Universal Sompo Health Insurance
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UNIVERSAL SOMPO HEALTH INSURANCE

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Universal Sompo Health Insurance

Overview
Universal Sompo Health Insurance Company is the only public-private joint venture in the general insurance space in India. This general insurance company that started its operations in India in 2007 has been formed by Indian Overseas Bank, Allahabad Bank, Karnataka Bank, Dabur Investment Corp and a leading general insurer from Japan Sompo Japan Nipponkoa Insurance Inc.  The JV has its headquarters in Mumbai and works through 7700 branches of its partner banks across the country apart form 11 of its own offices.

Universal Sompo Health Insurance at a Glance
  • Cashless facility at over 4000 hospitals across India
  • Company achieved a premium growth rate of 42.43% at Rs 1287.23 cr in FY 2016-17.
  • Company gives cover in the following areas Maternity/OPD/ Ayush/HIV.
  • Claim settlement ratio is at 99.23%  with all claims being paid through NEFT/RTGS reducing time taken for claim settlement

Awards & Recognitions
  • Won the Skoch order of Merit 2016 award for exemplary work in extending insurance benefits via common service centre
  • Won the Top 100 Projects in India award for 2016
  • Fintelekt-Insurance Award 2017 for leadership in claims service in Indian general insurance industry
  • Best customer service provider of the year at the 2nd India insurance summit

Documents needed to apply for Universal Sompo Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph

Why Universal Sompo Health Insurance?
Below are given some reasons why Universal Sompo is the right insurance provider for you:

Features Description
Sum Insured You can choose a sum insured ranging from Rs 1 lac to more than Rs 1 crore
Cashless hospitalisation Universal Sompo has a vast network of hospitals with over 4000 hospitals spanning the length and breadth of the country where you can avail cashless facility.
Claim process A time-efficient claim process that ensures the claims are settled within 7 working days. The claim must be filed within 30 days of discharge from hospital.
No-Claim Bonus (NCB)  Cumulative Bonus for every claim free year at 5% of Basic Sum Insured. The Cumulative Bonus can be accumulated to a maximum of 30%.
Discounted health care services The company's initiative Aarogyam enables its customers to present their health card and get discount at designated diagnostic centres, pharmacists and chemists, dental care centres or for OPD services and annual health check-ups
Policy Discounts Long-term family and group discounts available at the mandated rates under various policies .
Lifelong renewability  All plans offered by Universal Sompo have a lifelong renewability option
Value Added Services : Health & Wellbeing Services:
Newsletters and online health knowledgebase to help you to make simple changes to develop a healthier, more balanced and productive lifestyle.
'HELP (Health Education library for People)' portal: Active life, health and wellbeing programs designed to guide you to your health goals, prevent illness or manage existing conditions. You also get lot of medical information including information on diet and nutrition, help to stop smoking and guidance on travelling overseas.
Dial-a- Doctor: Consult a doctor any-time from anywhere for a second opinion if you have been diagnosed as suffering from any serious illness at no additional costs.
Health Checkup: Free health check after specified number of completed policy years.
Portability Universal Sompo plans can be ported from one insurer to another without losing the benefits like no-claim bonus and waiting period.
Pre And Post Hospitalisation Benefit Medical expenses covered from 30 days before hospitalization to 60 days after hospitalization for related medical expenses
Benefits of online process Virtual policy issuance of many products, online endorsement and online claim status tracking. E-policy discount also given if you choose to receive your policy only in electronic form.
Multiplier Benefit For every year without a claim, a bonus of 10% of the basic sum insured will be provided with a limit up to 50%.
Riders Critical Illness like paralytic stroke, Cancer, Kidney failure, Open chest CABG, major organ/bone marrow transplant, Coronary Artery Disease, Death and Total partial disability including loss of sight in only one eye due to accident covered.

Types of Universal Sompo Health Insurance Plans
Universal Sompo offers insurance coverage in three variations: Individual and Family Health Insurance Plans, Group Plans and Senior Citizen Health Insurance Plans.

1: Universal Sompo Complete Health Insurance Plan- This is the star insurance plan of Universal Sompo. The policy pays the Insured person(s) hospitalization expenses, including under AYUSH as well as pre and post hospitalisation and domiciliary hospitalisation benefits in case of an illness or accidental injury.

2: Universal Sompo Individual Health Insurance: The policy is designed to pay the insured person and/or his family hospitalization expenses as well as domiciliary hospitalization benefits if he/she suffers an illness or accidental injury during the policy period.

3: Universal Sompo Individual Accident Policy: A policy that gives you and your family much needed financial relief in case of death or injury leading to temporary or permanent; partial or total disablement of the insured.

4: Universal Sompo Group Health Insurance Policy: A policy designed to pay the insured person for hospitalization expenses and domiciliary hospitalization benefits for employees in trading and manufacturing/social sectors/ members of an institution/society/association/club.

