ProHealth Insurance

What is Health Insurance?

Insurance coverage that pays for medical and surgical expenses that are incurred by the insured person during the treatment of a disease or injury. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.

Why to choose CignaTTK ProHealth plan?

CignaTTK offers comprehensive coverage of medical expenses for Inpatient hospitalization including Daycare, Pre and Post hospitalization expenses. It offers AYUSH in-hospital cover, Restoration benefit and Smart non- reducing guaranteed Cumulative bonus as inbuilt features.

Policy also offers Optional Cumulative Bonus Booster which works on non-reducing basis and adds more to the policy every year irrespective of claims. It also covers Worldwide Emergency, Domiciliary treatment and Donor expenses upto Sum Insured.

Outpatient treatment, AYUSH, Doctor consultation, diagnostics and pharmacy bills are covered under Health Maintenance benefit. We offer Healthy Rewards as value added benefit associated with our ProActiv Living Program

All above features are also offered for policies where Optional Deductible or Voluntary co-pay has been opted**
Basic Covers Value Added Covers Optional Covers Add on Cover
a. In patient Hospitalization cover
b. Pre/Post Hospitalization cover
c. Day Care treatment
d. Domiciliary treatment
e. Ambulance Cover
f. Donor expenses
g. Worldwide Emergency Cover
h. Restoration of Sum Insured
i. AYUSH Cover
j. Health Maintenance Benefit
k. Cumulative Bonus on Health Maintenance Benefit
l. Maternity Expenses
m. New Born Baby Expenses
n. First Year Vaccinations
a. Health Check-Up
b. Expert Opinion on Critical Illness
c. Cumulative Bonus
d. Healthy Rewards
a. Hospital Daily Cash Benefit
b. Deductible*
c. Waiver of Deductible
d. Reduction in Maternity Waiting
e. Voluntary Co-pay*
f. Waiver of Mandatory Co-pay
g. Cumulative Bonus Booster
a. Critical Illness Add on

*Voluntary Co-pay and Deductible cannot be taken under a single plan.
Note - Above is the list of covers under the product and are applicable as per availability in the plan chosen.

Can I buy ProHealth online?

You can buy ProHealth Online by visiting our website www.cignattkinsurance.in

What coverages do I get?

Under this policy, coverages are divided into Basic, Value added, Optional and Add-on. The Basic, Value Added covers as detailed in (Q2) and will be available as per the plan and Sum Insured chosen.
The optional covers and Critical illness add-on can be opted by paying additional premium.

Can I increase/decrease the Sum Insured or change the plan in my policy?

Alterations like increase or decrease in Sum Insured, change in plan will be allowed at the time of Renewal of Policy. However, any such change request will be subject to underwriting decision or requirement of medical tests on a case to case basis.

How do I decide on an appropriate cover amount?

You can choose from 5 plan types (Protect/ Plus/ Preferred/ Premier / Accumulate).


Plan Protect Plus Preferred Premier Accumulate
Sum Insured 2.5 , 3.5 , 4.5, 5.5, 7.5, 10, 15, 20, 25, 30, 50 Lacs 4.5 , 5.5 , 7.5, 10, 15, 20, 25, 30, 50 Lacs 15, 30, 50 Lacs 1 Cr 5.5 , 7.5,10, 15, 20, 25, 30, 50 Lacs

All figures in rupees.

Does it cover Senior Citizens?

Yes, the Minimum age at entry is: 91 days (for Children); 18 years (for adult)Maximum age at entry: 23 years (for children under a floater); Lifetime (for adults)

What do you mean by entry age?

The age of eligibility of the insured for taking the policy is the Entry Age. Age will mean completed age as on last birthday.

Is there an Exit Age in ProHealth?

No, there is no exit age in this policy.

Is there any tax benefit?

Yes. Premium paid under the Policy shall be eligible for income tax benefit under Sec 80D of the Income Tax Act and any amendments thereon. If Policy Term is more than 1 year then tax benefit can be taken for all the years separately as applicable..

What do you mean by in-patient and out-patient treatment?

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as in-patient treatment.

Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted in the hospital.

What are the covers offered under In-patient Hospitalization?

