Universal Sompo Health Insurance

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Universal Sompo Health Insurance

Universal Sompo General Insurance Company Limited is a joint venture between Indian banks – Allahabad Bank, Karnataka Banka and Indian Overseas Bank, an Indian investment company, Dabur Investments and a Japanese insurance company, the Sompo Japan Insurance Company. Universal Sompo has its headquarters at Mumbai. The Sompo Japan Nipponkoa Insurance Inc. is a leading Japanese insurance provider and is the largest property and casual insurance company in the country of Japan. Universal Sompo is a rapidly growing insurance provider in India. It started operations in India in the year 2007 when it received its Licence and Certificate of Registration from the Indian Regulatory and Development Authority (IRDA). In case of Health Insurance, the company offers a range of plans that are designed to meet all the requirements of the individual.

Advantages of availing health insurance plans from Universal Sompo

The organization of Universal Sompo focuses on quality, customer relationships and the providing comprehensive health insurance across all segments of society in the country. Today the organization is among the preferred brands in the insurance industry in the country. Universal Sompo offers simple scalable health insurance plans that are robust and appropriate for all levels of income. Below are the advantages of buying health insurance plans from Universal Sompo:

  • There is cashless hospitalization all over the country at a network of  hospitals
  • Pre and post hospitalization expenses are covered
  • Tax benefit is provided under section 80D
  • Day care procedures are covered with selects plans
  • There is a free look-in period of 15 days
  • Portability is allowed

Why Health Insurance Plans?

Health Insurance Plans have become very important in the modern age due to the rising cost of medical expenses and the treatment costs of various ailments. Moreover, the current lifestyle of individuals has made them more prone to diseases and ailments that require medical attention. Medical costs are spiraling upwards and there is no relative growth in the income of the common man who eventually faces a financial crisis when faced with a medical emergency. Thus, it is prudent to insure oneself against any medical contingencies that may arise so that the financial aspect of the crisis is at leats handled by the insurance company and the medical costs do not become a burden on the average middle-class man

List of Health Insurance plans offered by Universal Sompo

The company offers different types of health insurance plans. Let us take a closer look at each plan in detail:

Universal Sompo Individual Health Insurance policy plan –

This is a health insurance plan that covers the hospitalization expenses of the individual with the following features:

  • Cashless hospitalization at any of the company’s network of hospitals
  • Medical expenses in case of hospitalization are covered
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home due to the following reasons:
    • The condition of the patient is such that he or she cannot be removed to a hospital
    • The patient cannot be moved to the hospital as there is a lack of accommodation available
  • Subject to a clean proposal form, medical tests are waived off up to the age of 45 years. Above the age of 45, medical tests are mandatory and 50% of the test charges are reimbursed to the customer
  • Additional cover may be purchased by the customer to cover certain critical illnesses
  • The premium depends of the age of the insured individual and the sum insured amount that is selected
  • Maximum coverage under this plan is Rs. 5 lakhs
  • Coverage under this plan includes expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees, charges for blood, oxygen, etc.

Eligibility

  • The entry age is restricted to 55 years only

Exclusions under the Universal Sompo Individual Health Insurance policy plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan
  • Any expense on hospitalization or domiciliary hospitalization incurred because of any illness contracted during the first thirty days from the date of commencement of the insurance cover will not be covered. However, this exclusion is not applicable if hospitalization is required because of an accident
  • During the first year of the cover, the expense on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis and related disorders are not covered
  • Injury or disease directly or indirectly attributable to war, invasion, Act of Foreign enemy not payable
  • Circumcision unless necessary for treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded
  • Dental treatment or surgery of any kind unless hospitalization is required is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Voluntary termination of Pregnancy
  • Pregnancy and Child-birth
  • Naturopathy Treatment

Universal Sompo Group Health Insurance policy plan –

This is a health insurance plan that covers the hospitalization and domiciliary expenses of the employees of groups in the trading/manufacturing sectors, social sectors and/or members of institutions/societies/associations/clubs. The following are the features of the Group Insurance policy plans:

  • Cashless hospitalization at any of the company’s network of hospitals
  • Medical expenses in case of hospitalization are covered
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home due to the following reasons:
    • The condition of the patient is such that he or she cannot be removed to a hospital
    • The patient cannot be moved to the hospital as there is a lack of accommodation available
  • Additional cover may be purchased by paying additional premium, which is dependent on the group size and profile. The following covers may be purchased:
  • Critical illness cover, which includes paralytic stroke, cancer, chronic renal failure, coronary artery bypass and the transport of organs such as – kidney, lung, pancreas and bone marrow NB. When the critical illness cover is chosen, the sum insured amount will be doubled
  • A Maternity Benefit cover may be purchased
  • Hospital Cash
  • Pre-existing diseases cover
  • Family floater cover
  • The premium depends of the age of the insured individual and the sum insured amount that is selected
  • Maximum coverage under this plan is Rs. 5 lakhs
  • Coverage under this plan includes expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees, charges for blood, oxygen, etc.

