Universal Sompo Senior Citizen Health Care Plan

Product Overview

Universal Sompo Senior Citizen 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 Senior Citizen Health Care Insurance Plan

• Health Check ups shall be paid after every 3 claim free renewals.
• Pre-Hospitalization and Post Hospitalisation expenses is covered under this plan
• Pre-Existing diseases are covered after a waiting period of 2 years.

Critical features of Universal Sompo Senior Citizen Health Care Insurance Plan

• Room rent:
  Limits imposed towards room and ICU rent expenses

1. Room Rent-1% the Sum Insured or whichever is less per day
2. ICU-2% the Sum Insured or whichever is less per day
3. Overall limit:25% of the S.I. per illness/injury or actuals whichever is less
4. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses-(Up to 25% of Sum Insured per illness/ Injury or actuals whichever is less)
5. Anaesthesia, Blood, Oxygen, OT charges, Surgical appliances(any disposable surgical consumables subject to upper limit of 7% of Sum Insured), Medicines, drugs, Diagnostic material X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of stent implants-(Up to 50% of Sum Insured per illness/Injury or actuals whichever is less)

• Co-Pay:
  Specific % of admissible claim amount to be borne by Insured

1. Admissible on all hospitalisation claims under the Policy - 10% Shall apply
2. Arising out of pre-existing diseases (including for roll-over cases) - 20% shall apply except for claims arising under section B - Critical Illness
3. Day Care Procedures- 15% Shall Apply
4. Packaged Charges by Hospital - No co-pay shall be applicable on packaged charges by Hospital

• 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
  5% of basic sum insured up to a maximum of 10 % for each unclaimed year in case opted for(The cumulative bonus will reduced by 5% 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 2 years is case of pre-existing diseases

Eligibility Criteria

• Minimum Age of Entry:- 60 years
• Maximum age of Entry:- 70 years
• Sum Insured:- 1 lakh to 5 lakhs
• Policy Tenure:- 1, 2 & 3 years
• Premium Calculated on Basis of:- Age, (i.e. sum Insured Chosen)

Add-ons

Additional discounts

• Discount for multi-year polices-10% discount for opting 2yr policy tenure and for 3yrs tenure 15%
• Family discount: A family discount of 10% shall be applicable on hospitalisation premium when you opt for covering your spouse under the policy on individual Sum Insured basis. This discount shall not be applicable when your Spouse is covered under the Policy on Floater Sum Insured basis.

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:

1. Cataract
2. Benign Prostatic Hypertrophy
3. Myomectomy, Hysterectomy unless because of malignancy
4. All types of Hernia, Hydrocele
5. Fissures and/or Fistula in anus, hemorrhoids/piles
6. Arthritis, gout, rheumatism and spinal disorders
7. Sinusitis and related disorders
8. Stones in the urinary and billiary systems
9. Dilatation and curettage , Endometriosis
10. All types of Skin and internal tumors/ cysts /nodules/ polyps of any kind including breast lumps unless malignant
11. Dialysis required for chronic renal failure
12. Surgery on tonsils, adenoids and sinuses
13. Gastric and Duodenal erosions ulcers
14. Deviated Nasal Septum
15. Varicose Veins/ Varicose Ulcers
16. Joint replacements unless due to accident

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

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