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Submitted URL: http://www.manipalcigna.com/make-payment
Effective URL: https://buyonline.manipalcigna.com/buy-health-insurance/makepayment
Submission: On March 19 via api from US — Scanned from DE
Effective URL: https://buyonline.manipalcigna.com/buy-health-insurance/makepayment
Submission: On March 19 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST
<form id="makepayment-form" method="POST" class="form ng-pristine ng-valid" novalidate="novalidate">
<div class="plans-heading clearfix">
<div class="col-xs-12">Make Payment</div>
</div>
<div class="col-xs-12">
<div id="container_panel">
<!-- <i class="icon-remove icon-black"></i> -->
<section data-rel="proposal_form" id="__proposal_form">
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Proposal Type</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<label><span class="copay-radio active">
<input type="radio" name="app_type" value="NB" checked="checked"></span>New Application </label>
<label ng-class="renew_enable==1?'show-inline':'hide'" class="show-inline"><span class="copay-radio">
<input type="radio" name="app_type" value="RW"></span>Renewal </label>
<label><span class="copay-radio">
<input type="radio" name="app_type" value="AOBFEE"></span>Agent Recruitment </label>
</div>
</div>
</div>
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Payment for</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<select name="payment_for" class="form-control required" id="payment_for" aria-required="true">
<option value="">Choose</option>
<!-- ngRepeat: option in payment_options -->
<option ng-repeat="option in payment_options" value="DFP" on-option-render="" class="ng-scope ng-binding">Deficit Payment</option>
<option ng-repeat="option in payment_options" value="LDP" on-option-render="" class="ng-scope ng-binding">Loading Payment</option>
<option ng-repeat="option in payment_options" value="NBP" on-option-render="" class="ng-scope ng-binding">Premium Payment</option>
<option ng-repeat="option in payment_options" value="INST" on-option-render="" class="ng-scope ng-binding">Installment payment</option>
</select>
</div>
</div>
</div>
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading" id="pno_title">Proposal Number *</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<input type="text" class="form-control required policysequence" id="proposal_number" name="proposal_number" value="" aria-required="true">
</div>
</div>
</div>
<div class="form-control-outr clearfix" id="proposer_amount">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Amount *</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<input type="text" class="form-control required numericonly" id="premium_amount" name="premium_amount" value="" aria-required="true">
</div>
</div>
</div>
<div id="proposer_details">
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Proposer's Name *</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<input type="text" class="form-control required name_class" id="proposer_name" name="proposer_name" value="" aria-required="true">
</div>
</div>
</div>
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Mobile *</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<input type="text" class="form-control required valid_mobile" id="proposer_mobile" name="proposer_mobile" value="" maxlength="10" aria-required="true">
</div>
</div>
</div>
<div class="form-control-outr clearfix">
<div class="row">
<div class="col-sm-4 col-xs-12 control-heading">Email *</div>
<div class="col-sm-5 col-xs-12 padt15-mob">
<input type="text" class="form-control required email" id="proposer_email" name="proposer_email" value="" aria-required="true">
</div>
</div>
</div>
</div>
<div class="form-control-outr border0 clearfix">
<div class="row">
<div class="col-sm-6 col-sm-push-3 pad0-mob">
<button class="button-active" id="validate_policy">Proceed</button>
</div>
</div>
</div>
</section>
<section data-rel="review-pay" id="__review_form">
<div class="formWrapper plan-selected mtop15">
<div class="plan-detl">
<div class="plan-box1 pad15 pbot0">
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type !== 'AOBFEE'">
