Universal Sompo Senior Citizen Health Care Plan

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Universal Sompo Senior Citizen Health Care Plan Overview

Universal Sompo Senior Citizen Health Care is policy that can be taken by a senior citizen who is above 60 years of age for covering himself/herself and his/her spouse. The policy covers hospitalization charges for the insured and also offers optional cover of critical illness occurring 90 days after the policy issue date.

Key Features of Universal Sompo Senior Citizen Health Care Plan

  • The policy consists of 2 sections consisting of Hospitalization and an optional section of Critical illness.
  • The applicant or his/her spouse has to go undergo certain number of medical tests for purpose of consideration of proposal.
  • If proposal is accepted, 50% of the costs incurred in conducting the tests shall be reimbursed.
  • Only critical illness specified in the policy will be covered under the policy.
  • The sum insured under both the sections need not be identical.
  • Additional discount of 10% is given if you choose to cover your spouse under the policy on individual Sum Insured basis instead of floater basis.

Benefits of Universal Sompo Senior Citizen Health Care Plan

  • Specified procedures/ surgeries requiring less than 24 hours of hospitalization would be covered under the policy.
  • 25% sum insured per injury/illness for medical tests.
  • 50% sum insured per injury/ illness for blood, oxygen, surgical appliances, diagnostic materials etc.
  • Up to 2% sum insured per day if admitted in IC unit.
  • Ambulance charges to the extent of 1% of sum insured or Rs 1500. 

Universal Sompo Senior Citizen Health Care Premium Details

Premium for Hospitalization ( Individual Plan/ 1 Adult)
Age/ Sum Insured 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000
60-65 years 4358 8820 13493 16196 18848
66-70 years 5403 10937 16731 20083 23371
71-75 years 5796 11731 17946 21541 25068
76-80 years 7130 14429 22072 26496 30832
80-85 years 7628 15438 23618 28350 32991
86-90 years 9383 18989 29049 34871 40578
90 years 11259 22787 34859 41845 48694

 

Premium for Hospitalization (1 + 1 Adult Plan on Individual Sum Insured basis)
Age/ sum insured 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000
60-65 years 8279 16758 25636 30773 35810
66-70 years 10266 20780 31789 38158 44405
71-75 years 11012 22288 34097 40928 47629
76-80 years 13546 27416 41937 50342 58542
80-85 years 14494 29333 44874 53865 62683
86-90 years 17827 36080 55193 66254 77098
90 years 21393 43296 66232 79505 92519

 

Premium for Hospitalization (1 + 1 Adult Plan on Floater Sum Insured basis)
Age/ sum insured 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000
60-65 years 6101 12348 18890 22675 26387
66-70 years 7564 15311 23423 28117 32719
71-75 years 8114 16423 25123 30157 35095
76-80 years 9981 20201 30900 37094 43166
80-85 years 10680 21613 33065 39690 46187
86-90 years 9383 26585 40669 48819 56809

90 years

15763

31902

48803

58583

68171

 

Premium for Critical Illness Insurance (Applicable for each insured person on individual SI basis only)
Age/ sum insured 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000
60-65 years 2179 4410 6746 8099 9424
66-70 years 2702 5468 8365 10042 11685
71-75 years 2898 5865 8973 10771 12534
76-80 years 3565 7215 11037 13248 15416
80-85 years 3815 7720 11809 14175 16496
86-90 years 4691 9495 14525 17435 20289

90 years

5630

11394

17430

20922

24347


*The above rates may change. Please check the policy wordings for more details. 

Universal Sompo Senior Citizen Health Care Policy Details

Renewal - the policy is ordinarily renewable till 80 years of age except on grounds of fraud, moral hazard or misrepresentation.

Cancellation - You may cancel this policy by sending a written notice to us. Retention premium for the period will be calculated based on following short period table and the balance will be refunded

Cancellation Period
Cover Period Within 1 month From 1 month to 3 months From 3 months to 6 months From 6 months to 1 year During 2nd year During 3rd year
1 year 75% 50% 25% 0% NA NA
2 year 75% 65% 50% 25% 0% NA
3 year 75% 70% 60% 45% 11% 0%


Continuity 
- In case company decides to withdraw Sampoorna Suraksha Bima Policy, option shall be available to migrate to nearest substitute product.

Co-Payment - There is a cost sharing requirement applicable under this Policy in which you shall bear the percentage of the admissible claim amount specified in table below.

Admissible on all hospitalization claim under the Policy

10% shall apply

Arising out of pre-existing diseases

20% shall apply except for claims arising under critical illness

Day care Procedures

15% shall apply

Packaged Charges by Hospital

No co-pay shall be applicable on packaged charges by Hospital


Sum Insured Enhancement
- sum insured can be enhanced only upon renewal

TPA and Network Providers- For assisting you during claims related services we have engaged a Third Party Administrator and also tied-up with a lot of hospitals all over India for securing a cashless claims processing.

Region of cover- we shall pay for treatment confined to the Hospitals in India only.       

Loadings under Universal Sompo Senior Citizen Health Care Insurance Policy

  1. Loading based on location: load premium up to 10% if you are a resident of any one for the Tier 1 cities ( Delhi/NCR, Mumbai, Chennai etc,)
  2. Health status loading: load premium up to 100% under the Policy as under depending your health status. 

Exclusions in Universal Sompo Senior Citizen Health Care insurance

  • Any condition, ailment, injury or related conditions for which the insured have been diagnosed, received medical treatment, had signs or symptoms, prior to the inception of the policy until 24 months from the date of inception.
  • Medical expenses incurred by you on treatment of following illness until 24 months from the date of inception:
    • Cataract
    • Benign Prostatic Hypertrophy      
    • All types of Hernia, Hydrocele
    • Stones in the urinary and billiary systems
    • All types of Skin and internal tumors
    • Dialysis required for chronic renal failure
    • Cosmetic, aesthetic, or related treatments will not be covered.
    • Expenses arising from HIV or AIDS and related diseases.
    • Any illness or disease contracted due to intake of alcohol or other addictive substances will not be covered.
    • Treatments consisting of non-allopathic medicine are not covered under this policy.
    • Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind. 

Documents Required to buy Universal Sompo Senior Citizen Health Care Insurance

To buy the policy, an ‘Application form/ proposal form’ is required to be filled. It should be submitted along with accurate medical history and the address proof. Medical examination may be required in some cases, based on the sum insured and the age of the person.

Eligibility to buy Universal Sompo Senior Citizen Health Care Insurance

  • You must be above 60 years of age on last birthday under the Policy.
  • Must be permanent resident of India.
  • Maximum entry age under the policy for you and your spouse is restricted to 70 years. The renewals for the policy are provided for lifetime.