Jerome naveen Cordero

S O JOACHIM CORDEIRO NO. 25 6 390 1 HIS GRACE

UJJODI 1ST CROSS VALENCIA KANKANADY MANGALORE
Dakshina Kannada
Karnataka 575002
Mobile No :8660861536

PROHLV050102058

Dear Jerome naveen Cordero,

Welcome to ManipalCigna Health Insurance family. 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 PROHLV050102058 claims process. Here's how it works,

Contact Number 8660861536 Download Medibuddy app

Real-time claims status
or visit www.medibuddy.in
E Mail ID jeromec8@rediffmail.com
Cover Start Date 12/03/2022 Claims Helpline No. 1800-419-1159
Cover End Date 11/03/2023
Plan Type Family Floater Claims Email ID manipalcigna@mediassist.in

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)

We offer you a 15 days free-look period. Please read your policy schedule and policy wording for the full terms and conditions relating to the benefits

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.

 The Personalized Health Card: Membership card that will help you access our services 24 hours a day, 7 days a week.

 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.
Your Health Card:

POLICY NUMBER : PROPRM050000258

Powly N V 14/07/1965
Paul Dsilva 11/06/1961

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

 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) First Floor, Above Kotak Mahindra Bank, Next To Hotel Ayodhya,
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Westem Pvc Circle,Kodialbailpost,Mangalore-575003 Ph:
Express Highway, Goregaon (East), Mumbai - 400063.
Contact no. + 91 22 61703600
Intermediary Name : SHILPA H
Code : 1051784-01 Contact Numbers : 7975194427

POLICYHOLDER DETAILS:
Name : Jerome naveen Cordero Customer ID : 1001869914
Address : S O JOACHIM CORDEIRO NO. 25 6 390 1 HIS GRACE UJJODI 1ST CROSS VALENCIA KANKANADY
MANGALORE Dakshina Kannada 575002 Karnataka
Telephone number(s): : (R) 0 (O) 0 (M) 8660861536
Email ID : jeromec8@rediffmail.com Subscribed to important alert on WhatsApp : YES

POLICY DETAILS :
Plan : ProHealth - Protect Policy Number : PROHLV050102058
Policy Period:| Inception Date : From: 00:00 hrs on 12/03/2022 Expiry date : To: 24:00 hrs on 11/03/2023 | Tenure (in years) : 1
Policy Type : Family Floater Zone of Cover : ZONE3
Portable Case : Yes Migrated Case : No Policy Category : Fresh
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
Sr. Name Of The Insured Date of Customer Sum
With Gender Age (In Pre-existing Disease / Illness / Condition Occupation
No. Person(s) Birth ID Insured
Policyholder Years)
SELF-
Self
1 Jerome naveen Cordero PRIMARY Male 04/04/1972 49 NIL 1001869914
Employed
MEMBER
2 Joswin Cordeiro Wife Female 10/08/1976 45 NIL 1001869943 Any Other 450000
3 Jennica velanie Cordeiro Daughter Female 05/09/2004 17 NIL 1001869942 Any Other
4 Joen sam Cordeiro SON Male 20/07/2013 8 NIL 1001869944 Any Other

Address of the Insured :

Insured ID Insured Address
1001869914 S O JOACHIM CORDEIRO NO. 25 6 390 1 HIS GRACE UJJODI 1ST CROSS VALENCIA KANKANADY MANGALORE Dakshina Kannada Karnataka 575002

NOMINEE DETAILS:
Nominee Name: JOSWIN CORDEIRO 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
JEROME NAVEEN National Insurance '60430050201000
12/03/2019 - 200000 200000 2 YEARS 40000
CORDERO Co.LTD 1330
JOSWIN National Insurance '60430050201000
12/03/2019 - 100000 100000 2 YEARS 20000
CORDEIRO Co.LTD 1330
JENNICA
National Insurance '60430050201000
VELANIE 12/03/2019 - 50000 50000 2 YEARS 10000
Co.LTD 1330
CORDEIRO
JOEN SAM National Insurance '60430050201000
12/03/2019 - 50000 50000 2 YEARS 10000
CORDEIRO Co.LTD 1330

