Cigna TTK ProHealth Group Insurance Policy- Features & Exclusions

Updated: 22-01-2024 11:20:36 AM

Employers and institutions are highly valued when they look after the health of their members through health insurance. Coverage for health is one of the best ways for an organization to treat its members like family and form a strong bond. Cigna TTK ProHealth Group Insurance Policy is a specialized product offering that provides basic coverage along with a myriad of customizable cover options for both employer-employee groups and for other types of organizations as well. Furthermore, to serve the unique healthcare needs of different individuals, Cigna TTK provides comprehensive healthcare options to ensure quality healthcare.

Eligibility Criteria

Eligibility criteria for the plan are mentioned in the table given below:

Parameters	Details
Sum Insured (Max)	Rs. 100 lakhs
Sum Insured (Min)	Rs. 5,000
Minimum age required	No bar on minimum age
Maximum age required	No bar on maximum age
Other Criteria
Should be an employee or group member of the organization
Coverage can be extended to member’s spouse as well as dependent parents
Dependent children of age less than 25 can be covered under the policy
Renewal can be extended for lifetime

Features of Cigna TTK ProHealth Group Insurance Policy

Mentioned below are the features of the plan:

• Under this policy, there is a choice available for members to choose between individual basis and family floater basis.
• Apart from the benefits of the base cover, 7 in-built additional facilities will be provided.
• Option to add 41 additional cover options to the base cover benefits
• This policy also covers AYUSH treatment, which includes facilities such as Ayurveda, Unani, Yoga, Sidha, Naturopathy, as well as Homeopathy.
• The unique feature of the plan is that you can accumulate the benefits of the plan forward if policy is renewed.
• Option to include covers such as accidental cover, hospital cash benefits, as well as a cover for critical illness.
• Can extend cover and provide benefits to family members as well
• Easily add or remove plan extensions
• Flexible payout options such as fixed payout and indemnity payout
• Responsive dedicated service provided for advanced assistance.
• Grace period of 30 days is provided after completion of policy term. However, no claims will be received in the grace period of the policy.

Advantages Cigna TTK ProHealth Group Insurance Policy

There are some of the major advantages covered under the plan as mentioned below:

• Hospitalization charges
• Expenses for day-care procedures
• Pre-hospitalization expenses
• Post-hospitalization expenses
• Expenses for Road Ambulances
• Hospitalization at home
• Donor expenses

Also Read: CignaTTK ProHealth Cash and its Types, Eligibility & Exclusions

Optional Covers (41 types of optional covers)

1. Disease category sub limit
2. Maternity charges coverage
3. Out-patient treatment
4. Accumulate cover
5. In-patient hospitalization
6. Deductible on treatment/surgery
7. Voluntary co-payment of hospital expenses
8. Annual Aggregate deductible
9. Deductible on per-claim basis
10. Corporate deductible allotment for groups
11. Setting a cap on out-of-pocket expenses
12. Completely customized directed plan
13. Specific re-imbursement only cover
14. Daily hospital cash benefit
15. Critical illness cover
16. Individual accidental cover
17. Dental charges cover
18. Eye-care expenses cover
19. Cover for refractive keratotomy and LASIK surgery
20. Physiotherapy charges cover
21. Routine vaccination cover
22. Home-nursing cover
23. Regular health check-up cover
24. Emergency cover for family member for accident
25. Air-ambulance cover
26. Cover for emergency evacuation
27. Cover for medical equipment expenses
28. Cover for Bariatric surgery
29. Special cover for taking part in adventure activities
30. Birth control procedure coverage
31. Cover for IVF or other fertility treatments
32. In-patient hospitalization expenses for AYUSH treatment (alternative medicine treatment cover)
33. Extended accidental cover
34. Global emergency coverage
35. Base sum restoration cover
36. Cumulative bonus on base sum insured
37. Corporate buffer
38. Corporate buffer exclusive for critical illness coverage
39. Healthy living rewards program
40. Health maintenance reward program
41. Wellness management program

Free Look Period

This policy provides the first 15 days since policy initiation as free-look period. During this period, members can return policy papers to opt out of insurance. However, it is not allowed if any claims are made within the first 15 days of the policy. Any premium paid during this period is returned after deducting the risk premium.

