Universal Sompo Senior Citizen Health Care Plan

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.