium can avail treatment all over India
without any sub limits.
(b) Persons paying Zone II premium
i) Can avail treatment in Zone II and Zone III without any sub
limits.
ii) Availing treatment in Zone I will have to bear Co-pay of 10% of
each and every claim#.
(c) Person paying Zone III premium
i) Can avail treatment in Zone III, without any sub limits.
ii) Availing treatment in Zone II will have to bear Co-pay of 10%
on each and every claim#.
iii) Availing treatment in Zone I will have to bear Co-pay of 20%
on each and every claim#.
Health Insurance
#Co-payments will not be applicable on emergency
hospitalization due to Accidents.
15. What happens if the illness/disease/injury is of such a nature
that it is covered under domiciliary hospitalization but
requires nurse to attend to the patient?
A: Domiciliary Hospitalization benefits cover the expenses on
employment of qualified nurses, who are employed on the
recommendation of the attending Medical Practitioner and who
holds a certificate of a recognized Nursing Council. However the
treatment has to be under a qualified Medical Practitioner only.
16. What happens when I have to undergo a treatment like
dialysis when I am discharged on the same day?
A: In this scenario, the medical treatment and expenses will be
covered under Day Care Procedure.
17. What is meant by Pre-existing disease?
A: Pre-existing Disease includes any condition, ailment or injury or
related condition(s) for which insured had signs or symptoms,
and / or were diagnosed, and / or received medical advice /
treatment within 48 months prior to the first policy issued by the
insurer.
18. What is included in Donor expenses?
A: CignaTTK under this policy will cover In-patient Hospitalization
Medical Expenses towards the donor for harvesting the organ up
to the limits of the Sum Insured, provided that:
1. The organ donor is any person in accordance with the
Transplantation of Human Organs Act 1994 (amended) and other
applicable laws and rules.
2. The organ donated is for the use of the Insured Person who has
been asked to undergo an organ transplant on Medical Advice.
3. We have admitted a claim under in-patient hospitalization.
We will not cover:
a. Any pre or post hospitalization expenses
b. Cost towards donor screening
c. Cost directly associated to the acquisition of the organ
d. Any other medical treatment or complication in respect of the
donor, consequent to harvesting.
19. What is expert opinion on Critical Illnesses?
A: Insured may choose to secure a second opinion from Our panel
of Medical Practitioners, if an Insured Person is diagnosed with a
covered Critical Illness during the Policy Period. The second
opinion would be directly sent to the Insured Person by the
Medical Practitioner if opted.
20. What diseases are included in Critical Illness?
A: Critical Illness includes
a. Cancer of specified severity
b. First Heart Attack of specified severity
c. Open Chest CABG
d. Open Heart Replacement or Repair of Heart Valves
e. Coma of specified severity
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f. Kidney failure
g. Stroke resulting in permanent symptoms
h. Major Organ or Bone marrow transplant
i. Permanent Paralysis of limbs
j. Motor Neurone Disease with Permanent Symptoms
k. Multiple Sclerosis with Persisting Symptoms
21. What is covered under maternity benefits?
A: Maternity benefits include expenses for the delivery of child or
expenses related to medically necessary and lawful termination
of pregnancy.
Maximum to 2 deliveries / terminations covered during the
lifetime of an insured between the age group of 18-45 years.
Coverage will be restricted to the sum insured as per policy.
22. What is new born baby cover?
A: This benefit will include:
• Expenses which are medically necessary for the treatment of the
insured's new born baby while the insured is hospitalized as an
in-patient and the claim is admissible for the insured with us
• Within limits of the sum insured the policy will cover in-patient
hospitalization expenses incurred for the new born during and
post birth upto a period of 90 days.
• New born means baby born during the policy period and aged
between 1-90 days.
For coverage beyond 90 days the new member needs to be
added to the policy through endorsement.
23. What are reasonable and customary charges/expenses?
A: Reasonable and Customary Charges means the charges for
services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking into
account the nature of the illness / injury involved.
24. What is Health Check-up?
A: For insured that have completed 18 years of age can avail a
comprehensive health check-up with Our Network Provider once
every 3rd Policy year for Protect Plan and at each renewal for
Plus, Preferred and Premier Plan as per the table below.