For in-patient hospitalization we will pay for the below medical expenses:

  • Reasonable and Customary Charges for Room Rent for accommodation in Hospital room
  • Intensive Care Unit charges for accommodation in ICU ,
  • Operation theatre charges,
  • Fees of Medical Practitioner ,
  • Anaesthetist,
  • Qualified Nurses,
  • Specialists,
  • Cost of diagnostic tests,
  • Medicines,
  • Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices recommended by the attending Medical Practitioner and that are used intra operatively during a Surgical Procedure.

What is Day Care Procedure?

It refers to any medical treatment and/or surgical procedure which are:
i. Undertaken under general/local anesthesia in a hospital/day care center with less than 24 hours stay due to technological advancement, and
ii. Which would have otherwise required hospitalization of more than 24 hours.
*Treatment normally taken on an out-patient basis is not included in the scope of this definition.

Is there any List of Day Care Procedures?

ProHealth Insurance covers 546 listed day care treatments or surgery that requires less than 24 hours hospitalization due to advancement in technology and which is undertaken in a hospital / nursing home/day care centre on the recommendation of a medical practitioner. Coverage is available upto the Sum Insured opted under the plan.

What are Pre & Post Hospitalization expenses?

Pre-hospitalization expenses are medical expenses incurred immediately before the insured is hospitalized provided that:

i.Such hospitalization expenses are incurred for the same condition for which the insured Person’s hospitalization was required
ii.And an in-patient hospitalization claim is admissible for that hospitalization by CignaTTK Health Insurance.

Post-hospitalizationmedical expenses include expenses incurred immediately after the insured is discharged from the hospital provided that:

i.Such medical expenses are incurred for the same condition for which the insured’s Hospitalization was required
ii.An in-patient hospitalization claim is admissible for that hospitalization by CignaTTK Health Insurance.

Are both allopathic and non-allopathic systems of medicine covered under this insurance plan?

Yes, prescribed Allopathic and Non-allopathic treatments including Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy are covered under this insurance. However facilities and services availed for pleasure or rejuvenation or as a preventive aid like beauty treatments, Panchakarma, purification, detoxification and rejuvenation etc., Hydrotherapy, Acupuncture, Reflexology, Chiropractic treatment or any other form of indigenous system of medicine are permanently excluded under this policy.

You are also covered for AYUSH treatments on out-patient basis under Health Maintenance Benefit provided it is prescribed by a Certified Medical Practitioner.

What is Domiciliary Hospitalization?

It means medical treatment for an illness/disease/injury which normally would require care and treatment at a hospital but is actually taken while confined at home because:

- The condition of the patient is such that he/she cannot be moved to a hospital, or
- The patient takes treatment at home under the care of a medical practitioner on account of non- availability of room in a hospital.
Claims for pre-hospitalization and post-hospitalization expenses will be payable upto 30 days each.

What is AYUSH Cover?

AYUSH covers in-patient treatment under Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy for an illness or injury that occurs during the policy year. Coverage is available upto the sum insured provided:
i. Treatment is taken in a government Hospital or in any institute recognised by government and/or accredited by government authority.
ii. Facilities and services availed for pleasure or rejuvenation or as a preventive aid like beauty treatments, Panchakarma, purification, detoxification and rejuvenation etc. is an exclusion under this benefit.

What is meant by Zone based premium?

For calculating premium the country has been divided into 3 zones. Zone will be identified based on the location city of the insured person and premium will be calculated accordingly.

Zone I: Mumbai, Thane / Navi Mumbai, Gujarat, Delhi and NCR
Zone II: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata and Pune
Zone III: Rest of India excluding the locations mentioned under Zone I & Zone II

(a) Persons paying Zone I premium can avail treatment all over India without any sub limits.
(b) Persons paying Zone II premium
i) Can avail treatment in Zone II and Zone III without any sub limits.
ii) Availing treatment in Zone I will have to bear Co-pay of 10% of each and every claim#.
(c) Person paying Zone III premium
i) Can avail treatment in Zone III, without any sub limits.
ii) Availing treatment in Zone II will have to bear Co-pay of 10% on each and every claim#.
iii) Availing treatment in Zone I will have to bear Co-pay of 20% on each and every claim#.

