Universal Sompo Complete Health Insurance Plan for Family

A comprehensive health insurance program is provided by the general insurance service provider, and it is called Universal Sompo Complete Healthcare Insurance. This adaptable coverage comes in a variety of sum-insured options. If you want to enroll your complete Health Insurance Plan for Family policy, this is the perfect coverage for you. This policy cover can be quickly purchased online with few documents if you are a young, healthy individual. This policy includes a variety of add-on advantages in addition to the standard health insurance benefit to improve your overall coverage.

You can enroll in this health insurance plan as early as age 18 or as late as age 70. It comes in two varieties: the individual policy and the family floater policy. This health insurance plan provides coverage for care received through conventional allopathic medicine as well as through complementary therapies like homeopathy and Ayurveda. Additionally, it is a coverage that will pay for outpatient care and vaccinations if an accident makes them necessary.

Eligibility of Universal Sompo Complete Healthcare Insurance Program

The following qualifications must be met in order to sign up for Universal Sompo Complete Healthcare Insurance:

  • The maximum age to purchase this policy is 70 years old.

  • This policy shall be proposed by an adult.

  • Children who are dependent may be covered as early as day 91 of life. Dependent children are protected with floater coverings starting on the day of birth.

  • Dependents who are unmarried or without a job are covered until they turn 25.

  • Once purchased, this policy has a lifetime renewal option.

Key Aspects and Coverage of the Universal Sompo Complete Health Care Insurance Plan

  • There are individual and family floater covers for this medical insurance policy.

  • The sum insured options for this policy range from Rs. 1 lakh to Rs. 10 lakhs.

  • Termination of the insurance is possible at any moment with a 15-day written notice from the policyholder. A part of the premium will be reimbursed in the event that no claims have been filed under the policy.

  • Customers have a range of 1 to 3-year policy terms to pick from.

  • For a 2-year policy term, there is a 5% discount and for a 3-year insurance term, there is a 7.5% discount.

  • Depending on the number of family members covered by this policy, a family discount on this health insurance coverage is available up to 10%.

  • Policyholders under the age of 55 are exempt from the requirement for a pre-insurance medical exam.

  • The business has network connections with more than 4000 hospitals spread across the nation.

  • For up to 30 days, pre-hospitalization medical costs are reimbursed. However, the business will pay the real costs for up to 60 days if the hospitalization is disclosed 5 days in advance.

  • Medical hospitalization is reimbursed for up to 60 days. However, the firm would cover these costs for up to 90 days if the hospitalization is disclosed 5 days in advance.

  • Within the first 30 days of the policy’s start, any hospitalization for illness will not be covered.

  • There is a 36-month waiting period for pre-existing conditions. The coverage must be ongoing for the entire three years.

  • Subject to a 3-year waiting period, this policy also offers maternity benefits.

  • The waiting period for outpatient treatment coverage is 36 months.

  • Hospitalisation costs for a minimum of 24 hours, including room and board, nursing costs, doctor’s fees, anesthesia, blood, oxygen, critical care unit costs, medications, drugs, operating room costs, etc.

  • This policy also covers daycare treatment if the hospital stay is less than 24 hours.

  • Additionally included are any essential post-hospitalization follow-up appointments, prescription drugs, and diagnostics.

  • Organ donation with reimbursed expenses for both you and the donor

  • Additionally, the cost of the ambulance service will be reimbursed, but only to a certain extent.

  • Any dental-related treatment is covered by this policy in the event of accidents.

  • Homeopathy, Unani, Siddha, and Ayurveda are also covered by this policy.

  • Youngsters under the age of 12 who are dependents or children who require hospitalization for a period of time longer than 72 hours will also have their medical expenses covered by the insurance.

  • Vaccinations and immunizations are covered by the policy.

  • Diagnostic procedures, non-emergency dental care, the need for eyeglasses, contact lenses, a hearing aid, etc.

  • Prenatal and postnatal costs, are also available.

  • For any of the above critical illnesses, there is a 90-day waiting period if critical illness coverage is chosen as optional insurance.

  • Under this policy, you have a 15-day free look period to evaluate the terms and conditions.

  • According to IRDAI rules, Universal Sompo permits portability without reducing any accrued benefits. In this case, the employer must be informed at least 45 days prior to the renewal date.

  • According to Section 80D of the Income Tax Act, the premium amount paid for this policy’s coverage is eligible for income tax relief.

Additional benefits  of Universal Sompo Complete Health Care Insurance Plan

  • Additional coverage options – Any of the additional coverage options from the list of five coverage options can be chosen in order to improve the plan. Following are the choices:

  • Personal Accident: If the insured suffers accidental death or total permanent disability as a result of the accident, an additional sum assured is paid.

  • 11 serious illnesses are covered by this option, and upon the diagnosis of any one of them, the option will pay a lump sum of the additional Sum Assured.

  • Hospital Daily Cash – Under this option, the policyholder will receive a daily allowance if their hospitalisation lasts longer than three consecutive days.

  • Sub-limits – The plan provides a premium savings for freely selecting sub-limits on specific illnesses.

  • Treatment in a tier hospital: If the policyholder agrees to only receive care at the insurer’s partnered hospitals and pays 10% of the claim’s costs, a 5% premium discount is permitted.

