Cigna TTK Health
About Cigna TTK
- Cigna TTK Health Insurance Company Limited is a joint venture between the U.S. based global health services leader, Cigna Corporation and Indian conglomerate, TTK Group. Company received the regulatory license from IRDA in November 2013 and launched its operations in February 2014.
- ProActiv Living, Cigna TTK’s unique approach to the Indian market provides assistance based on medical, behavioral and lifestyle factors associated with chronic conditions, which includes a number of services designed to help customers better understand and manage their health.
- Cigna TTK’s mission is to improve the health, well-being and sense of security of the people they serve.
- The Company will strongly leverage Cigna’s global health service expertise along with the trust, credibility and experience of the TTK group, to offer products and services exclusively designed for Indian market.
About Health Insurance
- Cigna Health Insurance Plan provides adequate insurance coverage to the Insured, for expenses related to medically necessitated hospitalization for a minimum duration of consecutive 24 hours due to an Illness, Disease or an Accidental Injury.
- The basic criteria for the policy to trigger is Hospitalization for minimum of 24 hours and administered with an active line of treatment which is advised by a Medical Practitioner.
- The only exception to the above is the Day Care Procedures which are covered (Only Listed Treatments) due to the medical advancements even if the hospitalization is only for a few hours.
Why Cigna TTK ProHealth Insurance ?
- Save up to 30% of premium under various discounts.
- More coverage with 100% restoration of sum insured.
- Additional non-reducing Cumulative Bonus
- Reduce your renewal premium up to 10% with healthy rewards.
- Total protection with Protective Healing and ProActiv living.
- One of its kind with Health Maintenance Benefit
- Emergency Worldwide cover up to sum insured.
Plans In Cigna TTK
Accommodation charges will be covered as per the plan choosen by the insured.
Pre and Post Hospitalization
Pre Hospitalization: Cigna TTK will cover medical expenses of an Insured person due to a disease or injury or illness incurred immediately prior to hospitalization, up to the limits specified under the plan opted by the Insured subject to a claim being admissible under In-patient Hospitalization and expenses are related to the same illness/condition.
Post Hospitalization: Cigna TTK will cover medical expenses of an Insured person incurred post hospitalization due to a disease or injury or illness up to the limits specified under the plan opted by the Insured subject to a claim being admissible under In-patient Hospitalization and expenses are related to the same illness/condition.
Day Care Procedures/ Treatments
- Cigna TTK will cover payment of medical expenses of an Insured Person in case of medically necessary day care treatment or surgery that requires less than 24 hours hospitalization due to advancement in technology and which is undertaken in a hospital / nursing home on the recommendation of a medical practitioner.
- Cigna TTK covers 171 day care procedures.
- Some of the day care procedures are :- Cataract, Chemotherapy, Dialysis, Hemodialysis.
- Cigna TTK will cover medical expenses of an Insured person for treatment of a disease, illness or injury taken at home which would otherwise have required hospitalization or since the Insured person's condition did not allow a hospital transfer or a hospital bed was unavailable.
- This is provided that, the condition for which treatment is required continues for at least 3 days and is on the advice of a medical practitioner. Claims for pre-hospitalization expenses up to 30 days shall be payable, however, post-hospitalization medical expenses shall not be payable.
- Cigna TTK will cover in-patient hospitalization medical expenses towards the donor for harvesting the organ in case of major organ transplant if it is in accordance with the Transplantation of Human Organs Act 1994 (amended) and other applicable laws and rules. The organ donated is for the use of the Insured person per Medical Advice and a claim has been admitted under in patient hospitalization.
- However, Pre-Post hospitalization expenses towards the donor, cost towards donor screening, cost directly or indirectly associated to the acquisition of the organ or any other medical treatment for the donor consequent on the harvesting will not be covered.
World Wide Emergency Cover
- Those medical expenses incurred for emergency treatments for an illness or injury sustained or contracted outside of India which cannot be postponed until the Insured Person has returned to India up to limits specified under the plan opted by the Insured and admissible under In Patient Hospitalization cover as per the terms of the Policy.
- Such treatment received outside India should be medically necessary and has been certified as an emergency by a medical practitioner and intimation of such hospitalization has been made to us within 48 hours of such admission.