Eligibility

  • The entry age is restricted to 55 years only

Exclusions under the Universal Sompo Group Health Insurance policy plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan, unless the pre-existing diseases cover is specifically chosen
  • Any expense on hospitalization or domiciliary hospitalization incurred because of any illness contracted during the first thirty days from the date of commencement of the insurance cover will not be covered. However, this exclusion is not applicable if hospitalization is required because of an accident
  • During the first year of the cover, the expense on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis and related disorders are not covered
  • Injury or disease directly or indirectly attributable to war, invasion, Act of Foreign enemy not payable
  • Circumcision unless necessary for treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded
  • Dental treatment or surgery of any kind unless hospitalization is required is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Voluntary termination of Pregnancy
  • Pregnancy and Child-birth
  • Naturopathy Treatment

Universal Sompo Pravasi Bharatiya Bima Yojana plan –

This is a health insurance plan that covers the medical expenses of the individuals who are emigrating and whose passports are endorsed with “Emigration check required”. These are the features of this plan:

  • Personal accident is covered where a personal bodily injury by accident solely and directly causes the death or permanent disablement of the insured person.
  • In the event of the accidental death of the insured person while on employment outside of the country, the company will reimburse the actual cost of transporting the mortal remains of the deceased individual back to India. The cost of an economy class return airfare for one attendant to accompany the mortal remains from the place of death to India will also be covered.
  • Medical expenses in case of hospitalization are covered
  • The hospitalization expenses of the insured’s family members are covered. This covers the spouse up to the age of 65 and two children up to the age of 21. The following expenses are included for coverage :
  • Room, board and nursing expenses
  • Medical practitioner, anesthetist, consultant fees
  • Expenses on anesthesia, blood, oxygen, operation theatre, surgical appliances, medicines, diagnostic materials, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of organs and other such expenses
  • Cost of vitamins and tonics when prescribed by the attending medical practitioner
  • Daycare procedures are covered where the procedures or surgeries require less than 24 hours hospitalization
  • The maternity expenses of a woman insured will be covered
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home due to the following reasons:
    • The condition of the patient is such that he or she cannot be removed to a hospital
    • The patient cannot be moved to the hospital as there is a lack of accommodation available
  • The airfare for one way economy class ticket will be covered under the following circumstances:

(a) Insured Person is/has not been received on behalf of employer, when he/she arrives at his/her workplace or destination abroad i.e. employer refuses the job/employment to the Insured Person

(b) If there is any substantive change in the job/employment contract/agreement to the disadvantage of the Insured Person.

(c) If the employment is prematurely terminated within first three months of Period of Insurance for no fault of the Emigrant (Insured Person)

(d)When the emigrant (insured individual) falls sick or is declared medically unfit to  commence or continue working and the contract if terminated by the employer within first twelve months of the start of cover under the policy

  • Coverage under this plan includes expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees, charges for blood, oxygen, etc.
  • Medical tests are required for insured individuals who are above the age of 45 years

Eligibility

  • The entry age is restricted to 18 to 65 years for Indian citizens who are staying abroad and having a valid visa for employment

Exclusions under the Universal Sompo Pravasi Bharatiya Bima Yojana plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • If the insured person is travelling against the advice of a medical practitioner
  • If the insured person is on a waiting list for a specific medical treatment
  • If the insured person has received  a terminal prognosis of a medical condition
  • If the insured person takes part in a naval, military or air force operation
  • If the insured person works in a different profession or occupation or in a different country or for a different employer than what is declared in the  proposal form
  • A claim will not be covered when there is war or military action occurring against the country or internal conflict in the country where the insured individual has gone to work
  • If a claim arises after the expiry of the insured individuals’ passport or visa
  • Circumcision unless necessary for treatment of a disease is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • War or any act of war, invasion, act of foreign enemy, war like operations, civil war, public defense, rebellion revolution, insurrection, military or usurped acts, riot, terrorism, chemical, radioactive or nuclear contamination.
  • Participation or involvement in naval, military or air force operations, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.

