Universal Sompo General Insurance Company started as a joint venture company between Karnataka Bank, Dabur Investment Corporation, Indian Overseas Bank, Indian Bank and Sompo Japan Insurance Incorporation in 2007. The company is recognised as one of the Best BFSI Brands of 2021 by Economic Times and has a PAN India presence with 117 offices, 5000+ network hospitals and 24/7 customer assistance.
The company offers a Complete Healthcare Insurance Plan which is a comprehensive health cover with added features. It includes 14 base covers and 26 add-on covers with a sum insured ranging from ₹ 1 lakh to ₹ 50 lakhs. The plan is available in 6 variants: Basic, Essential, Privilege, Plus, Premier, Executive, and Digi-Pro. In this article, we will talk about Universal Sompo Complete Health Care Privilege Plan.
Universal Sompo Complete Health Care Privilege Policy is a comprehensive health cover that reimburses expenses incurred due to hospitalisation. The company indemnifies medical expenses if the insured is hospitalised due to illness or injury during a policy period. Let us look at the various aspects of the plan.
Entry Age - For adults, it is 18 to 75 years, and for dependent children, it is 1 day to 25 years.
Policy Type - Individual and Family Floater
Number of Members Covered - The maximum number of insured persons in a policy is up to 6 members and can be increased up to 20.
Relations Covered - Self, spouse, children, parents, parents-in-law, siblings, grandparents, grandchildren, son-in-law, daughter-in-law, brother-in-law, sister-in-law, nephew and niece.
Policy Period - 1/2/3 years
Sum Insured - 6 to 10 lakhs
Free-look Period - 15 days
Allowed Maternity Age group - 18 to 45 years
Cumulative Bonus – 10% of the base sum insured is applicable for every claim-free year accumulating up to 50% of the base sum insured.
Discounts
Given below are the details of the coverage available under the health insurance policy. It includes base covers, additional benefits, value-added services and add-on covers.
In-patient Treatment is covered up to the sum insured and includes hospitalisation expenses like room rent, ICU charges, nursing charges, Doctor’s fees, medicines, anaesthesia, blood, oxygen, OT charges, surgical, appliances, etc.
Day Care Procedures are covered for less than 24 hrs hospitalisation up to Sum insured.
Pre-hospitalisation expenses are covered for 30 days and can be extended to 60 days if required.
Post-hospitalisation expenses are covered for 60 days and can be extended up to 90 days.
Domiciliary Treatment is covered up to 20% of the Base sum insured and also covers pre and post-hospitalisation expenses.
Organ Donor medical expenses due to hospitalisation for an organ transplant are also covered by up to 20% of the sum insured.
Ambulance expenses are covered up to 1% of the base sum insured or ₹ 3000 or actuals, whichever is less.
In-patient dental treatments in case of accidents are covered up to 100% of the in-patient treatment sum insured.
AYUSH benefit is available up to the sum insured for in-patient treatment taken in an AYUSH hospital.
Daily cash for accompanying an insured child up to 12 years of age is available for accompanying adults. ₹ 1000 per day is available, subject to a maximum of ₹ 15000 if hospitalisation exceeds 72 hrs.
Post-bite vaccination is available up to 100% in-patient treatment sum insured or actuals, whichever is less.
OPD cover, including consultation, diagnostic tests, dental treatments and spectacles, contact lenses or hearing aids, is available up to 1 % of the base sum insured or actuals, whichever is less subject to a maximum of ₹ 7,500.
Convalescence benefit of a flat ₹ 10,000 per member is available when hospitalisation exceeds 10 days.
Mother and child care benefits, including routine pregnancy, pre as well as post-natal expenses and newborn care, are available up to ₹ 25,000 for normal delivery or actuals, whichever is less. For c-section delivery, it is up to ₹ 50,000 (including pre as well as post-natal expenses up to ₹ 2000) or actuals, whichever is less.
Restore benefit equal to 100% of the base sum insured is automatically available for a particular policy year, in case the sum insured and NCB are exhausted during that policy year.