5: Universal Sompo Group Personal Accident Policy: The Policy comes in 3 options - Basic Cover, Wider Cover and Comprehensive Cover-and protects against consequences of unforeseen accidents to the policy holder and his employees including dependent children/parents of the employees.

6: Universal Sompo Senior Citizen Health Insurance Policy: A plan designed to meet the medical needs of senior citizens and their spouse who must be permanent resident of India and aged between 60-70 years at the time of entry. The plan has two parts the first - hospitalisation is mandatory while the second covering critical illnesses is optional.

7: Universal Sompo Aapat Suraksha Bima Policy: This policy is designed to give lump sum money (other than medical treatment expenses) in case the insured is diagnosed with listed major diseases - Paralytic Stroke, Cancer, Renal Failure, Coronary Artery Disease and Major Organ Transplant.

8: Universal Sompo Loan Secure Policy: Any person between 20 and 50 years of age having a bank loan can avail this policy. The coverage can also be offered to SMEs- proprietorship and partnership concerns borrowing from banks..

9: Hospital Cash Insurance Policy: The policy provides cash benefit in case of hospitalisation of the insured so that the insured's financial worries could be mitigated

10: Universal Sompo Critical Illness Insurance: This insurance is aimed at mitigating your financial hardship when faced with 11 critical illnesses

11: Universal Sompo Saral Suraksha Bima (Micro Insurance Policy): Policy targets members of NGOs, Self help groups, Co-operative Banks, FCIs, Shareholders of Banks/Public ltd Companies, holders of Depositor Certificate by Banks/NBFCs, Members of Registered Service Clubs and Employer - Employee relationship including dependants of the employee, etc.

12: Universal Sompo Janta Personal Accident Insurance: It provides you and your family financial aid in case of unforeseeable accidents. It targets members of APL and BPL segments of society, employees of a firm/Company and members of an association/club, depositors of banks, members of SHGs and NGO and members of cooperative societies, Kisan Credit Card Holders etc.

13: Universal Swarna Gramin Bima Yojana - Individual: The Policy is aimed at Villagers for covering themselves and their families / or organisations such as NGOs, financial institutions for covering its rural clientele and banks to cover Kisan credit card holders.

14: Universal Swarna Gramin Bima Yojana – Group: The Policy is aimed at Villagers for covering themselves and their families / or organisations such as NGOs, financial institutions for covering its rural clientele and banks to cover Kisan credit card holders in the form of a group.

15: Sampoorna Suraksha Bima (Micro Insurance Policy): A policy aimed at people who want to ensure the well being of their near and dear ones with limited resources.

16: Pravasi Bhartiya Bima Yojana: This policy is aimed at Indian citizen emigrants who have availed this policy before leaving India and whose passport is endorsed as “Emigration Check Required”.

17: Universal Sompo Sarva Vidyarthi Bima Yojana: This plan is designed to catered towards educational institutes and schools to meet the needs of students and their educational needs

Universal Sompo Health Insurance Plans in detail
1: Universal Sompo Complete Healthcare Insurance Plan
Features Description
Entry age Minimum: 18 years for adults and policy holders. Dependent children 91 days. 1 day for children under floater plan.
Maximum: 70 years, Dependent children up to 25 years
Type of Plan Individual / Family Floater
Sum Insured Individual Floater
Basic Rs 1 Lacs, Rs 2 Lacs Rs 1 Lacs, Rs 2 Lacs
Essential Rs 3, 4 and 5 Lacs Rs 3, 4 and 5 Lacs
Privilege Rs 6,7, 8, 9 ,10 Lacs Rs 6,7, 8, 9 ,10 Lacs
Coverage for Maximum 6 people with the maximum number of adults is 2 and maximum number of children being 4.
Policy term 1-3 years
Premium Frequency Single Premium