Universal Sompo Surva Vidyarthi Bima Yojana plan –

This is a health insurance plan that can be taken by an educational institution for the benefit of the students. These are the features of this plan:

There are separate sections, one is Section A, which is compulsory and the rest of the sections are optional.

  • Section A has the following benefits:
    • Death of the Parent resulting from Accident
    • Permanent Total Disablement of the Parent resulting from Accident
    • Permanent Partial Disablement of the Parent resulting from Accident
    • Death of Student resulting from Accident
    • Permanent Total Disablement of Student following an Accident
    • Permanent Partial Disablement of the Student resulting from Accident
  • The following extensions may be taken under Section A
    • Loss of Personal Belongings
    • Pedal Cycle- Cover for loss or theft of pedal cycle
    • Cost of Study in case of Accidental Death/ Permanent Total Disablement of Parent
    • Ambulance Charges Extension
    • Compassionate Visit
    • Reimbursement of Examination Fees
  • Section B has the following benefits:
    • Medical expenses cover where the following are included for coverage - Room, board and nursing expenses, Nursing expenses, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances(any disposable consumables subject to upper limit of 10% of Sum Insured), Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Stents and implants
  • Section C has the following benefits:
    • Fire cover where the company will pay the market value of the insured property and / or the amount of damage in the event of any loss or damage to the insured property arising out of the perils – fire, explosion/implosion, Loss or damage by aircraft, other aerial or space devices and articles dropped there from excluding those caused by pressure waves, Storm, cyclone, typhoon, tempest, hurricane, tornado, flood & inundation, Impact damage by any rail/ road vehicle or animal by direct contact, Subsidence and Landslide including rockslide, Bursting and/or overflowing of Water Tanks, Apparatus and Pipes, Missile Testing Operations, Leakage from Automatic Sprinkler Installations and Bush Fire
  • Extensions available under Section C are as follows:
    • Staff secure extension that provides accidental benefit to the teaching and non teaching staff for accidental death, permanent total disablement and permanent partial disablement.
    • Library books extension that provides for reimbursement up to the Sum Insured for all the library books available in the educational institution against fire and other allied risks.
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home due to the following reasons:
    • The condition of the patient is such that he or she cannot be removed to a hospital
    • The patient cannot be moved to the hospital as there is a lack of accommodation available
  • Additional benefits may be purchased by paying additional premium,. The following covers/extensions may be purchased:
  • Reinstatement value clause (applicable on Section C) where Universal Sompo will compensate the insured educational institute against fire and allied perils on reinstatement value basis i.e. there would not be any deduction for depreciation while settling claims
  • On premise cover (applicable on Section A) where the insured educational institute will be offered a discount of 25% if it opts for the policy on “On premises basis”, which includes accidental risks faced by students while on premises, cover for pedal cycle and loss of personal belongings within the premises and travel by the students to the premises of the educational institute from the place of residence and back, if student is not a resident within the Premises, for the purpose engaging in activities carried out by the Educational Institution/Schools
  • Content insurance (applicable on Section A) where coverage for home content is provided up to Rs. 15000 against burglar, fire and allied perils is taken by all the parents for the benefit of the child undergoing studies at no additional premium under the Policy
  • The premium depends of the age of the insured individual and the sum insured amount that is selected
  • The sum insured may be enhanced on renewal

Eligibility

  • Students and staff between the ages of three to 65 years can be covered

Exclusions under the Universal Sompo Surva Vidyarthi Bima Yojana plan –

  • Exclusions in respect of Accidental Claims (Applicable to Section A)

The company will not pay the insured for:-

  • The insurance company liability during one annual policy period is limited to the sum insured under the policy, once the sum insured is exhausted on the payment of one or more than one claim during one annual policy period, further payment of claim amount exceeding the sum insured of the policy would be excluded.
  • Any existing physical defect, disablement/injury unless endorsed otherwise.
  • Death or disablement due to child birth or from pregnancy or in consequence thereof.
  • Payment of compensation in respect of injury, disablement or death - a. From intentional self-injury, suicide or attempted suicide. b. Whilst under the influence of liquor or drugs or other intoxicants. c. Emotional distress d. Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. e. Directly or indirectly, caused by venereal disease, AIDS or insanity. f. Arising or resulting from the Parent/ Student committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanor or civil commotion. g. Whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports and the like. h. Due to war or ionising radiation or nuclear perils. i. Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.
  • Exclusions in respect of Medical Claims (Applicable to Section B)

The company is not be liable to make any payment under this Policy in respect of any expenses whatsoever incurred by the Student in connection with or in respect of :

