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Universal Sompo Surva Vidyarthi Bima Yojana Health Insurance Plan

Universal Sompo Surva Vidyarthi Bima Yojana Health Insurance Plan - This is a health insurance plan that can be taken by an educational institution for the benefit of the students. These are the features of this plan. There are separate sections, one is Section A, which is compulsory and the rest of the sections are optional.

  • Section A has the following benefits:
    • Death of the Parent resulting from Accident
    • Permanent Total Disablement of the Parent resulting from Accident
    • Permanent Partial Disablement of the Parent resulting from Accident
    • Death of Student resulting from Accident
    • Permanent Total Disablement of Student following an Accident
    • Permanent Partial Disablement of the Student resulting from Accident
  • The following extensions may be taken under Section A
    • Loss of Personal Belongings
    • Pedal Cycle- Cover for loss or theft of pedal cycle
    • Cost of Study in case of Accidental Death/ Permanent Total Disablement of Parent
    • Ambulance Charges Extension
    • Compassionate Visit
    • Reimbursement of Examination Fees
  • Section B has the following benefits:
    • Medical expenses cover where the following are included for coverage - Room, board and nursing expenses, Nursing expenses, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances(any disposable consumables subject to upper limit of 10% of Sum Insured), Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Stents and implants
  • Section C has the following benefits:
    • Fire cover where the company will pay the market value of the insured property and / or the amount of damage in the event of any loss or damage to the insured property arising out of the perils – fire, explosion/implosion, Loss or damage by aircraft, other aerial or space devices and articles dropped there from excluding those caused by pressure waves, Storm, cyclone, typhoon, tempest, hurricane, tornado, flood & inundation, Impact damage by any rail/ road vehicle or animal by direct contact, Subsidence and Landslide including rockslide, Bursting and/or overflowing of Water Tanks, Apparatus and Pipes, Missile Testing Operations, Leakage from Automatic Sprinkler Installations and Bush Fire
  • Extensions available under Section C are as follows:
    • Staff secure extension that provides accidental benefit to the teaching and non teaching staff for accidental death, permanent total disablement and permanent partial disablement.
    • Library books extension that provides for reimbursement up to the Sum Insured for all the library books available in the educational institution against fire and other allied risks.
  • 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 benefits may be purchased by paying additional premium,. The following covers/extensions may be purchased:
  • Reinstatement value clause (applicable on Section C) where Universal Sompo will compensate the insured educational institute against fire and allied perils on reinstatement value basis i.e. there would not be any deduction for depreciation while settling claims
  • On premise cover (applicable on Section A) where the insured educational institute will be offered a discount of 25% if it opts for the policy on “On premises basis”, which includes accidental risks faced by students while on premises, cover for pedal cycle and loss of personal belongings within the premises and travel by the students to the premises of the educational institute from the place of residence and back, if student is not a resident within the Premises, for the purpose engaging in activities carried out by the Educational Institution/Schools
  • Content insurance (applicable on Section A) where coverage for home content is provided up to Rs. 15000 against burglar, fire and allied perils is taken by all the parents for the benefit of the child undergoing studies at no additional premium under the Policy
  • The premium depends of the age of the insured individual and the sum insured amount that is selected
  • The sum insured may be enhanced on renewal

Eligibility - Universal Sompo Surva Vidyarthi Bima Yojana Health Insurance Plan

  • Students and staff between the ages of three to 65 years can be covered

Exclusions - Universal Sompo Surva Vidyarthi Bima Yojana Health Insurance Plan

  • Exclusions in respect of Accidental Claims (Applicable to Section A)

The company will not pay the insured for:-

  • The insurance company liability during one annual policy period is limited to the sum insured under the policy, once the sum insured is exhausted on the payment of one or more than one claim during one annual policy period, further payment of claim amount exceeding the sum insured of the policy would be excluded.
  • Any existing physical defect, disablement/injury unless endorsed otherwise.
  • Death or disablement due to child birth or from pregnancy or in consequence thereof.
  • Payment of compensation in respect of injury, disablement or death - a. From intentional self-injury, suicide or attempted suicide. b. Whilst under the influence of liquor or drugs or other intoxicants. c. Emotional distress d. Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. e. Directly or indirectly, caused by venereal disease, AIDS or insanity. f. Arising or resulting from the Parent/ Student committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanor or civil commotion. g. Whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports and the like. h. Due to war or ionising radiation or nuclear perils. i. Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.
  • Exclusions in respect of Medical Claims (Applicable to Section B)

The company is not be liable to make any payment under this Policy in respect of any expenses whatsoever incurred by the Student in connection with or in respect of :