Inclusions, Benefits and Features
  • In-Patient Hospitalisation: Medical expenses for hospitalisation for a minimum period of 24 hours are covered including room charges, nursing expenses and intensive care unit charges to surgeon‘s fees, doctor‘s fees, anaesthesia, blood, oxygen, operation theatre charges , medicines, drugs, consumables etc.
  • Pre-Hospitalisation: Any medical expenses like examinations, tests and medicines that have been incurred 60 days prior to the hospitalisation for the same illness will also be covered.
  • Post-Hospitalisation: Similarly, medical expenses including medication, confirmatory tests, follow-up visits to the doctor incurred 60 days after being released from the hospital and for the same illness will also be covered. This period would extend up to 90 days if you had informed us about your hospitalisation at least 5 days prior to the actual hospitalisation.
  • Day-Care Procedures:- The medical expenses for all day-care procedures, which do not require more than 24 hours of admittance, will also be covered. Under this medical expenses of 141 procedures as enlisted are taken care of.
  • Domiciliary Treatment: Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy provided it entails medical treatment that would have actually required hospitalisation of more than 3 days the cover under this benefit is available to the extent of the chosen sum assured.
  • Organ Donation: In case of organ donation to you not only your medical costs but the treatments expenses of your organ donor too are covered by us to the maximum limit of the sum insured.
  • Daily Cash for Choosing Shared Accommodation–The policy entitles the insured person to lump sum amount for choosing shared accommodation at a hospital.
  • Emergency Ambulance: Expenses incurred for emergency ambulance service will be reimbursed as per your chosen plan. This includes transportation to both network and non-network hospitals .
  • Dental treatment in case of accidents: Any dental treatment required as an in-patient in a hospital is covered to the extent of your policy sum.
  • AYUSH treatment: The cover is not just for allopathic treatment but also covers treatment as in-patient using the Ayurvedic, Unani, Sidha or Homeopathic treatment if you desire.
  • Child hospitalisation: If your child is who is less than 12 years is in a hospital continuously for more than 72 hours then the policy provides you with a daily allowance as per your plan to meet non-medical expenses.
  • Vaccination: Cost incurred on vaccination if you are bitten including inoculation and immunizations in case of such post-bite treatment.
  • OPD charges: Charges for diagnostic tests done at a diagnostic centre (not necessarily to be prescribed by network medical practitioner), OPD dental treatment, excluding cosmetic treatment, One pair of spectacles, contact lenses, Hearing Aid when prescribed by an eye specialist, medical Practitioner, OPD Consultation to assess your health condition for any Illness. A waiting period of 3 years is applicable before any expenses under any of the above heads
  • Convalescence benefit: Rs 10,000 will be paid once during the policy year if you are seriously ill and hospitalised for more than 10 days. This benefit is payable flat on per member basis without taking into account the actual medical expenses incurred during those 10 days.
  • Maternity and child care benefit: Medical expenses associated with normal pregnancy and childbirth, including caesarean costs while hospitalised. Pre and Post natal expenses as well as expenses incurred on care of the new born for medical expenses incurred as in –patient till the expiry of your policy or till the child is 91 days old whichever is earlier.
  • No Claim Bonus: The sum insured is increased by 10% subject to maximum of 50% if no claim has been made under the policy including for optional benefits. If a claim is made in subsequent year, the increased cumulative bonus is decreased by 10% keeping your chosen sum insured intact.
  • People with HIV/AIDS also covered: The policy covers medical expenses if an insured is hospitalised, even if he/she is diagnosed with HIV/ AIDS in case it is available under your chosen plan and its limit.
  • Restore Benefit: This policy enables the basic sum assured including cumulative bonus earned to be reinstated once it has been exhausted during the year. This reinstated Sum Insured can be used for future claims, not related to the injury or illness for which the claim has been made during the same policy year.
  • Extended family coverage: The plans are designed to cover not only you but your extended family too. Extended family members who can be covered under a single policy on an individual basis are: Self, Spouse, Son, Daughter-in-law, Daughter, Father, Mother, Brother(s) or Sister(s), Father-in-law, Mother-in-law, Grandparents and Grandchildren.
Features Basic Essential Privilege
Basic Sum insured per insured person per policy year(Rs. in Lacss) 1, 2 3,4, 5 7,8, 9, 10
Inpatient treatment Available Available Available
Pre-hospitalisation Available Available Available
Post hospitalisation Available Available Available
Day Care procedures Available Available Available
Domiciliary treatment Available Available Available
Organ donor Available Available Available
Emergency Ambulance Lesser of 1% of Sum insured, Rs 1000 or actuals Lesser of 1% of Sum insured, Rs 2000 or actuals Lesser of 1% of Sum insured, Rs 3000 or actuals
Dental treatment in case of accident Inpatient treatment covered Inpatient treatment covered Inpatient treatment covered
AYUSH Benefit Up to sum inured Up to sum inured Up to sum inured
Restore Benefit Equal to 100% of basic sum insured including cumulative bonus Equal to 100% of basic sum insured including cumulative bonus Equal to 100% of basic sum insured including cumulative bonus
Vaccination (Post bite treatment) Inpatient treatment- Up to 100% of In-patient Treatment, Sum Insured or actuals whichever is less. Up to 100% of In-patient Treatment, Sum Insured or actuals whichever is less. Inpatient treatment- Up to 100% of In-patient Treatment, Sum Insured or actuals whichever is less.
OPD treatment (As per the prescribed conditions) Up to 1% of SI or actuals whichever is less. Up to Rs. 2500 Up to 1% of SI or actuals whichever is less. Up to Rs. 5000 Up to 1% of SI or actuals whichever is less. Up to Rs. 7500
Convalescence Benefit If hospitalisation exceed 10 days then Rs 10000 per member If hospitalisation exceed 10 days then Rs 10000 per member If hospitalisation exceed 10 days then Rs 10000 per member
Maternity Benefit (Waiting period of 3 years) Not covered Normal delivery: Lesser of Rs 15,000 or actuals
Caesarean: Lesser of Rs 25,000 ( including pre and post-natal expenses up to Rs 2,000) or actuals
Normal delivery: Lesser of Rs 25,000 or actuals
Caesarean: Lesser of Rs 50,000 ( including pre and post-natal expenses up to Rs 2,000) or actuals
New Born Baby Not covered Up to basic SI from day 1 till expiry of policy or when the child is 91 days old whichever is earlier Up to basic SI from day 1 till expiry of policy or when the child is 91 days old whichever is earlier