- The medical expenses payable shall be limited to Inpatient hospitalization and shall be made in India and in Indian Rupees on reimbursement basis. Cashless Facility may be arranged on a case to case basis. Insured Person can contact Us at the numbers provided on the Health Card for any claim assistance. In case where Cumulative Bonus accumulated is used for payment of claim under this benefit, the maximum liability under a single Policy year shall not exceed the Opted Sum Insured including Cumulative Bonus or Cumulative Bonus Booster as applicable.
Restoration Benefit For New Illness
- In case the Sum Insured inclusive of earned cumulative bonus (if any) or Cumulative Bonus Booster (if opted) is insufficient due to claims paid or accepted as payable during the policy year, then we will restore 100% of the Sum Insured once in a policy year. This restored amount can be used for all future claims not related to the illness/disease/injury for which a claim has been made in the particular policy year for the same Insured Person. Restoration will not trigger on the first claim.
- In case the Restored Sum Insured is not utilized in a policy year, it shall not be carried forward to subsequent policy year. Any restored Sum Insured will not be used to calculate the Cumulative Bonus or Cumulative Bonus Booster
Health Maintenance Benefit (OPD)
- For Protect, Plus, Preferred & Premier Plans We will cover, only by way of reimbursement costs towards Reasonable and Customary Charges incurred by the Insured Person for Medically Necessary charges incurred on an Out Patient basis. We will cover costs incurred towards:
- Diagnostic tests, preventive tests, drugs, prosthetics, medical aids, prescribed by the specialist Medical Practitioner up to the limits specified in the Schedule.
- Towards Dental Treatments and Alternative Forms of Medicines wherever prescribed by a Medical Practitioner.
- Any unutilized HMB limit shall lapse at the end of the Policy Year and fresh limits will be available as per the Plan under the new Policy Year.
- Cigna TTK will cover Maternity Expenses for the delivery of a child and/or maternity expenses related to medically necessary and lawful termination of pregnancy limited to maximum 2 deliveries during the lifetime of an Insured person between 18 years to 45 years, subject to limits under the plan opted by the Insured.
- The Insured person should have been continuously covered under this policy for at least 48 months before availing this benefit, except in case of opting for 'Reduction in maternity waiting' where the limit will be relaxed to 24 months of waiting.
New Born Baby
First Year Vaccination
Value Added Covers
- Cigna will provide for a comprehensive Health Check-Up as listed in the eligibility table below, to all Insured Persons who are 18 years of age. Heath Check Ups will be available irrespective of their claim status under the policy and will be arranged by Us at Our network providers.
- The coverage under this benefit will not be available on reimbursement basis.
- Any claim under this benefit shall not impact Cumulative Bonus.
- For Protect & Accumulate plan -available once every 3rd Policy year.
- For Plus, Preferred and Premier Plan -available once each year, excluding the first policy year.
List of Health Check-ups for Protect and Plus
List of Health Check-ups for Preferred, Premier, Accumulate
Expert Opinion On Critical Illness
- We will provide the Insured person the choice to avail of an expert second opinion from Our network of medical practitioners for an Insured person who is diagnosed with a covered critical illness as listed below, during the policy period.
- Any claim under this benefit shall not impact Cumulative Bonus.
- This benefit can be availed once, by each Insured person during an annual policy period and once during the lifetime for the same Critical Illness.
- Covered Critical Illnesses shall include:
Cancer of specific severity, First Heart Attack of specified severity, Open Chest CABG, Open Heart Replacement or Repair of Heart Valves, Coma of specified severity, Kidney Failure requiring regular dialysis, Stroke resulting in permanent symptoms, Major Organ/Bone Marrow Transplant, Permanent Paralysis of Limbs, Motor Neurone Disease with permanent symptoms, Multiple Sclerosis with persisting symptoms.
- Cigna will increase the Sum Insured as specified under the Plan opted, at the end of the policy year if the policy is renewed with us provided that there are no claims paid or outstanding in the expiring Policy Year.
- If the Policy is a Family Floater Policy, then the Cumulative Bonus will accrue only if no claims have been made in respect of all the Insured Persons in the expiring Policy Year.
- No cumulative bonus will be added if the policy is not renewed with us by the end of the grace period. The cumulative bonus will not be accumulated in excess of 100% of the sum insured under the current policy with us under any circumstances.
- Any earned Cumulative Bonus will not be reduced for claims made in the future unless utilized.
