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Universal Sompo Complete Health Care Insurance Plan

Universal Sompo Complete Health Care Insurance Plan - This is a health insurance plan that covers the hospitalization and medical expenses of the individual with the following features:

  • There are three types of plan options, which are Basic, Essential, and Privilege.
  • The plan can be taken on an Individual Sum Insured Basis and Floater Basis.
  • Medical expenses in case of hospitalization are covered
  • Daycare procedures are covered
  • Post hospitalization expenses are also covered
  • Organ donor treatment is covered
  • Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home.
  • Ambulance charges are reimbursed
  • Dental treatment is reimbursed if is required as a treatment for accidental injuries
  • Alternate in-patient treatments such as ayurveda, unani, homeopathy, siddha are reimbursed
  • If the insured child of an age less than 12 years is hospitalized for more than 72 hours then Universal Sompo will provide a daily allowance as per the chosen medical plan to meet any non-medical expenses
  • In the event of being bitten, vaccination charges are covered
  • Outpatient charges are covered.
  • Diagnostic tests are covered
  • Outpatient dental treatment is covered by the plan
  • One pair of spectacles or one pair of contact lenses are covered on the condition that it has been prescribed Consultation charges are reimbursable
  • Convalescence Benefit – Rs. 10,000 is paid if the insured person is hospitalized or their family member is hospitalized for more than 10 days.
  • Pre and post maternity expenses are covered
  • Coverage is provided for the new born baby till the policy expires or till the baby is 91 days old, whichever is earlier
  • Coverage can be enhanced or waived as per the customers ‘choice. The following 5 options are offered for enhancement or waiver:-
    • Personal Accident
    • Critical Illness
    • Hospital Cash
    • Sublimit
    • Treatment in tiered network
  • A single premium can be paid for a three years coverage
  • There is an E policy discount when the customer opts to receive his or her policy in electronic form
  • There is a family discount when covering family members under a single policy
  • There is a “Dial-a-doctor” facility where the customer can get medical advice from a doctor through telephonic or online modes
  • Customers get access to the company’s “Health Educational Library for People” (HELP)
  • Customers get a monthly newsletter with diet and health tips and similar information
  • Customers get a second opinion on their health condition
  • Customers receive a specialist e-consultation with two follow-up sessions for seeking expert opinions on any chronic conditions
  • Customer can avail a wellness package where they get discounts on health and wellness products and services listed

Eligibility - Universal Sompo Complete Health Care Insurance Plan

  • The entry age is 18 to 70 years
  • Dependent children from the age of 91 days may be covered
  • Entry age for dependent children under the floater plan is 1 day

Exclusions - Universal Sompo Complete Health Care Insurance Plan

The policy will not cover loss, damage, illnesses or diseases that arise due to the following:

  • Pre-existing diseases will not be covered under this plan until 36 months have passed
  • Circumcision unless necessary for treatment of a disease is excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Voluntary termination of Pregnancy
  • Psychiatry is not covered
  • Sleep disorders and sleep problems are not covered
  • Treatment of infertility is not covered
  • Treatment of developmental delay is not covered
  • Unproven and experimental treatment is not covered
  • Treatment of sexual dysfunction is not covered
  • Private duty nursing will not be covered
  • Weight loss surgery is not covered
  • Birth control is not covered
  • Artificial life maintenance will not be covered
  • Unrelated expenses and  vitamins/nutritional expenses are not covered
  • Cost of artificial limbs are not covered.

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