Basant Sharma

N 91 KENDRIYA VIHAR SECTOR 6

NEAR VIDHYDHAR NAGAR POLICE STATION
Jaipur
Rajasthan 302023
Mobile No :9799515555

PROHLN000239510

Dear Basant Kumar Sharma,

Thank you for choosing us as your trusted health insurance partner. We have highlighted some important points regarding your policy that you should
keep in mind, so please read it carefully.

KNOW YOUR POLICY HOW TO SUBMIT YOUR CLAIM?

Name of Your Plan ProHealth - Protect For hassle free claims experience, we have simplified our
Policy Number PROHLN000239510 claims process. Here's how it works,

Contact Number 9799515555 Download Medibuddy app

Real-time claims status
or visit www.medibuddy.in
E Mail ID BASANTSH@HOTMAIL.COM
Cover Start Date 25/11/2021 Claims Helpline No. 1800-419-1159
Cover End Date 24/11/2022
Plan Type Individual Claims Email ID cigna@mediassistindia.com

Policy Term 1 Year

Ported Policy Yes REACH US FOR ASSISTANCE:
Zone III - Avail treatment in Zone III without co-pay, Visit - www.manipalcigna.com
Zone avail treatment in Zone II with 10% copay & avail
treatment in Zone I with 20% copay on every claim
Call us - 1800-102-4462
PED Declared No

Email us - customercare@manipalcigna.com

WAITING PERIOD IN YOUR POLICY

PARTICULARS DETAILS
Initial Waiting Period 30 days (Except accident and for renewal policies without break)
Pre Existing Disease (PED) Waiting period Covered after 48 months of continuous coverage
Specific Waiting Period 24 months since inception of first policy with us
Permanent Exclusions As mentioned in Policy Wording
* For rollover / portability cases continuous coverage will be considered from first policy inception date with us or other insurer (as applicable)

Please read your policy schedule and policy wordings for detailed terms and conditions relating to the benefits. For policy wordings information, visit
https://www.manipalcigna.com

Incase of any queries or clarifications, please feel free to contact your advisor or reach us at any of our touch points.

Thank you for choosing us as your partner in illness and wellness. Assuring you of our best services at all times.

Yours Sincerely,

ManipalCigna Health Insurance Company Limited

ManipalCigna Health Insurance Company Limited (Formerly known as Cigna TTK Health Insurance Company Limited). CIN U66000MH2012PLC227948. IRDAI Reg. No. 151.
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai - 400063.
Toll free number: 1800-102-4462, Website address: www.manipalcigna.com
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by
ManipalCigna Health Insurance Company Limited under license.

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

 Your Policy Kit Includes:
 The Policy Schedule: Presents the details of policy, such as level of protection, the premium payable for the cover, date of
commencement, persons covered, specific conditions related to plan and any special terms that apply to the policy.

 The Policy Wording: Details the terms and conditions, definitions and exclusions of the policy.

 Premium Receipt: Receipt issued for the premium paid by you.

This kit will help you understand your policy in detail and give you more information on how to access our services easily.
We request you to read the policy terms and conditions carefully so that you are fully aware of your policy benefits.

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

 MANIPALCIGNA PROHEALTH INSURANCE
Customer Information Sheet
Description Refer to the
following
Title
Please refer to the Plan and Sum Insured you have opted to understand the available benefits Policy
under your plan in brief Section
number in
the Policy
Your Wording
Coverage Identify your Plan Protect Plus Preferred Premier Accumulate for more
Details: details on
each cover
` 2.5 Lacs `4.5 Lacs `15 Lacs, `100 Lacs `5.5 Lacs,
` 3.5 Lacs `5.5 Lacs, `30 Lacs, `7.5 Lacs,
` 4.5 Lacs, `7.5 Lacs, `50 Lacs `10 Lacs,
` 5.5 Lacs, `10 Lacs, `15 Lacs,
` 7.5 Lacs, `15 Lacs, `20 Lacs,
Identify your Opted
` 10 Lacs, `20 Lacs, `25 Lacs,
Sum Insured (SI)
` 15 Lacs, `25 Lacs, `30 Lacs,
` 20 Lacs,
`30 Lacs, `50 Lacs
` 25 Lacs,
`50 Lacs
` 30 Lacs,
` 50 Lacs
For Sum Insured Covered upto any Room Category except Suite or For Sum Insured
up to `5.5 Lacs - higher category `5.5 Lacs -
Covered up to Covered up to Single
Single Private Private Room
Room For Sum Insured `
Inpatient
For Sum Insured 7.5 Lacs and Above -
Hospitalisation
`7.5 Lacs and Covered up to any D.I.1
(When you are
Above - Room Category
hospitalised)
Covered up except Suite or
to any Room higher category
Category except
Suite or higher
category

Pre - hospitalisation Medical Expenses Covered up to 60 days before date of hospitalisation D.I.2

Medical Expenses Covered up to 90 days

Basic Cover: Covered up to post discharge from
This section Post - Medical Expenses Covered up to 180 days post
90 days post hospital D.I.3
lists the Basic hospitalisation discharge from hospital
discharge from

ManipalCigna ProHealth Insurance | Customer Information Sheet | UIN: MCIHLIP21546V052021 | October 2021
benefits hospital
available on
your plan
Day Care Treatment Covered up to the limit of Sum Insured opted D.I.4

Domiciliary
Treatment
Covered up to the limit of Sum Insured opted D.I.5
(Treatment at
Home)
Ambulance Cover Upto `2000 Upto `3000 Actual incurred expenses paid per Upto `2000 paid per D.I.6
(Reimbursement paid per paid per hospitalisation event hospitalisation event
of Ambulance hospitalisation hospitalisation
Expenses) event event

Donor Expenses
(Hospitalisation
Expenses of the Covered up to full Sum Insured D.I.7
donor providing the
organ)

Worldwide
Emergency Cover Covered up to full Sum Insured once in a Policy Year D.I.8
(Outside India)

Restoration of Sum
Insured (When
Multiple Restoration is available in a Policy Year for unrelated illnesses in addition to the Sum
opted Sum Insured D.I.9
Insured opted
is insufficient due to
claims)
 AYUSH Cover Covered up to full Sum Insured D.I.10