<div class="col-xs-6 col-sm-5">Proposal Number</div>
<div class="col-xs-6 col-sm-7 bold ng-binding"></div>
</div>
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type == 'AOBFEE'" style="display: none;">
<div class="col-xs-6 col-sm-5">Agent Recruitment Form Number</div>
<div class="col-xs-6 col-sm-7 bold ng-binding"></div>
</div>
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type !== 'AOBFEE'">
<div class="col-xs-6 col-sm-5">Proposer's Name</div>
<div class="col-xs-6 col-sm-7 bold ng-binding"> </div>
</div>
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type !== 'AOBFEE'">
<div class="col-xs-6 col-sm-5">Application Type</div>
<div class="col-xs-6 col-sm-7 bold ng-binding"></div>
</div>
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type !== 'AOBFEE'">
<div class="col-xs-6 col-sm-5">Payment Type</div>
<div class="col-xs-6 col-sm-7 bold ng-binding"></div>
</div>
<div class="row padtb15 clearfix" ng-show="proposer_data.app_type == 'AOBFEE'" style="display: none;">
<div class="col-xs-6 col-sm-5">Payment Type</div>
<div class="col-xs-6 col-sm-7 bold">Agent Recruitment Fee</div>
</div>
<!-- ngIf: proposer_data.app_type == 'NB' && proposer_data.payment_type =='INST' -->
<div class="row padtb15 clearfix">
<div class="col-xs-6 col-sm-5">Amount</div>
<div class="col-xs-6 col-sm-7 bold">
<b class="blue ng-binding"></b> (INR) <div>
<!-- <span class="quickpay_emi_holder"><b class="blue">EMI </b>starts at <b class="blue">₹ {{proposer_data.lowest_emi}}</b> per month <span title="" data-placement="right" class="tooltip-btn option" data_price="{{proposer_data.amount}}" id="emi_builder">i</span>
<div class="listing-popup list-pnew"></div>
</span> -->
</div>
</div>
</div>
<div class="row">
<div class="mob_divider clearfix"></div>
</div>
<!-- ngIf: proposer_data.payment_type !== 'INST' -->
<div id="to_show" ng-if="proposer_data.payment_type !== 'INST'" class="ng-scope">
<div class="form-control-outr mob_bod_none row padtb15 clearfix">
<div class="col-xs-12 col-sm-5 padt15">Email Address*</div>
<!-- ngIf: proposer_data.email.length>0 -->
<!-- ngIf: proposer_data.email=='' -->
</div>
<div class="form-control-outr mob_bod_none row padtb15 clearfix">
<div class="col-xs-12 col-sm-5 padt15">Mobile Number*</div>
<div class="col-xs-12 col-sm-7 padt15-mob">
<input type="text" class="form-control required valid_mobile" id="mobile" name="mobile" value="" maxlength="10" aria-required="true">
<a id="send_otp" href="javascript:void(0);" ng-click="send_QP_OTP();" analytics-label="Send OTP Button Click" analytics-value="Request OTP">Send OTP</a>
</div>
<div class="col-sm-7 col-sm-push-5 col-xs-12 padb15-mob">
<div class="messages otp-message hide-box mtop15">Please wait while we generate and send your OTP (One-time password) to verify the phone number you have entered.</div>
<div class="otp-passwrd-outr row mtop15 hide-box">
<div class="col-xs-4">
<input type="number" pattern="[0-9]*" class="form-control setpadding" name="otp" disable-arrows="" analytics-on="focus" analytics-value="OTP Entered">
</div>
<div class="col-xs-8 padl0">
<p id="otp_message">Didn’t receive OTP? <span><a href="javascript:void(0);" ng-click="resend_QP_OTP();">Send again</a></span>
</p>
<p></p>
<input type="hidden" id="quote_otp" value="" name="quote_otp">
</div>
</div>
</div>
</div>
</div>
<!-- ngIf: proposer_data.amount > 100000 -->
<div class="form-control-outr clearfix" ng-show="!nach_registration_status.is_si_registrated && proposer_data.app_type == 'NB' && proposer_data.payment_type =='INST' || nach_data.statusCd == 'Lapsed'"
style="display: none;">
<div class="row" id="payment_option_panel">
<div class="col-sm-12 col-xs-12 padt15-mob ">
<div class="custom-checkbox clearfix">
<label class="address-check">
<span class="check-selector">
<input type="checkbox" name="si_option" value="1" analytics-on="click" analytics-event="Same Insurer" analytics-category="application" analytics-label="si_option" analytics-value="">
</span>Please enroll for instalment/renewal premium payment through NACH or standing instruction </label>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="form-control-outr btnWrapper clearfix">
<div class="outerBoxcheck fullWidth tooltipbox">
<!-- <p class="contentTxtbox">
