Prohealth Prime Protect in one table
| Insurer | Manipal Cigna Health Insurance Company Limited |
|---|---|
| Sum insured | ₹3 lakh to ₹1 crore, in tiers of 3 / 4 / 5 / 7.5 / 10 / 12.5 / 15 / 20 / 25 / 30 / 40 / 50 / 100 lakh |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Prohealth Prime Protect covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from ManipalCigna's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | None if you are treated in your own zone or a cheaper one. 10% or 20% of every claim if you are treated in a costlier zone than the premium you paid, except after an accident | No Co-payment |
| Room Rent Limit | Up to a single private A/C room; ICU up to the sum insured. A higher category triggers a proportionate deduction | No room rent capping |
| Disease sub-limit | No disease sub-limits in the base cover. They apply only if you choose the Assure package on a ₹3 lakh to ₹5 lakh cover | No sub-limit |
| Cumulative Bonus | A guaranteed 25% of the sum insured for every completed policy year, irrespective of claims, up to a maximum accumulation of 200% | 50% each year (Minimum upto 100%) |
| Restoration of Sum Insured | Multiple restorations in a policy year, for related and unrelated illnesses, over and above the sum insured. It does not trigger on the first claim | 100% restoration once in a year |
| Pre-Hospitalization | 60 days | At least 60 days |
| Post-Hospitalization | 180 days | At least 120 days |
| Consumables | Not in the base cover – the Non-Medical Items optional cover pays them up to the sum insured | Consumables covered |
| Day Care Treatment | Covered up to the sum insured | Covered without a capped list |
| Air Ambulance | Up to the sum insured, capped at ₹10 lakh, over and above the sum insured | Included |
| Domiciliary Hospitalization | Up to 10% of the sum insured, with 30 days of pre and post cover | Covered up to the sum insured |
| Mental Illness Cover | Covered up to the sum insured, after a 24-month wait on the listed ICD codes | Included |
| Entry age | Adults from 18, no upper limit · children 91 days to 25 years | No maximum entry age |
Prohealth Prime Protect add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Prohealth Prime Protect discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Family discount | Up to 20% | Covering 2 or more members under the same policy on a multi-individual basis. |
| Long-term policy discount | Up to 7.5% or 10% | 7.5% on a 2-year policy and 10% on a 3-year policy, available only on the single premium payment mode. |
| Worksite marketing discount | Up to 10% | On policies sourced through the worksite marketing channel. Applied once, at inception. |
| Existing customer discount | Up to 5% | For customers already covered under a ManipalCigna group or retail product. Applied once at inception, and not offered on portability or migration cases. |
| No claim discount | Up to 1% | On the renewal premium if no claim was made in the expiring year. Using the health check-up, second opinion, tele-consultation, switch-off or wellness benefits does not count as a claim. |
| Wellness rewards | Up to 20% | Reward points earned through the Healthy Life Management Program, redeemed against the renewal premium from the first renewal onwards. |
From the ManipalCigna ProHealth Prime prospectus. The total discount on a single policy cannot exceed 40%.
Prohealth Prime Protect waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Specific Illness | 24 months |
| Pre-Existing Disease | 24 months on a cover of ₹7.5 lakh and above; 36 months on a cover up to ₹5 lakh |
| Maternity and bariatric surgery | 36 months |
The named illnesses that wait 24 months
Payable once the policy has run 24 months without a break; an accident is covered from day one. This list is indicative – the policy wording carries the full set.
Prohealth Prime Protect exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Prohealth Prime Protect falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Prohealth Prime Protect questions, answered
How does the zone co-payment work?
Premiums are set by three zones and the co-payment follows the zone you paid for, not where you live. Pay a Zone I premium and you can be treated anywhere in India with no co-payment. Pay Zone II and treatment in Zone I costs you 10% of the claim. Pay Zone III and treatment in Zone II costs 10%, Zone I costs 20%. It does not apply to hospitalisation after an accident. If you expect to travel to a metro for surgery, ask for a Zone I premium at the outset.
Is the cumulative bonus a no-claim bonus?
No. The customer information sheet calls it a guaranteed bonus of 25% of the sum insured for every completed policy year, irrespective of claims. What it has is a ceiling: accumulation stops at 200% of your sum insured. The optional Cumulative Bonus Booster doubles the annual rate to 50% and replaces the base bonus.
What is the pre-existing disease waiting period?
It depends on the cover you buy. On a sum insured of ₹7.5 lakh or more it is 24 months. On a sum insured of ₹5 lakh or less it is 36 months. That is a full year of difference for what is often a small premium step, so if you have a declared condition it is worth pricing ₹7.5 lakh before settling for ₹5 lakh.
How many times does the cover restore?
Multiple times in a policy year, and it works for the same illness as well as an unrelated one, which is more generous than the usual rule. It does not trigger on the first claim of the year, and any single claim is capped at base sum insured plus cumulative bonus plus the restored amount.
Which room am I entitled to?
A single private air-conditioned room, with ICU covered up to the sum insured. If you are admitted to a higher category you bear a proportionate share of the associated medical expenses. Two routes change it: the Enhance Plus package upgrades the entitlement to any room category, and the Prime Plus rider offers the same upgrade.
Does this plan cover maternity?
Not in the base cover. Maternity comes through the Enhance Plus optional package, which pays up to 10% of the sum insured capped at ₹1 lakh for up to two deliveries or terminations, plus newborn hospitalisation and first-year vaccinations. The maternity waiting period is 36 months, so it only makes sense if you are planning several years ahead.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other ManipalCigna plans we have read
ManipalCigna files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.