Option to choose
from - `5000,
`10,000, `15,000,
`20,000 per policy
Health Maintenance
year
Benefit
Can also be used
(Treatment that
Covered up to Covered up to to pay for Co-pay or
does not require Covered up to `15,000 per policy
`500 per policy `2000 per policy Deductible. D.I.11
hospitalisation and year.
year year Up to 50 % of the
can be carried out
accumulated Health
in an Out Patient
Maintenance Benefit
Department)
can be utilised for
payment against
premium from first
renewal of the policy
Covered upto
Covered upto Covered upto
`15,000 for
`50,000 for `100,000 for
normal delivery
normal delivery normal delivery
and `25,000 for
and `100,000 and `200,000
Maternity Expenses C- Section per D.I.12
for C-Section per for C-Section per
event,
event, after a event, after a
after a Waiting
waiting Period of waiting Period of
Period of 48
Not Available 48 months 48 months Not Available
months
Covered for the inpatient hospitalisation expenses of
New Born Baby
a new born up to the limit provided under Maternity D.I.13
Expenses
Expenses
Covered as per national immunisation programme over
First Year
and above Maternity Sum Insured D.I.14
Vaccinations

Available once
every 3rd Policy Available once every
year to all 3rd Policy year to all
Available each policy year(excluding the first year), to
Health Check-up insured persons insured persons who D.II.1
Value Added all insured persons who have completed 18 years of Age
who have have completed 18
Covers completed 18 years of Age
years of Age
This section
lists the Expert Opinion on
additional Critical illness Available once during the Policy Year D.II.2

ManipalCigna ProHealth Insurance | Customer Information Sheet | UIN: MCIHLIP21546V052021 | October 2021
value added (By a Specialist)
benefits that
are available A guaranteed
A guaranteed 5%
along with your 5% Increase in
Increase in Sum
plan Sum Insured
A guaranteed 10% Increase in Sum Insured per policy Insured per policy
Cumulative Bonus per policy year, D.II.3
year, maximum up to 200% of Sum Insured. year, maximum up
maximum up to
to 200% of Sum
200% of Sum
Insured.
Insured.
Reward Points equivalent to 1% of paid premium, to be earned each year. Rewards can also be
earned for enrolling and completing Our Array of Wellness Programs. These earned Reward Points
can be used against payable premium (including Taxes) from 1st Renewal of the Policy.
Healthy Rewards OR they can be redeemed for equivalent value of Health Maintenance Benefits any time during the D.II.4
policy OR as equivalent value while availing services through our Network Providers as defined in
the policy.
 `1000 for each `2000 for each
continuous continuous `1000 for each
and completed and completed continuous and
`3000 for each continuous
24 Hours of 24 Hours of completed 24 Hours
and completed 24 Hours of
Hospital Daily Cash Hospitalisation Hospitalisation of Hospitalisation
Hospitalisation during the Policy Year D.III.1
Benefit during the Policy during the Policy during the Policy
up to a maximum of 30 days in a
Year up to a Year up to a Year up to a
policy year
maximum of 30 maximum of 30 maximum of 30 days
days in a policy days in a policy in a policy year
year year
Deductible
(Please select the
Sum Insured and
Deductible amount
as you have opted
`0.5/ 1/ 2/ 3/ 4/ 5/
on the Policy. `1/ 2/ 3/ 4/ 5/ 7.5 /10 Lacs Not Available D.III.2
7.5 / 10 Lacs
Deductible is the
amount beyond
which a claim will
Optional be payable in the
Covers Policy)

This section Waiver of

lists the Available Not available Available D.III.2
Deductible
available
optional covers
under your Reduction in Maternity waiting period Reduced from 48 months to 24
Not available Not available D.III.3
plan and the Maternity Waiting months
limits under
each of these Voluntary Co-pay
options (The cost sharing
percentage that
you have opted 10% or 20%
will apply on each voluntary co-
10% or 20% Voluntary Co-payment
claim.) Not Available payment for each D.III.4
for each and every claim as opted
If you have opted and every claim as
for a Deductible, opted on the Policy
Voluntary
Co-payment does
not apply
Waiver of
Mandatory Waiver of Mandatory co-payment of 20% for Insured Persons aged 65 years and above D.III.5
Co-pay
A guaranteed 25%
increase in Sum

ManipalCigna ProHealth Insurance | Customer Information Sheet | UIN: MCIHLIP21546V052021 | October 2021
Cumulative Bonus A guaranteed 25% increase in Sum Insured per policy Insured per policy
Not Available D.III.6
booster year, maximum up to 200% of Sum Insured year, maximum up
to 200% of Sum
Insured
Add on
cover(Rider)
This section Lump sum payment Add on
lists the Add Lump sum payment of an additional 100% of Sum of an additional
Critical Illness Not Available policy
on cover Insured Opted 100% of Sum
available Insured Opted wordings
under your
plan
 Please note that this is an indicative list of exclusions; please refer the Policy wording and clauses for the
complete list of exclusions.
- Investigation & Evaluation- Code- Excl. 04
- Rest Cure, rehabilitation and respite care- Code- Excl. 05
- Obesity/ Weight Control: Code- Excl. 06
- Change-of-Gender treatments: Code- Excl. 07
- Cosmetic or plastic Surgery: Code- Excl. 08
- Hazardous or Adventure sports: Code- Excl. 09
- Breach of law: Code- Excl. 10
- Excluded Providers: Code- Excl. 11
- Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
What are the Code- Excl. 12
Major
exclusions in - Treatments received in heath hydros, nature cure clinics, spas or similar establishments s. Code- Excl. 13
the Policy - Dietary supplements and substances that can be purchased without prescription. Code- Excl. 14
- Refractive Error: Code- Excl. 15
This section
provides a - Unproven Treatments: Code- Excl. 16
brief list of the - Sterility and Infertility: Code- Excl. 17 E
major charges/ - Maternity: Code Excl. 18 (applicable to Protect and Accumulate plan)
treatments
which will not - External Congenital Anomaly or defects.
be covered - Dental treatment.
under the - Circumcision
Policy
permanently. - Prostheses, corrective devices and/or medical appliances
- Treatment received outside India other than for coverage under World Wide Emergency Cover, Expert Opinion on
Critical Illnesses.
- All Illness/expenses caused by ionizing radiation or contamination by radioactivity.
- All expenses caused by or arising from war or war-like situation.
- Annexure IV list I of “Items for which Coverage is not available in the Policy”.
- Any form of Non-Allopathic treatment (except AYUSH In-patient Treatment),
- Any stay in Hospital without undertaking any treatment or any other purpose other than for receiving eligible treatment
of a type that normally requires a stay in the hospital.
- Costs of donor screening or costs incurred in an organ transplant surgery involving organs not harvested
from a human body.
*Note: This list does not apply to coverage under Health Maintenance Benefit

