Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
ManipalCigna Flexicare Group Insurance Policy
CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.
Title Description Policy
S.No (Please refer the Policy Clause Number in next column) Clause
1 Name of Insurance ManipalCigna Flexicare Group Insurance Policy
Product/Policy
2 Policy Number 508300000023/01/00
3 Type of Insurance Both Indemnity and Benefit
Product/ Policy
4 Sum Insured Individual Sum Insured –
Insured Name Sum Insured(in Rs)
Abhinav Shukla 750000.00
5 Policy Coverage
• Travel/Loss of Baggage Cover D.IV.68.
In the event of total and complete loss of Checked-in Baggage whilst on a Trip and whilst it is in the
custody of the Common Carrier, We will pay the Insured Person, the Market Value of such
Checked-in Baggage up to the limit, as specified in the Policy Schedule/Certificate of Insurance.
• Travel/Travel Accidental Death D.IV.1.
If an Insured Person suffers an Injury due to an Accident whilst on a Trip, and that Injury solely and
directly results in the Insured Person’s death within 365 days from the date of the Accident, We will
pay the Sum Insured as specified in the Policy Schedule/Certificate of Insurance.
• Travel/Travel Accidental Hospitalisation Cash D.IV.9.
If an Insured Person during a Trip suffers an Injury due to an Accident while engaging in an
Adventure Sport covered under the policy and that Injury solely and directly results in the
Hospitalization of the Insured Person, We will pay the Cash Benefit for each continuous and
completed period of Hospitalization as specified in the Policy Schedule/Certificate of Insurance,
provided that the purpose of Hospitalization is to avail Medically Necessary Treatment of the
Insured Person and admission date of Hospitalization is within the Policy Year.
• Travel/Travel Emergency Medical Cover (Hospitalisation Day Care) D.IV.36
On the occurrence of any Illness contracted or Injury sustained by an Insured Person due to an
Accident in a Place of visit, whilst on a Trip, which requires Emergency Care, We will pay the Day
Care Medical Expenses incurred, as per the limit specified in the Policy Schedule/Certificate of
Insurance
• Travel/Travel Emergency Medical Cover (Outpatient Expenses) D.IV.36
On the occurrence of any Illness contracted or Injury sustained by an Insured Person due to an
Accident in a Place of visit, whilst on a Trip, which requires Emergency Care, We will pay the
Outpatient Medical Expenses incurred, as per the limit specified in the Policy Schedule/Certificate
of Insurance
• Travel/Travel Emergency Evacuation Cover D.I.24. A
If the Insured Person suffers an Injury, solely and directly due to an Accident, caused by an
event/peril covered under the policy, that occurs during the Policy Year and if adequate medical
facilities are not available locally, We will pay the expenses up to the limit as specified in the Policy
Schedule towards the arrangement for an Emergency evacuation of the Insured Person to the
nearest facility, within India.
• Travel/Travel Permanent Total Disablement D.I.55.
If during the Policy Year, the Insured Person suffers an Injury due to an Accident, caused by an
event/peril covered under the policy and that Injury solely and directly results in the Permanent
Total Disablement of the Insured Person which is of the nature specified in the table below, within
365 days from the date of the Accident, We will pay the Sum Insured as specified in the Policy
Schedule/Certificate of Insurance.
• Travel/Travel Repatriation of Mortal Remain Cover D.IV.63
If during the Policy Year, the Insured Person suffers an Injury due to an Accident, caused by an
event/peril covered under the policy and that Injury solely and directly results in death of the
Insured Person, at a place away from home location, We will pay the expenses up to the limit as
specified in the Policy Schedule/Certificate of Insurance, towards the cost associated with the
transportation of mortal remains from the place of death to the home location.
6 Exclusions
E.I.4 Investigation & Evaluation- Code- Excl 04
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are
excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and
treatment are excluded.
Customer Information Sheet | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 1
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
E.I.5 Rest Cure, rehabilitation and respite care- Code- Excl 05
a. Expenses related to any admission primarily for enforced bed rest and not for receiving
treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities
of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-
skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual
needs.