What happens if the illness/disease/injury is of such a nature that it is covered under domiciliary hospitalization but requires nurse to attend to the patient?

Domiciliary Hospitalization benefits cover the expenses on employment of qualified nurses, who are employed on the recommendation of the attending Medical Practitioner and who holds a certificate of a recognized Nursing Council. However the treatment has to be under a qualified Medical Practitioner only.

What happens when I have to undergo a treatment like dialysis when I am discharged on the same day?

In this scenario, the medical treatment and expenses will be covered under Day Care Procedure.

What is meant by Pre-existing disease?

Pre-existing Disease includes any condition, ailment or injury or related condition(s) for which insured had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the first policy issued by the insurer.

What is included in Donor expenses?

CignaTTK under this policy will cover In-patient Hospitalization Medical Expenses towards the donor for harvesting the organ up to the limits of the Sum Insured, provided that:
1. The organ donor is any person in accordance with the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules.
2. The organ donated is for the use of the Insured Person who has been asked to undergo an organ transplant on Medical Advice.
3. We have admitted a claim under in-patient hospitalization. We will not cover:
       a. Any pre or post hospitalization expenses
       b. Cost towards donor screening
       c. Cost directly associated to the acquisition of the organ
       d. Any other medical treatment or complication in respect of the donor, consequent to harvesting.

What is Expert opinion on Critical Illnesses?

Insured may choose to secure a second opinion from Our panel of Medical Practitioners, if an Insured Person is diagnosed with a covered Critical Illness during the Policy Period. The second opinion would be directly sent to the Insured Person by the Medical Practitioner if opted.

What is covered under maternity and new born expenses?

Maternity benefits include expenses for the delivery of child or expenses related to medically necessary and lawful termination of pregnancy.
Maximum 2 deliveries / terminations are covered during the lifetime of an insured between the age group of 18-45 years after a waiting period of 48 months.
Coverage will be restricted to the sum insured as per policy.


Plan Plus Preferred Premier
Maternity & New Born Expenses ₹ 15,000 for normal delivery & ₹ 25,000 for C-section per event ₹ 50,000 for normal delivery & ₹ 1 lac for C-section per event ₹ 1 lac for normal delivery & ₹ 2 lacs for C-section per event

What is new born baby cover?

This benefit will include:
-Expenses which are medically necessary for the treatment of the insured’s new born baby while the insured is hospitalized as an in-patient and the claim is admissible for the insured with us.
-Within limits of the maternity sum insured the policy will cover in-patient hospitalization expenses incurred for the new born during and post birth upto a period of 90 days.
New born means baby born during the policy period and aged between 1-90 days.
For coverage beyond 90 days the new member needs to be added to the policy through endorsement and premium will be charged on pro-rata basis.

What are reasonable and customary charges/expenses?

Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved.

What is Health Check-up?

For insured that have completed 18 years of age can avail a comprehensive health check-up with Our Network Provider once every 3rd Policy year for Protect/Accumulate Plan and at each renewal for Plus, Preferred and Premier Plan as per the table below.


Plan Name

Sum Insured

Age

List of tests

Protect, Plus & Accumulate

2.5 Lacs,

3.5 Lacs,

4.5 Lacs,

₹ 5.5 Lacs

>18 years

Vitals, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, SGPT

Protect, Plus & Accumulate

7.5 Lacs,

10 Lacs

18 to 40 years

Vitals, ECG, FBS, Sr. Creatinine,SGPT, CBC-ESR, Lipid Profile, SGOT, GGT

> 40 years

For Females only - Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TSH

For Males only- Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT

Protect, Plus & Accumulate

₹15 Lacs and above

18 to 40 years

For Females only - Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TSH

For Males only - Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT

> 40 years

For Females only - Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TSH, TMT

For Males only - Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TMT

Preferred & Premier

₹15 Lacs and above

18 to 40 years

For Females only - Vitals, ECG, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TSH, Pap smear, Mammogram

For Males only - Vitals, ECG, FBS, Sr. Creatinine, CBC, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, PSA