E.I.3
Waiting a. First 30 days from the Policy start date, for all illnesses except accidents. 90 days waiting period will be applicable Add on
Period for listed Critical Illness where Critical Illness Add on cover has been opted. policy
wordings

ManipalCigna ProHealth Insurance | Customer Information Sheet | UIN: MCIHLIP21546V052021 | October 2021
This sections
lists the b. Specified disease/procedure waiting period: Two Year Waiting Period will be applicable for specific illnesses E.I.2
applicable c. A 48 months of waiting period will be applicable for Maternity, New Born and First year Vaccination expenses
period (days/ E.II.1
(Except where Reduction in Maternity Waiting is opted)
months)
before you can d. A Personal waiting period may apply to individuals depending upon declarations on the proposal form and existing
make a claim health conditions. Please refer to the “Special Conditions” Column on your Policy Schedule to identify if any E.II.2
for the listed personal waiting period is applied to your Policy.
diseases/ e. Pre-existing disease waiting period: A 48 months waiting period will be applicable for any Pre-existing disease, for
treatments Protect, a 36 months waiting period for any Pre-existing disease, for Plus and Accumulate plan and 24 months E.I.1
waiting period for Preferred & Premier Plan.
a. For all covers (excluding Critical Illness Add On Benefit and Hospital Daily Cash Benefit) pay-out will be
Pay-out on reimbursement of actual expenses either by way of Cashless to the Hospital/ Network provider when a
Basis G.I
cashless facility is availed or directly to you as a reimbursement against the bills when you have paid for the
expenses.
This section
lists the Add on
manner in b. Critical Illness Add on pay-out will be on benefit payment basis as a lump sum fixed amount. policy
which the wordings
proceeds of
the Policy will c. Health Maintenance Benefit will be on reimbursement basis on submission of bills or payment towards
be paid to you G.I.12
Deductible or Co pay wherever opted.
 a. A mandatory co-payment will be applicable for insured’s aged 65 years and above F.II.6
Cost
Sharing b. A Voluntary co-payment of 10% or 20% on admissible claim amount (final payable claim amount after
D.III.4
assessment) will apply to each and every claim if opted under the plan.
This sections
c. A deductible option of `1 Lac, `2 Lacs, `3 Lacs, `4 Lacs, `5 Lacs, `7.5 Lacs, `10 Lacs as per plan selected
lists the
will apply on the Policy if opted. All payable claims up to this amount will be borne by you. Any claim over and
various
above this limit will become payable under the Policy. To know the applicable deductible on your Policy please G.I.16
circumstances
refer the Policy Schedule benefits. Co-pays under “b” above will not be applied for a Deductible Cover.
under which
Persons opting to take treatment outside of their Zone will bear a 10% or 20% co-pay as applicable.
you will bear
some portion d. A deductible of `50,000, `1Lac, `2 Lacs, `3 Lacs, `4 Lacs, `5 Lacs, `7.5 Lacs,`10 Lacs as opted will apply
of the claim on Accumulate Plan. All payable claims up to this amount will be borne by you. Any claim over and above this
out of your G.I.16
limit will become payable under the Policy. To know the applicable deductible on your Policy please refer the
pocket Policy Schedule benefits.
e. If a special sub-limit is applied at the time of Underwriting on a particular medical condition, the Policy will pay
F.II.12
only 75% of the payable claim amount arising out of the specified illness/medical condition.
a. This Policy is ordinarily renewable for lifetime on mutual consent, subject to application of Renewal and
realisation of Renewal premium.
Renewal b. Continuity will be provided if renewed within 30/15 days from the date of expiry of previous policy. If there is a
Conditions break in the policy, any claim occurring within the break in period will not be covered under the Policy.
This section F.II.8, F.I.9 &
lists the terms c. Renewals will not be denied except on grounds of misrepresentation, fraud, non-disclosure or non-co-operation
from the Insured. F.II.9
of renewals
under the d. Alterations in the policy such as Increase/ decrease in Sum Insured or Change in Plan/Product, addition/ deletion
Policy of members, addition deletion of Medical Condition will be allowed at the time of Renewal of the Policy. We
reserve Our right to carry out underwriting in relation to any request for changes on the Policy. The terms and
conditions of existing policy will not be altered.
Renewal a. Cumulative Bonus- We will provide a 5% or 10% or 25% increase in Sum Insured for every policy year, subject
Benefits to a maximum of 200% accumulation, as per the Plan opted. The cumulative bonus will remain intact and not get D.II.3
This section reduced in case a claim is made during the policy.
lists the
various b. Health check-up – A health check-up is provided for persons aged 18 years and above, irrespective of the claim
benefits you status of the Policy.
D.II.1
can avail/ For Protect & Accumulate plan – Available once every 3rd Policy year
accumulate For Plus, Preferred and Premier Plan – Available once at each policy year (excluding first year)
every time you
renew a Policy c. Healthy Rewards – Reward Points are earned for each year of premium paid D.II.4
with us
a. Cancellations may be intimated to Us by giving 15 days’ notice wherein We shall refund the premium for the
Cancellation unexpired term on the short period scale as mentioned in the Policy wordings enclosed in the kit.
The section The Premium shall only be refunded only if no claim has been made under the Policy.
explains
the Policy b. This Policy can be cancelled on grounds of misrepresentation, fraud, non-disclosure of material fact, upon F.I.6
cancellation giving 15 days’ notice without refund of premium.
process in
brief c. Cover may end immediately for all Insured Persons, if there is non-cooperation by You/ Insured person, with

ManipalCigna ProHealth Insurance | Customer Information Sheet | UIN: MCIHLIP21546V052021 | October 2021
refund of premium on pro rata basis after deducting Our expenses, by giving 15 days’ notice in writing.