BENEFITS UNDER THE POLICY:

Protect Plan

ManipalCigna ProHealth - Protect | UIN : MCIHLIP21546V052021

 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
In-patient Hospitalization
to any Room Category except Suite or higher category
Pre - Hospitalization Medical Expenses Covered up to 60 days before date of hospitalisation
Post - Hospitalization Medical Expenses Covered up to 90 days post discharge from hospital
Day Care Treatment Covered up to the limit of Sum Insured opted
Domiciliary Treatment Covered up to the limit of Sum Insured opted
Ambulance Cover Up to ₹ 2000 per hospitalization event
Donor Expenses Covered upto full Sum Insured
Worldwide Emergency Cover Covered upto full Sum Insured once in a policy year
Restoration Of Sum Insured Multiple Restoration is available in a Policy Year for unrelated illnesses in addition to the Sum Insured opted
Ayush Covered up to full Sum Insured
Health Maintenance Benefit Covered up to ₹ 500 per policy year
Value Added Covers
Health Check-Up Available once every 3rd Policy year to all insured persons who have completed 18years of Age
Expert Opinion on Critical illness Available once during the Policy Year
Cumulative Bonus 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
Healthy Rewards (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: manipalcigna@mediassist.in 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)
16439.77 0 0 0 2959.15 0 19398.92
*Note: Only applicable Loadings and Discounts will be displayed as per policy.

PAN No.: AAECC7904J

The stamp duty of ` 1 paid vide receipt no, 00062224942202122' dated 15/02/2022. 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 12/03/2022

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

 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. JEROME NAVEEN CORDERO has paid the

premium of

₹19,398.92 (in words) Nineteen Thousand Three Hundred and Ninety Eight and Ninety Two paise only for the

period 12/03/2022 to 11/03/2023 towards Premium for Health Insurance policy for term of One Year policy.

Policy
Number PROHLV050102058

Receipt Receipt Payment

R002128234 Date 09/03/2022 19,399.00 CHEQUE
Number Amount Mode

* 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: 13/03/2022
Location: Mumbai

ManipalCigna ProHealth Insurance MCIHLIP21546V052021 PROHLV050102058

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

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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
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2 OTP will be sent on registered mobile

number for verification.
SWITCH TO

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3 Click on banking and insurance &

select ManipalCigna Health Insurance.
NOW

4 Fill in the required details & fetch the policy

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SCAN HERE

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 CLAIMS PROCESS

PRE-AUTHORIZATION REIMBURSEMENT

1 Customer requires
hospitalisation.

1 At the time of hospitalization,

customer calls Claims
customer care 1800-419-1159.

2 2
Planned Hospitalistion- 3 days
Emergency- within 48hrs

Customer calls Claims ManipalCigna registers

customer care 1800-419-1159. claim intimation in system.

3 3
Planned Hospitalisation- 3 days

ManipalCigna Customer Customer receives

care team provides notification on email
required information. 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 Claim assessment
pre-auth and is done. (Approved/
acknowledgement is Rejected/ Additional
sent to customer, hospital Information)

6 6
and advisor.

Final decision is ManipalCigna releases payment

communicated to to the customer on approval.
customer, hospital & Email/SMS/ Mail notification is
advisor after pre- sent to customer- on claim
authorisation rejected/Add Info or for any

7 7
assessment. additional information.

Email/SMS notification is sent ManipalCigna Customer service

and customer is called in case team updates the customer on
of claim rejection or for any the status.

8 8
addition information.

ManipalCigna Customer ManipalCigna Customer

service team collects service team collects
Feedback. Feedback.

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 Bengaluru – 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 |