Universal Sompo Critical Illness Insurance Policy

Critical illness covers typically provide lump sum benefit following the first diagnosis of any of the named critical illness. The benefits obtained from these covers can be used to manage any of the expenses as per the beneficiary’s discretion. Universal Sompo’s Critical Illness Insurance Policy is one such cover that provides benefits against various life-threatening health ailments that could wipe you an individual’s life savings. This policy comes with a lot of flexible options, and it is ideal for people looking for health insurance coverage at an affordable price.

Eligibility for Universal Sompo Critical Illness Insurance Policy

People who meet the following eligibility criteria can avail coverage under Universal Sompo Critical Illness Insurance Policy:

• The proposer of the policy must be at least 18 years of age.
• This can be availed by people between the ages of 5 years and 65 years.
• Lifelong renewability option is available once people have successfully entered this cover.

Features of Universal Sompo Critical Illness Insurance Policy

This policy comes with the following list of features:

• The sum insured amount for this policy cover ranges between Rs.2.5 lakh and Rs.20 lakh.
• The premium amount for this policy varies based on the age of the insured person and the sum insured chosen.
• Medical examination is mandatory for applicants who are over 55 years of age. The type of medical tests required may vary based on the sum insured amount chosen.
• Premium discount is available for long-term policy coverage. A 10% discount is available for 2 years and a 15% discount is available for 3 years.
• Any critical illness diagnosed within the first 90 days of commencement of the policy will not be covered by this policy. However, this does not apply for renewals.
• Pre-existing diseases have a waiting period of 48 months of continuous policy coverage.
• Following the first diagnosis of any of the named critical illness, the insured must survive for at least 30 days in order to obtain benefits under this cover.
• Premium loading might be applicable based on the occupational risk of the insured person. A loading of 15% and 20% shall be applicable for medium and heavy occupational risks respectively.
• The sum insured amount chosen at the time of enrollment can be enhanced subject to the approval of the underwriter.
• There is a 15-day free look period according the regulations set forth by the IRDAI.
• A grace period of 30 days from the date of expiry shall be provided to renew this policy cover.
• Income tax relief is available for the premium amount paid towards this policy as per Section 80D of the Income Tax Act.
• Portability option is available as per the regulations set forth by the IRDAI. The company must be notified at least 45 days before the date of renewal in this case.

Benefits of Universal Sompo Critical Illness Insurance Policy

The benefits available under Universal Sompo Critical Illness Insurance Policy can be given as follows:

Exclusions of Universal Sompo Critical Illness Insurance Policy

Some of the exclusions applicable to Universal Sompo Critical Illness Insurance Policy can be given as follows:

• Any illness other than the named critical illness mentioned in the policy schedule
• Any medical or non-medical expenses related to accidental hospitalisation
• Cosmetic or aesthetic treatments of all kinds
• Expenses related to weight loss or weight control treatments
• Expenses related to convalescence, general debility, rest cure, etc.
• Intentional self-injury or suicide attempt
• Hospitalisation due to war, invasion, or nuclear exposure
• Any losses caused while under the influence of alcohol or drugs
• Any claims arising out of venereal diseases or sexually transmitted diseases
• Claims that can be attributed to mental insanity or emotional distress
• Illnesses or injuries resulting from participation in criminal activities
• Congenital anomalies or related complications
• Any kind of unproven or experimental treatment methods
• Expenses related to alternate treatments

Claim Procedure

Following the diagnosis of any of the named critical illness, the company must be notified with immediate effect. The customer service department can be contacted and notified of a claim. After the notification of the claim, the following documents must be submitted within a maximum of 30 days:

• Policy copy
• Claim form
• Copies of original bills
• Medical reports
• Diagnostic reports
• Any other documents requested by the insurer or TPA

Once the claim documents are submitted, the company will verify the validity of the claim. Acceptance or rejection of the claim will be communicated to the insured within a maximum of 30 days. If the claim is accepted, the company will provide the settlement amount within 7 days.