  • Pre-existing diseases will not be covered until 48 months of continuous coverage have elapsed, since inception of the first Policy with Universal Sompo
  • Any disease other than those stated in Clause 3 below, contracted by the Student during the first 30 days from the commencement date of the policy.
  • Any Sickness that has been classified as an Epidemic by the Central or State Government
  • Injury or disease directly or indirectly caused by or arising from or attributable to War invasion Act of Foreign Enemy Warlike operations (whether war be declared or not).
  • Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as part of any illness.
  • The cost of spectacles and contact lenses hearing aids.
  • Any Dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from accidental injury and which requires hospitalization for treatment.
  • Convalescence general debility `Run Down’ condition or rest cure, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol, rehabilitation therapy in any form. 9. All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymph trophic Virus Type III (HTLB-III) or Lymphadenopathy Associated Virus (LAV) or any Syndrome or condition of a similar kind commonly referred to as AIDS.
  • Charges incurred at Hospital or Nursing Home primarily for neither diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with nor incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home.
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
  • Treatment arising from or traceable to pregnancy childbirth including caesarean section. 14. Naturopathy treatment
  • 15. Any experimental / unproven treatments are excluded from the policy coverage.
  • Fire covers exclusions (Applicable to Section C)

Exclusions - Universal Sompo Surva Vidyarthi Bima Yojana Health Insurance Plan

  • The first 5% of each and every claim subject to a minimum of Rs.10, 000 in respect of each and every loss arising out of “Act of God perils” such as Lightning, STFI, Subsidence, Landslide and Rock slide covered under the policy.
  • The first Rs 10,000 for each and every loss arising out of other perils in respect of which the Insured is indemnified by this Policy.
  • The Excess shall apply per event per Insured Event
  • Loss, destruction or damage caused by war, invasion, act of foreign enemy hostilities or war like operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular rising, military rising, rebellion, revolution, insurrection or military or usurped power.
  • Loss, destruction or damage directly or indirectly caused to the property insured by i. Ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. ii. The radioactive toxic, explosives or other hazardous properties of any explosive nuclear assembly or nuclear component thereof
  • Loss, destruction or damage caused to the insured property by pollution or Contamination excluding i. Pollution or contamination which itself results from a peril hereby insured against. ii. Any peril hereby insured against which itself results from pollution or contamination.
  • Loss, destruction or damage to the stocks in Cold Storage premises caused by change of temperature.
  • Loss, destruction or damage to bullion or unset precious stones, any curios or works of art for an amount exceeding Rs. 10000/-, goods held in trust or on commission, manuscripts, plans, drawings, securities, obligations or documents of any kind, stamps, coins or paper money, cheques, books of accounts or other business books, computer systems records, explosives unless otherwise expressly stated in the policy.
  • Loss, destruction or damage to any electrical machine, apparatus, fixture, or fitting arising from or occasioned by over-running, excessive pressure, short circuiting, arcing, self heating or leakage of electricity from whatever cause (lightning included) provided that this exclusion shall apply only to the particular electrical machine, apparatus, fixture or fitting so affected and not to other machines, apparatus, fixtures or fittings which may be destroyed or damaged by fire so set up.
  • Expenses necessarily incurred on (i) Architects, Surveyors and Consulting Engineer's Fees and (ii) Debris Removal by the Insured following a loss, destruction or damage to the Property insured by an insured peril in excess of 3% and 1% of the claim amount respectively.
  • Loss of earnings, loss by delay, loss of market or other consequential or indirect loss or damage of any kind or description whatsoever.
  • Loss or damage by spoilage resulting from the retardation or interruption or cessation of any process or operation caused by operation of any of the perils covered.
  • Loss by theft during or after the occurrence of any insured peril.
  • Any Loss or damage occasioned by or through or in consequence directly or indirectly due to earthquake, volcanic eruption or other convulsions of nature.
  • Loss or damage to property insured if removed to any building or place other than in which it is herein stated to be insured, except machinery and equipment temporarily removed for repairs, cleaning, renovation or other similar purposes for a period not exceeding 60 days.
  • Riot, Strike and Malicious Damage: Loss of or visible physical damage or destruction by external violent means directly caused to the property insured but excluding those caused by i. Total or partial cessation of work or the retardation or interruption or cessation of any process or operations or omissions of any kind; ii. Permanent or temporary dispossession resulting from confiscation, commandeering, requisition or destruction by order of the Government or any lawfully constituted Authority; iii. Permanent or temporary dispossession of any building or plant or unit or machinery resulting from the unlawful occupation by any person of such building or plant or unit or machinery or prevention of access to the same; iv. Burglary, housebreaking, theft, larceny or any such attempt or any omission of any kind of any person (whether or not such act is committed in the course of a disturbance of public peace) in any malicious act.
  • Storm, cyclone, typhoon, tempest, hurricane, tornado, flood and inundation: Loss destruction or damage directly caused by storm, cyclone, typhoon, tempest, hurricane, flood or inundation excluding those resulting from volcanic eruption or other convulsions of nature.