Legal disclaimer: The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with
the product brochures and Policy document. In case of any conflict between the Prospectus and the Policy document the terms and
conditions mentioned in the Policy document shall prevail.
For benefit illustration with indicative ages and Sum Insured, please refer Annexure to CIS - Benefit Illustration
 Annexure to CIS - Benefit Illustration

ProHealth Protect

Notes:

 All the premiums are excluding taxes

 All the premiums mentioned below are for illustration purpose only. The Premium charged on the Policy will depend on the Plan, Sum Insured,
Policy Tenure, Age, Policy Type, Gender, Zone of Cover, Optional Covers and Add On Benefits opted. Additionally, the health status of the
individual will also be considered.

2A

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

20 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA

8,293.96 8,293.96 5,50,000
18 5,174.22 5,50,000 5,174.22 1,293.56 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.11,020.58 when Rs. 8,265.44 when they are covered under a
8,293.96
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

30 6,290.22 5,50,000 6,290.22 1,572.56 4,717.67 5,50,000 NA

8,928.06 8,298.06 5,50,000
25 5,174.22 5,50,000 5,174.22 1,293.55 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs. 11,464.44 when Rs.8,598.34 when they are covered under a
8,928.06
each member is single policy
covered separately

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Sum Insured available
Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

40 7,951.55 5,50,000 7,951.55 1,987.89 5,963.66 5,50,000 NA

11,299.57 11,299.57 5,50,000
35 6,201.45 5,50,000 6,201.45 1,550.36 4,651.09 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is Rs.
Total Premium when policy is opted on floater basis is Rs.
is Rs.14,153 when each 10,614.75 when they are covered under a single
11,299.57
member is covered policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy(Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

50 12,161.94 5,50,000 12,161.94 3,040.49 9,121.46 5,50,000 NA

17,399.57 17,399.57 5,50,000
45 8,357.37 5,50,000 8,357.37 2089.34 6,268.03 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is
is Rs.20,519.31 when Rs.15389.49 when they are covered under a
Rs.17399.57
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

60 22,434.28 5,50,000 22,434.28 5,608.57 16,825.71 5,50,000 NA

32,288.12 32,288.12 5,50,000
55 14,305.18 5,50,000 14,305.18 3576.29 10,728.89 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.36,739.46 when Rs.27,554.60 when they are covered under a
32,288.12
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

65 26,695.40 5,50,000 26,695.40 6,673.85 20,021.55 5,50,000 NA

38,451.52 38,451.22 5,50,000
60 19,568.17 5,50,000 19,568.17 4892.04 14,676.13 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.46,263.57 when Rs.34,697.68 when they are covered under a
38,451.52
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

70 36,130.73 5,50,000 36,130.73 9,032.68 27,098.05 5,50,000 NA

52,135.29 52,135.29 5,00,000
65 23,220.56 5,50,000 23,220.56 5805.14 17,415.42 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs. 59,351.29 when Rs.44,513.47 when they are covered under a
52,135.29
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

2A + 2C

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

20 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA

19 5,174.22 5,50,000 5,174.22 1293.55 3,880.67 5,50,000 NA
12,225.35 12,225.35 5,50,000
1 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
1 5,174.22 5,50,000 5,174.22 1293.55 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.22,041.16 when Rs.16,530.87 when they are covered under a
12,225.35
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

30 6,290.22 5,50,000 6,290.22 1,572.56 4,717.67 5,50,000 NA

25 5,174.22 5,50,000 5,174.22 1293.55 3,880.67 5,50,000 NA
12,922.86 12,922.86 5,50,000
3 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
2 5,174.22 5,50,000 5,174.22 1293.55 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.22,485.02 when Rs.16,863.77 when they are covered under a
12,922.86
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each
family )
insured (at a single point in member of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

40 7,951.55 5,50,000 7,951.55 1,987.89 5,963.66 5,50,000 NA

35 6,201.45 5,50,000 6,201.45 1550.36 4,651.09 5,50,000 NA
15,979.19 15,979.19 5,50,000
5 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
4 5,174.22 5,50,000 5,174.22 1293.55 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is
is Rs.25,173.68 when Rs.18,880.18 when they are covered under a
Rs.15,979.19
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

50 12,161.94 5,50,000 12,161.94 3,040.49 9,121.45 5,50,000 NA

45 8,357.37 5,50,000 8,357.37 2089.3425 6,268.03 5,50,000 NA
22,421.60 22,421.60 5,50,000
15 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
10 5,174.22 5,50,000 5,174.22 1293.555 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.31,539.89 when Rs.23,654.91 when they are covered under a
22,421.60
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

60 22,434.28 5,50,000 22,434.28 5,608.57 16,825.71 5,50,000 NA

55 14,305.18 5,50,000 14,305.18 3576.295 10,728.89 5,50,000 NA
37,183.33 37,183.33 5,50,000
20 5,846.36 5,50,000 5,846.36 1,461.59 4384.77 5,50,000 NA
15 5,174.22 5,50,000 5,174.22 1293.555 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.47,760.04 when Rs.35,820.03 when they are covered under a
37,183.33
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

65 26,695.40 5,50,000 26,695.40 6,673.85 20,021.55 5,50,000 NA

60 19,568.17 5,50,000 19,568.17 4892.0425 14,676.13 5,50,000 NA
42,687.28 42,687.28 5,50,000
23 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
20 5,174.22 5,50,000 5,174.22 1293.555 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.57,284.15 when Rs.42,963.11 when they are covered under a
42,687.28
each member is single policy
covered separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

Coverage opted on
Age of Individual basis Coverage opted on Individual basis covering
Coverage opted on family floater basis with overall sum
the covering each member multiple members of the family under a single
insured (Only one sum insured is available for entire
members of the family separately policy (Sum Insured is available for each member
family )
insured (at a single point in of the family)
time)

Premium or
Premium Consolidated
Sum Sum Floater Premium
Premium Premium Discount, after premium for Sum Insured
Insured Insured Discount, after
(Rs.) (Rs.) if any discount all members (Rs.)
(Rs.) (Rs.) if any discount(Rs.)
(Rs.) of family
(Rs.)