2: Universal Sompo Individual Health Insurance Plan
Features Description
Entry age Up to 55 years
Type of Plan Individual / Floater
Sum Insured 5 Lacs
Coverage for Inpatient and domiciliary hospitalisation expenses for treatment of illnesses and accidental fallouts; cover subject to sub-limits within the overall limit of the chosen sum assured.
Premium Based on age and chosen sum assured

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Maximum coverage of Rs 5 Lacs
  • Domiciliary Treatment
  • The coverage includes expenses incurred towards room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen etc.
  • Inpatient and domiciliary hospitalisation expenses for treatment of illnesses and accidental fallouts; cover subject to sub-limits within the overall limit of the chosen sum assured.
  • Any expense on hospitalisation or domiciliary hospitalisation on account of any illness contacted during first 30 days from the date of commencement of an insurance cover is not covered except in case of hospitalisation due to an accident.
  • During the first year of the cover, treatment of diseases like Benign Prostatic Hypertrophy, Hysterectomy, Cataract, Piles, Sinusitis and related disorders are not payable

3: Universal Sompo Individual Accident Policy
Features Description
Entry age 5to 65 years. Fresh proposals for persons above 65 years till 75 years of age may be accepted with 20% loading on premium.
Type of Plan Individual /Floater
Sum Insured Death only cover --- 10 times yearly Income
Wider Cover --- 5 times the yearly Income Comprehensive Cover --- 5 times the yearly Income (Rs 500,000/- max)
Coverage for Individual/Family with 3 options:
Basic Cover - Covers only Death
Wider Cover - Death, Permanent Total Disablement Permanent Partial Disablement
Comprehensive Cover - Death, Permanent Total Disablement Permanent Partial Disablement Temporary Total Disablement
Policy term 12 months

Inclusions, Benefits and Features
  • Optional cover extension under comprehensive cover policy: The policy can be extended to cover medical expense restricted to 40% of Personal Accident Claim or actual medical expenses whichever is less and Hospital Confinement Allowance: of not more than 500/- per day for a maximum of 30 days .
  • Notice: The Company gives the policy holder at least 3 months notice if it revises, modifies or withdraws the product.
  • Discounts: The policy offers family discount to a maximum of 15% if 5 members or more of the same family are covered. It also offers a loyalty discount of 1st year 5% for 1st year. 10% for 2nd year and 15% for 3rd year

4: Universal Sompo Group Health Insurance Policy:
Features Description
Entry Age Maximum 55 years
Type of Plan Individual / Floater
Sum Insured Maximum Rs 5 Lacs

Inclusions, Benefits and Features
  • Hospitalisation expenses covered
  • Treatments only in the Hospitals / Nursing homes in India are covered
  • The coverage includes expenses incurred towards room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen etc
  • Domiciliary Treatment: Medical treatment for a period exceeding 3 days for such illness which in the normal course require treatment in a hospital but actually taken whilst confined at home in India
  • Facility to purchase additional cover for critical illness, maternity, hospital cash, family floater

5: Universal Sompo Group Personal Accident Policy:
Features Description
Entry age 18-65 year
Type of Plan Group Personal Accident Policy
Sum Insured NA
Coverage for Individuals
Policy term 1 year

Inclusions, Benefits and Features
  • Basic Cover: covers against Death only
  • Wider Cover: covers against Death, Permanent Total Disablement Permanent Partial Disablement
  • Comprehensive Cover: covers against Death, Permanent Total Disablement Permanent Partial Disablement Temporary Total Disablement
  • Transportation Cost: For carriage of dead body to Home including funeral charges. 1% of Capital Sum Insured or 2,500/- (Two thousand five hundred) whichever is lower.
  • Ambulance charges: For transportation of Insured person to Hospital after an Accident (Actual expenses subject to maximum of Rs 1000)
  • Education Fund: In the event of death, permanent total disablement of the insured compensation to be paid for education of up to 2 dependent children up to 5% (Five percent) of sum insured with a maximum of Rs 15000.
  • Loss of Employment: In case of Permanent Total Disability due to an accident compensation to a maximum of 2% of sum insured subject to a maximum of Rs 25000/-
  • Employees or members can extend the cover to include medical expenses and hospital confinement allowance for themselves only by paying additional premium
  • Compensation is not payable in case of Self-injury, suicide, venereal disease or insanity; Influence of intoxicating liquor or drugs; Death due to pregnancy or childbirth; Breach of law with criminal intent
  • Comprehensive cover is not available to dependent family members
  • The compensation benefits will depend upon the nature of injury and the Capital Sum Insured under the Policy.
  • For Temporary Total Disablement, compensation at 1% of Capital Sum Insured or Rs 5000/- whichever is less per week for a maximum of 104 weeks.