> 40 years

For Females only - Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TSH, TMT, Pap smear, Mammogram, Uric acid, USG Abdomen & Pelvis

For Males only - Vitals, FBS, Sr. Creatinine, SGPT, CBC-ESR, Lipid Profile, SGOT, GGT, TMT, PSA, Uric acid, USG Abdomen & Pelvis

Full explanation of Tests is provided here:
Vitals – include (height/weight,Blood Pressure, Pulse, BMI ,Chest Circumference & Abdominal Girth), FBS – Fasting Blood Sugar, GGT – Gamma-Glutamyl Transpeptidase, ECG – Electrocardiogram, CBC-ESR – Complete Blood Count-Erythrocyte Sedimentation Rate, SGPT – Test Serum Glutamic Pyruvate Transaminase, SGOT – Serum Glutamic Oxaloacetic Transaminase, TSH – Thyroid Stimulating Hormone, TMT – Tread Mill Test, PSA – Prostate Specific Antigen.
Benefit under this value added cover will not be available on reimbursement basis. For Protect and Accumulate plan if not availed on the 3rd Policy year, next health check - up will be available on the 6th Policy year and so on.

What are Healthy Rewards?

Healthy Rewards are points earned for each year of premium payment. Points can also be earned by enrolling and completing our array of wellness programs.
Details of reward points that can be accrued are listed below.

Program Type Points to be earned as a percentage of previous Policy Period Premium
Health Risk Assessment (HRA) / Targeted Risk Assessment (TRA) 2.50% each
Lifestyle Management Program (LMP) 3%
Chronic Condition Management Programs 3%
Participating in CignaTTK Sponsored Programs and Worksite or Online/Offline Health Initiatives 2% per program, Maximum 5 programs per policy year
Health Check Up 0.5%

Reward Points, wherever offered under any specific Sponsored Program will be the same for all customers.
Each program can be opted once per Policy Year by a particular Insured Person.(in Individual & Family Floater Policy)
There will be no limitation to the number of programs one can enrol however maximum rewards that one can earn in a single policy period will be limited to 20% of premium paid in the Policy.

These earned points can be

  • used to get a discount against payable premium (including taxes) from 1st renewal of policy
  • redeemed for equivalent value of Health Maintenance Benefit anytime during policy
  • redeemed as equivalent value while availing services through any of Our Network Providers
  • unutilized reward points can be carried forward to the next policy year subject to renewal
  • if policy is cancelled the unutilized reward points will get lapsed.

Does Worldwide Emergency benefit cover medical expenses due to Terrorism attack?

Yes, this benefit provides for reimbursement of medical expenses incurred for availing emergency medical assistance due to illness, injury sustained or contracted outside the territorial limits of India.

The benefit amount will be limited to the sum insured for all plan types available under ProHealth Insurance.

Expenses will be limited to in-patient and day care hospitalization only. All payments will be in Indian rupees on reimbursement basis and as per the Exchange rate published by RBI (Reserve Bank of India) on the date of payment to the hospital.

Although, I have your Policy available, yet, I am visiting abroad for one month for which I have opted for on 'Overseas Mediclaim Policy' from another company. Can you refund me the premium for the said period of one month?

The premium rate calculated for the given policy is on an annual basis and cannot be bifurcated to monthly period.

Also the coverage is available for the term opted under the policy.

Accordingly the refund of premium option is not available in this scenario.

Our Policy also provides for worldwide emergency coverage outside of India. You can avail of this benefit during your trip outside.

What do you mean by Restoration benefit?

Under this benefit the Sum Insured if insufficient due to claims paid or payable during the policy year, will be restored to 100% with below conditions:

i. The Basic SI and Cumulative bonus (if any) is insufficient to pay for a claim in that year

ii. The benefit is not available for claims towards an illness, disease, injury, for which a claim has been paid in the current year for the same insured.

iii. Restored SI is not being utilized to calculate no claim bonus.

iv. Restoration will not trigger in case of a claim under Maternity, New Born Baby and First Year Vaccinations.

Note: Each insured under an individual policy can avail the benefit. If policy is issued on a floater basis, the restored SI will also be available on floater basis.

If restored SI is not utilized in a policy year, it will not be carried forward to subsequent year.