  • Premium discounts – The plan provides three different types of discounts or refunds, as follows:

  • Family Discount – A premium discount is permitted if family members are covered under the policy. The discount is as follows and is determined by the number of covered members: 2-3 participants 5%; 4% to 5% of members and More than 5 participants: 10%.

  • Long-term policy discount: The premium rate may be reduced by between 5% and 7.5% if the insurance is held for two or three years.

  • Discount of Rs. 110 is permitted for purchasing the policy online and obtaining an ePolicy.

  • Cumulative Bonus – The Sum Assured is enhanced by 10% subject to a cap for each year the proposer hasn’t filed a claim under the policy.

  • A Sum Assured increase of no more than 50%.

  • Portability: The proposer has the option to migrate his current health insurance policy from another company to this one. Requests for porting must be made at least 45 days prior to the expiration of the prior policy being migrated.

  • Cumulative Bonus: The Sum Assured is enhanced by 10%, up to a maximum of 50%, for each year that the Proposer has not filed a claim under the policy.

  • Free Look Period – After the policy is issued, the policyholder is given a 15-day “cooling off” or “free look” period to study the terms and conditions of the policy. If the plan is discovered to be unsatisfactory, it may be terminated within this time frame, and the premium paid will be repaid after the applicable mortality fee, service tax, cess, and stamp duty have been deducted.

  • Grace Period – After the due date, a 30-day grace period is given for premium payments, during which the policy’s coverage is maintained.

  • Plan cancellation – In the event of fraud, misrepresentation, or non-disclosure, the company may terminate the insurance. The paid premiums in this instance are not reimbursed. The insurance may also be cancelled by the proposer at any time, in which case premium payments would be repaid less the cost of coverage for the time the policy was in effect and associated costs.

Exclusion of Universal Sompo Complete Health Care Insurance Plan

The following are only a few of the major exclusions from the Universal Sompo Complete Healthcare Insurance:

  • Costs associated with substance abuse or addiction

  • Accidents incurred while engaging in adventure sports

  • External medical equipment, such as prosthetic limbs

  • Injuries received while intentionally breaking the law

  • All kinds of aesthetic or cosmetic procedures

  • Sexually transmitted illnesses of any kind

  • Costs associated with preventing illness or doing research

  • Treatment costs for mental or psychiatric problems

  • Costs associated with any experimental or untested treatments for obesity or weight loss

  • Injuries or illnesses brought on by conflict, invasion, exposure to radiation, etc.

  • Costs associated with purchasing vitamins or other food supplements

  • Any type of non-medical costs spent while in the hospital

Plan Type

  • Basic: Individual and family floater policies must have a sum insured of Rs. 1 lakh or Rs. 2 lakhs.

  • Essential: For individuals and families with floaters, it is essential to have a sum insured of Rs. 3 lakhs, Rs. 4 lakhs, or Rs. 5 lakhs.

  • Privilege: Individual and family floater sums insured of Rs. 6 lakhs, Rs. 7 lakhs, Rs. 8 lakhs, Rs. 9 lakhs, or Rs. 10 lakhs.

Benefits of Universal Sompo Complete Health Care Insurance Plan

  • This policy’s 15-day free look period begins on the day you receive the policy materials.

  • Section 80D of the Income Tax Act of 1961 provides tax advantages for premium payments made toward the policy.

  • This policy also offers a reinstatement benefit, meaning that if the total benefit is used up, the total benefit will be restored.

  • Hospitalization at any of the network hospitals without payment.

  • As a no-claim bonus, a minimum cumulative bonus of 10% and a maximum cumulative bonus of 50% will be provided.

  • Additionally, this policy provides a 30-day grace period from the due date for the premium payment.

Required Documents needed for the purchase of a Universal Sompo Complete Health Care Insurance Policy

A proposer must complete an “Application form/proposal form” with an accurate medical history and address verification in order to purchase the policy. Depending on the insured amount and the person’s age, a medical checkup may be necessary for specific circumstances.

How to claim Universal Sompo Complete Health Care Insurance Plan

In the event of a scheduled hospitalization, the firm must be notified 72 hours in advance, and in the event of an emergency, within 24 hours of the hospitalization.

The first step in a cashless treatment procedure is to notify the company of the claim. You can submit a pre-authorization request to the business directly from the hospital. When submitting the company with your request for authorization, you must provide information about your insurance. Following submission of the request, the business will examine the claim request and grant authorization.

Requests for reimbursement must be submitted following hospital release. The insured must first pay for hospital fees and gather all original receipts and paperwork. Medical bills, cash receipts, a doctor’s certificate, prescriptions, pharmacy receipts, and other items are among the documentation that must be submitted. The company will check the claim’s validity after receiving these papers and will decide whether to accept or reject the claim based on that legitimacy. The insurer will get the compensation sum from the company if the claim is approved.

Take Away

Your financial future is secured against potential medical costs thanks to Complete Health Care Insurance. It is a comprehensive plan that provides you with reasonable financial assistance to cover the costs incurred as a result of severe sickness and accidents, as well as value-added services for you and your loved ones.

Critical Illness Coverage Add-ons to Improve Benefits are included in the plan. Up to an additional Sum Insured limit equivalent to his or her Basic Sum Insured, the firm will pay for reasonable and usual charges incurred on costs stated under “What We Cover” if you want to add-on critical illness coverage and have paid an additional premium. The additional amount insured for a serious illness provided under this optional extension cover will not be eligible for a cumulative bonus or the cap on daily allowance, ambulance costs, or health check-up costs.