Preventive health checkup cost is reimbursed up to the specified limits on each continuous 2 claims-free renewal of the policy.
Value Added Services - Universal Sompo Health Insurance provides the following complimentary services under the plan during the policy year.
Dial a Doctor - The insured can seek medical advice from a doctor either online or through a call.
Health Educational Library for People (HELP) - It gives access to various health resources such as guides, videos, live chats or asking an expert.
Second Opinion - You can seek a second opinion on your health condition.
Specialist Consultation - Specialist e-consultation is provided with 2 follow-ups for any chronic condition suffered by the insured.
Wellness package - You can avail of discounts on wellness products and services listed on the company’s website.
24/7 Customer Service - Assist you with queries on claims, benefits, claim processing and other plan inquiries.
Monthly Newsletter - It provides nutritional information and other health-related tips.
Add-on Covers - There are a number of add-on covers available that you can include in your plan to enhance coverage on payment of additional premiums.
11 listed critical illnesses are covered up to 100% of the base sum insured
Hospital Daily Cash of ₹ 1000 per day for more than 3 days of hospitalisation for a maximum of 7 days.
Sub-limits for listed surgeries and medical procedures
5 % discount on treatments taken in a network hospital
Pre and post-hospitalization days can be extended up to 90 and 120 days, respectively.
Modification of the waiting period for maternity and child care benefits to 12 months.
Coverage for non-medical items is available for up to ₹ 7500
Condition Waiver under Restore Benefit
Modification of the OPD waiting period to 24 months.
Emergency travelling allowance up to 1 % of the base sum insured.
1 second-opinion consultation in a policy year up to ₹ 2500
Rest, rehabilitation and respite care for ₹ 1000 per day
Weight control treatment expenses covered up to ₹ 1 lakh
Enhanced organ Donor Cover up to ₹ 2 lakhs
The premium waiver is available from the 4th year after 3 claim-free years
Medically Advised Support Devises up to ₹ 15000
Co-Payment 10 to 50%
Modern treatments
Emergency Assistance Services
Wellness Benefit Disease Management
Tailor-made Plans: The plan can be customised using a wide range of add-on covers, enhancing sub-limits, extending pre and post-hospitalisation days and including a host of wellness benefits and modern treatments.
Flexible Sum Insured: The plan offers multiple sum insured options ranging from 6 lakhs to 10 lakhs at an affordable premium. Also, it restores 100 % sum insured during a policy period automatically, in case the sum insured and no claim bonus is exhausted in that policy period.
Value-added Services: These services are only available with basic, essential and privilege plan variants, where you can utilise available resources for seeking medical advice and improving your knowledge on various health topics.
Reasonable waiting periods: The waiting period under the plan for pre-existing diseases is 36 months and for specific listed diseases is 12 months which is less compared to other plans. The plan also gives an option to reduce waiting periods on payment of additional premiums.
Option to include Exclusions: Exclusions like sterility and infertility treatments, rehabilitation treatments, and obesity control treatments can be included as add-on covers in the policy.
Wellness Benefits: The company rewards its policyholders for taking up wellness initiatives and participate in wellness programs. It provides facilities like Health Risk Assessment, electronic health Records and Health Screening through its wellness mobile application.
The claim process for Universal Sompo Health Insurance Plans is easy and hassle-free. You can request a claim through
a cashless facility availed for treatment in a network hospital, or
reimbursement of the claim for treatment in a non-network hospital.
In both cases notify the company 48 hrs before planned hospitalisation and 24 hours within emergency hospitalisation. For cashless claims, you need to provide your health policy details and the details of your treatment while you are admitted. On approval, the company directly settles the hospital bills.
For reimbursement claims, you have to provide all the documents after the discharge within 30 days and once approved the company reimburses the claim amount as per your policy.
For a detailed claim process and list of documents refer to the policy documents.
Universal Sompo Complete Health Care Privilege Plan offers some unique features and comprehensive coverage which can be customised as per individual requirements. The policy is cost-efficient with a range of benefits. To understand the policy better, go through the policy terms and conditions and take note of inclusions and exclusions.