- Wherever the earned cumulative bonus is used for payment of a claim during a particular policy year, the balance cumulative bonus if any will be carried forward to the next policy year.
You can earn reward points equivalent to 1% of premium paid including taxes & levies for each Policy. In addition to this You can accumulate rewards by opting for an array of Our wellness programs listed below, that will help You to assess Your health status and aid in improving Your overall well-being.
Each program can be opted once per Policy Year by a particular Insured Person. There will be no limitation to the number of programs one can enrol however maximum rewards that one can earn in a single policy period will be limited to 10% of premium paid in the Policy . Details of reward points that can be accrued are listed below.
- Reduction In Maternity Waiting
Cigna provide option to the Insured person to reduce the mandatory waiting period on Maternity from 48 months to 24 months from the date of inception of first policy with us, depending upon the plan selected.
In case of opting for this benefit, the new born baby cover and first year vaccinations will also follow reduction in waiting period under maternity cover and coverage under both the features will be capped as per the limits specified under Maternity Sum Insured as opted by the insured. All other terms, conditions and exclusions under Maternity Cover shall apply.
Waiver Of Mandatory Co-pay
An option to remove Mandatory co-pay under Section VI. viii, which is applicable for persons aged 65 years and above will be available on payment of additional premium
Cumulative Bonus Booster
Cumulative Bonus Booster-2
- First 30 days waiting period is applicable for all illness other than any accidents.
- If the insured wants to take expert opinion on critical illness, he has to wait for 90 days.
- Pre-existing diseases will be covered after certain waiting period as per the plan chose by the insured.
List Of Specific Diseases
- Cataract, Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus unless necessitated by malignancy myomectomy for fibroids,
- Knee Replacement Surgery (other than caused by an Accident), Noninfectious Arthritis, Gout, Rheumatism, Oestoarthritis and Osteoposrosis, Joint Replacement Surgery (other than caused by Accident), Prolapse of Intervertibral discs(other than caused by Accident), all Vertibrae Disorders, including but not limited to Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal
- Varicose Veins and Varicose Ulcers, Stones in the urinary uro-genital and biliary systems including calculus diseases, Benign Prostate Hypertrophy, all types of Hydrocele,
- Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess related to the anal region.
- Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis and related disorders, Surgery on tonsils/Adenoids, Tympanoplasty and any other benign ear, nose and throat disorder or surgery.
- Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps/internal tumors/skin tumors, and any type of Breast lumps(unless malignant), Polycystic Ovarian Diseases,
- Any surgery of the genito-urinary system unless necessitated by malignancy.
1. Genetic disorder and stem cell implantation/surgery, harvesting, storage or any kind of treatment using stem cells.
2. Dental treatment, dentures or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours hospitalization or treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage.
3. Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder or due to an accident.
4. Birth control procedures, contraceptive supplies or services including complications arising due to supplying services, hormone replacement therapy and voluntary termination of pregnancy during the first 12 weeks from the date of conception, surrogate or vicarious pregnancy.
5. Routine medical, eye and ear examinations, cost of spectacles, laser surgery for cosmetic purposes or corrective surgeries, contact lenses or hearing aids, cochlear implants, vaccinations except post-bite treatment or for new born baby up to 90 days, any physical, psychiatric or psychological examinations or testing , any treatment and associated expenses for alopecia, baldness, wigs, or toupees and hair fall treatment & products, issue of medical certificates and examinations as to suitability for employment or travel.
6. Laser Surgery for treatment of focal error correction other than for focal error of +/- 7 or more and is medically necessary.
7. All expenses arising out of any condition directly or indirectly caused due to or associated with human T-call Lymph tropic virus type III (HTLV-III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) and its variants or mutants, Acquired Immune Deficiency Syndrome (AIDS) whether or not arising out of HIV, AIDS related complex syndrome (ARCS) and all diseases / illness / injury caused by and/or related to HIV.
8. All sexually transmitted diseases including but not limited to Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis.
9. Vitamins and tonics unless forming part of treatment for disease, illness or injury and prescribed by a Medical Practitioner.
10. Instrument used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump or any other external devices used during or after treatment.
11. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.
12. Treatment for developmental problems including learning difficulties eg. Dyslexia, behavioral problems including attention deficit hyperactivity disorder