Do all ProHealth Insurance plans offer Restoration benefit?

Multiple Restoration is available in a Policy Year for unrelated illnesses in addition to the Sum Insured opted under all ProHealth Insurance plans (Protect, Plus, Preferred, Premier and Accumulate).

How can I use Health Maintenance Benefit?

Health Maintenance benefit covers all medical expenses incurred on out-patient basis.

In Protect, Plus, Preferred, Premier and Accumulate plans, we will cover costs incurred towards:

      - Diagnostic tests, preventive tests, drugs, prosthetics, medical aids, prescribed by the specialist Medical Practitioner up to the limits specified in the Schedule.

      - Towards Dental Treatments and Alternative Forms of Medicines wherever prescribed by a Medical Practitioner.


In addition, for Accumulate Plan:

Available HMB limit during the Policy Year can also be utilised towards

-Payment of the deductible/co-pay/non payable component of a claim wherever opted and applicable including any cashless facility in case of a Hospitalization or Day Care Claim.

-Payment of renewal premium: Up to 50 % of the accumulated HMB can be utilised for payment against premium from first renewal of the policy. This is subject to renewal of the policy in Accumulate Plan.

Will additional premium be charged for reduction in maternity waiting period?

Insured can opt for a reduction in maternity waiting period by paying one-time additional premium.

On availing this benefit, the mandatory waiting period for maternity cover will be reduced from 48 to 24 months. New born cover and First Year Vaccination will follow reduction in waiting period.

What is First Year Vaccination?

It includes all reasonable and customary vaccination expenses of the new born as per the National Immunization Scheme (India) until the new born completes one year (ie.12 months).

If the policy ends before the new born baby completes 12 months, this benefit will continue subject to policy being renewed in the subsequent year.

What is a guaranteed Cumulative Bonus?

It means an increase in the Sum Insured granted by the insurer for a policy year irrespective of a claim without an increase in the premium provided the policy is renewed with the insurer.
For Protect and Accumulate plans there is a guaranteed 5% increase in sum insured.
For Plus, Preferred and Premier plans there is a guaranteed 10% increase in sum insured.

The maximum accumulation is upto 200% of sum insured.

Cumulative Bonus shall not be available for claims made for maternity expenses, new born baby cover, first year vaccination.

What is a guaranteed Cumulative Bonus Booster?

It allows an increase in the Sum Insured by a fixed percentage of 25 % for a policy granted by the insurer. The maximum accumulation is upto 200%. This benefit is available with additional premium. Cumulative Bonus Booster (CBB) if opted will be in place of Cumulative Bonus in the base policy.

Cumulative Bonus Booster is not applicable under Premier Plan.

Cumulative Bonus Booster shall not be available for claims made for maternity expenses, new born baby cover, first year vaccination.

Can I opt out of Cumulative Bonus Booster before and after accumulating 200% of Sum Insured?

One can opt in or opt out of the Cumulative Bonus Booster option at every renewal before and after accruing 200%. Post removing CBB if the bonus is utilized to settle any claim, one can opt for CBB at policy renewal to accrue bonus in future renewals.

What is Hospital Daily Cash Benefit (HDCB)?

Hospital daily cash is a pre-defined benefit where a fixed amount per day of hospitalization (each continuous and completed 24 hours) is paid in lump-sum to the policyholder/insured person. The benefit has no link with the actual medical expenses incurred.

The benefit is payable subject to:

a. The hospitalisation claim is admissible under the Base cover.(Inpatient Hospitalisation, Worldwide Emergency & Maternity Cover)

b. The Benefit will be available up to the maximum 30 days per Policy Year.

c. The Benefit under this cover will be over and above the Sum Insured.

Plan Protect Plus Preferred Premier Accumulate
HDCB 1000 2000 3000 3000 1000

What is a Deductible? Explain with an example?

Deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. It’s a cost sharing mechanism that helps reducing the insurance premium.

One can opt a deductible in ProHealth Protect, Plus and Accumulate plans. Cigna TTK will cover all admissible medical expenses beyond the deductible amount.

Deductible amount will be applied on each policy year on the aggregate of all admissible claims in that policy year.