Pre and Post-Hospitalization

Base Plan Coverage	30 days of pre-hospitalization and 60 days of post-hospitalization
Extended cover option 1	60 days of pre-hospitalization and 90 days of post-hospitalization
Extended cover option 2	90 days of pre-hospitalization and 180 days of post-hospitalization

Exclusions under the plan

• Any type of beauty treatments, detox procedures, spa treatments are not covered under the policy
• Expenses related to purchase spectacles, lenses, or any other visual aids are not covered under the policy.
• Stem-cell therapy and related procedures are not covered.
• Unless medically required to prevent more damage, circumcision is not covered under the policy
• Any type of birth control procedures or hormone replacement therapies are not covered
• Expenses for hearing aids and ear-exams
• Any type of hair-fall treatment or laser hair surgeries are not covered
• Treatment expenses for venereal diseases or other STDs
• Expenses to treat or help with developmental problems such as dyslexia or ADHD
• Conditions such as debility or generally run-down are not covered
• Any condition or injury caused by self-inflicted harm will not be covered under the policy
• Medical procedures for increasing fertility such as hormone replacement therapy and IVF
• Treatment for any psychiatric condition or mental disorder, as well as admission in a facility that treats mental disorders.
• Any procedure or treatment performed outside India
• Injury or illness as a result of participation in adventurous activities such as rafting, scuba diving, rock-climbing, mountaineering, bungee jumping, etc.
• Any injury caused as a result of foreign invasion, war, and acts of terrorism

Filing Claim with Cigna TTK ProHealth Group Insurance Policy

There are 2 types of scenarios when it comes to reporting claims:

• Under planned hospitalization, you should contact Cigna TTK 3 days prior  to hospitalization. After admission in a network hospital, you have the choice of either opting for cashless claim or re-imbursement. In cashless claims, the insured member has to show a Cigna TTK card at the hospital and pay a small security deposit.
• Under unplanned instance of hospitalization, you have the option of choosing cashless/re-imbursement. After paying at the hospital, the insured member has to visit www.cignattkinsurance.in and download the claim form. You have to report the claim for re-imbursement while attaching the required documents.

Renewal Process with Cigna TTK ProHealth Group Insurance Policy

• The policy would be considered fresh if there is a break of more than 30 days between the previous policy expiry date and start of current policy.
• Waiting period will be considered fresh if opted for increased sum insured

Documents Required to Claim Insurance

• Duly filled Claim-form
• Medical Certificate from consulting doctor to confirm Critical Illness
• Certificate from Medical doctor to confirm that the claim does not relate to pre-existing illness or injury
• Discharge Summary
• Diagnostic examination reposts showing critical illness
• First consultation letter and doctor’s prescriptions
• KYC documents
• Critical illness specific documents
• FIR copy in case of an accident is the primary cause of critical illness
• As per case situations, the insurance company can ask other relevant documents.

FAQs

Q1. What is the range of sum insured for ProHealth Group Policy?

You can insure an amount from INR 5,000 up to INR 1,00,00,000 under this policy.

Q2. What is day-care treatment?

Instance of treatment in hospital where the discharge is given within 24 hours are considered as day-care treatments.

Q3. Is home-nursing and domiciliary treatment the same?

No. While home-nursing is a special type of treatment provided for assistance to people for daily activities such as bathing, eating, washing, etc., domiciliary treatment is a scenario where treatment has to be provided at home. It can happen if there is a lack of availability of rooms as a hospital or treatment has to be started urgently.

Q4. How can I use the amount generated through the accumulate benefit?

You can use the amount generated through accumulate benefit to pay for your deductibles and co-payment. Another thing to keep in mind is that your unused ‘sum insured’ will also be carried forward to the next year.

Q5. What are deductibles?

Deductible is the amount that will be paid out-of-your pocket for medical expenses before the medical insurance provider starts paying for them. For instance, if the deductible is set at INR 20,000, you will pay for your medical needs up to that amount, after which Cigna TTK will take over.

Q6. What is co-payment?

If you opt for 50% co-payment, it implies that 50% of your medical expenses will be covered by the insurer and you will pay the rest of the 50% out of your pocket.

Q7. Can I opt for both deductibles and co-payment?

No. you can only opt for either one of these additional covers for your policy.