70 36,130.73 5,50,000 36,130.73 9,032.68 27,098.05 5,50,000 NA

65 23,220.56 5,50,000 23,220.56 5805.14 17,415.42 5,50,000 NA
57,563.14 57,563.14 5,50,000
23 5,846.36 5,50,000 5,846.36 1,461.59 4,384.77 5,50,000 NA
20 5,174.22 5,50,000 5,174.22 1293.555 3,880.67 5,50,000 NA
Total Premium for all
members of the family Total Premium for all members of the family is
Total Premium when policy is opted on floater basis is Rs.
is Rs.70,371.87 when Rs.52,778.91 when they are covered under a
57,563.14
each member is covered single policy
separately

Sum Insured available

Sum Insured available for each family member is
for each individual is Rs. Sum Insured of Rs. 5,50,000 available for the entire family
Rs. 5,50,000
5,50,000

ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021

Note: Premium rates specified in the above illustration shall be standard premium rates without considering any loading. Also, the premium rates shall
be exclusive of taxes applicable
 ManipalCigna ProHealth Insurance
POLICY SCHEDULE
Policy Issuing Office: Policy Servicing Office:
ManipalCigna Health Insurance Company Limited (Formerly known ManipalCigna Health Insurance Company Limited,
as Cigna TTK Health Insurance Company Limited) Office No. 507-510, 5th Floor, Landmark Building, Ahinsa Circle, C
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Westem Scheme, Jaipur 302001, Rajasthan, India Ph: 1414165500
Express Highway, Goregaon (East), Mumbai - 400063.
Contact no. + 91 22 61703600
Intermediary Name : Kavita Gautam
Code : 1018587-01 Contact Numbers : 9829408084

POLICYHOLDER DETAILS:
Name : Basant Kumar Sharma Customer ID : 1001529774
Address : N 91 KENDRIYA VIHAR SECTOR 6 NEAR VIDHYDHAR NAGAR POLICE STATION Jaipur 302023 Rajasthan
Telephone number(s): : (R) 0 (O) 0 (M) 9799515555
Email ID : BASANTSH@HOTMAIL.COM Subscribed to important alert on WhatsApp :

POLICY DETAILS :
Plan : ProHealth - Protect Policy Number : PROHLN000239510
Policy Period:| Inception Date : From: 00:00 hrs on 25/11/2021 Expiry date : To: 24:00 hrs on 24/11/2022 | Tenure (in years) : 1
Policy Type : Individual Zone of Cover : ZONE3
Portable Case : Yes Migrated Case : No Policy Category : Renewal_01
Premium Payment Mode : Single
Pre- Existing Disease waiting period : Covered after 48 months of continuous coverage
For Roll over/Portability cases continuous coverage will be considered from first policy inception date with Us or other insurer(as applicable).

INSURED PERSON'S DETAILS:

Relationship Completed Pre-existing Cumulative
Sr. Name Of The Date of Date of Customer Sum Bonus Earned
With Gender Age (In Disease / Illness / Occupation
No. Insured Person(s) Inception Birth ID Insured
Policyholder Years) Condition % Amount
SELF-
Basant Kumar Self
1 25/11/2020 PRIMARY Male 02/02/1969 52 NIL 1001529774 450000 5 22500
Sharma Employed
MEMBER
2 Pragya Sharma 25/11/2020 Wife Female 10/03/1974 47 NIL 1001529972 Any Other 450000 5 22500

Health Rewards
Sr. Medical Condition Acquired post
Name Of The Insured Person(s) Customer ID Points Earned through Point Earned through
No. Issuance of the policy
Wellness Programs Premium Paid
1 Basant Kumar Sharma 1001529774 NIL
156
2 Pragya Sharma 1001529972 NIL

Address of the Insured :

Insured ID Insured Address
1001529774 N 91 KENDRIYA VIHAR SECTOR 6 NEAR VIDHYDHAR NAGAR POLICE STATION Jaipur Rajasthan 302023

NOMINEE DETAILS:
Nominee Name: pragya sharma Relationship with proposer: Wife

CAREGIVER DETAILS:
Caregiver Name Relationship with proposer
Mobile Number - E-mail ID -

FAMILY PHYSICIAN DETAILS:

Family Physician Name Address
Family Physician
- E-mail ID -
Contact Number

PREVIOUS INSURED DETAILS:

Name of insured Date of first Previous policy Type of Total Ported Sum Break up of Ported Sum Waiting period Cumulative
Previous Insurer
person enrolment number cover Insured Insured waived off Bonus
Apollo Munich
'11040011001000
BASANT SHARMA 25/11/2013 Health Insurance - 200000 200000 4 YEARS 180000
053743-06
Company Limited
Apollo Munich
'11040011001000
PRAGYA SHARMA 25/11/2013 Health Insurance - 200000 200000 4 YEARS 180000
053743-06
Company Limited

BENEFITS UNDER THE POLICY:

Protect Plan

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021


In-patient Hospitalization
Pre - Hospitalization
Post - Hospitalization
Day Care Treatment
Domiciliary Treatment
Ambulance Cover
Donor Expenses
Worldwide Emergency Cover
Restoration Of Sum Insured
Ayush
Health Maintenance Benefit
Health Check-Up
Expert Opinion on Critical illness
Cumulative Bonus
Healthy Rewards
Base covers
For Sum Insured up to 5.5 Lacs -Covered up to Single Private Room ; For Sum Insured 7.5 Lacs and Above -Covered up
to any Room Category except Suite or higher category
Medical Expenses Covered up to 60 days before date of hospitalisation
Medical Expenses Covered up to 90 days post discharge from hospital
Covered up to the limit of Sum Insured opted
Covered up to the limit of Sum Insured opted
Up to ₹ 2000 per hospitalization event
Covered upto full Sum Insured
Covered upto full Sum Insured once in a policy year
Multiple Restoration is available in a Policy Year for unrelated illnesses in addition to the Sum Insured opted
Covered up to full Sum Insured
Covered up to ₹ 500 per policy year
Value Added Covers
Available once every 3rd Policy year to all insured persons who have completed 18years of Age
Available once during the Policy Year
A guaranteed 5% Increase in Sum Insured per policy year, maximum up to 200% of Sum Insured.
Reward Points equivalent to 1% of paid premium, to be earned each year. Rewards can also be earned for enrolling
and completing Our Array of Wellness Programs.These earned Reward Points can be used against payable premium
(including Taxes) from 1st Renewal of the Policy.OR they can be redeemed for equivalent value of Health
Maintenance Benefits any time during the policy OR as equivalent value while availing services through our Network
Providers as defined in the policy.

IN THE EVENT OF A CLAIM:

Medi Assist Insurance TPA Pvt. Ltd. Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bengaluru – 560029
Address for correspondence
OR Nearest ManipalCigna Health Insurance Branch.
HealthLine No: Call (Toll Free): 1800-419-1159 Fax Number : 1800-425-9559 E-mail ID: cigna@mediassistindia.com Web: www.manipalcigna.com

YOUR PREMIUM DETAILS:

Additional Loading Discount
Basic Premium (`) Add on Premium (`) Goods & ServiceTax (`) GST Cess (`) Total Premium (`)
(if applicable) (if applicable)
17666.46 0 0 4416.61 2384.97 0 15634.82
*Note: Only applicable Loadings and Discounts will be displayed as per policy.

PAN No.: AAECC7904J

The stamp duty of ` 1 paid vide receipt no, MH006596141202122P dated 23/09/2021. Government Notification Revenue and Forest Department No.
Mudrank 2004/4125/CR/690/M-1, dated 31/12/2004

NOTE:
Basic premium is exclusive of opted Add on’s and before adjustment of premium discounts, wherever applicable.

In the event of dishonour of cheque, this policy document automatically stands cancelled from inception, irrespective of whether a separate
communication is sent or not.
This Policy has been issued based on the information provided by you on the proposal form. Attached with this Policy Schedule are the Policy Terms &
Conditions and Annexures. Please ensure that these documents have been received, read and understood. If any of these documents have not been
received, please contact our Customer Service at the below mentioned details at the earliest. In case you find any discrepancy in the same, please
contact us immediately.

For any grievance related to the policy you may write to The Grievance Officer at the policy issuing office address mentioned above or email at
headcustomercare@manipalcigna.com or call at +91 2261703600.
You may also write to us at customercare@manipalcigna.com Or call us at HealthLine No. (Toll Free): 1800-102-4462 or at +91 2261703600

In witness, where of this Policy has been signed at Mumbai on 24/11/2021

Yours Sincerely,

ManipalCigna Health Insurance Company Limited

(Formerly known as CignaTTK Health Insurance Company Limited)
This is a system generated communication and does not require signature.

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

 Annexure to Policy Schedule

Insured Name Sum Insured Waiting Period Start Date

MR. BASANT SHARMA 450,000.00 25-Nov-2020

MRS. PRAGYA SHARMA 450,000.00 25-Nov-2020

Yours Sincerely,

ManipalCigna Health Insurance Company Limited

"This is a System generated communication and does not require signature."

MCIHLIP21546V052021 ManipalCigna ProHealth Insurance

 Premium Certificate

For the purpose of deduction under section 80D of Income Tax Act, 1961 and any amendments made thereafter*.

This is to certify that MR. BASANT SHARMA has paid the premium of

₹15,634.82 (in words) Fifteen Thousand Six Hundred and Thirty Four and Eighty Two paise only for the period

25/11/2021 to 24/11/2022 towards Premium for Health Insurance policy for term of One Year policy.

Policy
Number PROHLN000239510

Receipt Receipt Payment

R001980249 Date 24/11/2021 1,553.00 HRP
Number Amount Mode

Receipt Receipt Payment

R001980251 Date 24/11/2021 14,081.82 CREDITCARD
Number Amount Mode

Refer annexure-1 for the detailed breakup of the insurance premium paid & eligibility under section 80D.

* Note:
1. For your eligibility and deductions please refer to provisions of Income Tax Act, 1961 as modified and/or consult your tax
consultant.
2. Any amount paid in cash towards premium will not qualify for tax benefits.
3. In case of dishonour of premium instrument, the policy will be deemed cancelled ab initio.
4. Deduction under section 80D shall not be allowed if the premium is paid by third party (other than proposed/insured) under
this policy.
5. This certificate must be surrendered to us in case of cancellation of Policy or for issuance of fresh certificate in case of any
alteration in the insurance affecting the premium.

Yours Sincerely,
ManipalCigna Health Insurance Company Limited

(Formerly known as CignaTTK Health Insurance Company Limited)

‘This is a system generated communication and does not require signature’.

Date: 24/11/2021
Location: Mumbai

ManipalCigna ProHealth Insurance MCIHLIP21546V052021 PROHLN000239510

Stamp duty has been paid vide receipt no 0000398681202021 dated 04th June 2020.
 Premium Certificate

Annexure-1

Detailed breakup of the insurance premium paid for One Year policy.