Plan Name Sum Insured Age List of tests

Protect `2.5 Lacs, >18 years MER, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, Urine Routine, SGPT
`3.5 Lacs,
`4.5 Lacs,
Plus `4.5 Lacs, 18 to 40 years MER, ECG,CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT,
`5.5 Lacs, SGPT, GGT, Uric Acid
`7.5 Lacs,
`10 Lacs
>= 41years MER, ECG,CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT, SGPT,
GGT, Uric Acid
For females only - TSH, Pap smear, Mammogram
For males only - PSA
Preferred & `15 Lacs, 18 to 40 years MER, Lipid Profile, HbA1c, Sr. Creatinine, CBC-ESR, RUA, SGPT, ECG, SGOT,
Premier `30 Lacs, GGT, Uric Acid
`50 Lacs, For females: Pap smear, TSH, Mammogram
For males: PSA
`100 Lacs >= 41 years MER, CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT, SGPT, GGT,
(For males only) Uric acid, TMT, USG Abdomen & Pelvis, PSA
>= 41 years MER, CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT,
(For females only) SGPT, GGT, TMT, Uric acid, USG Abdomen & Pelvis, Pap smear, Mammogram,
TSH

25. What are Healthy Rewards? also be earned by enrolling and completing our Online Wellness
Programs. These earned points can be used to get a discount in
A: Healthy Rewards are points earned for each year of premium the premium from 3rd Annual Premium or these can be
payment and these will be accumulated for 2 years. Points can redeemed for equivalent value of Health Maintenance Benefit.

Details of available online programs and rewards that can be accrued are provided below -

Online Program Reward Points Reward Points Reward Points Reward Points to be
under Protect Plan under Plus Plan under Preferred earned under Premier Plan

Health Risk Assessment (HRA) 25 40 80 120

Targeted Risk Assessment (TRA) 50 80 160 240

Online Lifestyle Management 50 80 160 240

Program (LMP)