  • Pre-existing diseases will not be covered until 48 months of continuous coverage have elapsed, since inception of the first Policy with Universal Sompo
  • Any disease other than those stated in Clause 3 below, contracted by the Student during the first 30 days from the commencement date of the policy.
  • Any Sickness that has been classified as an Epidemic by the Central or State Government
  • Injury or disease directly or indirectly caused by or arising from or attributable to War invasion Act of Foreign Enemy Warlike operations (whether war be declared or not).
  • Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as part of any illness.
  • The cost of spectacles and contact lenses hearing aids.
  • Any Dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from accidental injury and which requires hospitalization for treatment.
  • Convalescence general debility `Run Down’ condition or rest cure, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol, rehabilitation therapy in any form. 9. All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymph trophic Virus Type III (HTLB-III) or Lymphadenopathy Associated Virus (LAV) or any Syndrome or condition of a similar kind commonly referred to as AIDS.
  • Charges incurred at Hospital or Nursing Home primarily for neither diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with nor incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home.
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
  • Treatment arising from or traceable to pregnancy childbirth including caesarean section. 14. Naturopathy treatment
  • 15. Any experimental / unproven treatments are excluded from the policy coverage.
  • Fire covers exclusions (Applicable to Section C)

This Policy will not cover

  • The first 5% of each and every claim subject to a minimum of Rs.10, 000 in respect of each and every loss arising out of “Act of God perils” such as Lightning, STFI, Subsidence, Landslide and Rock slide covered under the policy.
  • The first Rs 10,000 for each and every loss arising out of other perils in respect of which the Insured is indemnified by this Policy.
  • The Excess shall apply per event per Insured Event
  • Loss, destruction or damage caused by war, invasion, act of foreign enemy hostilities or war like operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular rising, military rising, rebellion, revolution, insurrection or military or usurped power.
  • Loss, destruction or damage directly or indirectly caused to the property insured by i. Ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. ii. The radioactive toxic, explosives or other hazardous properties of any explosive nuclear assembly or nuclear component thereof
  • Loss, destruction or damage caused to the insured property by pollution or Contamination excluding i. Pollution or contamination which itself results from a peril hereby insured against. ii. Any peril hereby insured against which itself results from pollution or contamination.
  • Loss, destruction or damage to the stocks in Cold Storage premises caused by change of temperature.
  • Loss, destruction or damage to bullion or unset precious stones, any curios or works of art for an amount exceeding Rs. 10000/-, goods held in trust or on commission, manuscripts, plans, drawings, securities, obligations or documents of any kind, stamps, coins or paper money, cheques, books of accounts or other business books, computer systems records, explosives unless otherwise expressly stated in the policy.
  • Loss, destruction or damage to any electrical machine, apparatus, fixture, or fitting arising from or occasioned by over-running, excessive pressure, short circuiting, arcing, self heating or leakage of electricity from whatever cause (lightning included) provided that this exclusion shall apply only to the particular electrical machine, apparatus, fixture or fitting so affected and not to other machines, apparatus, fixtures or fittings which may be destroyed or damaged by fire so set up.
  • Expenses necessarily incurred on (i) Architects, Surveyors and Consulting Engineer's Fees and (ii) Debris Removal by the Insured following a loss, destruction or damage to the Property insured by an insured peril in excess of 3% and 1% of the claim amount respectively.
  • Loss of earnings, loss by delay, loss of market or other consequential or indirect loss or damage of any kind or description whatsoever.
  • Loss or damage by spoilage resulting from the retardation or interruption or cessation of any process or operation caused by operation of any of the perils covered.
  • Loss by theft during or after the occurrence of any insured peril.
  • Any Loss or damage occasioned by or through or in consequence directly or indirectly due to earthquake, volcanic eruption or other convulsions of nature.
  • Loss or damage to property insured if removed to any building or place other than in which it is herein stated to be insured, except machinery and equipment temporarily removed for repairs, cleaning, renovation or other similar purposes for a period not exceeding 60 days.
  • Riot, Strike and Malicious Damage: Loss of or visible physical damage or destruction by external violent means directly caused to the property insured but excluding those caused by i. Total or partial cessation of work or the retardation or interruption or cessation of any process or operations or omissions of any kind; ii. Permanent or temporary dispossession resulting from confiscation, commandeering, requisition or destruction by order of the Government or any lawfully constituted Authority; iii. Permanent or temporary dispossession of any building or plant or unit or machinery resulting from the unlawful occupation by any person of such building or plant or unit or machinery or prevention of access to the same; iv. Burglary, housebreaking, theft, larceny or any such attempt or any omission of any kind of any person (whether or not such act is committed in the course of a disturbance of public peace) in any malicious act.
  • Storm, cyclone, typhoon, tempest, hurricane, tornado, flood and inundation: Loss destruction or damage directly caused by storm, cyclone, typhoon, tempest, hurricane, flood or inundation excluding those resulting from volcanic eruption or other convulsions of nature.