6: Universal Sompo Senior Citizen Health Insurance Policy
Features Description
Entry age 60 to 70 years
Type of Plan Individual / Floater (Floater option only for hospitalisation cover)
Sum Insured Hospitalisation: Rs 1 Lacs to Rs 5 Lacs, in multiples of Rs 1 Lacs
Critical Illness: Rs 1 Lacs to Rs 5 Lacs, in multiples of Rs 1 Lacs
Coverage for Self, Spouse
Policy term 1-3 years ( If you take a 2 year policy a discount 10 % is given on the premium while for a 3 year policy it is 15%)

Inclusions, Benefits and Features
  • Inpatient Treatment:- The Policy shall cover your expenses subject to limits. it includes room charges, boarding expenses, Fees of Surgeon, Anaesthetist, Medical Practitioner, Consultants etc, Nursing expenses, Charges for Anaesthesia, Blood, Oxygen, Medicines, drugs, Diagnostic material etc,
  • Day Care Procedures/ Surgeries:- Specified Procedures / Surgeries requiring less than 24 hours of hospitalization would be covered under the Policy.
  • Pre-Hospitalisation expenses
  • Post-Hospitalisation expenses
  • Domiciliary Hospitalisation expenses
  • Cost of Health Check-up
  • Daily Allowance
  • Ambulance Charges
  • Expenses of accompanying person (All of the above subject to limits)
  • If you have taken the critical illness option then the following illnesses are covered: Cancer of specified severity, Open Chest CABG, Kidney failure requiring regular dialysis, Stroke resulting in permanent symptoms, Major Organ /Bone Marrow Transplant, Multiple Sclerosis with persisting symptoms
  • Cumulative Bonus: Subject to no claims and continuous renewal of the Policy with us, the Sum Insured under the Policy under Section A “Hospitalisation” shall be increased by 5% subject to maximum of 10 such non claim years.

7: Universal Sompo Aapat Suraksha Bima Policy
Features Description
Entry age 18-65 years
Type of Plan Individual
Policy term 1 year
Sum Insured NA

Inclusions, Benefits and Features
Policy Coverage: The Policy pays onetime payment equal to the sum insured on conclusive diagnosis of existence of any of the five critical illnesses, or occurrence of accidental death and/or permanent total disablement resulting from an accident.

Critical Illness covered: Paralytic Stroke, Cancer, Renal Failure, Coronary Artery Disease, and Major Organ Transplant

Accidental Death Cover: The nominee gets a onetime payment equal to Capital Sum Insured if the insured dies in an accident.

Permanent Total Disablement: The insured is entitled to receive the percentage of the capital sum insured as per the table of benefit if he suffers a permanent and total loss of limbs, sight in an accident.

Exclusions:
  • Any illness diagnosed within first 90 days of the Policy taken for the first time
  • Any pre existing illness
  • Any accident resulting from intentional self injury, suicide or whilst the insured is under the influence of intoxication

8: Universal Sompo Loan Secure Insurance Policy
Features Description
Entry age Any person between 20 -50 years with a bank loan
Renewal till 55 years
Type of Plan Individual
Policy term Maximum 3 years
Sum Insured More than 1 crore

Inclusions, Benefits and Features
  • Pre Insurance Health Check up: A person who want to avail this policy will have to undergo the prescribed medical tests on his own cost under certain specific conditions.
  • Coverage: The policy has 2 sections compulsory section where in you can choose cover for 9, 12, 15 and 18 Major Medical Illness Procedures like cancer, stroke, deafness, paralysis, coma, kidney failure etc under different plans - silver, gold, platinum, diamond. The 2nd is the Personal Accident section: It covers accidental death permanent total disablement due to an accident; Loss of job due to termination, dismissal, temporary suspension or retrenchment. .
  • Loss or Damage of household contents or dwelling of the insured borrower due to Fire, Lightning Explosion, Landslides, Overflowing of water tank etc subject to prescribed limits
  • Sum Insured Options: You can choose between fixed sum insured ( sum insured remains the same) or reducing balance option where sum insured goes on decreasing as the Loan outstanding decreases.

