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.
People who wish to enroll themselves in Universal Sompo Complete Healthcare Insurance must meet the following eligibility criteria:
Universal Sompo Complete Healthcare Insurance is available with the following list of features:
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:
|Benefits||Extent of Coverage|
|In-patient hospitalisation||Covered up to the sum insured limit|
|Day care treatment||Covered for up to 141 procedures|
|Domiciliary treatment||Covered up to the sum insured limit|
|Emergency ambulance cover||Up to 1% of the sum insured amount Max. Rs.1,000 for SI Rs.1 lakh & Rs.2 lakh Max. Rs.2,000 for SI Rs.3 lakh, Rs.4 lakh, & Rs.5 lakh Max. Rs.3,000 for SI Rs.6 lakh to Rs.10 lakh|
|AYUSH benefit||Up to the sum insured limit|
|Outpatient treatment (after 3 years of waiting period)||Up to 1% of the sum insured (Rs.2,500 to Rs.7,500 based on the sum insured chosen)|
|Convalescence benefit||Rs.10,000 if the hospitalisation exceeds 10 days|
|Cumulative bonus||10% increase in sum insured for every claim-free year subject to a maximum of 50% of the sum insured amount|
|Daily cash benefit for accompanying an insured child||Available for sum insured Rs.3 lakh and above|
|Maternity coverage (after 3 years of waiting period)||Sum insured Rs.3 lakh to Rs.5 lakh: Normal delivery - up to Rs.15,000, Cesarean delivery - up to Rs.25,000 Sum insured Rs.6 lakh to Rs.10 lakh: Normal delivery - up to Rs.25,000, Cesarean delivery - up to Rs.50,000|
|Newborn baby cover||Available for sum insured Rs.3 lakh and above|
|Health check up||Available at the end of every two claim-free years|
|Type of coverage||Benefits|
|Personal accident cover||Lump sum benefit for accidental death or disability|
|Critical illness cover||Lump sum benefit following the first diagnosis of a named critical illness|
|Daily hospital cash cover||Rs.200 to Rs.1,000 per day based on the sum insured amount chosen|
|Sub limit applicability||Premium discounts on availing sub limits for certain conditions|
|Treatment in tied networks||5% discount for treatment in network hospital 10% co-pay shall be applicable for treatment in non-network hospitals|
Some of the key exclusions listed under Universal Sompo Complete Healthcare Insurance can be given as follows:
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.
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