Deductible shall apply to all sections other than Hospital Daily Cash Benefit, Health Maintenance Benefit, Health Check Up benefits and Add On Riders if opted.

Deductible options -

For Protect & Plus plans: ₹ 1 Lac, ₹ 2 Lacs, ₹ 3 Lacs, ₹ 4 Lacs, ₹ 5 Lacs, ₹ 7.5 Lacs, ₹ 10 Lacs.

For Accumulate plan: 50k, ₹ 1Lac, ₹2 Lacs, ₹3 Lacs, ₹4 Lacs, ₹5 Lacs, ₹ 7.5 Lacs, ₹ 10 Lacs.

Example - Say, one opts for Plus plan of Rs. 5.5 lacs with deductible of Rs. 2 lacs for 1 year period.

His first claim amounts to Rs. 1.5 lacs due to accident. He has to bear the medical expenses out of pocket or using any other health insurance as claim is within deductible limit. However, on submission of claim documents, Deductible amount will be reduced by the claim admissible amount (1.5 lacs). Remaining deductible applicable is Rs.50,000.

In the same year, he submits a claim for jaundice of Rs.1 lac. Cigna TTK will pay Rs.50,000 out of 5.5 lacs after adjusting balance deductible of Rs.50,000.

Can deductible option be removed at the time of renewal?

Yes, deductible can be removed at renewal subject to below conditions.
I. Opt out/Waiver of Deductible within 48 months: The enhanced coverage during any policy renewals will not be available for an illness, disease, injury already contracted under the preceding Policy Periods or earlier. All waiting periods as mentioned under the policy shall apply afresh for this enhanced limit from the effective date of such enhancement.
That is, continuity benefit will be available with fresh waiting period for the deductible amount that’s being removed from the expiring policy and on any additional sum insured in the renewal policy.
II. Opt out/Waiver of Deductible after 48 months: The enhanced coverage will be available for any illness, disease, injury already contracted under the preceding Policy Periods or earlier with continuity of coverage in terms of waiver of waiting periods to the extent of benefits covered under this Policy, provided that it has been renewed with Us continuously and without any interruption.
Premium for the opted indemnity health insurance Policy (without any Deductible) would be charged as per the age of insured member at renewal.

Where will Deductible apply?

Deductible shall apply to all policy benefits other than Hospital Daily Cash Benefit, Health Maintenance Benefit, Health Check-up Benefits and Add On Rider if opted.

What is Waiver of Mandatory Co-pay?

This option allows to remove mandatory co-pay applicable for persons aged 65 years and above on payment of additional premium.

What do you mean by cashless hospitalization?

It’s a facility where the insured can get hospitalized in any of our network hospitals & the payments of the costs of treatment undergone by the insured in accordance with the policy terms and conditions are made directly to the network provider(hospital) by the insurer provided that the condition is payable under the terms and conditions of the policy.

What do you mean by Reimbursement?

It is the amount paid back to the insured, by the insurer for admissible medical expenses incurred by the insured.

What do you mean by period of the policy?

Policy Period means the period between the inception date and the expiry date of the policy as specified in the Schedule to this Policy or the date of cancellation/termination of this policy, whichever is earlier.

What do you mean by Voluntary Co-payment?

Under a health insurance policy co-payment works as a cost sharing mechanism where the policy holder/insured will bear an agreed specified percentage of each & every admissible claim amount.

In ProHealth Protect, Plus and Accumulate plans one can opt for a 10% or 20% Voluntary co-pay. It will apply on each claim under the policy.

What all discounts are available in ProHealth Insurance?

You can avail of the following discounts on the premium on Your policy:

Family Discount: 25% for Protect and Plus Plan and 10% for Preferred, Premier and Accumulate Plans covering 2 and more family members under the same individual policy.

Long Term Policy Discount: 7.5% for selecting a 2 years policy and 10% for selecting a 3 years policy.

Worksite Marketing Discount – A discount of 10% will be available on polices which are sourced through worksite marketing channel.

Maximum discount applicable on a single policy shall not exceed 40%, excluding discount for Voluntary Co-pay.

Who can be covered in ProHealth Insurance policy?

