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Universal Sompo Individual Essential Plan

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.

Written By: PolicyBazaar - Updated: 09 January 2020
Average Rating
(Based on 12 Reviews)
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Universal Sompo Individual Essential Plan Reviews & Ratings
4.7 / 5 (Based on 12 Reviews)
(Showing Newest 12 reviews)
Sandeep
Mumbai, March 26, 2017
Health
I had prchased health insurance and maid a claim . i have received superior service for customer service team.
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

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