ProHealth Insurance Accumulate

CignaTTK Health Insurance
ProHealth Insurance Accumulate
  • PROHEALTH INSURANCE ACCUMULATE DESCRIPTIONMORE ABOUT PROHEALTH INSURANCE ACCUMULATE

    Our Accumulate plan gives you the best of both worlds. It helps you take care of your present healthcare expenses and build a reserve for your future health needs with accumulation of Health Maintenance Benefit.

    Your Health Maintenance Benefit builds up a reserve with a 5 % bonus every year on the unutilized value. It’s a unique plan with the advantage of protection against rising health care costs and also provides tax benefit. 

     

    Insured age (years) 36 37 38 39 40
    Time line (Years) Year 1 Year 2 Year 3 Year 4 Year 5
    HMB opted every year <A> 20000 20000 20000 20000 20000
    HMB + CB c/f from last year if any <B> Nil 10500 26775 41764 54352
    HMB used <C> 10000 5000 7000 10000 12000
    HMB unused <D>=(A+B-C) 10000 25500 39775 51764 62352
    Cumulative Bonus @ 5% on unused HMB <E> 500 1275 1989 2588 3118
     
    HMB reserve = D+E 10500 26775 41764 54352 65470

     

    Note – Above is only an illustration of how Health Maintenance Benefit builds into a reserve  over the years for future health expenses.

    You can use the Health Maintenance Benefit to cover out-patient expenses including dental and AYUSH treatment and even to pay for deductible or co-pay amount or towards payment of non-admissible component of a claim.

    The plan works as a one stop solution from Day Care, Domiciliary to hospitalization cover. Also you enjoy Cumulative Bonus for 'No Claims', Second Opinion help on Critical Illnesses, Healthy Rewards and a Worldwide Emergency Cover when you are away from home. Even in multiple claims you are protected with 100% additional sum insured under Restoration.

     

    • Sum insured options: Rs. 5.5 lakhs, 7.5 lakhs, 10 lakhs, 15 lakhs, 20 lakhs, 25 lakhs
    • Entry age & renewal:The minimum entry age is 91 days for children and 18 years for adults. There is no maximum age limit for entry under this policy. The plan provides lifetime renewal opportunity.
    • Is a medical test required before enrolment? Depends on the age and the sum insured opted for.
    • What determines premium? Apart from age, lifestyle, sum insured, gender and results of the medical test (if undertaken), the geographical location also determines premium. Cities and town have been divided into 3 separate zones.
    • Policy period:One can choose between 1 year, 2 years and 3 years term.
    • Family discount:10% discount on the premium amount for enrolling more than 2 family members under a single individual policy.
    • Long term discount:7.5% for selecting a 2 year and 10% for selecting a 3 year single premium policy.
  • KEY FEATURESPROHEALTH INSURANCE ACCUMULATE KEY FEATURES, EXPANDED.

    • In-patient Hospitalization

      We will cover hospital accommodation upto Single private room, charges in Intensive Care Unit, related hospitalization expenses such as surgeon’s fees, nursing, anesthesia, blood, oxygen, operation theater charges, surgical appliances, medicines, drugs and consumables up to the sum insured.

    • Pre - Hospitalization

      You may incur some expenses before you are hospitalized, like doctor’s fees, pharmacy related expenses or diagnostic tests. All such costs will be covered by us up to 60 days before your hospitalization.

    • Post - Hospitalization

      After you get home from the hospital, there are still expenses to be taken care of, like consultation fees, diagnostic tests, pharmacy related costs among other things. We will cover such expenses related to your hospitalization up to 90 days after your discharge.

    • Day Care Treatment

      You might need to be hospitalized for less than 24 hours for certain procedures like dialysis, radiation therapy, cataract surgery among others. We will cover the cost of such procedures up to the sum insured.

    • Domiciliary Treatment

      If you need to be treated at home due to unavailability of a bed at the hospital or because your health condition did not allow hospital transfer and doctor recommended home care, we will cover the expenses for it, up to the sum insured.

    • Ambulance Cover

      We understand the need for emergency ambulance service; should you need immediate assistance we will cover the ambulance expenses up to 2000 rupees every time you get hospitalized.

    • Donor Expenses

      For situations like an organ transplant, the medical expenses incurred for the in-patient hospitalization of the donor is also covered by us. The coverage will be up to the sum insured.

    • Worldwide Emergency Cover

      You might need to avail emergency medical assistance when you are abroad. We understand the problems you might face in such situations. Don’t worry, we will cover your medical expenses abroad up to the full sum insured on reimbursement basis.

    • Restoration of Sum Insured

      If the Sum Insured and Cumulative Bonus/Cumulative Bonus Booster (if any) is insufficient due to claims paid & accepted, we will restore 100% of Sum Insured once in a policy year to meet future claims for all unrelated diseases/injury.
      For example, an insured has taken a cover of Rs. 5.5 lakhs and a claim of Rs. 5 lakhs has been paid. Now, he is admitted to hospital for an unrelated disease and files a fresh claim of Rs. 2 Lakh. Under restoration benefit, the policy will provide an additional Rs.5.5 Lakhs of Sum Insured. Fresh claim and any future claims can be settled out of the balanced Sum Insured plus the restored Sum Insured within the same policy year.
      For a policy year the maximum aggregate Claim amount payable shall be sum of the:
      a. Sum Insured
      b. Cumulative Bonus (if earned) or Cumulative Bonus Booster (if opted)
      c. Restored Sum Insured.
      Restoration will not trigger in case of a claim under Worldwide Emergency Cover, Maternity, New Born Baby and First Year Vaccinations.

