ManipalCigna Health Insurance Claims Procedure

Manipal Cigna has become a household name when it comes to being a medical insurance provider. Not only does it have a wide range of hospitals in its network and provide great cover it also has a very hassle free claim process to make it one of the most popular and competitive insurance providers in the market. The claims are mainly cashless claims and reimbursements claims. Cashless claims involve both emergency visits and planned visits wherein Manipal Cigna settles the bill directly with the hospital and reimbursement claims, it reimburses the money spent on hospitalization expenses by the patient or the policyholder. Manipal Cigna has a huge network of hospitals that provide for . The process to apply for a claim are discussed below.

Incurred Claim ratio of Manipal Cigna Insurance:

Before moving onto the process, it behoves one to know the ICR of Manipal Cigna. ICR stands for Incurred Claim Ratio and differs from Claim Settlement ratio. ICR is the Incurred claim ratio which is the overall amount or value of claims paid by the company divided by the total sum of premiums collected by that company for a specified period. The ICR is not indicative of time taken to settle a claim. The valuable ICR data is published by the IRDA on a yearly basis and the below table highlights the Incurred Claim ratio of Manipal Cigna for the year 2014-15 and 2015-16

Incurred Claims Ratio of Manipal Cigna Health Insurance for the Year 2016-17:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
181.77 crore 87.50 crore 48.14%

Incurred Claims Ratio of Manipal Cigna Health Insurance for the Year 2017-18:

Net earned premium (in Crore) Net claims paid (in Crore) Incurred claims ratio(in %)
266.14 crore 123.20 crore 46.29%

Even though the net earned premium and net claims paid numbers are lower than other insurance providers the ICR of Manipal Cigna is in a good position and shows that the insurance products from Manipal Cigna are high quality products that are favoured by customers.

Claim procedure:

With Manipal Cigna Insurance, the claims procedure varies for cashless claims and reimbursement claims. The procedure for cashless and reimbursements are mentioned below.

Cashless Claim:

In cashless claim, as the name suggests, the patient or policyholder is not required to pay the main hospital bill as Manipal Cigna will settle the bill with the hospital directly. They may still however need to pay for other charges not covered by the health insurance policy.

Cashless Claims Procedure for Emergency Admission:

Emergency hospital visits are seldom planned and can cause enough worry without adding financial burden to the equation. During the time of admission, the patient should check if the hospital falls in the cashless claim network. If so, then the below procedure needs to be followed:

  • Intimate Manipal Cigna of the emergency hospital admission within 48 hours by calling on the toll free number which is 1800-102-4462. Reach out to the hospital insurance help desk and provide key details such as Manipal Cigna health card and valid photo ID. The hospital should then fill in the details of the cashless claim and send it over to Manipal Cigna along with details of medical history, an estimated cost and the line of treatment to be provided. This claim needs to be certified by the attending doctor. Manipal Cigna may request for additional documents as and when necessary
  • Along with the submitted documents, Manipal Cigna may require additional supporting documents. The claim will be reviewed upon receipt of the required documents and if approved, the hospital bill will be paid by Manipal Cigna. There may be some additional expenses that may not be covered by the insurance policy. In such cases, the expenses will have to be borne by the patient or policyholder.
  • If for any particular reason a claim is not approved by Manipal Cigna then the bills and other expenses need to be borne by the patient and a request for reimbursement can be filed. Rejection of a cashless claim does not void a reimbursement claim. In cases of rejection, a rejection letter stating the reasons for rejection will be issued.

Cashless Claims Procedure for Planned Admission:

If the patient or policyholder plans on admitting themselves for a particular treatment in a hospital that is on the cashless claim network then they need to follow the below procedure for claiming the cashless facility

  • Firstly they need to select the hospital they plan to admit themselves into from the cashless claim network
  • Then they must intimate Manipal Cigna about the admission at least 3 days prior to admission by calling the toll free number 1800-102-4462
  • The cashless request form must then be filled in by the patient or policyholder and faxed to Manipal Cigna along with other relevant details such as photo id and the Manipal Cigna Health Card. The hospital insurance help desk will then forward the insurance claim along with the necessary medical documents and a certificate from the attending doctor.
  • Manipal Cigna will then review the submitted documents and in some cases request for further documents. Upon the receipt of all required documents, Manipal Cigna will review the documents and approve the claim. If the claim is rejected for some reason, the rejection letter stating the reasons of rejection will be issued to the policyholder. In such cases, the policyholder will have to pay for the hospital expenses and file for a reimbursement claim

Reimbursement of Treatment Expenses:

Certain times, the cashless claim may be rejected for a variety of reasons. Lack of documents or the hospital the patient is being admitted into not falling in the cashless claim network are the primary reasons for rejection of cashless claims. In such cases, the hospital expenses need to be borne by the policyholder and they can then file a claim for reimbursement of expenses incurred. Patients or policyholders need to follow the below procedure to make reimbursement claims.

  • Firstly the sooner one intimates Cigna TK of the admission or treatment, the better the chances are of successful reimbursement. Claim intimations can be done by calling on the toll free number which is 1800-102-4462
  • Patients or policyholders must provide key information such as policy numbers while making intimations along with details of their health card
  • The claim form can be downloaded from the official website or use the claim form provided in the policy packet or can collect the form from their nearest Manipal Cigna Branch.
  • The claim form needs to be duly filled in along with the necessary documents such as original bills, discharge summaries, prescription receipts and investigative reports and mailed or faxed to the Manipal Cigna Branch.

Documents Required:

Documents required while applying for reimbursement claims are as follows

  • The duly filled claim form along with the certificate from the attending doctor
  • Discharge summary along with other related documents such as the original hospital bills, pre and post hospitalization reports including investigative reports, results and their receipts and their corresponding receipts for prescriptions purchased outside the hospital, prescriptions notes from the attending doctor and other documents as mentioned in the claim form

Claims Process:

  • The claim processing team review the documents submitted. If there is a need for additional documents, the same will be requested by ManipalCigna and upon their receipt the claims will be assessed
  • The claims if approved will be paid by ManipalCigna to the policyholder either through a cheque or DD or through online transfer of funds.

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