Universal Sompo Complete Healthcare Insurance

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

Universal Sompo Complete Healthcare Insurance is a comprehensive health insurance plan offered by the general insurance service provider. This is a flexible cover that is available in multiple sum insured variants. This is an ideal cover if you wish to enroll your entire family within a single health insurance policy. If you are a young and healthy individual, this policy cover can be easily bought online with minimal documentation. In addition to the regular health insurance benefit, this policy also comes with a range of add-on covers to enhance your overall coverage.

Eligibility for Universal Sompo Complete Healthcare Insurance

People who wish to enroll themselves in Universal Sompo Complete Healthcare Insurance must meet the following eligibility criteria:

• The maximum entry age for this policy is capped at 70 years.
• The proposer of this policy must be an adult.
• Dependent children can be covered from their 91st day of birth. In floater covers, dependent children are covered from the very first day of birth.
• Unmarried/unemployed dependents can be covered up to the age of 25.
• This policy offers lifelong renewability option once entered.

Features of Universal Sompo Complete Healthcare Insurance

Universal Sompo Complete Healthcare Insurance is available with the following list of features:

• This medical insurance policy is available in both individual and family floater covers.
• This policy is available in multiple sum insured variants ranging from Rs.1 lakh to Rs.10 lakh.
• Customers can choose policy terms ranging from 1 to 3 years.
• There is a 5% discount for 2-year policy term and a 7.5% discount on 3-year policy term.
• Family discount on this health insurance cover is offered for up to 10% depending upon the number of members covered in this policy.
• Pre-insurance medical checkup is not required for policyholders up to the age of 55.
• The company has network tie-ups with over 4000 hospitals in different locations across the country.
• Pre hospitalisation medical expenses are covered for up to 30 days. However, if the hospitalisation is intimated 5 days in advance, the company will reimburse the actual expenses for up to 60 days.
• Post hospitalisation medical expenses are covered for up to 60 days. However, if the hospitalisation is intimated 5 days in advance, the company will reimburse these expenses for up to 90 days.
• Any sickness hospitalisation incurred within the first 30 days of commencement of the policy will not be covered.
• Pre-existing illnesses have a waiting period of 36 months. The coverage must be continuous during these 3 years.
• Maternity benefits are also available under this policy subject to a 3-year waiting period.
• Outpatient treatment coverage has a waiting period of 36 months.
• If critical illness coverage is taken as an optional cover, a waiting period of 90 days is applicable for any of the named critical illness.
• There is a 15-day free look period available under this policy to review the terms and conditions.
• As per the IRDAI regulations, Universal Sompo allows portability without losing out on any accumulated benefits. Here, the company must be notified at least 45 days before the date of renewal.
• The premium amount paid under this policy cover is eligible for income tax relief as per Section 80D of the Income Tax Act.

Benefits of Universal Sompo Complete Healthcare Insurance

This is a comprehensive cover that provides extensive benefits for all the insured persons. Some of the major benefits available under this policy can be given here:

Add-on Covers

Exclusions of Universal Sompo Complete Healthcare Insurance

Some of the key exclusions listed under Universal Sompo Complete Healthcare Insurance can be given as follows:

• Expenses related to addiction or substance abuse
• Injuries sustained while participating in adventure sports
• External medical accessories including artificial limbs
• Injuries sustained while breaching the law with criminal intent
• Cosmetic or aesthetic treatments of all kinds
• Any kind of sexually transmitted diseases
• Expenses incurred for preventative or explorative treatments
• Treatment expenses for psychiatric or mental disorders
• Expenses incurred for any unproven or experimental treatment
• Any treatment related to obesity or weight loss
• Injuries or illnesses caused by war, invasion, nuclear exposure, etc.
• Expenses incurred for vitamins or nutritional substances
• Any kind of non-medical expenses incurred during hospital stay

Claim Procedure

The company must be notified 72 hours in advance in case of planned hospitalisation and within 24 hours of hospitalisation in case of an emergency.

Cashless treatment procedure begins with an intimation to the company about the claim. You can file a pre authorisation request to the company from the hospital itself. You must provide your insurance details while filing the authorisation request to the company. Once the request is filed, the company will verify the claim request and provide the authorisation.

For reimbursement claims, the request must be filed after discharge from the hospital. The insured must pay for the hospital expenses first and collect all the original bills and documents. Some of the required documents include medical bills, cash receipts, physician certificate, prescriptions, pharmacy receipts, etc. When these documents are submitted, the company will verify the validity of the claim and accept or reject the claim based on its validity. Once the claim is accepted, the company will provide the reimbursement amount to the insured.