26. Does Worldwide Emergency benefit cover medical
expenses due to Terrorism attack?
A: This benefit provides for reimbursement of expenses incurred for
availing emergency medical assistance due to illness, injury
sustained or contracted outside the territorial limits of India.
The benefit amount will be limited to the sum insured for Protect
and Plus plan and upto Rs.10 lacs for Preferred and Premier plan.
Expenses will be limited to in-patient and day care hospitalization
only. All payments will be in Indian rupees and as per the
Exchange rate published by RBI (Reserve Bank of India) on the
date of payment to the hospital.
27. Although, I have your Policy available, yet, I am visiting
abroad for one month for which I have opted for on
'Overseas Mediclaim Policy' from another company. Can
you refund me the premium for the said period of one
month?
A: The premium rate calculated for the given policy is on an annual
basis and cannot be bifurcated to monthly period.
Also the coverage is available for the term opted under the policy.
Accordingly the refund of premium option is not available in this
scenario.
Our Policy also provides for worldwide emergency coverage
outside of India. You can avail of this benefit during your trip
outside.
28. What do you mean by Restoration benefit?
A: Under this benefit the Sum Insured if insufficient due to claims
paid or payable during the policy year, will be restored to 100%
with below conditions:
i. The Basic SI and Cumulative bonus (if any) is insufficient to pay
for a claim in that year
ii. The benefit is available only for future claims that become
payable under the policy (not allowed for the 1st claim under the
Policy).
iii. The benefit is not available for claims towards an illness, disease,
injury, for which a claim has been paid in the current year for the
same insured.
iv. Restored SI is not being utilized to calculate no claim bonus.
v. The benefit is available only once during the policy year.
* Each insured under an individual policy can avail the benefit.
* If policy is issued on a floater basis, the restored SI will also be
available on floater basis.
* If restored SI is not utilized in a policy year, it will not be carried
forward to subsequent year.
29. Will additional premium be charged for reduction in
maternity waiting period?
A: Insured can opt for a reduction in maternity waiting period by
paying additional premium.
On availing this benefit, the mandatory waiting period for maternity
cover will be reduced from 48 to 24 months. New born cover and
First Year Vaccination will follow reduction in waiting period.
30. What is First Year Vaccination?
A: It includes all reasonable and customary vaccination expenses of
the new born as per the National Immunization Scheme (India)
until the new born completes one year (ie.12 months).
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31. What do you mean by Floater option?
A: It means a policy wherein you and your eligible dependents
named in the schedule are insured from the date of
commencement of the policy.
The Sum Insured for a family floater means the sum shown in the
schedule which represents our maximum liability for any and all
claims made by you and all your dependent during each policy
period.
32. What do you mean by Entry Age?
A: The age eligibility of the insured for taking the policy is the Entry
Age. Age will mean completed age as on last birthday.
33. Is there a maximum entry age?
A: Yes, for children the Maximum age at entry is 23 years in case of a
floater and for adults it is Lifetime. Age will mean completed age
as on last birthday.
34. Is there an Exit Age in ProHealth?
A: No, there is no exit age in this policy.
35. Whom can I keep as my nominee?
A: A nominee can be anyone - spouse, children, and blood relatives.
A minor should not be declared as a nominee.
36. What do you mean by cashless hospitalization?
A: It's a facility where the insured can get hospitalized in any of our
network hospitals & the payments of the costs of treatment
undergone by the insured in accordance with the policy terms
and conditions are made directly to the network
provider(hospital) by the insurer provided that the condition is
payable under the terms and conditions of the policy.
37. What do you mean by period of the policy?
A: Policy Period means the period between the inception date and
the expiry date of the policy as specified in the Schedule to this
Policy or the date of cancellation/termination of this policy,
whichever is earlier.
38. What do you mean by Reimbursement?
A: It is the amount paid back to the insured, by the insurer for
admissible medical expenses incurred by the insured.
39. What do you mean by Co-payment?
A: Under a health insurance policy co-payment works as a cost
sharing mechanism where the policy holder/insured will bear an
agreed specified percentage of each & every admissible claim
amounts.
40. What is a Cumulative Bonus?
A: It means an increase in the Sum Insured granted by the insurer
for a claim free policy period without an increase in the premium.
41. Who can be covered in ProHealth?
A: An individual policy can be taken for self, spouse, parents,
siblings, in-laws, grandparents and grandchildren.
Family floater with maximum 2 adults and 3 children can be taken
for self, spouse, dependent children or dependent parents.
42. Is Medical Test mandatory for everyone?
A: Medicals will be triggered on the basis of the age of t insured, the
plan type and sum insured selected.

