Universal Sompo Swarna Gramin Bima Yojana Group Health Plan

Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

Swarna Gramin Bima Yojana (Group) is an all-round health insurance plan for Gramin (Village Dweller) that covers the medical expenses incurred in case of illness or accident. You can also add your family members under this plan. It is the perfect Health protection for you, your family, people of your organization or NGO and also rural clientele of Financial Institutions.

No pre-acceptance medical tests up to 45 years of age , however, if you are above 45 years, then, you may require to undergo medical tests ( BP, Fasting Sugar, ECG) at our listed diagnostic centers, 50% cost of which will be borne by us in case of accepted proposals.
The policy consists of 3 sections:

Section A - Personal Accident
Section B - Critical Illness
Section C - Hospital Cash

Policy renewals will be for your lifetime.

Benefits of Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

Benefit under section A

Sr. No.	Benefits	Payable Amount
Benefit 1	Death of the Insured or his/ her family members upon accident	100% of Sum Insured
Benefit 2	Permanent Total Disablement of the Insured or his/her family members resulting from Accident	125% of Sum Insured
Benefit 3	Permanent Partial Disablement of the Insured or his/ her family members resulting from Accident	Depending on % of disablement

Section 2- Critical Illness

The following Critical Illnesses and Surgical Procedures shall be covered up to the Sum Insured:

Option 1	Option 2	Option 3
Cancer of specified severity	Option 1 +	Option 2+
First Heart Attack of specified severity	Kidney Failure requiring regular dialysis	Major Organ /Bone Marrow Transplant
Open Chest CABG	Stroke resulting in permanent symptoms	Motor Neurone Disease with Permanent Symptoms
Open Heart Replacement	Permanent Paralysis of Limb
Coma of Specified Severity	Multiple Sclerosis with persisting symptoms

Section C- Hospital Cash

This column shows you the options you have as paid amount upon hospitalization, subject to your minimum hospital stays of 2 days.

Benefit Options
Maximum Amount	Option 1	Option 2	Option 3
	Rs 250/ - per day	Rs 500/- per day	Rs 1000/- per day
	Rs 45000/-	Rs 90,000/-	Rs 1,80,000/-

Double Benefit - If the insured person is admitted in an ICU, the amount mentioned in the optio0ns listed above shall be subsequently doubled for the maximum stay of 7 days.

Premium details of Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

Basic Premium Rate for Personal Accident

Age Band	SUM INSURED
(Years)	50,000	75,000	1,00,000	1,25,000	1,50,000	1,75,000	2,00,000
0.5-25	15	20	25	32	41	52	64
26-35	20	25	33	42	53	67	84
36-45	25	33	43	54	69	87	109
46-55	33	43	55	71	90	113	141
56-65	43	56	72	92	117	147	184
66-75	72	94	121	155	197	249	311
76-80	94	122	158	202	257	323	404
>80 years*	141	183	237	303	385	484	606

Basic Premium Rate For Critical Illness

Age Band	50000	75000	100000	125000	150000	175000	200000
5-25 Yrs	180	271	361	451	541	631	722
26-35 Yrs	219	329	438	548	658	767	877
36-45 Yrs	329	493	657	822	986	1150	1314
46-55 Yrs	378	567	756	945	1133	1322	1511
56-65 Yrs	692	1038	1384	1730	2075	2421	2767
66-75 Yrs	1071	1606	2141	2677	3212	3747	4282
76-80 Yrs	1369	2053	2738	3422	4106	4791	5475
80 Yrs	1750	2625	3500	4375	5250	6125	7000

Basic Premium for Section - Hospital Cash ( for 30 days)

Age Band	250 per day	500 per day	1000 per day
5-25 Yrs	188	377	753
26-35 Yrs	196	392	783
36- 45 Yrs	209	417	834
45- 55 Yrs	225	450	900
56- 65 Yrs	263	525	1050
66-75 Yrs	300	600	1200
76-80 Yrs	375	750	1500
>80 Yrs	413	825	1650

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

Additional Benefits

Discount under the Policy - Group discount as per below when the number of persons covered under the Policy exceeds 25.

Number of Persons covered	Applicable discount
Up to 25 persons	No discount
Between 25 and 50 persons	5% on total premium
Between 51 and 100 persons	10% on total premium
Between 101 and 300 persons	15% on total premium
Between 301 and 400 persons	20% on total premium
Between 401 and 500 persons	25% on total premium
Over 500 persons	35% on total premium

Tax Benefit - Avail of tax benefit under section 80D of Income Tax Act on the premium applicable for Critical Illnesses & Surgical Procedures cover.

Policy Details of Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

Free Look period - You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable
Sum Insured enhancement - The Sum Insured under the Policy can only be enhanced on renewal subject to approval from underwriter.
Renewal - Your Policy shall ordinarily be renewable for lifetime except on grounds of fraud, moral hazard or misrepresentation or non‐cooperation by you/ any of the Insured Persons.

How to cancel Universal Sompo Swarna Gramin Bima Yojana (Group) Policy?

By You: You may terminate this Policy at any time by giving us written notice, and the Policy shall terminate when such written notice is received. If no claim has been made under the Policy, then we will refund premium in accordance with the table below:

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 #rd 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%

By Us: We may at any time terminate this Policy on grounds of misrepresentation, fraud, non-disclosure of material facts or non-cooperation by you or any Insured Person or anyone acting on your behalf or on behalf of an Insured Person upon 30 days notice by sending an endorsement to your address shown in the Schedule without refund of premium.

Documents Required for Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

In case of Death

Policy Copy
Post Mortem Report (certified copies) - as applicable
F.I.R. or Death report or Inquest Panchnama (in original or certified copies)
Spot Panchnama (certified copies)- if applicable
Death certificate (in original or certified copy)

In case of Permanent Total Disablement/Permanent Partial Disablement

Policy Copy
Disability certificate - Authorized Medical Practitioner of the district/ units concerned, (certificate) stating percentage of disablement
F.I.R. and Panchnama wherever applicable (original or certified copies)
Medical report
Investigation reports like laboratory test, X-rays and reports essential of confirmation of the type and percentage of disability
Original medical bills

In case of Critical Illnesses and Surgical Procedures

Original Bills or their copies (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill and any attachments thereto like receipts or prescriptions in support of any amount claimed)
All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
A precise diagnosis of the treatment for which a claim is made.
A detailed list of the individual medical services and treatments provided and a unit price for each.

In case of Hospital Cash

Photo copy of bills, receipt and discharge certificate/card from the Hospital.
Photocopy of F.I.R. copy in case of an accident.
Complete set of Hospital/medical records

Eligibility Criteria For Universal Sompo Swarna Gramin Bima Yojana (Group) Policy

Entry age for the proposer is 18 years and he can opt for this policy up to the age of 65 years.
Entry age for dependent children is 6 months.
Maximum of 2 Adults and 2 Dependent Children (up to 25 years of age) can be covered under the Policy.

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