Sr. Name of the Age Relationship with Premium paid Premium eligible
No. insured person the policyholder (inclusive of GST) u/s 80D (*)
1. Premium paid for self & family
Mr. Basant Sharma 52 Self- Primary Member 9,305.29
Mrs. Pragya Sharma 47 Wife 6,329.53
Total ( A ) 15,634.82 14,081.82
Total premium paid (A+B+C) 15,634.82 14,081.82

Note:
Tax deduction on health insurance premium paid can be claimed under section 80D is as follows:

Description Self,spouse and Parents Total deduction

dependent childeren
No one has attained the age of 60 years Rs.25,000 Rs.25,000 Rs.50,000
Assessee and his/her family is less than 60 years and
parents are 60 years of age or more Rs.25,000 Rs.50,000 Rs.75,000

Assessee and his/her parents have attained the age of

Rs.50,000 Rs.50,000 Rs.100,000
60

ManipalCigna ProHealth Insurance MCIHLIP21546V052021 PROHLN000239510

 Location Address GSTIN PROVISIONAL ID

Mumbai HO 401/ 402, 4th Floor, Raheja Titanium, Off. Western Express Highway, Goregaon (East), Mumbai - 400 063 27AAECC7904J1ZI

Mumbai 402A, Raheja Titanium, Off Western Express Highway, Goregaon (East), Mumbai 400 063, Maharashtra, India 27AAECC7904J1ZI

Borivali 104, 1st Floor, Orchid Plaza, Datta Park, Near S V Road, Boriwali west, Mumbai - 400 092 27AAECC7904J1ZI

Thane Office no. 203, Vinita Apartment, Naupada, Near Malhar Cinema, Thane West - 400602. 27AAECC7904J1ZI

Pune 2nd Floor, Subhadra Bhawan, 1240 A, Apte Road, Shivaji Nagar, Pune 411 004, India 27AAECC7904J1ZI

Nashik 308, B-Square Apartments, Near Shradhha Petrol Pump, Yeolekar Mala, College Road, Nashik , Maharashtra 422005, India. 27AAECC7904J1ZI

Nagpur 148,3rd Floor, Thapar Enclave, Ramdaspeth, Maharagbagh Road, Nagpur, Maharashtra- 440010 27AAECC7904J1ZI

Kolhapur 1667-1669, 2nd Floor, White Box, Rajarampuri, 11th Lane, Rajarampuri Main Road, Kolhapur - 416008, Maharashtra, India 27AAECC7904J1ZI

Pimpri Office No. 17, 2nd Floor, Sukhwani Fortune, Landmark – Above Gharounda Hotel, Pimpri, Pune – 411 018 Maharashtra, India 27AAECC7904J1ZI

Ahmedabad 201, 2nd Floor, Megha House,b/s HDFC Mutual Fund Office,Opp Mayor's Residence, Mithakali Six Road, Navrangpura, Ahmedabad - 380009 24AAECC7904J1ZO

Vadodara 204, 2nd Floor, Taksh Paradigm, Old Padra Road, Vadodara - 390007, Gujarat, India 24AAECC7904J1ZO

Surat 303, 3rd Floor, Meridian Tower, Near UTC Building, Landmark – Opp. to Reliance Mall, Udhana Darwaja, Surat - 395002, Gujarat, India 24AAECC7904J1ZO

Bangalore Rajat Tower, 2nd Floor, 4/21, 11th Main, 4th Block, Jayanagar, Bangalore - 560011 29AAECC7904J1ZE

Mangalore First Floor, Above Kotak Mahindra Bank, Next To Hotel Ayodhya, Pvc Circle,Kodialbailpost,Mangalore-575003 29AAECC7904J1ZE

Mysore 1st Floor, Mysore Trade Center, L-36/A, B N Road,Mysore - 570001, Karnataka India 29AAECC7904J1ZE

Malleshwaram No.251/2, II Floor, 2nd Main Road, 17th Cross, Sampige Road, Malleshwaram, Bangalore 560003, Karnataka, India 29AAECC7904J1ZE

Hubli 2nd floor, SVB Centre, Club Road, Hubli 580020, Karnataka, India 29AAECC7904J1ZE

Chandigarh 1st Floor, SCO 149/150, Sector – 9-C,Next To Yes Bank,Madhya Marg, Chandigarh - 160009 04AAECC7904J1ZQ

Chennai 2nd Floor, Corporation No. 33, Ward 126/Zone 8, Venkatanarayana Road, T Nagar, Chennai 600 017 33AAECC7904J1ZP

Coimbatore 2nd floor, Sasha Building, East Venkataswamy Road, R S Puram, Coimbatore - 641002 33AAECC7904J1ZP

Cochin 1st Floor, Mathewsons Centre Point, Mamangalam,Above Kotak Mahendra Bank,Nr Mamangalam Church, Ernakulam, Cochin - 682025 32AAECC7904J1ZR

Thrissur Office no. 26/548-17, 6th Floor, Capital City, Korappath Lane, Thrissur - 680020, Kerala, India 32AAECC7904J1ZR

Kozhikode 63-88B, IInd Floor, Josela’s Galleria, Wayanad Road, Kozhikode - 673011, Kerala, India 32AAECC7904J1ZR

Delhi 32-B, Pusa Road, Rajinder Nagar, Opp. Pillar no. 122 of Metro station, Karol Bagh, New Delhi - 110005 07AAECC7904J1ZK

South Delhi Office No. 607, 6th Floor, Siddharth Building, 96, Nehru Place, New Delhi-110019, Delhi, India 07AAECC7904J1ZK

Hyderabad Office No. 12, 4th Floor,Eden Amsri Square,9-1-87 St.John's Road,Sangeet X Roads, Secunderabad, Telangana – 500003. 36AAECC7904J1ZJ
Hyderabad
2nd Floor, GBR Towers, H. No. 13-2-42/ 1 to 6, Chaitanyapuri, Dilsukh Nagar, Hyderabad 500060 36AAECC7904J1ZJ
Dilsukh Nagar
Kolkata Unit No. 18, 4th Floor, Chowringhee Court, 55 Chowringhee Road, Kolkata 700071, West Bengal, India 19AAECC7904J1ZF

Asansol Unit No. CP-202, Second Floor, Chatterjee Plaza, G. T. Road, Rambandhu Tala, Asansol - 713303, West Bengal, India 19AAECC7904J1ZF

Jaipur Office No. 507-510, 5th Floor, Landmark Building, Ahinsa Circle, C Scheme, Jaipur 302001, Rajasthan, India 08AAECC7904J1ZI

Jodhpur 1st Floor, Chaudhary Bhawan, Nr. Sanichar ji ka than, Chopsani road, Jodhpur- 342001, Rajasthan, India 08AAECC7904J1ZI

