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?

Unexpected illnesses wipe out all your savings. CignaTTK offers a health insurance plan that provides below benefits in one policy. 

Basic Covers Value Added Covers Optional Covers Add on Cover

a. In patient 

Hospitalization cover

a. Health Check-Up a. Deductible* a. Critical Illness Add on

b.Pre/Post Hospitalization cover

b.Expert Opinion on CI b. Reduction in Maternity Waiting  
c. Day Care treatment c.Cumulative Bonus c. Voluntary Co-pay*  
d. Domiciliary treatment d. Healthy Rewards *Voluntary Co-pay and Deductible
cannot be
taken under a single plan.
 
e. Ambulance Cover      
f. Donor expenses      
g.Worldwide Emergency Cover      
h. Restoration of Sum Insured      
i. Maternity Expenses & New
Born Baby Expenses
     
j. First Year Vaccinations      

 

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 and Value Added covers as detailed in (Q2) will be available as per the plan and SI 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 4 plan types (Protect/Plus/Preferred/ Premier)

 

Protect 2.5 , 3.5 , 4.5 Lacs
Plus 4.5 , 5.5 , 7.5, 10 Lacs
Preferred 15, 30, 50 Lacs
Premier 1 Cr

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)

Is there any tax benefit?

Yes. Premium paid under the Policy shall be eligible for income tax deduction benefit under Sec 80 D of the Income Tax Act and any amendments thereon.

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 of consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted under a day care or as an in-patient.

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.

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-hospitalization medical expenses include expenses incurred immediately after the insured is discharged from the hospital provided that:

iii. Such medical expenses are incurred for the same condition for which the insured's Hospitalization was required

iv. An in-patient hospitalization claim is admissible for that hospitalization by CignaTTK Health Insurance.

Are all the systems of medicine covered under this insurance plan?

Any form of Non-Allopathic treatment, Naturopathy,hydrotherapy, Ayurvedic, Homeopathy, Acupuncture,Reflexology, Chiropractic treatment or any other form of indigenous system of medicine are permanently excluded under this policy. However you can cover AYUSH treatments 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:

i. The condition of the patient is such that he/she cannot be moved to a hospital, or

ii. The patient takes treatment at home under the care of a medical practitioner on account of non-availability of room in a hospital.

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 and Delhi NCR

Zone II: Bangalore, Hyderabad, Chennai, Chandigarh, Ludhiana, Kolkata, Gujarat

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#.

#Co-payments will not be applicable on emergency hospitalization due to Accidents.

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 diseases are included in Critical Illness?

Critical Illness includes

a. Cancer of specified severity

b. First Heart Attack of specified severity

c. Open Chest CABG

d. Open Heart Replacement or Repair of Heart Valves

e. Coma of specified severity

f. Kidney failure

g. Stroke resulting in permanent symptoms

h. Major Organ or Bone marrow transplant

i. Permanent Paralysis of limbs

j. Motor Neurone Disease with Permanent Symptoms

k. Multiple Sclerosis with Persisting Symptoms

What is covered under maternity benefits?

Maternity benefits include expenses for the delivery of child or expenses related to medically necessary and lawful termination of pregnancy.

Maximum to 2 deliveries / terminations covered during the lifetime of an insured between the age group of 18-45 years.

Coverage will be restricted to the sum insured as per policy.

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 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.

What are Healthy Rewards?

Healthy Rewards are points earned for each year of premium payment and these will be accumulated for 2 years. Points can Details of available online programs and rewards that can be accrued are provided below 

Online Program Reward Points under Protect Plan Reward Points under Plus Plan Reward Points under Preferred Reward Points to be earned under Premier Plan
Health Risk Assessment (HRA) 25 40 80  120
Targeted Risk Assessment (TRA) 50 80 160 240
Online Lifestyle Management Program (LMP) 50 80 160 240

 

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

This benefit provides for reimbursement of 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 Protect and Plus plan and upto Rs.10 lacs for Preferred and Premier plan.