9: Universal Sompo Hospital Cash Insurance Policy
Features Description
Entry age 18 to 70 years Dependent children between 6 months to 25 years are covered
Type of Plan Individual / Floater
Sum Insured 2-50 Lacs
Coverage for Spouse, dependent children (Maximum 2) and dependent parents.
Policy term 1 year
Policy Duration 1 -3 years

Inclusions, Benefits and Features
  • Hospital Confinement Benefit: A daily allowance to be paid in case of normal hospitalisation (excluding ICU) ranging from Rs 500/day to Rs 3000/day as opted by you.
  • If the insured or his family members are admitted to an ICU the amount of daily allowance given above is doubled.
  • Convalescence Benefit: A convalescence benefit of Rs 10,000 if hospitalization exceeds 21 days but this benefit is not applicable if the Hospital Cash Period is opted for 30 days or more maximum upto 180 days. flexibility to choose Hospital Cash for a fixed no of 15, 30, 45, 60, 90 or 180 days
  • Long Term policy discount: If the policy is taken for 2 or 3 years by paying a single instalment a discount of 10 percent and 15% of the total premium respectively is given.

10: Universal Sompo Critical Illness Insurance Policy
Covers hospitalization expenses incurred on account of Accident to the Workmen during and in the course of the employment.

Features Description
Entry age Proposer: 18 to 65 years. Members : 5 years to 65 years
Type of Plan Individual
Sum Insured Rs 2.5 Lacs to Rs 20 Lacs
Coverage for Individual, his/her spouse, his/her and/ or parents/ parents-in-law
Policy term 1 year

Inclusions, Benefits and Features
  • Pre Insurance Health Check up: a person who want to avail this policy will have to undergo the prescribed medical tests on his own cost if the 1) Sum Insured more than Rs 1 Crore 2) If he suffers from a pre-existing disease 3) If his age is above 55 years as on last birthday. If his proposal is accepted, 50% cost of cost will be refunded to Insured.
  • Illnesses covered: First Heart Attack of pre-determined severity; Cancer of pre-determined severity; Open Chest CABG, Coma of pre-determined severity, Open Heart Replacement, Severity, Kidney failure leading to regular dialysis, Permanent Paralysis of Limbs, Stroke resulting in permanent symptoms, Major Organ /Bone Marrow Transplant, Motor Neurone Disease with Permanent Symptoms, Multiple Scelerosis with persisting symptoms.
  • Long Term policy discount: If the policy is taken for 2 or 3 years by paying a single instalment a discount of 10 percent and 15% of the total premium respectively is given.
  • Loading on premium: A loading may have to be paid on the premiums if you come in the prescribed risk categories divided in medium risk and high risk categories.

11: Universal Sompo Saral Suraksha Bima
Features Description
Entry age Proposer: 18 to 65 years. Unmarried children : 10 years to 25 years
Type of Plan Individual
Sum Insured CI: Rs 10,000, Rs 20,000, Rs 25,000
Personal Accident: Rs 20,000, Rs 40,000 Rs 50,000

Inclusions, Benefits and Features
  • Policy targets members of NGOs, Self help groups, Co-operative Banks, FCIs, Shareholders of Banks/Public ltd Companies, holders of Depositor Certificate by Banks/NBFCs, Members of Registered Service Clubs and Employer - Employee relationship including dependants of the employee, etc. Individuals can also request for this policy
  • Under the policy a lump sum amount as selected by the proposer is paid if any untoward incident takes place including Accidental Death, Permanent Total Disablement due to an accident and diagnosis of any of the listed five Critical Illnesses
  • Coverage: The following five critical Illnesses are covered- Open Chest CABG, Major Organ/Bone Marrow Transplant, Stroke leading to permanent symptoms, Cancer of specified severity, Kidney Failure that needs regular dialysis. In addition the policy also covers Accidental Death and Permanent Total Disablement due to an accident.

12: Universal Sompo Janta Personal Accident Insurance
Features Description
Entry age 18 - 65 years, Dependent children up to 25 years
Fresh proposals for people 65-75 years with 20% loading on premium
Type of Plan Individual
Coverage for Individual employee
Sum Insured Max Rs. 5 Lacs

Inclusions, Benefits and Features
  • Covers: Death due to accident, Permanent total disability, partial disability, temporary total disability
  • Compensation Benefit: The compensation benefits will depend upon the nature of injury and the Capital Sum Insured under the Policy. For accidents resulting in death or permanent total disablement, the company provide compensation equivalent to the full capital sum insured.
  • Discounts under the Policy: Group Discount: Group discount will be provided if the group size under the policy exceeds 25 people as per the below table.
Features Description
Number of Persons covered
Up to 25 persons
Applicable discount
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 To be decided by Corporate Office

  • On Duty Cover Discount: Up to 25% of the basic premium may be given as discount when the cover is only for restricted hours of duty (and not for all 24 hours of day and night) for the Insured Persons in the Policy.
  • Off Duty Cover Discount: Up to 50% of the basic premium may be given as discount when the cover is only for off duty hours .