Lucknow 19 - A, Punjab National Bank Building, Vidhan Sabha Marg, Behind – Akashvani, Hazrat Gunj, Lucknow – 226001 09AAECC7904J1ZG

Noida Zygon Square, Office no 204, Plot No.1, Block - H-1A Sector -63, Noida, UP – 201307 09AAECC7904J1ZG

Kanpur 2nd Floor, 212-213, Kan Chambers, Civil Lines, Kanpur-208001 09AAECC7904J1ZG

Bhubaneswar Room No. 13, 2nd floor, Deendayal Bhavan, Ashok Nagar , Unit-II, Bhubaneswar, Dist-Khurdha, (Orissa) - Pin -751009 21AAECC7904J1ZU

Ludhiana 1st Floor, Sandhu Tower-I, Gurdev Nagar, Ferozepur Road, Ludhiana-141001. 03AAECC7904J1ZS

Amritsar SCO 106 , 6th Floor, Ranjit Avenue, District Shopping Center, Amritsar-143001, Punjab, India 03AAECC7904J1ZS

Jalandhar 1st Floor, Satnam Complex BMC Chowk, G. T Road Jalandhar 144001, Punjab, India 03AAECC7904J1ZS

Gurgaon 2nd Floor, SCO No. 12, Sector 14, Gurgaon 122001, Haryana, India 06AAECC7904J1ZM

Jamshedpur My Branch, Unit 1B, 1st floor , Fairdeal Complex , Opp- Ram Mandir, Main Road Bistupur Jamshedpur- Jharkhand , Pincode – 831001 20AAECC7904J1ZW

Ranchi Unit No.-5 , 2nd Floor, Nile Commercial Complex,PS- Lower Bazar, Old HB Road, Ranchi-834001, Jhrakhand, India 20AAECC7904J1ZW

Bhopal My Branch,Guru Arcade, 2nd Floor,Plot No-153, Ramgopal Maheshwari Marg, Zone 1-MP Nagar ,Bhopal-462011 23AAECC7904J1ZQ

Indore Unit no. 106, Fortune Ambience, Sriram Nagar, 4/2 - South Tukoganj, Indore - 452001, Madhya Pradesh, India 23AAECC7904J1ZQ

Guwahati My Branch,ITag Plaza, 2nd Floor, 2C, Near Rajiv Bhawan, ABC, G S Road, Main Road, Bhangagarh, Guwahati-781005 18AAECC7904J1ZH

Dehradun 123, First Floor, Shakumbri Plaza, Anikant Palace, Rajpur Road, Dehradun-248001, Uttarakhand, India 05AAECC7904J1ZO

Patna 5th Floor, Office No.-505, Kaushalya Estate, New Dak Bunglow Road, Patna-800001, Bihar, India 10AAECC7904J1ZX

Vizag 204, 1st Floor, VRC Complex, Dwarakanagar,Visakhapatnam - 530016, Andhra Pradesh, India 37AAECC7904J2ZG

Vijaywada Utham Towers, 3rd Floor, MG Road, Vijayawada, Landmark- Opp. Joy Lukash, Dist- Krishna, Andhra Pradesh, India - 520010 37AAECC7904J2ZG

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

SWITCH TO AN HASSLE-FREE AND SECURED
DOCUMENTATION SPACE!
SWITCH TO DigiLocker!

Dear Customer,
The Ministry of Electronics and Information Technology (MeitY), Government
of India under its Digital India initiative has introduced digitalized online
service- DigiLocker. You can access all your authentic documents including
health insurance documents here anytime.
It's time to get rid off from physical documents and go paperless - go digital!

GET ACCESS TO YOUR DOCUMENTS WITH

1
One needs to download the Digilocker Mobile
Application from the app store and create an
account using mobile or Aadhar number.

2 OTP will be sent on registered mobile

number for verification.
SWITCH TO

MOBILE APP

3 Click on banking and insurance &

select ManipalCigna Health Insurance.
NOW

4 Fill in the required details & fetch the policy

documents.

SCAN HERE

5
Requested Policy document will get
auto-saved in “Issued Document”, which can
be Viewed / downloaded / shared.
 CLAIMS PROCESS
PRE-AUTHORIZATION REIMBURSEMENT

1 1
At the time of hospitalization,
customer calls Claims
Customer requires customer care 1800-419-1159
hospitalisation
Planned Hospitalistion- 3 days
Emergency- within 48 hrs

2 Customer calls Claims

customer care 1800-419-1159
Planned Hospitalisation- 3 days
2 ManipalCigna registers
claim intimation in system

3 ManipalCigna Customer
care team provides
required information

3 Customer receives
notification on Email
and SMS

4 Customer gets admitted and

Hospital sends documents to
ManipalCigna

4 Customer submits claim

documents to Medi Assist TPA
Head office within 15 days of
discharge

5 5
Claim team registers
the pre-auth and Claim assessment is done.
acknowledgement is (Approved / Rejected
sent to customer, / Additional Information)
hospital and advisor

6 6
Final decision is ManipalCigna releases payment
communicated to to the customer on approval.
customer, hospital & Email/SMS/ Mail notification is
advisor after sent to customer- on claim
preauthorisation rejected/Add Info or for any
assessment additional information

7 Email/SMS notification is sent

and customer is called in case
of claim rejection or for any
addition information
7 ManipalCigna Customer service
team updates the customer on
the status

8 8
For internal circulation only

ManipalCigna Customer ManipalCigna Customer

service team collects service team collects
feedback Feed back

Know Your Customer: Help us remain as your trusted service partner by ensuring we have a copy of all your documents.
A Color passport size photograph not older than 6 months A Original Cancelled cheque A Copy of PAN card and address proof for claims over 1 lakh
Medi Assist Insurance TPA Pvt. Ltd.
Head Office: Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bangalore – 560029
ManipalCigna Health Insurance Company Limited (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151| Reg. Office: 401/402,
4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462| Website address-www.manipalcigna.com | Trade Name / Trade
Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license| Apr2019 onwards|