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Universal Sompo Complete Health Care Plan

Universal Sompo’s Complete Healthcare Plan is a comprehensive health insurance plan which can be taken for self or for your family. The plan, besides providing essential health coverages, also allows additional coverage benefits which can be chosen to increase the scope of protection.

Key features of the plan

  • This is a health insurance plan which can be taken for self or family. Under the family floater option, a maximum of six individuals can be covered which includes self, spouse and dependent children.
  • The plan can be taken for up to 3 years.
  • Five types of optional coverages can be taken to customize the policy. While 3 features increase the coverage and require an additional premium, the other two reduce the premium.
  • Premium discounts are given for buying a 2 or 3 year policy or for buying a policy online. Moreover, if more family members are also covered under the plan, a further premium discount is allowed.
  • No medical tests are required up to 55 years of age.

How does the plan work?

Step 1 – the policyholder chooses the Sum Assured, the policy term and the members covered.

Step 2 – the policyholder can also choose any additional coverage from 5 optional benefits.

Step 3- If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.

Step 4 – if the plan matures and no medical contingencies occur, no benefit is paid.

Example

Ram, a non-smoking male aged 40 years, buys the plan for himself and his wife for a Sum Assured of Rs.5 lakhs.

Option 1 – Ram suffers from Appendicitis and is hospitalized. His total hospital bill comes to Rs.1.5 lakhs which is paid by the policy.

Option 2 – if the plan matures and Ram or his wife doesn’t suffer any medical emergency, no benefit is paid.

Plan benefits

  • Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:
  • Hospitalization Covered
    Day care treatments 141 treatments are covered
    Pre-hospitalization 30 or 60 days
    Post hospitalization 60 or 90 days
    Domiciliary hospitalization Covered if treatment exceeds 3 days
    Organ donor expenses Covered
    Ambulance cover Lower of 1% of the Sum Insured or Rs.2000
    Accidental dental treatments Up to 100% of hospitalization Sum Insured
    AYUSH coverage Covered up to Sum Insured
    Daily cash for accompanying a minor child Rs.300/day up to a maximum of Rs.9000
    Vaccination expenses for post-bite treatments Up to 100% of hospitalization Sum Insured
    OPD cover for OPD consultations, diagnostic tests, dental treatments, spectacles, contact lenses, hearing aids, etc. Lower of 1% of Sum Insured or actual expense up to a maximum of Rs.5000
    Convalescence benefit Rs.10,000/member if hospitalization exceeds 10 days
    Maternity expenses Normal delivery– lower of actual expenses or Rs.15,000
    Cesarean delivery – lower of actual expenses or Rs.25,000 which also includes pre and post-natal expenses of Rs.2000
    New born baby cover Up to basic Sum Insured till the completion of plan tenure of till the child attains 91 days whichever is earlier
    Restoration of Sum Assured Covered as an additional benefit
    Health check-ups 1 coupon every claim-free year. For family floater 2 coupons are allowed every claim-free year.
    Value Added Benefits:
    1. Dial A Doctor
    2. Health Educational Library for People (HELP)
    3. Second opinion
    4. Specialist consultation with 2 follow-ups
    5. Wellness package
    6. 24*7 customer service
    7. Newsletter
    Covered
  • Optional Coverage benefits – the plan allows 5 types of additional coverage features which can be added to the plan. These features are as follows:
    • Personal Accident – this feature pays the Sum Assured in case of accidental death or disability.
    • Critical Illness – the Sum Assured is paid in case the insured suffers from any of the covered illnesses
    • Hospital Daily Cash – if hospitalization exceeds 3 days, an additional cash allowance of Rs.500/day is paid
    • Sub-limits – if the policyholder chooses sub-limits on various treatments, the plan offers a premium discount ranging from 5% to 10% based on the amount of sub-limits chosen.
    • Treatment only in tiered hospitals – through this benefit, hospitalization in a tiered hospital requires 5% co-pay and in a non-tiered hospital the co-pay is 10%.
  • No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a No Claim Bonus of 10% increase in the Sun Insured at the same rate of premium. This increase continues for every successive claim-free year up to a maximum of 50%.
    • Premium discounts – premium discounts are allowed for the following:
    • For buying a long-term policy- 5% discount for a 2 year policy and 7.5% for a 3-year policy.
    • For buying online – a discount of Rs.110 for buying the policy online
    • For including family members – 5% for covering 2 or 3 members, 7% for 4 or 5 members and 10% for more than 5 members.

Eligibility Criteria

  Minimum Maximum
Age at entry (in completed years) Policyholder and adults - 18 years
Dependent children – 91 days
Dependent children in family floater – 1 day
70 years
Term of the plan 1 year 3 years
Premium paying options Single pay
Sum Assured Rs.3 lakhs Rs.5 lakhs

What is not covered by the plan?

Illnesses suffered during the first 30 days of the plan commencement are not covered.

Critical Illnesses suffered during the first 90 days of the plan commencement are not covered.

Pre-existing illnesses or conditions, OPD coverage and maternity related expenses are not covered by the plan in the first 3 years of the policy

Specific illnesses are not covered in the first year of the plan.

Illnesses or accidents caused due to substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.

Treatments like dental treatments, cosmetic treatments, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.

Premium Illustration

Below are the sample rates of premium payable by a non-smoking male for different combinations of age and members covered. The Sum Assured is chosen to be Rs.5 lakhs and the policy is taken for 1 year.

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