E.I.6 Obesity/ Weight Control: Code- Excl 06
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1. Surgery to be conducted is upon the advice of the Doctor
2. The surgery/Procedure conducted should be supported by clinical protocols
3. The member has to be 18 years of age or older and
4. Body Mass Index (BMI);
a. greater than or equal to 40 or
b. greater than or equal to 35 in conjunction with any of the following severe co-morbidities
following failure of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
E.I.7 Change-of-Gender treatments: Code- Excl 07
Expenses related to any treatment, including surgical management, to change characteristics of the
body to those of the opposite sex.
E.I.8 Cosmetic or plastic Surgery: Code- Excl 08
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for
reconstruction following an Accident, Burn(s) or
Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to
the insured. For this to be considered a medical
necessity, it must be certified by the attending Medical Practitioner for reconstruction following an
Accident, Burn(s) or Cancer.
E.I.9 Hazardous or Adventure sports: Code- Excl 09
Expenses related to any treatment necessitated due to participation as a professional in hazardous
or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering,
rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep-sea diving.
E.I.10 Breach of law: Code- Excl 10
Expenses for treatment directly arising from or consequent upon any Insured Person committing or
attempting to commit a breach of law with
criminal intent. (e.g. Intentional self-Injury, suicide or attempted suicide (whether sane or insane).
E.I.11 Excluded Providers: Code- Excl 11
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other
provider specifically excluded by the Insurer and disclosed in its website / notified to the
policyholders are not admissible.
However, in case of life threatening situations or following an accident, expenses up to the stage of
stabilization are payable but not the complete
claim.
(Explanation: Details of excluded providers shall be provided with the policy document. Insurers to
use various means of communication to notify the policyholders, such as e-mail, SMS about the
updated list being uploaded in the website.)
E.I.12 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and
consequences thereof. Code- Excl 12
E.I.13 Treatments received in heath hydros, nature cure clinics, spas or similar establishments or
private beds registered as a nursing home attached to such establishments or where admission is
arranged wholly or
partly for domestic reasons. Code- Excl13
E.I.14 Dietary supplements and substances that can be purchased without prescription, including
but not limited to Vitamins, minerals and Organic substances unless prescribed by a Medical
Practitioner as part of
Hospitalization claim or day care procedure. Code- Excl 14
E.I.15 Refractive Error: Code- Excl 15
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5
dioptres
E.I.16 Unproven Treatments: Code- Excl 16
Expenses related to any unproven treatment, services and supplies for or in connection with any
treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical
documentation to
support their effectiveness.
Customer Information Sheet | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 2
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
E.I.17 Sterility and Infertility: Code- Excl 17
Expenses related to sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization
E.I.18 Maternity: Code Excl 18
i. Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during Hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of
pregnancy during the policy period.
For coverage specific exclusions refer policy terms & conditions.
7 Waiting period Specific Illness Waiting period - 0 Day since date of inception of the cover
Time period during
which specified
diseases/treatments are
not covered
It is counted from the
beginning of the policy
coverage.
