Universal Sompo Complete Health Care Plan
Product Overview
Universal Sompo - Complete Health Care Plan is an inpatient hospitalization policy, admission as an inpatient for a minimum period of 24hrs is required, except for day care treatments.
Unique Features of Universal Sompo Complete Health Care Plan
- Restore Benefits available in the event if the sum insured is exhausted.
- Under this plan Out Patients Treatment is covered.
- Maternity benefits is covered (Execpt Basic Plan) in this plan.
- Pre-Existing Disease are covered after a waiting period of 3 years.
- Organ Specific are Covered after 1 year like Arthritis - if non-infective, calculus, diseases of gall bladder, etc.
OneInsure App Benefits
Store Digitally | Get Premium Reminders | Service and Claim assistances | Empower Nominee
Critical features - Universal Sompo Complete Health Care Plan
- Room rent:
Limits imposed towards room and ICU rent expenses
- This Plan Has 3 Variants Basic,Essentail and Privilege Plan
- This Plan has No Capping on Room Rent
- No Claim Bonus:
Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal
10% of basic sum insured up to a maximum of 50 % for each unclaimed year in case opted for(The cumulative bonus will reduced by 10% of the Sum insured once a claim is made) - Co-Pay:
Specific % of admissible claim amount to be borne by Insured
- Copayment Clause:
Treatment only in tied Network - 5% discount if treatment is taken in tiered network and 10% co-pay shall be applicable for taking treatment in non-tiered network - Sub limits optional applicable as per the grid.
- Pre-Existing Diseases:
Means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer
This Plan has a waiting period of 3 years is case of pre-existing diseases
Maternity has a waiting period of 3 years(Applicable for Essential and Privilege Plan)
Eligibility Criteria
- Minimum Age of Entry:- 91 days
- Maximum age of Entry:- 70 years
- Sum Insured:-
Basic Plan - 1, 2 Lacs
Essential Plan - 3, 4, 5 Lacs
Privilege Plan - 6, 7, 8, 9, 10 Lacs - Policy Tenure:- 1, 2 & 3 years
- Premium Calculated on Basis of:- Age, (i.e. sum Insured Chosen)
Add-ons
- Critical illnesses:
When you avail this option, we shall pay you your chosen Sum insured, in the event that you are diagnosed with or undergoing any of the listed critical illness and / or surgical procedures. List of Critical Illness
- First Heart Attack - Of Specified Severity
- Cancer of specified severity
- Open Chest CABG
- Open Heart Replacement Or Repair Of Heart Valves
- Coma Of Specified Severity
- Kidney Failure requiring regular dialysis
- Major Organ /Bone Marrow Transplant
- Stroke resulting in permanent symptoms
- Kidney Failure requiring regular dialysis
- Permanent Paralysis Of Limbs
- Motor Neurone Disease With Permanent Symptoms
- Personal Accident:
When you avail this option, we shall pay you, your chosen sum insured, in the event of your accidental death or permanent total disablement on account of accident. - Hospital Cash Benefit:
When you avail this option, we shall provide you with daily cash for each day that you are hospitalised when your hospitalisation exceeds 3 days. - Treatment in Tired Hospital:
If you avail this option, you agree that if you are hospitalized in a hospital other than a network provider then, you shall bear 10% of the claim payable under the policy and our liability, if any, shall only be in excess of that sum. If you elect this option, and your premium would be reduced by 5% of the prevailing premium. - Sub limits:
When you choose to restrict your defined illness / diseases up to a certain limit as per below, Insurer will offer you discount for doing the same.
| Surgeries / Medical Procedures | Sub-limits (Rs.) | ||
| A | B | C | |
| Cataract per eye | 10,000 | 15,000 | 20,000 |
| Other Eye Surgeries | 15,000 | 22,000 | 35,000 |
| ENT | 15,000 | 22,000 | 35,000 |
| Surgeries for -Tumours/Cysts/Nodule/Polyp | 20,000 | 30,000 | 60,000 |
| Stone in Urinary System | 20,000 | 30,000 | 40,000 |
| Hernia Related | 20,000 | 30,000 | 60,000 |
| Appendectomy | 20,000 | 30,000 | 40,000 |
| Knee Ligament Reconstruction Surgery | 40,000 | 60,000 | 90,000 |
| Hysterectomy | 20,000 | 30,000 | 60,000 |
| Fissures/Piles/Fistulas | 15,000 | 22,000 | 35,000 |
| Spine & Vertebrae related | 40,000 | 60,000 | 90,000 |
| Cellulites/Abscess | 15,000 | 22,000 | 35,000 |
| Other Surgeries & Procedures | 25,000 | 37,000 | 55,000 |
| All Medical Expenses for any treatment not involving Surgery/Medical Procedure | 10,000 | 15,000 | 25,000 |
| Benefits | Sub limits Applicability |
| Basic Plan | Avail discount of 7.5% for choosing Sublimit A Avail discount of 5% for choosing Sublimit B |
| Essential Plan | Avail discount of 10% for choosing Sublimit A Avail discount of 7.5% for choosing Sublimit B Avail discount of 5% for choosing Sublimit C |
| Privilege Plan | Avail discount of 10% for choosing Sublimit A Avail discount of 7.5% for choosing Sublimit B Avail discount of 5% for choosing Sublimit C |
Additional discounts
- Discount for multi-year polices-5% discount for opting 2yr policy tenure and for 3yrs tenure 7.5%
- E-Discount policy-Rs 110
- Family discount: ( 5.0% for covering 2 to 3 members)(7% for covering 4 to 5 members )(10% for covering more than 5 members)
Waiting Period
- Covered from Day 1:
Accidental Injuries - Covered after 30 Days:
All incidences apart from specified surgeries, Permanent exclusion & Pre-existing diseases (if any) - Covered after 2 Years:
Arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal,ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant,Benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; surgery of gallbladder and bile duct unless necessitated by malignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of benign prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses; surgery for nasal septum deviation.
Exclusions
- From intentional self-injury, suicide or attempted suicide.
- Whilst under the influence of liquor or drugs or other intoxicants.
- Emotional distress
- Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
- Directly or indirectly, caused by venereal disease, AIDS or insanity.
- Arising or resulting from committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanour or civil commotion.
- Whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports and the like.
- Due to war or ionising radiation or nuclear perils.
- Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.
- Congenital anomalies or any complications or conditions arising there from
Note: Any claims arising out of or attributable to any of the following is not covered
Tax Benefits
The premium paid for health insurance policy is liable to get a tax rebate under section 80D of the Income Tax Act, 1961.
Claim Process
In case you would like to know about the Claim Process or would like to register a Claim please click the link below
