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Universal Sompo Senior Citizen Health Insurance Plan

Universal Sompo Senior Citizen Health Insurance Plan - This is a health insurance plan that covers the hospitalization and medical expenses of an individual above the age of 60. The following are the features of the Senior Citizen Health Care plans:

  • Medical expenses in case of hospitalization are covered, which include and are not limited to, room and boarding charges,  diagnostic tests, anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of stent implants.
  • Daycare procedures are covered
  • Pre and post hospitalization expenses are also covered for 30 and 60 days respectively
  • 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
  • Cost of health check up after three claim-free years are covered
  • A daily allowance is provided where 0.1% of the Sum Insured or Rs. 2500 (whichever is lower) is provided for each continuous and completed period of 24 hours of hospitalization
  • Ambulance charges are reimbursed
  • The expenses of an accompanying person is covered            
  • On the diagnosis of the following critical illnesses or surgical procedures, the Sum Insured is payable under the policy –
    • Cancer of a specified severity
    • Open chest CABG
    • Kidney failure requiring frequent dialysis
    • Stoke resulting in permanent symptoms
    • Major organ/bone marrow transplant
    • Multiple sclerosis with persisting symptoms
  • A cumulative bonus of 5% is available if no claims are made, subject to a maximum of 10 claim-free years
  • Policy terms of one to three years are available, when paying for two or three years, discounts on the premiums are available
  • A family discount of 10% is applicable on the hospitalization premium when the customer opts to cover his or her spouse under the policy on individual sum insured basis.
  • Sum insured options range from Rs. 1 lak to Rs. 5 lakhs
  • The sum insured may be enhanced upon renewal
  • A co-pay facility is available where the customer will bear a part of the percentage of the admissible claim amount. Co-payment will not reduce or effect the Sum Insured.

Eligibility - Universal Sompo Senior Citizen Health Insurance Plan

  • The entry age is at least 60 years. The maximum entry age is 70 years
  • There is lifetime renewability under this plan
  • The plan covers an individual over the age of 60 years and his or her spouse.

Exclusions - Universal Sompo Senior Citizen 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 until 24 months have passed
  • There is a waiting period of 24 months for the following medical expenses to be covered:
  • Cataract
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • All types of Hernia, Hydrocele
  • Fissures and/or Fistula in anus, hemorrhoids/piles
  • Arthritis, gout, rheumatism and spinal disorders
  • Sinusitis and related disorders
  • Stones in the urinary and billiary systems
  • Dilatation and curettage , Endometriosis
  • All types of Skin and internal tumors/ cysts /nodules/ polyps of any kind including breast lumps unless malignant
  • Dialysis required for chronic renal failure
  • Surgery on tonsils, adenoids and sinuses
  • Gastric and Duodenal erosions ulcers
  • Deviated Nasal Septum
  • Varicose Veins/ Varicose Ulcers
  • Joint replacements unless due to accident
  • Any loss resulting directly or indirectly, contributed or aggravated or prolonged by hormone replacement therapy
  • Any experiment that is experimental in nature
  • Cosmetic or aesthetic treatment are not covered
  • Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
  • Dental treatment will not be covered
  • Unrelated expenses and  vitamins/nutritional expenses are not covered
  • Hospitalization for the sole purpose of physiotherapy will not be covered
  • Special nursing care, routine health checks  or convalescence, custodial care, general debility, lethargy and rest cure are not covered.

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