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Universal Sompo Group Health Insurance Plan

Universal Sompo Group Health Insurance Plan - This is a health insurance plan that covers the hospitalization and domiciliary expenses of the employees of groups in the trading/manufacturing sectors, social sectors and/or members of institutions/societies/associations/clubs. The following are the features of the Group Insurance policy plans:

  • Cashless hospitalization at any of the company’s network of hospitals
  • Medical expenses in case of hospitalization are 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 due to the following reasons:
    • The condition of the patient is such that he or she cannot be removed to a hospital
    • The patient cannot be moved to the hospital as there is a lack of accommodation available
  • Additional cover may be purchased by paying additional premium, which is dependent on the group size and profile. The following covers may be purchased:
  • Critical illness cover, which includes paralytic stroke, cancer, chronic renal failure, coronary artery bypass and the transport of organs such as – kidney, lung, pancreas and bone marrow NB. When the critical illness cover is chosen, the sum insured amount will be doubled
  • A Maternity Benefit cover may be purchased
  • Hospital Cash
  • Pre-existing diseases cover
  • Family floater cover
  • The premium depends of the age of the insured individual and the sum insured amount that is selected
  • Maximum coverage under this plan is Rs. 5 lakhs
  • Coverage under this plan includes expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees, charges for blood, oxygen, etc.

Eligibility - Universal Sompo Group Health Insurance Plan

  • The entry age is restricted to 55 years only

Exclusions - Universal Sompo Group Health 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, unless the pre-existing diseases cover is specifically chosen
  • Any expense on hospitalization or domiciliary hospitalization incurred because of any illness contracted during the first thirty days from the date of commencement of the insurance cover will not be covered. However, this exclusion is not applicable if hospitalization is required because of an accident
  • During the first year of the cover, the expense on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis and related disorders are not covered
  • Injury or disease directly or indirectly attributable to war, invasion, Act of Foreign enemy not payable
  • Circumcision unless necessary for treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded
  • Dental treatment or surgery of any kind unless hospitalization is required 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
  • Pregnancy and Child-birth
  • Naturopathy Treatment.