An individual policy can be taken for self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunty, nephew & neice.


Family floater with maximum 2 adults and 3 children can be taken for self, spouse, dependent children or dependent parents.

What do you mean by Floater option?

It means a policy wherein you and your eligible dependents named in the schedule are insured from the date of commencement of the policy.

The Sum Insured for a family floater means the sum shown in the schedule which represents our maximum liability for any and all claims made by you and all your covered members during each policy period.

What is the difference between Individual and Floater options?

Under individual option each insured has separate Sum Insured.

Under floater option all members in the policy have a single sum insured.

What should I do if I want to insure more than 2 adults or 3 children in floater plan?

If you wish to insure more than 2 adults or 3 children in a floater plan, you need to buy an additional policy.

Whom can I keep as my nominee?

A nominee can be anyone - spouse, children, and blood relatives. A minor should not be declared as a nominee.

Is Medical Test mandatory for everyone?

Medicals will be triggered on the basis of the age of the insured, the plan type and sum insured selected.
** For details of medical tests kindly contact Customer Support Team, Health Advisor or Branch Service Desk.

Which are the medical tests one needs to go through?

The list of medical tests will be communicated by CignaTTK Health Insurance Company to the customer at the time of processing the insurance application as they will depend upon the Age, Sum Insured Opted and any medical history declared at the time of application.

Where will the medical tests be conducted?

The medical tests can be conducted at the network of diagnostic designated centers identified by CignaTTK Health Insurance Company.

Will I receive the medical reports?

In a situation where medicals are required to process the insurance application, the medical reports will be available with CignaTTK Health Insurance. The same will be shared with customer on request.

Will CignaTTK share medical reports if policy is not issued?

Yes, the medical reports will be shared on receiving a written request.

What do you mean by Policy Start Date?

Policy start date is the date from which the policy becomes valid.

What is the Policy Tenure?

The policy tenure available is 1 year, 2 years or 3 years. You can choose the tenure of the Policy at the time of buying the policy.

Can a child of age 5 years and below be covered under this plan?

The minimum entry age under this policy is 91 days for children and 18 years for adults.
Coverage for children:

a. Children from 91 days to 18 years will only be covered if one of the parents is the proposer.

b. Children up to 23 years can be covered under the floater.

c. Children beyond 23 years can be covered under an individual policy.

(Same clause will be applicable for Sibling and Grand Children)

How can I renew the policy?

You can renew the policy by any of the below methods:
i. Making premium payments at our local branches
ii. Paying premium online using your net banking facility/Credit Card or Debit Card.
Note: NACH facility is available with ProHealth Insurance policy to facilitate easy renewal.

What do you mean by Permanent Exclusion?

It means the disease mentioned under Permanent Exclusions will not be covered in the ProHealth Insurance Policy.

What if I have a medical policy of any other insurance company, can I still buy your product?

We do not have any limitation on buying ProHealth Insurance. It's as per your choice if you wish to have additional coverage, however you must inform us regarding the existing policy at the time of buying the ProHealth Insurance plan.

Can the customer choose only one from optional covers?

Yes, customer can choose one cover or more than one from all the optional covers available.

However, Co-pay and Deductible cannot be opted together in a single policy.

Does the plan cover Pre-existing diseases?

Pre-existing diseases/illness/injury/conditions will be covered post 24/36/48 months of continuous cover depending upon the plan opted.

*Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations.

Is genetic disorder covered in ProHealth Insurance?

For all Medical Expenses along with their complications our maximum liability arising out of any claim for a genetic disease treatment shall be covered in the existing policy upto the Sum Insured. For any Pre- existing diseases, waiting period will be applied as per plan type opted.

How do you decide if a disease is a pre-existing one or not?

At the time of buying a health insurance you need to provide details of the illnesses you have suffered during your lifetime. The insurer refers such cases to their medical panel to differentiate between pre-existing and newly contracted illnesses.

Note: Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future including Policy cancellation without any refund of premium.

Does the insured have to pay the difference if the actual expenses are more than the cover?

In a scenario where the actual expenses exceeds the amount of cover, insured will be liable to pay the difference amount.

