Universal Sompo Individual Essential Plan

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Universal Sompo is one of the renowned names in the Indian insurance market. The insurer is popular for its products especially health insurance. And its individual health insurance is worth your money.

Individual health insurance coming with three variants namely Basis, Essential and Privilege is designed to cater to the needs of every individual. The policy can be availed as floater basis as well, where the sum insured can be availed from Rs 1 lakh to Rs.10 lakh. In this article, we will discuss one of its variants, Individual Essential Plan. Let’s take a look at how this policy works and benefits you:

Unique features of Universal Sompo Individual Essential Plan

The policy comes with the below features

  • The policy sum insured can be availed as individual and floater basis with sum insured options ranging from 3 lakh to 5 lakh.
  • The policy coverage can be increased by opting for riders such as Personal Accident Cover and Critical Illness Cover, daily hospital cash etc.
  • As per the Income Tax Act, the premium paid for this cover is exempted from tax under Section 80 D
  • Takes care of your complete wellbeing by covering minor complications such as fever, cough and cold
  • Provides out-patient Dental Treatment cover
  • Avail 10% of cumulative bonus up to a maximum of 50% for not claiming the policy
  • This plan comes with lifetime renewability
  • Restore benefit in case the sum insured gets exhausted
  • Coverage to the person with HIV/AIDS
  • No cap on expenses such as room rent, operation theatre doctor‘s fees, allied charges etc.
  • Health check-up benefit is available

Eligibility Criteria

The minimum eligibility to avail this policy include:

Age at Entry

Policy Term

Premium Payment Frequency

 

Minimum

Maximum

 

1 to 3 years

 

 

 

Single premium

 

Adults

18 years

70 years

Dependent Children

91 days

25 years

Children under floater plan

from day 1

25 years

 

The Coverage under Universal Sompo Individual Essential Plan

 Under Universal Sompo Individual Essential Plan, you are covered for the following:

  • In-patient Cover: While hospitalised, you are covered for room rent, nursing charges, ICU rent, OT charges, surgeon’s fee, anaesthesia, blood, laboratory, oxygen, medicine, drugs etc.
  • Day-care Procedure: You are also covered for those treatments that don’t require 24 hours hospitalisation. 141 such procedures are covered
  • Pre Hospitalisation Cover: Medical expenses incurred 30 days prior to the hospitalisation in tests, medicines etc. are covered.
  • Post Hospitalisation Cover: Your recovery may take time to heal you properly, while you may require frequent follow-ups with the doctor, medication or test further. These post-hospitalisation expenses are covered as well.
  • Domiciliary Treatment Cover: if your state of health is such that you are unable to move to the hospital, you can avail treatment at home and the expenses incurred during availing treatment at home will be reimbursed.
  • Ambulance Cost: The cost of transportation to the nearest hospital will be reimbursed
  • Dental Treatment Cover: An accident leading to dental injury is covered, however up to a limit as per the sum insured option opted by you.
  • Ayush In-patient Cover: Non-allopathic treatment costs such as Ayurveda, Unani, Homeopathy, Siddha etc. are covered.
  • Vaccination Cover: In case of an animal bite that requires immediate vaccination is covered
  • Child Cover: If your child is less than 12 years old and being hospitalised for 72 hours continuously, a daily allowance of is offered to meet the medical needs.
  • Diagnostic Test: The laboratory tests taken by you are covered. In this regard, it is not necessary that the tests are to be prescribed by a network medical physician.
  • Convalescence Benefit: If you are hospitalised for more than 10 days due to a serious illness, Rs. 10,000 once during a policy term is offered as Convalescence Benefit.
  • Out-patient Consultation Cover: Consultation expenses incurred in availing medical advice. You are also covered for availing either one pair of contact lenses or spectacles, provided it is prescribed by an eye specialist.
  • Maternity & Child Birth Cover: maternity benefit can be availed without paying an additional cost. You’re covered for pre and postnatal expense, newborn baby cover from 91 days.

Value-added Services

  • Health and wellness programme with up to date and clinically validated information
  • Active care programmes to prevent illness
  • Active life programme to guide you lead a healthy life
  • Second E-opinion in case of serious illness
  • Newsletter facility
  • Telephonic consultation with a physician

Universal Sompo Individual Essential Plan Exclusions

The policy becomes inactive under certain situations including:

  • Pre-existing diseases are not covered before 36 months
  • You can’t claim your insurance for illness during the initial 30 days of the policy, from the commencement date. However, this clause is not applicable in case of an accidental claim
  • Claim arising out of specific illnesses such as Cataract, piles, Benign Prostatic Hypertrophy, Sinusitis, Hysterectomy etc. is not accepted during the first policy year.
  • Injury directly or indirectly related to the war, war-like situation, foreign invasion etc. are not covered.
  • Circumcision unless necessary for the treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded, unless it is prescribed by an eye specialist only and covered after 4 years
  • Venereal diseases, intentional self-injury, suicide or attempt to suicide, use of intoxicating drug or alcohol are excluded
  • Cosmetic or aesthetic treatment is excluded
  • Abortion/miscarriage
  • Maternity benefits to be covered after 3 years of waiting period

Discount to be Availed

  • NCB discount of 10% to 50% for not claiming the insurance
  • 5% discount for taking a 2 years policy
  • 5% discount for buying a 3 years policy
  • 110 additional discount if you choose to receive the policy online

Universal Sompo Individual Essential Policy Claim Process

The policy can be claimed either for cashless hospitalisation or reimbursement of expense facility in the following ways:

Cashless Claim

Reimbursement Claim

Inform the insurer immediately

Pay the hospital bills on your own

Fill the cashless request form  along with the relevant document and submit to the insurer

Collect all original bills, receipts and other related documents

the TPA will guide you and help you initiate the process further.

Submit all along with the filled claim form to the insurer to the address mentioned in the policy document

The insurer will either approve or reject the request. Avail the treatment if the cashless request is accepted. The hospital bill will be settled directly

The insurer will reimburse the amount up to an admissible limit, considering the policy terms and conditions

*Note: 72 hours of prior notice is required in case of planned hospitalisation. On the other hand, you’ll require to notify the insurer within 24 hours of hospitalisation if it is an emergency hospitalisation case.

Universal Sompo Individual Essential Policy Renewal

All health insurance plans of Universal Sompo come with lifetime renewal benefit. So there is no maximum age limit to claim the policy benefits. However, you need to renew the policy once the first policy term ends. However, the insurer provides a grace period of 30 days, in case you miss the actual renewal date. However, you have to renew the policy within these days, either online or offline.