Universal Sompo Swarna Gramin Bima Yojana policy plans (Individual and Group plans) –

This is a health insurance plan that can be taken by a gramin, that is, a village dweller for himself and his family and/ or organizations such as financial institutions and NGO’s for covering its rural clientele with the following features:

  • Personal Accident which includes the following benefits - Death of the Insured or his/ her family members upon accident, Permanent Total Disablement of the Insured or his/her family members resulting from Accident and Permanent Partial Disablement of the Insured or his/ her family members resulting from Accident.
  • Critical illness where the following illnesses are covered - Cancer of specified severity, First Heart Attack of specified severity, Open Chest CABG, Open Heart Replacement, Coma of Specified Severity, Kidney Failure requiring regular dialysis, Stroke resulting in permanent symptoms, permanent paralysis of limb, Multiple Sclerosis with persisting symptoms, major organ /bone marrow transplant, Motor Neuron Disease with Permanent Symptoms.
  • The following extensions are available under the policy –
  • Pre-existing diseases cover where pre-existing diseases are covered by paying additional premium
  • The policy term ranges from one to three years
  • A family discount is provided when the insured person covers his or her family members under the policy plan

Eligibility

  • The entry age is between 18 to 65 years
  • Entry age for dependent children is 6 months
  • There is lifetime renewability

Exclusions under the Universal Sompo Swarna Gramin Bima Yojana policy plans –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan unless specifically endorsed
  • Any expense on hospitalization or domiciliary hospitalization incurred because of any illness contracted during the first thirty days from the date of commencement of the insurance cover will not be covered. However, this exclusion is not applicable if hospitalization is required because of an accident
  • During the first year of the cover, the expense on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis and related disorders are not covered
  • Injury or disease directly or indirectly attributable to war, invasion, Act of Foreign enemy not payable
  • Circumcision unless necessary for treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded
  • Dental treatment or surgery of any kind unless hospitalization is required is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Voluntary termination of Pregnancy
  • Death or disablement due to pregnancy and Child-birth
  • Naturopathy or other forms of alternative treatment

Universal Sompo Aapat  Suraksha Bima Insurance plan –

This is a health plan that has a primary focus on providing insurance benefits to people against any form of critical illness. The plan seeks to benefit the insured where hospital expenses and other medical related expenses are concerned, when the person suffers from a critical illness. The features of the plan are as follows:

  • The major diseases covered are – paralytic stroke, cancer, renal failure, coronary artery disease and major organ transplant
  • The nominee will get a one-time lump sum payment equal to the sum insured if the insured individual dies in an accident
  • The insured individual will receive a percentage of the sum insured if he suffers a permanent or total loss of limbs or sight in an accident
  • Medical expenses in case of hospitalization are covered
  • Income tax benefit under Section 80D of the Income Tax Act on the premium that is paid

Eligibility

  • Any Indian resident individual is between the ages of 18 to 65 years with lifetime renewal.
  • Children between the ages of 6 years and 25 years are covered as long as the parents are insured.

Exclusions under Universal Sompo Aapat Suraksha Bima Insurance plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan unless specifically endorsed
  • Illnesses contracted or diagnosed within the first ninety days of the policy plan when taken for the first time
  • Death that occurs within the first thirty days following the diagnosis of the critical illness
  • Any accident that results from intentional self injury, suicide or when the insured individual is under the influence of alcohol or drugs
  • When the insured individual dies or suffers from permanent disablement while taking part in adventure sports or while travelling in an aircraft in any capacity other than a fare paying passenger in a schedule flight

Universal Sompo Hospital Cash Insurance Plan –

This is a policy that provides a cash benefit in case of hospitalization so that there is no drainage on the savings of the insured and his or her family. The features are as follows:

  • Hospital Confinement benefit – where a daily allowance is paid upon normal hospitalization (other than ICU) for a maximum number of days as chosen by the insured at the time of policy commencement.
  • Intensive Care Benefit – The amount as chosen by the insured for the Hospital Cash Benefit will be doubled in case of the Intensive Care Benefit when the insured person or their family member is hospitalized in the ICU.
  • Convalescence Benefit – Rs. 10,000 is paid if the insured person is hospitalized or their family member is hospitalized for more than 21 days.
  • The policy can be bought for one to three years by paying a single premium
  • A family discount of 5% is provided