For example, if the eligible maternity cover is for Rs.15000 and the actual expenses is Rs.20,000, then insured have to pay balance Rs.5000/-.

Will elimination or reduction of specific benefits in basic cover reduce premium?

The benefits available under Basic Cover cannot be eliminated or reduced.
However customer can choose from the optional and add on covers.
Accordingly the premium will be calculated.

What diseases come under Permanent Exclusions?

Unless necessary endorsements or exemptions are made below diseases and expenses arising out of or attributable to any of the following will not be covered in the policy.

1. Any kind of treatment using stem cells

2. Dental treatment or surgery

3. Circumcision

4. Birth control procedures

5. Expenses on spectacles, laser surgery, cosmetic surgery, contact lenses, hearing aids, hair fall treatment etc.

6. HIV, AIDS and all diseases/illnesses/injury caused by and/or related to HIV.

7. All sexually transmitted diseases.

8. Ailment requiring treatment due to use/abuse of intoxicant/drug/alcohol etc.

9. Expenses on prostheses, corrective devices and medical appliances.

10. Any robotic, remote surgery or treatment using cyber knife.

11. Expenses on Non-allopathic treatment, Naturopathy, Ayurvedic, Homeopathy, Acupuncture or any other form of indigenous system of medicine

12. Insured person engaged in racing, bungee jumping, ballooning, sky diving, para gliding, rock climbing etc.

13. Any expenses directly or indirectly caused by or arising from or attributable to foreing invasion, hostilities, war, rebellion, revolution, military or usurped power.

14. Any deductible amount or percentage of admissible claim under co-pay.

Please refer the Policy Wordings for detailed exclusions.

Which diseases are not covered under First 2 Years Exclusions?

24 months waiting period is applicable on specific ailments. Below list is only indicative and not exhaustive:

1. Cataract

2. Knee Replacement Surgery

3. Urinary Stones

4. All types of Hydrocele

5. Sinusitis, surgery on tonsils

6. Gastric, Cysts, Polyps, internal/skin tumors, breast lumps

7. Congenital disorder (Internal).

8. Surgery of Genito-Urinary system.

Please refer the Policy Wordings for detailed list.

Would I be able to avail of my medical & premium reimbursements in case my policy is rejected?

The pre-policy medical check-up cost will be paid by CignaTTK Health Insurance Company.

In case we are unable to underwrite your proposal we will intimate the same to you and refund any premium that has been collected.

Does a higher cover mean preferential treatment in case of hospitalization & claim?

A higher cover does not indicate or entitle the insured to preferential treatment in hospitalization and claim. Irrespective of the cover chosen you would get high quality service and treatment at our network hospitals.

Does a higher cover guarantee better protection?

In recent days people are more prone to various ailments and health problems due to fast paced life and erratic schedules. A higher cover protects you from a medical emergency which can burn a hole in your pocket and thus guarantee you a better protection.

If I have a health insurance policy in one city, can I make a claim in another city?

Your health insurance policy is in force across India. You can check whether there is any network hospital near to your residence as well the city of your current location. Network hospitals are the hospitals that have tie up with the Third Party Administrator for cashless settlement of claims. If there is no network hospital, you can opt for reimbursement mode of settlement.

Apart from this we also provide coverage in case of Emergency situations anywhere in the world.

Is there a limit as to how long can I stay in hospital?

There is no defined limit of the period of stay in hospital.

However the stay in hospital should be medically necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity.

  • Must have been prescribed by a Medical Practitioner.
  • Must confirm to the professional standards widely accepted in international medical practice or by the medical community in India.

The maximum insurance coverage will be upto the sum insured (opted), restored sum insured and cumulative bonus / cumulative bonus booster (if any earned).

What happens in case of an Emergency hospitalization where Cashless facility is not authorized to me?

If cashless facility is not authorized you can go for reimbursement mode of settlement.

What all documents do I need to furnish to get a Health Insurance?

To buy our Policy you will require to fill up the ProHealth Insurance - Proposal Form and submit the form to us along with the premium instrument.

Do I get a Health Identification Card?

Yes, all the policy holders are eligible for a health identification card and it will form a part of the policy kit.