13: Universal Swarna Gramin Bima Yojana – Individual
Features Description
Entry age Minimum: 18 years for adults and policy holders. Dependent children 6 months Maximum: 65 years, Dependent children up to 25 years
Type of Plan Individual / Family Floater
Coverage for Maximum 2 Adults and 2 dependent children
Sum Insured Rs. 2 Lacs

Inclusions, Benefits and Features
  • No medical tests up to 45 years of age, for those above 45 then, the you will have to undergo specified medical tests and if the proposal is accepted 50% of the cost is paid by the company
  • The policy covers personal accidents, Permanent Total Disablement and Permanent Partial Disablement of the Insured or his/ her family members due to accident and specified critical Illness and surgical procedures
  • Hospital Cash: A Daily Allowance -Rs 250 per day, Rs 500 per day or Rs 1000 per day is payable according to your policy in case of hospitalisation for more than 2 days
  • Double Benefit: In case of admittance to an ICU the above daily allowance is doubled for a maximum of 7 days.
  • Family and long term discount also available

14: Universal Swarna Gramin Bima Yojana – Group
Inclusions, Benefits and Features
Features Description
Entry age Minimum: 18 years for adults and policy holders. Dependent children 6 months Maximum: 65 years, Dependent children up to 25 years
Type of Plan Individual / Family Floater
Coverage for Maximum 2 Adults and 2 dependent children
Sum Insured Rs. 2 Lacs

Inclusions, Benefits and Features
  • The policy covers personal accidents, Permanent Total Disablement and Permanent Partial Disablement of the Insured or his/ her family members due to accident and specified critical Illness and surgical procedures
  • Critical illness coverage up to the sum insured
  • No medical tests up to 45 years of age
  • Hospital Cash: A Daily Allowance -Rs 250 per day, Rs 500 per day or Rs 1000 per day is payable according to your policy in case of hospitalisation for more than 2 days
  • Double Benefit: In case of admittance to an ICU the above daily allowance is doubled for a maximum of 7 days.
  • Group discount on premium as under available
Features Description
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% of total premium

15: Sampoorna Suraksha Bima (Micro Insurance Policy)
Features Description
Entry age Proposer: 18 years to 65 years. Unmarried
children : 91 days to 25 years
Type of Plan Individual
Sum Insured CI: Rs 10,000, Rs 20,000, Rs 25,000
Personal Accident: Rs 20,000, Rs 40,000 Rs 50,000

Inclusions, Benefits and Features
  • Cover: The first section gives cover against loss or Damage of household contents or dwelling of the insured borrower due to Fire, Lightning Explosion, Landslides, Overflowing of water tank etc subject to prescribed limits.
  • Burglary, Robbery: The Section covers loss or damage by actual or attempted burglary/ theft and/or robbery in respect of the following to items kept in the insured premises and also to the premises itself
  • Personal Accidents: It gives you compensation in case of bodily injury to you and your dependants named in the Policy Schedule including death or disablement like loss of sight; separation of or loss of ability to use one hand/one feet or both hands or both feet, permanent total disablement.
  • Pre- Hospitalisation: Related medical expenses incurred 30 days prior to Insured being hospitalised.
  • Post-Hospitalisation: Related medical expenses incurred 60 days after hospitalisation.
  • Domiciliary Hospitalisation: The Sum Insured is limited to 20% of SI.
  • Daily Allowance: 0.1% of Sum Insured or Rs 250 whichever is less, as a Daily Allowance, for 24 hours period subject to a maximum of Rs 2500.
  • Ambulance Charges:- Ambulance charges for admissible claim with a maximum of 1% of Sum Inured or Rs 1,000 whichever is less.

16: Universal Sompo Pravasi Bhartiya Bima Yojana:
A plan for emigrants who have availed this policy before leaving India and whose passport is endorsed as “Emigration Check Required”. Inclusions, Benefits and Features
  • Bodily injury or death by accident taking place anywhere in the world
  • Accident leading to permanent total disability or partial disability and leading to loss of employment abroad
  • Hospitalisation expenses of self, spouse (maximum age 65 years) and 2 children up to the age of 21 are covered.
  • In case of accidental death of the insured the cost of transporting mortal remains to India will be paid. The company also pays the cost of an attendant in this case.
  • Day care procedures requiring less than 24 hours of hospitalisation are also covered.
  • Maternity expense of insured women to be covered.
  • Domiciliary expense covered subject to conditions
  • Airfare of one way economy class ticket if the insured’s contract is change to his substantial detriment or when he falls sick or is declared mentally unfit to work and the work contract is terminated by the employer or in case of premature termination of employment within first 3 months of insurance for no fault of the insured.