8 1. Sublimit -
Financial limits of Hospitalisation - - Limit scope of cover to one or more trigger events -
coverage Hospitalisation due to accidental injury only whilst on the trip
i. Sub-limit (It is a pre-
defined limit and the
insurance company
Travel - NA
will not pay any
amount in excess of Death - NA
this limit)
PTD - NA
ii. Co-payment (It is a
specified Hospitalisation - - Condition for cover eligibility after continuous hospitalisation of
amount/percentage 1 hr - 30 days. - Condition for cover eligibility after continuous
of the admissible hospitalisation of 48 Hrs
claim amount to be
paid by - Maximum limit on out of pocket expenses against Co-pay/
policyholder/insured). deductible/ limits etc. - Deductible-24 Hrs (1 Day)
iii. Deductible (It is a
specified amount:
- up to which an
Death - NA
insurance company
will not pay any claim, Out-Patient Expenses - - Limit scope of cover to one or more trigger events - accidental
and injury only, whilst on the trip
- which will be
deducted from total
claim amount (if claim 2. Copayment -
amount is more than 3. Deductible -
the specified amount) Annual Aggregate : -
iv. Any other limit (as &bbsp; Other Limits & Conditions :
applicable) In case of multiple Deaths/Permanent Total Disablements due to single accident event, the claim will
be honored up to AOA limit of 30 lakhs ,the total AOA limit amount in that situation, will be divided
amongst insured or nominee of deceased members. As per the scope of cover under the scheme,
coverage will be effective for insured person on the trip considering the start and end date and
time, mentioned basis the ticket issued by the partner (travels). *Capital Sum Insured - The
maximum liability for any one or all claims under Accidental Death Benefit, Permanent Total
Disablement Benefit in a Policy Year will be limited to the Capital Sum Insured for that Insured
Person. Once the sum insured is paid equivalent to 100%, the cover for the insured person will
seize. In Situation of Loss of Baggage - is required to be reported to the Police having jurisdiction
at the place of loss within 24 hours of the occurrence of the incident, and a written FIR being
obtained for the same.
9 Claims/Claims Procedure Details of procedure to be followed for cashless services as well as for reimbursement of claim
including pre and post hospitalization:
To know the process for our cashless and reimbursement claims visit
https://www.manipalcigna.com/claims
Turn Around Time (TAT) for claim settlement
i. TAT for pre-authorization of cashless facility – 1 hour from the last complete document for initial
approval
ii. TAT for cashless final bill settlement – 3 hours from the last complete document
Web links for the followings:
i. Network hospital details - https://www.manipalcigna.com/locate-us
ii. Helpline Number - https://www.manipalcigna.com/claims
Customer Information Sheet | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 3
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
iii. Hospital which are blacklisted or from where no claims will be accepted by insurer -
https://www.manipalcigna.com/locate-us
iv. Link for downloading claim form -https://www.manipalcigna.com/downloads/claims
10 Policy Servicing Customer Service
For hassle free policy servicing contact us at our service toll-free number 1800-102-4462 or write
to us at servicesupport@manipalcigna.com
Claims:
For assistance related to Personal Accident or Critical Illness claims contact us at 1800-102-4462
Or write to us at servicesupport@manipalcigna.com
11 Grievances/Complaints LEVEL 1
Health Relationship Managers
Call our toll-free number 1800-102-4462 between 9:00 AM to 9:00 PM. Email us at -
headcustomercare@manipalcigna.com
For Senior Citizen Assistance - Seniorcitizensupport@ManipalCigna.com
LEVEL 2
Grievance Redressal Officer
Call us on 022-71781389 between 10 am to 6 Pm (Monday to Friday)
Email us at - complaints@manipalcigna.com
LEVEL 3
Chief Grievance Redressal Officer
Call us on 022-71781300 between 10 am to 6 Pm (Monday to Friday)
Email us at - Compliance@manipalcigna.com
For Senior Citizen Assistance - Seniorcitizensupport@ManipalCigna.com
LEVEL 4
Approach Ombudsman If the channels above have still not met your expectations you may
approach the insurance ombudsman, the office Name and address details applicable for your state
can be obtained from - https://www.cioins.co.in/Ombudsman
Courier: Any of Our Branch office or corporate office during business hours. Insured Person may
also approach the grievance cell at any of company’s branches with the details of the grievance.
If Insured Person is not satisfied with the redressal of grievance through one of the above methods,
insured person may contact the grievance officer at, ‘The Grievance Cell, ManipalCigna Health
Insurance Company Limited, TechWeb centre 2nd Floor New Link Rd, Anand Nagar, Jogeshwari
West, Mumbai, Maharashtra 400102, India or email - headcustomercare@manipalcigna.com.
For updated details of grievance officer, kindly refer link - https://www.manipalcigna.com/grievance-
redressal
If Insured person is not satisfied with the redressal of grievance through above methods, the
Insured Person may also approach the office of Insurance Ombudsman of the respective
area/region for redressal of grievance as per Insurance Ombudsman Rules 2017. The contact
details of Ombudsman offices attached as Annexure I to this Policy document.