Eligibility

  • Any Indian resident individual is between the ages of 18 to 65 years with lifetime renewal.
  • Children between the ages of 6 years and 25 years are covered as long as the parents are insured.
  • Policy can be taken by a individual to cover him or herself  and his or her family, that includes the spouse and two children and dependent parents
  • There is lifetime renewability on the plans

Exclusions under Universal Sompo Hospital Cash Insurance plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan until 48 months of continuous coverage has lapsed
  • Any accident that results from intentional self injury, suicide or when the insured individual is under the influence of alcohol or drugs
  • When the insured individual dies or suffers from permanent disablement while taking part in adventure sports or while travelling in an aircraft in any capacity other than a fare paying passenger in a schedule flight
  • Dental treatment is not covered
  • Circumcision, cosmetic and aesthetic treatments are not covered
  • Any treatment that is not performed by a physician or treatments of experimental nature

Universal Sompo Complete Health Care Insurance plan –

This is a health insurance plan that covers the hospitalization and medical expenses of the individual with the following features:

  • There are three types of plan options, which are Basic, Essential, and Privilege.
  • The plan can be taken on an Individual Sum Insured Basis and Floater Basis.
  • Medical expenses in case of hospitalization are covered
  • Daycare procedures are covered
  • Post hospitalization expenses are also covered
  • Organ donor treatment is covered
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home
  • Ambulance charges are reimbursed
  • Dental treatment is reimbursed if is required as a treatment for accidental injuries
  • Alternate in-patient treatments such as ayurveda, unani, homeopathy, siddha are reimbursed
  • If the insured child of an age less than 12 years is hospitalized for more than 72 hours then Universal Sompo will provide a daily allowance as per the chosen medical plan to meet any non-medical expenses
  • In the event of being bitten, vaccination charges are covered
  • Outpatient charges are covered
  • Diagnostic tests are covered
  • Outpatient dental treatment is covered by the plan
  • One pair of spectacles or one pair of contact lenses are covered on the condition that it has been prescribed
  • Consultation charges are reimbursable
  • Convalescence Benefit – Rs. 10,000 is paid if the insured person is hospitalized or their family member is hospitalized for more than 10 days.
  • Pre and post maternity expenses are covered
  • Coverage is provided for the new born baby till the policy expires or till the baby is 91 days old, whichever is earlier
  • Coverage can be enhanced or waived as per the customers ‘choice. The following 5 options are offered for enhancement or waiver:-
    • Personal Accident
    • Critical Illness
    • Hospital Cash
    • Sublimit
    • Treatment in tiered network
  • A single premium can be paid for a three years coverage
  • There is an E policy discount when the customer opts to receive his or her policy in electronic form
  • There is a family discount when covering family members under a single policy
  • There is a “Dial-a-doctor” facility where the customer can get medical advice from a doctor through telephonic or online modes
  • Customers get access to the company’s “Health Educational Library for People” (HELP)
  • Customers get a monthly newsletter with diet and health tips and similar information
  • Customers get a second opinion on their health condition
  • Customers receive a specialist e-consultation with two follow-up sessions for seeking expert opinions on any chronic conditions
  • Customer can avail a wellness package where they get discounts on health and wellness products and services listed

Eligibility

  • The entry age is 18 to 70 years
  • Dependent children from the age of 91 days may be covered
  • Entry age for dependent children under the floater plan is 1 day

Exclusions under the Universal Sompo Complete Health Insurance policy plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan until 36 months have passed
  • Circumcision unless necessary for treatment of a disease is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Voluntary termination of Pregnancy
  • Psychiatry is not covered
  • Sleep disorders and sleep problems are not covered
  • Treatment of infertility is not covered
  • Treatment of developmental delay is not covered
  • Unproven and experimental treatment is not covered
  • Treatment of sexual dysfunction is not covered
  • Private duty nursing will not be covered
  • Weight loss surgery is not covered
  • Birth control is not covered
  • Artificial life maintenance will not be covered
  • Unrelated expenses and  vitamins/nutritional expenses are not covered
  • Cost of artificial limbs are not covered

Universal Sompo Senior Citizen Health Care plan –

This is a health insurance plan that covers the hospitalization and medical expenses of an individual above the age of 60. The following are the features of the Senior Citizen Health Care plans:

  • Medical expenses in case of hospitalization are covered, which include and are not limited to, room and boarding charges,  diagnostic tests, anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of stent implants.
  • Daycare procedures are covered
  • Pre and post hospitalization expenses are also covered for 30 and 60 days respectively
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home
  • Cost of health check up after three claim-free years are covered
  • A daily allowance is provided where 0.1% of the Sum Insured or Rs. 2500 (whichever is lower) is provided for each continuous and completed period of 24 hours of hospitalization
  • Ambulance charges are reimbursed
  • The expenses of an accompanying person is covered            
  • On the diagnosis of the following critical illnesses or surgical procedures, the Sum Insured is payable under the policy –
    • Cancer of a specified severity
    • Open chest CABG
    • Kidney failure requiring frequent dialysis
    • Stoke resulting in permanent symptoms
    • Major organ/bone marrow transplant
    • Multiple sclerosis with persisting symptoms
  • A cumulative bonus of 5% is available if no claims are made, subject to a maximum of 10 claim-free years
  • Policy terms of one to three years are available, when paying for two or three years, discounts on the premiums are available
  • A family discount of 10% is applicable on the hospitalization premium when the customer opts to cover his or her spouse under the policy on individual sum insured basis.
  • Sum insured options range from Rs. 1 lak to Rs. 5 lakhs
  • The sum insured may be enhanced upon renewal
  • A co-pay facility is available where the customer will bear a part of the percentage of the admissible claim amount. Co-payment will not reduce or effect the Sum Insured.

Eligibility

  • The entry age is at least 60 years. The maximum entry age is 70 years
  • There is lifetime renewability under this plan
  • The plan covers an individual over the age of 60 years and his or her spouse

Exclusions under the Universal Sompo Senior Citizen Health Care policy plan –

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan until 24 months have passed
  • There is a waiting period of 24 months for the following medical expenses to be covered:
  • Cataract
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • All types of Hernia, Hydrocele
  • Fissures and/or Fistula in anus, hemorrhoids/piles
  • Arthritis, gout, rheumatism and spinal disorders
  • Sinusitis and related disorders
  • Stones in the urinary and billiary systems
  • Dilatation and curettage , Endometriosis
  • All types of Skin and internal tumors/ cysts /nodules/ polyps of any kind including breast lumps unless malignant
  • Dialysis required for chronic renal failure
  • Surgery on tonsils, adenoids and sinuses
  • Gastric and Duodenal erosions ulcers
  • Deviated Nasal Septum
  • Varicose Veins/ Varicose Ulcers
  • Joint replacements unless due to accident
  • Any loss resulting directly or indirectly, contributed or aggravated or prolonged by hormone replacement therapy
  • Any experiment that is experimental in nature
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Dental treatment will not be covered
  • Unrelated expenses and  vitamins/nutritional expenses are not covered
  • Hospitalization for the sole purpose of physiotherapy will not be covered
  • Special nursing care, routine health checks  or convalescence, custodial care, general debility, lethargy and rest cure are not covered

Applying for Health Insurance Plans from Universal Sompo  

Health insurance plans offered by the company can be applied to through multiple channels like:

  • Individuals desirous of availing any of the travel insurance plans can simply call the Sales helpline of the company and speak to the customer service representative.
  • Interested individuals can mail their queries at the following email ID contactclaims@universalsompo[dot]com or contactus@universalsompo[dot]com.
  • Lastly, customers may also visit the company’s branches or get in touch with an agent to buy the plans required.

  Universal Sompo Health Insurance- FAQs

1. How to pay premium? What are the modes of payment available?

Universal Sompo General Insurance offers three ways to pay the premium

  • Direct debit from your bank
  • Credit card payment
  • Cheque payment

You need to sign a debit mandate for the direct debit. Thus, you don’t have the stress to remember the premium due date.


2. How can I check policy status for Universal Sompo health insurance?

You can check the policy details online or via toll free number.

If you are a registered user, simply login to e-Portal with your username and password.

3. What is the policy renewal process for Universal Sompo health insurance?

There are three ways of renewing your policy with the company.

  • Debit mandate- Automatic bank transfer on the date as agreed in the Policy T&C.
  • Call toll-free number of the company to inquire about the renewal process. Submit the payment in the acceptable bank branch.
  • If you have an online insurer profile, directly pay the insurance premium.

4. What is the company’s process to settle claim for Universal Sompo health insurance?

Universal Sompo General Insurancetakes 7 business days to settle claims for minor accidents. You need to submit the mandatory hospitalization bills and reports in addition to the claims application and submit the same to the Claims department. The claim amount will be directly debited into the bank account of the policyholder.

5. What is the policy cancellation process for Universal Sompo health insurance?

You get a free look period of 15-days in which you can cancel the policy and premium will be deposited in your bank account, post deduction of incurred charges on your medical examination and the stamp duty charges.