For Protect plan no medicals are required for the insured upto
age 45 years.
For Plus plan with Sum Insured upto 7.5 lacs and age upto 45
years medicals will not be triggered.
For Plus plan with 10 lacs Sum Insured and age upto 40 years
medicals are not required.
For Preferred and Premier Plans medicals are mandatory
irrespective of the age & the Sum Insured chosen.
** For details of medical tests kindly contact Customer Support
Team, Health Advisor or Branch Service Desk.
43. Which are the medical tests one needs to go through?
A: The list of medical tests will be communicated by CignaTTK
Health Insurance Company to the customer at the time of
processing the insurance application as they will depend upon
the Age, Sum Insured Opted and any medical history declared at
the time of application.
44. Where will the medical tests be conducted?
A: The medical tests can be conducted at the network of diagnostic
designated centers identified by CignaTTK Health Insurance
Company.
45. Who will pay for pre-policy medical checkup?
A: The total cost of all medical tests will be borne by us (CignaTTK
Health Insurance).
46. Will I receive the medical reports?
A: In a situation where medicals are required to process the
insurance application, the medical reports will be available with
CignaTTK Health Insurance. The same will be shared with
customer on request.
47. Will CignaTTK share medical reports if policy is not issued?
A: Yes, the medical reports will be shared on receiving a written
request.
48. How can I renew the policy?
A: You can renew the policy by any of the below methods:
i. Making premium payments at our local branches
ii. Paying premium online using your net banking facility/Credit
Card or Debit Card.
49. What do you mean by Permanent Exclusion?
A: It means the disease mentioned under Permanent Exclusions
will not be covered in the ProHealth Insurance Policy.
50. What do you mean by Policy Start Date?
A: Policy start date is the date from which the policy becomes valid.
51. What is the difference between Individual and Floater options?
A: Under individual option each insured has separate Sum Insured.
Under floater option all members in the policy have a single sum
insured.
52. What if I have a medical policy of any other insurance
company, can I still buy your product?
A: We do not have any limitation on buying ProHealth Insurance. It's
as per your choice if you wish to have additional coverage,
however you must inform us regarding the existing policy at the
time of buying the ProHealth.
53. What should I do if I want to insure more than 2 adults or 3
children in floater plan?
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A: If you wish to insure more than 2 adults or 3 children in a floater
plan, you need to buy an additional policy.
54. What are the covers offered under In-patient Hospitalization?
A: For in-patient hospitalization we will pay for the below medical
expenses:
• Reasonable and Customary Charges for Room Rent for
accommodation in Hospital room
• Intensive Care Unit charges for accommodation in ICU ,
• Operation theatre charges,
• Fees of Medical Practitioner ,
• Anaesthetist,
• Qualified Nurses,
• Specialists,
• Cost of diagnostic tests,
• Medicines,
• 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.
55. What is the Policy Tenure?
A: The policy tenure available is either 1 year or 2 years. You can
choose the tenure of the Policy at the time of buying the policy.
56. Can a child of age 5 years and below be covered under this
plan?
A: Yes, new born aged 91 days and upto 23 years will be covered in
this policy.
Children between the age group of 3 months (91 days) to 5 years
will be covered only if either of the parents is covered. Children
from 6 years to 18 years will only be covered if one of the parents
is the proposer.
Siblings between 91 days to 5 years will be covered if at least 1
adult sibling is covered under the policy. Grandchild between 91
days to 5 years will be covered if at least 1 adult grandparent is
covered under the policy.
Children beyond 23 years if dependent on the parents can be
covered under an individual policy.
**The baby should be born to an insured and legally wedded wife
or a lawfully adopted child.
57. Can the customer choose only one from optional covers?
A: Yes, customer can choose one cover or more than one from all
the optional covers available.
However, Co-pay and Deductible cannot be opted together in a
single policy.
58. Does the plan cover Pre-existing diseases?
A: Pre-existing diseases/illness/injury/conditions will be covered
post 24/36/48 months of continuous cover depending upon the
plan opted.
*Such waiting period shall reduce if the insured has been covered
under a similar policy before opting for this policy, subject
however to portability regulations.
59. How do you decide if a disease is a pre-existing one or not?
A: At the time of buying a health insurance you need to provide
details of the illnesses you have suffered during your lifetime. The

