Universal Sompo Complete Health Care Basic Plan
Product Overview
Universal Sompo Complete Health Care Basic 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 Basic Plan
- Restore Benefits available in the event if the sum insured is exhausted.
- Under this plan Out Patients Treatment is covered.
- Non-Allopathic Treatment like ayurvedic, homepathic, etc. is covered under this policy.
- 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.
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Critical features of Universal Sompo Complete Health Care Basic Plan
- Room rent:
Limits imposed towards room and ICU rent expenses
This Plan has No Capping on Room Rent - 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.
- 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) - 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 in case of pre-existing diseases
Eligibility Criteria
- Minimum Age of Entry:- 91 days
- Maximum age of Entry:- 70 years
- Sum Insured:- 1 lakh & 2 lakhs
- Policy Tenure:- 1,2 & 3 years
- Premium Calculated on Basis of:- Age, (i.e. sum Insured Choosen)
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 | Basic Plan | Essential Plan | Privilege Plan |
| Sub limits Applicability |
Avail discount of 7.5% for choosing Sublimit A Avail discount of 5% fo choosing Sublimit B |
Avail discount of 10% for choosing Sublimit A Avail discount of 7.5% fo choosing Sublimit B Avail discount of 5% for choosing Sublimit C |
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 2 yrs policy tenure and for 3 yrs tenure 7.5%
- Family discount ( 5.0% for covering 2 to 3 members) (7% for covering 4 to 5 members ) (10% for covering more than 5 members)
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
When you pay the premium for your health insurance policy, you are 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
