Overview of ProHealth Prime Active
The ManipalCigna ProHealth Prime Active plan offers coverage for inpatient hospitalization, pre- and post-hospitalization expenses, and AYUSH treatments. It also provides value-added benefits like unlimited teleconsultations, a premium waiver on critical illness or accidental death, and a cumulative bonus to increase the sum insured. A standout is its 100% restoration benefit but only for unrelated illnesses.
Experts' Review of ProHealth Prime Active
Written by Nikhil Nair
Senior Writer
The ManipalCigna ProHealth Prime Active plan has a lot going for it in terms of coverage and features. Its restoration benefit is a big plus as it ensures that your coverage is restored to 100% of the sum insured any number of times in a policy year. With this, you can rest easy even if you have multiple hospitalizations. One thing to note is that this only applies for unrelated illnesses or injuries.
What I also like are the value-added covers, such as Premium Waiver Benefit, Domestic Second Opinion and Wellness Program. A key feature is its 90-day waiting period for treatment of pre-existing Asthma, Diabetes, Hypertension, Dyslipidemia, and Obesity, which is significantly less than the standard 24 months.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Day Care treatments covered, a highly valued feature.
Covers Alternative Medicine, which adds significant value to the policy.
Cons
Premiums are relatively high.
Special Bonus for being healthy and not claiming insurance, which is a notable gap.
Some coverage if you are forced to hospitalize at home, which could be a drawback for some.
Maternity benefits not offered, which is a key feature.
Manipal Cigna
Key Insights
Founded
2014
Manipal Cigna was established 12 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
90% CSR, calculated as a 3-year average
Manipal Cigna settles 90% of all claims it receives. This is reasonable performance, though there is room for improvement compared to top insurers.
Network Hospitals
14,000+
Manipal Cigna has a strong network with over 14,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
18 complaints per 10,000 claims registered
Manipal Cigna experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Features of ProHealth Prime Active
Co-payment
The policy will only cover 90% of the final bill. The rest is on you. They call this a co-payment.
Customisable
Waives off 10% of the co-payment.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
Your insurance cover won't be fully available in case you are treated for hernia, hysterectomy, benign prostate hypertrophy, stones, cataract, total knee replacement, breakage of bones, modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they'll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you are already dealing with Asthma, Diabetes, Hypertension, Dyslipidaemia & Obesity related conditions, then the insurer will cover you after 90 days. However, if you are dealing with other pre-existing diseases including thyroid and cardiovascular problems, then you’ll have to wait 2 years before they start covering these complications.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons of ProHealth Prime Active
Consumables Cover
Recommended
Covers list of 68 non-medical items as per list I
Worldwide Accidental Emergency Hospitalization Cover
Get international coverage up to 100% of the sum insured over and above the base cover for accidental emergency hospitalization.
Waiver of Mandatory co-payment
Waives off 10% of the co-payment.
Exclusions in ProHealth Prime Active
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract and other disorders of lens and retina
Hysterectomy for menorrhagia, fibromyoma, prolapse of uterus, or myomectomy for fibroids (unless necessitated by malignancy)
Surgery of hernia
Surgery of hydrocele
Benign ear, nose, and throat (ENT) disorders and surgeries (including tonsillectomy, adenoidectomy, mastoidectomy, tympanoplasty)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in ProHealth Prime Active
Special Bonus for being healthy and not claiming insurance.
Some coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Reviews for ProHealth Prime Active
S
Shreedhar Kulgod
The unlimited teleconsultations are the bit I actually use. Two calls a month for my younger one and nothing gets debited from the 10L cover. The Premium Waiver Benefit sold it to me though if I'm diagnosed with a critical illness the next renewal premium is waived. That's a thoughtful thing to build in.
F
Firoza Chhipa
AYUSH is covered up to the full sum insured, not some token 25 percent, and my mother-in-law's ayurvedic inpatient stay went through without a fight. Took 11 days for the reimbursement but no queries. Fair.
V
Vrushali Nadgouda
there's a 10% co-pay on every claim which nobody flags loudly enough at the time of buying. i paid extra for the Waiver of Mandatory Co-payment add-on, which basically means the base product is priced twice. works fine after that, but it's an annoying design.
T
Tapan Bhuyan
Restoration says 100% and unlimited, which sounds great until you read that it only triggers for an unrelated illness. My father had two cardiac admissions in the same year same condition so the second one had nothing to restore into. Read that line carefully.
K
Kanchan Rawat
Health check-up comes once in three years. Every other policy I looked at does it annually. For a plan sitting in the expensive bracket that's a strange corner to cut.
Frequently Asked Questions
Does ProHealth Prime Active have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 2-year waiting period for any pre-existing disease you may have while buying the policy.
- 90 days waiting period for illnesses and conditions arising out of Asthma, Diabetes, Hypertension, Dyslipidaemia & Obesity.
Does ProHealth Prime Active have room rent restrictions?
Does ProHealth Prime Active offer a restoration benefit?
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