<input type="checkbox" id="register" name="register" value="1" class="checkBoxalg space"><span>Register my payment mode for future modal/ECS payments with ManipalCigna Health (Standing Instruction on Credit Card)</span><br />
</p>
<br /> -->
<p class="contentTxtbox tnc">
<input type="checkbox" id="terms" name="terms" value="1" class="checkBoxalg space" checked="checked"><span>I hereby agree and confirm all <span class="tooltip-btn tooltip-btn-plain" data-toggle="tooltip" data-placement="bottom"
onclick="document.getElementById('innerDeclaration').style.display='block';">T&Cs</span></span>
<br>
</p>
<br>
</div>
<div class="innerDeclaration" id="innerDeclaration" style="display: none;">
<span class="closeData" onclick="document.getElementById('innerDeclaration').style.display='none';">X</span>
<b>Disclaimer :</b><br> According to Regulation 3(d), 3(f) & 3(g) of Insurance Regulatory and Development Authority (IRDA) (Manner of Receipt of Premium) Regulations, 2002, the premium to be paid by any person proposing to take an
insurance policy (hereinafter referred to as the proposer) or by the policyholder to an insurer may be made through credit/debit card held in his name, Internet or E-Transfer.<br> As per Anti-Money Laundering / Counter Financing of
Terrorism (AML/CFT) guidelines issued by IRDA for general insurance companies are required to carry out Know Your Customer (KYC) norms at the settlement stage where Claim payout /premium refund crosses a threshold of Rs. 1 lakh per claim
/premium refund.<br> Company may, at its sole discretion, call for any document before issuance of a policy or for processing the application of Claim payout /premium refund.<br>
<b>Terms and conditions</b><br> The premium is paid for purchase of insurance policy through net banking account or credit/debit card issued in my name, i.e. proposer/policyholder.<br> Any Document required by the Company before issuance
of a policy or for processing application of Claim payout / premium refund shall be provided by me to the Company. Whenever it is sought by the Company.<br> I hereby confirm that all premiums have been/will be paid from genuine sources
and no premiums have been/will be paid out of proceeds of crime related to any of the scheduled offences listed in Prevention of Money Laundering Act, 2002. I understand that the Company has the right to call for documents to establish
sources of funds. The insurance company has right to cancel the insurance contract in case I am/ have been found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money
laundering in India.<br>
</div>
<div>
<div class="form-control-outr border0 clearfix quickPayProceed">
<div class="row">
<div class="col-xs-12 col-sm-6 col-sm-push-3 pad0-mob">
<button class="button-active" ng-click="submission()">Review & Pay</button><!-- id="proceed_payment" -->
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</form>Text Content
* To Renew : 1800 102 4465 * To Buy : 1800 102 4464 Login Logo * Products * Claims * Renewal * Retail Customer * Group Customer * Learn * Wellness * About Us * Support Make Payment Proposal Type New Application Renewal Agent Recruitment Payment for Choose Deficit PaymentLoading PaymentPremium PaymentInstallment payment Proposal Number * Amount * Proposer's Name * Mobile * Email * Proceed Proposal Number Agent Recruitment Form Number Proposer's Name Application Type Payment Type Payment Type Agent Recruitment Fee Amount (INR) Email Address* Mobile Number* Send OTP Please wait while we generate and send your OTP (One-time password) to verify the phone number you have entered. Didn’t receive OTP? Send again Please enroll for instalment/renewal premium payment through NACH or standing instruction I hereby agree and confirm all T&Cs X Disclaimer : According to Regulation 3(d), 3(f) & 3(g) of Insurance Regulatory and Development Authority (IRDA) (Manner of Receipt of Premium) Regulations, 2002, the premium to be paid by any person proposing to take an insurance policy (hereinafter referred to as the proposer) or by the policyholder to an insurer may be made through credit/debit card held in his name, Internet or E-Transfer. As per Anti-Money Laundering / Counter Financing of Terrorism (AML/CFT) guidelines issued by IRDA for general insurance companies are required to carry out Know Your Customer (KYC) norms at the settlement stage where Claim payout /premium refund crosses a threshold of Rs. 1 lakh per claim /premium refund. Company may, at its sole discretion, call for any document before issuance of a policy or for processing the application of Claim payout /premium refund. Terms and conditions The premium is paid for purchase of insurance policy through net banking account or credit/debit card issued in my name, i.e. proposer/policyholder. Any Document required by the Company before issuance of a policy or for processing application of Claim payout / premium refund shall be provided by me to the Company. Whenever it is sought by the Company. I hereby confirm that all premiums have been/will be paid from genuine sources and no premiums have been/will be paid out of proceeds of crime related to any of the scheduled offences listed in Prevention of Money Laundering Act, 2002. I understand that the Company has the right to call for documents to establish sources of funds. The insurance company has right to cancel the insurance contract in case I am/ have been found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money laundering in India. Review & Pay * facebook * Instagram * Twitter CONTACT US Callers from India Toll-free number 1800-102-4462 Callers outside India +91 22 4985 4100 (Call charges as per the caller's tariff plan will apply) EMAIL For any queries email us at customercare@manipalcigna.com and for any policy alterations email us at mychangerequest@manipalcigna.com HEALTH INSURANCE PLANS * ManipalCigna Lifetime Health * ManipalCigna ProHealth Insurance * ManipalCigna Super Top Up * Arogya Sanjeevani Policy, ManipalCigna * ManipalCigna ProHealth Cash * Corona Rakshak Policy, ManipalCigna * Corona Kavach Policy, ManipalCigna * ManipalCigna ProHealth Group Insurance Policy * ManipalCigna Lifestyle Protection Group Policy * ManipalCigna Group Overseas Travel Insurance Policy * ManipalCigna FlexiCare Group Insurance Policy * ManipalCigna Global Health Group Policy WEBSITE * Privacy Policy * Terms and Conditions * Customer Login * Distributor Login * Disclaimer * Disclosures * Unclaimed Amount SERVICES * Service Request * Service Turn-around-Time * Quick Payment * Renew Now * Track Claim Application * Claim Process * Recurring Payment Opt Out ABOUT US * Management Team * Press Release * Careers * Key Persons * Board Members PARTNER SITES * Manipal University * Manipal Hospitals * Stempeutics Research * Manipal Foundation * Cigna Corporation COMPLIANCE * IRDAI Website * Do No Call * Grievance Redressal * Products Withdrawn * General Insurance Counsil * Corporate Agents * Blacklisted Agents QUICK LINKS * Downloads * FAQs * Glossary * Hospital Locator * Demat Policy Documents * Quick Quote ARTICLES * Blogs * Family Health * Healthy Ageing * Caregiver Resources * Exercise and Fiteness Logo KNOW MORE Logo Registered office: ManipalCigna Health Insurance Company Limited, 401/402,Raheja Titanium, Western Express Highway, Goregaon( East ), Mumbai – 400063. ManipalCigna Health Insurance Company Limited | CIN: U66000MH2012PLC227948 | IRDAI Reg. No.: 151 | Regd. Office: 401/ 402, 4th Floor, Raheja Titanium, Off Western Express Highway, Goregaon East, Mumbai – 400 063 | Toll Free: 1800-102-4462 | Website: www.manipalcigna.com | Category - General (Health) Insurance This advertisement is designed for combination of Benefits of two individual and separate products named (1) ManipalCigna ProHealth Insurance UIN: MCIHLIP21546V052021 & (2) ManipalCigna Super Top Up UIN: MCIHLIP21121V022021. These products are also available for sale individually without the combination offered / suggested and as per the need of the customer. There is no compulsion whatsoever that these products are to be taken together as suggested and presented above. *Deduction under section 80D is applicable under the provisions of Income Tax Act, 1961. Please consult your Tax advisor for more details on Tax benefits. Tax treatment are subject to change in Tax laws. #An individual or HUF can claim a deduction