    • Health Maintenance Benefit

      We provide reimbursement of Rs.5,000, Rs.10,000, Rs.15,000 or Rs.20,000 each year to cover out-patient expenses such as doctor’s consultation , pharmacy expenses or diagnostic tests, alternative forms of medicines (AYUSH) and more.
      You can also utilise the amount towards payment of the deductible/co-pay/non payable component of a claim wherever applicable including any cashless facility in case of a Hospitalization or Day Care Claim.
      Any unutilised Health Maintenance Benefit limit will be carried forward to the next year.

    • Health Check-Up

      We encourage the people we serve to stay healthy, that’s why, we provide a comprehensive health check-up for all insured persons above 18 years once every 3 years.

    • Expert Opinion on Critical illness

      We understand your need for an Expert opinion from our network of medical practitioners for deciding on the best course of action. We cover the cost of an Expert opinion on listed critical illnesses such as cancer or stroke before you decide on the best treatment or procedure.

    • Cumulative Bonus for No Claims

      You can even benefit from staying healthy. We increase the sum insured by 5% for each claim free year upto a maximum of 100%.
      For example, if you have a coverage of Rs. 10Lakhs and there is no claim in the first year, an additional Sum Insured of Rs.50,000 will be allowed as Cumulative Bonus. If a claim is made in the second year, the earned Cumulative Bonus is not reduced unless utilized to settle any claim.
      Only for Accumulate plan, you get a 5% cumulative bonus on the unutilized HMB limit available at the end of the policy year irrespective of whether a claim is made on the expiring policy. This unutilized HMB limit plus earned Cumulative Bonus will get carried forward to the next Policy Year.

    • Healthy Rewards

      We want you to always stay healthy. What's more, we grant you reward points equal to 1% of premium paid each year. In addition, you can accumulate points by opting for our online wellness programs. Each earned reward point will be valued at 1 Rupee. The accumulated points can be redeemed as a discount in premium from next renewal or reimbursed under health maintenance benefit or to avail services through our network partners.

    • Deductible

      We provide an option to select a deductible of Rs. 50,000, 1 Lakh, 2 Lakhs, Rs. 3 lakhs, 4 lakhs or 5 lakhs .The deductible amount will apply on the sum of all admissible claims in that policy year. This means that of your claims (should any be arising), you choose to pay the deductible amount either out of your own pocket or with the aid of an existing health insurance policy.

    • Voluntary Co-Payment*

      This option (when exercised) would mean that you choose to pay the first 10% or 20% of the claim and the balance would be covered by your plan. * Voluntary Co-pay & Deductible can not be opted in the same plan.

    • Waiver of Mandatory Co-pay

      You have an option to remove Mandatory co-pay applicable for persons aged 65 years and above on payment of additional premium.

    • Cumulative Bonus Booster

      If opted, an additional Sum Insured of 25% will be added as cumulative bonus at the time of renewal in case there is no claim in the expiring policy. Maximum accumulation is upto 100%. This benefit is available in place of cumulative bonus.

    • Critical Illness Add-On

      Persons between 18 to 65 years can opt for Critical Illness cover as add-on benefit. We will give a lump sum amount equal to Sum Insured in case of first diagnosis of the covered critical illnesses. In case of a family floater policy, once a claim has been paid for a critical illness under this benefit we will provide for 100% reinstatement of Sum Insured once during the lifetime of the policy for the other person covered.

    • Pre-existing Diseases Waiting Period

      Pre-existing diseases will be covered after 48 months of continuous coverage under this plan.

    • Free Look Period

      We know your need to try something before you trust it. A period of 15 days from the receipt of the policy document is available to review the terms and conditions of this policy. You can choose to cancel the policy by stating the reason for cancellation. If there are no claims in the policy, we will refund the premium paid.

    • Grace Period

      There is a grace period of 30 days for renewal of a single premium policy from the date of expiry.

    • Portability

      You can port your existing health insurance policy to the ProHealth Insurance policy, provided you are covered under an Indian Health Retail policy from a non- life insurance company.

    • Income Tax Benefit

      Along with other benefits, you can also claim tax deduction u/s 80D as per IT Act 1961 for premium paid towards this policy. For premiums paid in cash, tax benefit u/s 80D shall not be applicable. Please consult your tax advisor for more details

    • Cancellation

      You can place a request for cancellation any time during the term of the policy; premium refund will be on short period basis.

    • First 30 days waiting period

      A waiting period of 30 days from the Inception Date of the Policy will be applicable for all hospitalization claims except in case of accidents and policies accepted under portability norms.

    • First 90 days waiting period & Survival period (Applicable only to CI Add-on)

      From the policy inception date, there will be a waiting period of 90 days before the symptoms of any critical illness first occur for you to be able to make a claim. A 30 days survival period will also apply.

    • Two years waiting period

      Two Years Waiting Period will be applicable for specific illnesses.

    • Key Exclusions

      We will not pay any claims arising out of or attributable to any of the following: • HIV/AIDS and its complications• Genetic disorders• Mental disorders• Suicide or drug abuse• Any loss resulting from child birth or pregnancy. The above list is only indicative and not exhaustive. Please refer to the policy terms and conditions for complete details.