Universal Sompo Arogya Sanjeevani Insurance Policy

Universal Sompo Arogya Sanjeevani Insurance: Key Highlights

Coverage Offered

Given below are the in-built policy benefits and coverage that can be availed by insured under the Universal Sompo Arogya Sanjeevani Insurance policy:

• Hospitalization expenses that include:
  • Room rent, Nursing, Boarding expenses up to 2% of the Sum Insured, or a maximum of Rs 5000 per day
  • ICU/ICCU charges up to 5% of the Sum Insured or a maximum of Rs 10, 000 per day
  • Surgeon, Medical Practitioner, Anesthetist, Consultants fees
  • Expenses towards Blood, Oxygen, Anesthesia, Operation Theatre, Medicines, Drugs and other Diagnostics
  • Expenses for treating cataracts up to 25% of Sum Insured or Rs 40,000, whichever is lower, in a policy year.
• Dental treatment, if medically necessary
• Plastic Surgery, if medically necessary
• All day care treatments that require hospital admission of less than 24 hours
• Road Ambulance expenses up to a maximum of Rs 2000 per hospitalization.
• In-patient AYUSH treatment
• Pre-hospitalization expenses for maximum 30 days and Post-hospitalization expenses related up to 60 days

Inclusions of the Plan

The following procedures are covered under the Universal Sompo Arogya Sanjeevani Insurance policy either as in-patient care or as a part of daycare treatment in a hospital up to 50% of the Sum Insured, specified in the policy schedule during the policy period:

• Balloon Sinuplasty
• Oral Chemotherapy
• Deep Brain Stimulation
• IntraVitreal Injections
• Immunotherapy
• Robotic Surgeries
• Stereotactic radio surgeries
• Bronchial Thermoplasty
• Vaporization of the Prostate
• Intra Operative NeuroMonitoring
• Stem Cell therapy

Exclusions of the Plan

Given below is the list of exclusions for the Universal Sompo Arogya Sanjeevani Insurance plan:

• Admission primarily for evaluation and investigation purpose
• Admission mainly for a Rest cure, respite and rehabilitation
• Expenses related to surgical treatment of obesity that does not fulfill the policy conditions
• Change of gender treatments
• Expenses for plastic or cosmetic surgery
• Injury or illness that occurred due to participation in a hazardous or adventure sport
• Expenses for treatment of injuries resulting from a breach of law or criminal offense by the insured
• Treatment for drug or alcohol abuse
• Dietary supplements not prescribed by the medical practitioner
• Maternity expenses related to childbirth, miscarriage, complications and termination of pregnancy

Features & Benefits of the Universal Sompo Arogya Sanjeevani Insurance Plan

Given below are the salient features and benefits of the Universal Sompo Arogya Sanjeevani Insurance plan:

• The policy offers Sum Insured options between Rs 1 lakh and Rs 5 lakh in multiples of Rs 50,000.
• This policy can be availed by adults up to 65 years of age.
• Pre-policy medical examination is not required for subscribers less than 55 years of age.
• Pre-existing diseases will be covered after a waiting period of 48 months of continuous coverage, and specific illnesses have a waiting period of 24 months.
• 5% of the claim amount admissible as Co-payment and payable as per the policy terms for every claim
• The premium paid and the benefits received under this policy are eligible for tax deduction under Section 80D of the Income Tax Act 1961.

Eligibility Criteria

To avail this policy, one has to fulfill the following benefits:

Cancellation of the Policy

• The insured may cancel the policy after giving 15 days' notice to the insurance company. In such an event, the insurance company will refund the premium on short term rates for the unexpired policy period provided no claims have been filed or availed.
• The company may cancel the policy on the grounds of non-disclosure of information, misrepresentation, and fraud after giving 15 days' notice. There would be no refund of the premium in this case.

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