Expenses will be limited to in-patient and day care hospitalization only. All payments will be in Indian rupees 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 available only for future claims that become payable under the policy (not allowed for the 1st claim under the Policy).

iii. 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.

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

v. The benefit is available only once during the policy year.

* 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.

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

Insured can opt for a reduction in maternity waiting period by A: An individual policy can be taken for self, spouse, parents, paying 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).

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 dependent during each policy period.

What do you mean by Entry Age?

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

Is there a maximum entry age?

Yes, for children the Maximum age at entry is 23 years in case of a floater and for adults it is Lifetime. 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.

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.

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 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 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 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 amounts.

What is a Cumulative Bonus?

It means an increase in the Sum Insured granted by the insurer for a claim free policy period without an increase in the premium.

Who can be covered in ProHealth?

An individual policy can be taken for self, spouse, parents, siblings, in-laws, grandparents and grandchildren.

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

Is Medical Test mandatory for everyone?

Medicals will be triggered on the basis of the age of t insured, the plan type and sum insured selected.

For Protect plan no medicals are required for the insured upto age 45 years.

For Plus plan with Sum Insured upto 7.5 lacs and age upto 45 years medicals will not be triggered.

For Plus plan with 10 lacs Sum Insured and age upto 40 years medicals are not required.

For Preferred and Premier Plans medicals are mandatory irrespective of the age & the Sum Insured chosen.

** 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.

Who will pay for pre-policy medical checkup?

The total cost of all medical tests will be borne by us (CignaTTK Health Insurance).

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.

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.

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 do you mean by Policy Start Date?

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

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 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.

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.

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 the Policy Tenure?

The policy tenure available is either 1 year or 2 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?

Yes, new born aged 91 days and upto 23 years will be covered in this policy.

Children between the age group of 3 months (91 days) to 5 years will be covered only if either of the parents is covered. Children from 6 years to 18 years will only be covered if one of the parents is the proposer.

Siblings between 91 days to 5 years will be covered if at least 1 adult sibling is covered under the policy.

Grandchild between 91 days to 5 years will be covered if at least 1 adult grandparent is covered under the policy. Children beyond 23 years if dependent on the parents can be covered under an individual policy

**The baby should be born to an insured and legally wedded wife or a lawfully adopted child.

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.

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. Genetic Disorder

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 & medical appliances.

10. Treatment of any mental diseases.

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 foreign 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. 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.

  o Must have been prescribed by a Medical Practitioner.

  o Must confirm to the professional standards widely accepted in international medical practice or by the medical community in India.

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 filling up the ProHealth Insurance - Proposal Form and submitting 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.

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 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

2.5 Lacs,

3.5 Lacs,

4.5 Lacs,

 

>18 years MER, ECG, Total Cholesterol, FBS, Sr. Creatinine, CBC, Urine Routine, SGPT
Plus

4.5 Lacs,

5.5 Lacs,

7.5 Lacs,

10 Lacs

18 to 40 years MER, ECG,CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT,SGPT, GGT, Uric Acid
    >= 41years

MER, ECG,CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT, SGPT,GGT, Uric Acid

For females only - TSH, Pap smear, Mammogram

For males only - PSA

Preferred & Premier

15 Lacs,

30 Lacs,

50 Lacs,

18 to 40 years

MER, Lipid Profile, HbA1c, Sr. Creatinine, CBC-ESR, RUA, SGPT, ECG, SGOT,GGT, Uric Acid

For females: Pap smear, TSH, Mammogram

For males: PSA

  100 Lacs

>= 41 years

(For males only)

>= 41 years

(For females only)

MER, CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT, SGPT, GGT,Uric acid, TMT, USG Abdomen & Pelvis, PSA

MER, CBC-ESR, Lipid Profile, HbA1c, Sr. Creatinine, RUA, SGOT,SGPT, GGT, TMT, Uric acid, USG Abdomen & Pelvis, Pap smear, Mammogram,
TSH