Cigna TTK’s ProHealth Insurance Accumulate plan is a unique health insurance plan. This plan allows you a comprehensive scope of coverage along with creating reserves for future use. You get a Health Maintenance Benefit (HMB) under the plan which can be accumulated for future use. Furthermore, a bonus is also added to the accumulated HMB which enhances its value.
- The plan allows you to save for future medical expenses through Health Maintenance Benefit (HMB) feature
- HMB can be used to pay for any non-covered medical expenses
- Unused HMB is carried forward
- Bonus is declared on HMB even if you make a claim in any policy year
- Premium discounts are given if you maintain a healthy lifestyle
- There are other premium discounts as well which help in reducing the premium charged
Scope of cover
|Entry age||Adults – 18 years|
Children – 91 days
|Number of members covered||Minimum – 1|
|Sum Insured||Rs.5.5,7.5,10,15,20,25 lakhs|
|Family Discount applicable||10% if more than 2 members are covered|
|Policy periods available||1,2 or 3 years|
|Pre-policy medical check-up||Required|
Common benefits and features
- Hospitalisation expenses cover – if you are hospitalised and your stay exceeds 24 hours, you get coverage for the medical expenses incurred. A single private AC room is allowed and coverage for doctor’s fee, oxygen, blood, surgeon’s fee, etc. is given.
- Emergency Ambulance – if you require an ambulance to take you to the hospital, the charges incurred on the ambulance are covered for up to Rs.2000
- Pre hospitalisation – any expense incurred before hospitalisation is covered for up to 60 days.
- Post-hospitalisation – expenses which are incurred after hospitalisation are also covered for up to 90 days,
- Day care treatments –There are treatments which do not require 24-hour hospitalisation. They are called day-care treatments and they are covered by the plan.
- Domiciliary hospitalisation – treatments taken at home are covered under the plan if such treatments continue beyond 3 days. Coverage is available only if you cannot be moved to a hospital or there is no hospital bed.
- Cumulative Bonus – on the amount of Health Maintenance Benefit available at the end of the policy year, a 5% bonus is added whether you make a claim under the plan or not. Furthermore, if you do not make any claim in a policy year, your sum insured is increased by 5%. This increase is cumulative for every claim-free year up to a maximum of 100%.
- Organ donor cover – if you require an organ transplant and there is an organ donor, the expenses incurred in hospitalisation of the donor for harvesting the organ are covered under the plan.
- Sum insured restoration – if you use up your original sum insured on any major claim, the plan restores the sum insured by 100% to meet any new claim.
- Health Maintenance Benefit – a lump sum benefit is paid by the plan every year. This can be used to avail treatment on an out-patient basis where there is no hospitalisation or for AYUSH coverage. You can also use this benefit to pay for any non-payable expenses under the plan. This is called Health Maintenance Benefit (HMB) and the amount is Rs.5000, Rs.10, 000, Rs.15, 000, or Rs.20, 000. If the HMB is not used in the year, it is carried forward to the next year.
- Free health check–ups – if you are above 18 years of age, you can avail free health check-ups once after every 3 policy years.
- Worldwide emergency cover – the plan doesn’t have any geographical limitations. Coverage is allowed worldwide.
- Expert opinion on critical illness– if you are diagnosed with a critical illness, you might need a second opinion. The plan allows you to opt for expert opinion on your illness free of cost.
- Premium discounts – you can avail various premium discounts under the plan. For covering more than 2 family members you get a discount of 10%. For a 2-year policy period there is a discount of 7.5% and for a 3-year policy period there is a discount of 10%. You can avail a further 10% premium discount if the policy is bought online from the company’s website.
- Healthy rewards – you can get 1% premium credit for each premium payment. This credit is a reward point which can be accumulated by choosing the company’s online wellness programs. These accumulated reward points, up to a maximum of 10% can be availed as discounts in renewal premiums.
Optional Additional Features
- Waiver of mandatory co-payment – there is a compulsory co-payment for individuals aged 65 years and above. You can opt for the waiver of this co-payment by paying an additional premium.
- Deductible – there are deductible limits of Rs.50, 000 and Rs.1-5 lakhs. If you choose any deductible amount it means that you would pay such amount in case of claim and the company would pay the rest. If you choose this deductible feature you can get a premium discount.
- Voluntary co-payment – instead of deductible, you can choose a voluntary co-payment of 10% or 20%. This would mean that the first 10% or 20% of the claim amount would be paid by you. Choosing voluntary co-payment earns a premium discount.
- Cumulative bonus booster – this add-on increases the rate of no claim bonus. You can earn 25% increase in sum insured through this booster instead of 5% if you don’t make any claim.
- Critical illness add-on – the plan provides an optional cover for critical illness. 11 major illnesses are covered and if you are diagnosed with any one you get the sum insured paid in lump sum.
Terms and Conditions
- Co–payment – a co-payment of 20% per claim would be applicable if the age is 65 years and above. This means that you would have to pay 20% of the claim amount on each and every instance of claim.
Waiting period and exclusions
- Cooling-off period – any illnesses or diseases suffered within the first 30 days of buying the policy are excluded from coverage.
- Waiting period for specific illnesses –treatments like cataract, gall bladder diseases and treatments, transplant related surgeries, etc. are not covered in the first 2 years of the policy.
- Waiting period for pre-existing illnesses – If you suffer from pre-existing illnesses or conditions, such illnesses or conditions would be covered after 4 consecutive policy years.
- Waiting period for critical illness add–on – if the critical illness add-on is opted, the illness should appear after the first 90 days of the policy. Moreover, the insured should survive for at least 30 days after the diagnosis of the illness to receive the benefit.
- Standard Exclusions –
- Illnesses or injuries suffered due to suicide, war and war-like situations, nuclear weapons or materials, participation in hazardous activities, etc. are not covered.
- Moreover, circumcision, dental treatments, etc. are also not covered.
- Treatment outside India is not covered
- Hospitalization for diagnosis purpose with no specific treatment
- Non-allopathic form of treatment or naturopathy
- Self-inflicted injury, alcohol or drug abuse, HIV/AIDS, etc.
Cigna TTK ProHealth Insurance Accumulate Plan is suitable if you are looking to build a reserve health plan for future uses. The plan is suitable for yourself and your family too.
The plan provides a unique benefit called Health Maintenance Benefit which can also be carried forward to subsequent policy years if it is not used. You also earn a bonus on the accumulated benefit. IN terms of coverage, the plan is exhaustive and the sum insured levels are also optimal.
You can port out of ProHealth Insurance Accumulate Plan and choose another plan of the same company or another company. Porting is allowed if you make a formal request to the insurance company for porting at least 45 days before the policy renewal date.