17: Universal Sompo Surva Vidyarthi Bima Yojana
A plan designed for educational institutes for their children

Inclusions, Benefits and Features
  • Covers students from 3 to 65 years of age
  • Covers death of parent, death/permanent total or permanent partial disablement of a student/parent due to accident
  • Medical expenses including nursing expenses, Operation theatre charges, surgeon fees, medicine and drugs etc
  • Fire cover
  • Domiciliary expenses
  • Extensions / Add-ons available for the policy to cover loss of personal belongings, exam fee reimbursement if in case the student is unable to attend the exam, etc

Universal Sompo Exclusions:
  • There is an initial waiting period as prescribed in the particular policy (usually 30 days) for all ailments except an accidental injury.
  • No treatments for mental disorders, cosmetic surgery, congenital diseases, and weight control treatments, contact lens, spectacles and dental treatments
  • Treatments for de-addiction not covered.
  • Hospitalisation due to war or nuclear threat
  • Experimental treatments not covered.   
  • Delivery and pre-existing diseases are covered after a waiting period and per the terms and conditions specified in the plan you choose

Universal Sompo contact:
Post: Universal Sompo General Insurance Company Ltd., Plot No - EL-94, KLS Tower, TTCIndustrial Area, MIDC, Mahape, Navi Mumbai 400710.
Phone: Customer Care Helpline: 1800 22 4030, 1800 200 4030, 022 - 27 63 9800,022 - 39133700
Health Product Customers Helpline: 1800 200 5142, 022 – 39 63 5200 Fax - 1800 200 9134
Email: contactus@universalsompo.com
Claims: contactclaims@universalsompo.com

Universal Sompo Health Insurance Renewal:
  • Health policies are renewable for lifetime except on account of moral hazard, fraud or misrepresentation or non-cooperation by the insured.
  • Change of sum insured, addition or removal of dependants, attaching or removal of riders can be done at the time of renewal subject to terms and conditions.
  • There is a 30-day grace period within which to renew your policy without losing benefits

Universal Sompo Health Insurance Claim Settlement
Cashless Claim Reimbursement Claim
Visit a network hospital of the insurer to avail cashless treatment. If the cashless claim is denied, or you go to a non-network hospital the insured member can get treated and file for a reimbursement claim after discharge.
Display your health card at the network hospital help desk. Call Health Helpline 1800 200 5142 or email at healthserve@universalsompo.com and inform about your Claim within 24 hrs in case of emergency admission and 48 hrs. prior to hospitalisation in case of planned admission.
Call Health Helpline 1800 200 5142 and Intimate Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission. Submit the claim form along with the medical documents to the below address: Universal Sompo General Insurance Company Limited Health Claims Management Office 5thFloor ,Assotech One C-20/1 A, Block- C Sector- 62, Noida Uttar Pradesh, Pincode:201309
The hospital will verify your identity details and submit a duly-filled and signed ‘Cashless Request Form to the insurer.  
The insurer verifies the Cashless Request Form , and informs you and the hospital accordingly.  
The hospital will proceed with the cashless treatment for the insured member. The insurer will settle the bill directly with the hospital. The insured has to pay those bills that are not covered under the policy. On receipt of the document your claim will be processed as per Terms & Conditions of policy and the same will be communicated to you.

Universal Sompo Health Insurance FAQs:
1.What is a Health Card?
An Identity card given to every person covered by the health policy. This can be shown in the network hospitals for getting cashless facility

2.What is the use of a health card and what information does it contain?
This card entitles you to avail cashless hospitalization facility at network hospitals. A health card has the contact details of the TPA. You can call these numbers for any queries and clarifications and for any kind of assistance.

3.How long is the Health card valid?
The health card must be renewed or re-issued during the policy tenure. Depends on the policy tenure, its validity is 1-2 years etc

4.What is a TPA?
Third Party Administrator is a service provider appointed by the insurance company to provide various necessary services related to benefits mentioned in the health policy.

5.What is Pre-existing disease?
Any injury, condition, ailment for which you had signs or symptoms, and / or were diagnosed, and/ or received medical advice / treatments within stipulated months as mentioned in your policy prior to your first policy with us.

6.Are Pre existing diseases covered or not?
Pre-existing diseases are covered subject to waiting period as mentioned the policy. It can be typically from 24-48 months

7.Which family members can get covered in one policy?
Spouse, Dependent Children (all unmarried children including stepchildren or legally adopted children above 91 days and under 23 years of age ), Dependent parents up to 70 years of age. Some policies cover new borns and parents in law also.

8.Can I buy more than one Health Insurance policy?
Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay rateable proportion of the loss.

9.What is a Network Hospital and where can I get a list of such hospitals?
Those hospitals which are part of our network and give you cashless service are called Network hospitals. You are given a list of network hospitals along with your health card but this can change. Updated list is available on TPA website.