Grievance may also be lodged at IRDAI complaints management system -
https://bimabharosa.irdai.gov.in/ You may also approach the Insurance Ombudsman if your
complaint is open for more than 30 days from the date of filing the complaint
12 Things to remember Free Look Cancellations: The Free Look period shall be applicable on new individual health
insurance policies and not on renewals or Ported/Migrated policies.
The insured person shall be allowed a free look period of 30 days from date of receipt of the policy
document to review the terms and conditions of the policy and to return the same if not acceptable.
Free look is applicable only, if the insured has not made any claim or opted for any benefit during
the Free Look Period.
To avail:
- Customer can request for cancellation writing to servicesupport@manipalcigna.com from the
registered email id with us.
OR
- Customer can also visit any MCHI Branch and give a written request
Policy Renewal: The policy shall ordinarily be renewable except on grounds of established fraud or
non-disclosure or misrepresentation by the insured person.
Migration: The Insured Person will have the option to migrate the Policy to other health insurance
products/plans offered by the company by applying for migration of the policy at least 30 days
before the policy renewal date as per IRDAI guidelines on Migration. If such person is presently
covered and has been continuously covered without any lapses under any health insurance
product/plan offered by the company, the insured person will get the accrued continuity benefits in
Customer Information Sheet | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 4
Toll Free No: 1800-102-4462
Website: www.manipalcigna.com
waiting periods as per IRDAI guidelines on migration.
To avail:
- Customer can share for migration of the policy 30 days prior to the renewal date by writing to
servicesupport@manipalcigna.com from an email registered with us
OR
- Visit nearest ManipalCigna Branch and submit a written request
OR
- Contact the intermediary/agent assigned to the customer for assistance
Portability: The Insured Person will have the option to port the Policy to other insurers by applying
to such insurer to port the entire policy along with all the members of the family, if any, at least 45
days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines
related to portability. If such person is presently covered and has been continuously covered
without any lapses under any health insurance policy with an Indian General/Health insurer, the
proposed Insured Person will get all the accrued continuity benefits in waiting periods as per IRDAI
guidelines on portability.
To avail:
- Customer can share for portability of the policy 45 days prior to the renewal date by writing to
servicesupport@manipalcigna.com from an email registered with us
OR
- Visit nearest ManipalCigna Branch and submit a written request
OR
- Contact the intermediary/agent assigned to the customer for assistance
Change in Sum Insured: It will be allowed at the time of Renewal of the Policy. You can submit a
request for the changes by filling the proposal form before the expiry of the Policy. We reserve Our
right to carry out underwriting in relation to acceptance of request for change of Sum Insured.
Moratorium Period: After completion of 60 continuous months of coverage (including portability and
migration) in health insurance policy, no policy and claim shall be contestable by the insurer on
grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period
of 60 continuous months is called as moratorium period. The moratorium would be applicable for
the sums insured of the first policy and subsequently completion of 60 continuous months would be
applicable from date of enhancement of sums insured only on the enhanced limits. The policies
would however be subject to all limits, sub limits, co-payments, deductibles as per the policy
contract.
13 Your Obligations Please disclose all Pre-existing disease/s or condition/s before buying a Policy.
The Policy shall be null and void and all premiums paid thereon shall be forfeited to the Company
in the event of misrepresentation, mis-description or non-disclosure of any material fact by the
policyholder.
(“Material facts” for the purpose of this policy shall mean all relevant information sought by the
company in the proposal form and other connected documents to enable it to take informed
decision in the context of underwriting the risk)
Declaration by the Policyholder,
I have read the above and confirm having noted the details.
Place:
Date: (Signature of Policyholder)
Note - Benefits and exclusion are applicable as per the plan chosen under the group scheme offered, please refer the Certificate of Insurance for more details.
Customer Information Sheet | ManipalCigna FlexiCare Group Insurance Policy| UIN:MCIHLGP20120V011920 Page 5