You can cancel your policy by

E-mail: contactus@universalsompo[dot]com

Letter: Universal Sompo General Insurance Company Ltd.,

Plot No - EL-94,KLS Tower, TTC Industrial Area,

MIDC, Mahape,

Navi Mumbai 400710.

Reviews for Universal Sompo Health Insurance

TOTAL REVIEWS (11)
SHAILENDRA
Delhi
February 24, 2016

superb health plan...

I purchase universal sompo health insurance policy plan and the plan is great with huge benefits. Policy coverage is 90%, claims are high approx. Rs.2.8 lakhs. Service is quick and always on time. Ambulance is also provided without taking any charges.
Plan Name: Universal Sompo Individual Basic
Agent Code: BPW01735

Rekha
Thane
February 04, 2016

"Excellent"

I got a health policy with Star Health Insurance. They provided the best policy I ever seen and the customer service is the best. Claims are easy to get and the coverage is 80-85%. I must say guys good job. Happy to get this great deal...
Plan Name: Universal Sompo Individual Essential
Agent Code: BPW01735

NITIN
Mumbai
February 01, 2016

Beneficial

I came to know about Universal Sompo health insurance by an advertisement. It had tied up with 14-15 major hospitals in my area. Universal Sompo general health insurance covers all medical expense. And best part is that they also send reminder of my premium so that I get full benefit of it.
Plan Name:Univerdal Sompo Indiviual Essential
Agent Code:BPW01676

Anupam
Delhi
February 01, 2016

"Recommandable Policy.."

I purchased a health plan from Universal Sompo Insurance Company for my parents because it is good and cheap as well. But, the customer care service is the worst. I would recommend Bajaj Allianz to my friends who have low budget.
Plan Name:Univerdal Sompo Indiviual Basic
Agent Code:BPW01735

Shekhar
Pune
February 01, 2016

Good Service!!

I bought Universal Sompo Health Insurance Policy when I was advised by my friend. It has been two years since then, I am very happy with their service and I had claimed it once.
Plan Name:Universal Sompo Individual Basic
Agent Code:BPW01676

Ketul
Ahmedabad
February 01, 2016

Best Policy

I have purchased Universal Sompo Health insurance policy. This is provided by my employer. It gives me coverage of Rs 2 lakh for my family. I have heard about positive response during claim. All over process was hassle free and easy.
Plan Name:Univerdal Sompo Indiviual Basic
Agent Code:BPW01676

Santosh
Navi_mumbai
January 30, 2016

"Good Coverage"

I am having the health insurance policy with the Univerdal Sompo Indiviual Basic from the last two years of time. It has been provided by my employer, also the medical coverage value is around 10 lakh Rupees which inclusive of myself and my family. It will go via mediassist and every interaction will be with them only. I'm happy with policy which providing me good service and coverages.
Plan Name:Univerdal Sompo Indiviual Basic
Agent Code:BPW01735

ATUL
Kutch_(bhuj)
January 29, 2016

"Good Benefits"

The service provided was good with Universal Sompo General Insurance based on the health Insurance service. They do ask confirmation to the customer before processing the request which was good. They do have cashless facility available in the Insurance. I have to pay around Rs9000 as a premium for the Insurance. I have to pay a coverage amount around Rs3Lakhs in the Insurance. Allover good policy and services.
Plan Name: Univerdal Sompo Indiviual Essentia
Agent Code: BPW01735

Shiv
Lucknow
January 29, 2016

"Best Policy.. "

My health insurance policy has been taken from Universal Sompo General Insurance. I undergone an accident which got covered by company and in future also I need to re operate it, so I stick with them. The services are good with them and I am paying around Rs8000 as the premium and the total insured value is around Rs3 lakh.
Plan Name: Univerdal Sompo Indiviual Essential
Agent Code: BPW01735

Ravinder
Delhi
January 29, 2016

"Satisfactory"

It is a corporate health insurance from Universal Sompo General insurance. The services are good from them. Though I have not had a claim experience yet. The coverage is good. It is for my family and myself. The premium is renewed by my employer. They have a tie up with a good net work of hospitals.
Plan Name: Univerdal Sompo Indiviual Basic
Agent Code: BPW01676

Priya
Ghaziabad
January 29, 2016

Satisfactory

Universal Sompo health insurance has many terms and conditions. A policy holder needs to be admitted in hospital for more than 24 hours, I order to get full benefit of reliance health insurance. I bought money back guaranteed plan. The premium is moderate and coverage is only for me.
Plan Name:Univerdal Sompo Indiviual Essential
Agent Code:BET01306