up to ₹ 25,000 for the insurance of self, spouse, and dependent children. An additional deduction for the insurance of parents is available to the extent of ₹ 25,000 if parents are less than 60 years of age, or ₹ 50,000 if parents are aged above 60 years. Deduction of ₹ 1 lac is available if the age of Self & parents is above 60 days or more. Please consult your tax advisor for more details on tax benefits. ~optional covers are available on payment of additional premium **Available on porting existing base sum insured (excluding bonus) of ₹ 10 lakhs & more ~~ Under Premium Waiver Benefit, 1 year premium is waived off if the insured who is also the proposer suffers from any of the covered contingencies +Coverage outside India is available with Lifetime Health Global plan for opted major illness/es within opted area of cover ##Available for coverage in India (1)Terms & Conditions apply. Restoration is available unlimited times for unrelated illnesses, injury. (2)Sum Insured of ₹ 1 crore is available only under ProHealth Insurance Premier Plan. (3)Annual Premium including taxes for ProHealth Protect Plan for Sum Insured of ₹ 5.5 lakhs for family floater plan (2 Adults) policy with highest insured aged 30 years for Zone 1. Premium applicable for standard healthy life. Per day premium mode is not available. Premium payment mode available as: Monthly, Quarterly, Half yearly, Yearly, Single. (4)5% or 10% of the base sum insured every policy year (irrespective of claims) as per plan opted, maximum accumulation up to 200%. (a) Annual premium including taxes for Lifetime Health India Plan for sum insured of ₹ 50 lakhs is ₹ 12,899/- for the individual insured of age 45 years. Premium applicable for standard healthy life. Per day premium mode is not available. Premium payment mode available as: Monthly, Quarterly, Half yearly, Yearly, Single. (b) Annual premium including taxes for Lifetime Health India Plan for sum insured of ₹ 1 Crore is ₹ 14,213/- for the individual insured of age 45 years. Premium applicable for standard healthy life. Per day premium mode is not available. Premium payment mode available as: Monthly, Quarterly, Half yearly, Yearly, Single. (c) Annual premium including taxes for Lifetime Health Global Plan for sum insured of ₹ 50 lakhs each is ₹ 21,081/- for coverage in India and abroad for the individual insured of age 45 years where the coverage outside India is for the listed 27 major illnesses and area of cover as Worldwide excluding India. Premium applicable for standard healthy life. Per day premium mode is not available. Premium payment mode available as: Monthly, Quarterly, Half yearly, Yearly, Single. (d) Annual premium including taxes for Lifetime Health Global Plan for sum insured of ₹ 1 Crore each is ₹ 26,622/- for coverage in India and abroad for the individual insured of age 45 years where the coverage outside India is for the listed 27 major illnesses and area of cover as Worldwide excluding India. Premium applicable for standard healthy life. Per day premium mode is not available. Premium payment mode available as: Monthly, Quarterly, Half yearly, Yearly, Single. ^Annual Premium including taxes @₹ 920 for Super Top Up Plus Plan for the Sum Insured of ₹ 10 Lacs; with deductible of ₹ 10 lacs for family floater ( 2 Adults + 2 Kids) policy with the highest insured age as 35 years. Premium applicable for standard healthy lives. ^^Annual Premium including taxes for Super Top Up Plus Plan for the Sum Insured of ₹ 10 Lacs with Deductible of ₹ 5 Lacs; for an individual insured aged 35 years. Premium applicable for standard healthy life. ₹ 15 lacs= ₹ 5 lacs existing health insurance sum insured and ₹ 10 lacs Super Top Up Sum Insured. UIN -: ManipalCigna ProHealth Insurance : MCIHLIP21546V052021 | ManipalCigna Super Top Up : MCIHLIP21121V022021 | Corona Kavach Policy, ManipalCigna : MCIHLIP21070V012021 | Arogya Sanjeevani Policy, ManipalCigna : MCIHLIP20156V011920 | ManipalCigna Lifetime Health : MCIHLIP21559V012021 | Saral Suraksha Bima, ManipalCigna : MCIPAIP21622V012021 © 2019 ManipalCigna Health Insurance Company Limited. All rights reserved. Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale. Test Mode