insurer refers such cases to their medical panel to differentiate
between pre-existing and newly contracted illnesses.
Note: Insurance is a contract based on good faith and any willful
non-disclosure of facts might lead to problems in future including
Policy cancellation without any refund of premium.
60. Does the insured have to pay the difference if the actual
expenses are more than the cover?
A: In a scenario where the actual expenses exceeds the amount of
cover, insured will be liable to pay the difference amount.
For example, if the eligible maternity cover is for Rs.15000 and
the actual expenses is Rs.20,000, then insured have to pay
balance Rs.5000/-.
61. Will elimination or reduction of specific benefits in basic
cover reduce premium?
A: The benefits available under Basic Cover cannot be eliminated or
reduced.
However customer can choose from the optional and add on covers.
Accordingly the premium will be calculated.
62. What diseases come under Permanent Exclusions?
A: Unless necessary endorsements or exemptions are made below
diseases and expenses arising out of or attributable to any of the
following will not be covered in the policy.
1. Genetic Disorder
2. Dental treatment or surgery
3. Circumcision
4. Birth control procedures
5. Expenses on spectacles, laser surgery, cosmetic surgery,
contact lenses, hearing aids, hair fall treatment etc.
6. HIV, AIDS and all diseases/illnesses/injury caused by and/or
related to HIV.
7. All sexually transmitted diseases.
8. Ailment requiring treatment due to use/abuse of intoxicant/
drug/alcohol etc.
9. Expenses on prostheses, corrective devices & medical appliances.
10. Treatment of any mental diseases.
11. Expenses on Non-allopathic treatment, Naturopathy, Ayurvedic,
Homeopathy, Acupuncture or any other form of indigenous
system of medicine
12. Insured person engaged in racing, bungee jumping, ballooning,
sky diving, para gliding, rock climbing etc.
13. Any expenses directly or indirectly caused by or arising from or
attributable to foreign invasion, hostilities, war, rebellion,
revolution, military or usurped power.
14. Any deductible amount or percentage of admissible claim under
co-pay.
* Please refer the Policy Wordings for detailed exclusions.
63. Which diseases are not covered under First 2 Years
Exclusions?
A. 24 months waiting period is applicable on specific ailments.
Below list is only indicative and not exhaustive:
1. Cataract
2. Knee Replacement Surgery
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3. Urinary Stones
4. All types of Hydrocele
5. Sinusitis, surgery on tonsils
6. Gastric, Cysts, Polyps, internal/skin tumors, breast lumps
7. Surgery of Genito-Urinary system.
* Please refer the Policy Wordings for detailed list.
64. Would I be able to avail of my medical & premium
reimbursements in case my policy is rejected?
A: The pre-policy medical check-up cost will be paid by CignaTTK
Health Insurance Company.
In case we are unable to underwrite your proposal we will intimate
the same to you and refund any premium that has been collected.
65. Does a higher cover mean preferential treatment in case of
hospitalization & claim?
A: A higher cover does not indicate or entitle the insured to
preferential treatment in hospitalization and claim. Irrespective of
the cover chosen you would get high quality service and
treatment at our network hospitals.
66. Does a higher cover guarantee better protection?
A: In recent days people are more prone to various ailments and health
problems due to fast paced life and erratic schedules. A higher
cover protects you from a medical emergency which can burn a
hole in your pocket and thus guarantee you a better protection.
67. If I have a health insurance policy in one city, can I make a
claim in another city?
A: Your health insurance policy is in force across India. You can check
whether there is any network hospital near to your residence as
well the city of your current location. Network hospitals are the
hospitals that have tie up with the Third Party Administrator for
cashless settlement of claims. If there is no network hospital, you
can opt for reimbursement mode of settlement.
Apart from this we also provide coverage in case of Emergency
situations anywhere in the world.
68. Is there a limit as to how long can I stay in hospital?
A: There is no defined limit of the period of stay in hospital.
However the stay in hospital should be medically necessary to
provide safe, adequate and appropriate medical care in scope,
duration or intensity.
o Must have been prescribed by a Medical Practitioner.
o Must confirm to the professional standards widely accepted in
international medical practice or by the medical community in
India.
69. What happens in case of an Emergency hospitalization
where Cashless facility is not authorized to me?
A: If cashless facility is not authorized you can go for reimbursement
mode of settlement.
70. What all documents do I need to Furnish to get a Health
Insurance?
A: To buy our Policy you will require filling up the ProHealth
Insurance - Proposal Form and submitting the form to us along
with the premium instrument.
71. Do I get a Health Identification Card?
A: Yes, all the policy holders are eligible for a health identification
card and it will form a part of the policy kit.