Universal Sompo Pravasi Bharatiya Bima Yojana

Universal Sompo Pravasi Bharatiya Bima Yojana is an insurance cover specifically designed for emigrants leaving India for employment in another country. This policy provides a combination of benefits including personal accident coverage, hospitalisation coverage, employment related contingencies, legal costs, etc. Despite the range of benefits offered, this policy is priced within the affordable range of the middle-class population of the country. This is a necessary protection cover to have if you are considering foreign travel for a particular period of time.

Eligibility for Universal Sompo Pravasi Bharatiya Bima Yojana

The following eligibility criteria applies to those who wish to take the Universal Sompo Pravasi Bharatiya Bima Yojana:

• This policy can be bought by emigrants before they leave the country. The passport of the eligible person must bear the “Emigration Check Required” endorsement.
• The primary insured must have a valid visa for staying abroad for the purpose of employment.
• The proposer of the policy must be between 18 years and 65 years.
• This policy cover is available for the spouse and dependent children of the primary insured.

Features of Universal Sompo Pravasi Bharatiya Bima Yojana

Some of the notable features of Universal Sompo Pravasi Bharatiya Bima Yojana can be listed as follows:

• This policy can be availed in 2 and 3-year policy terms based on the discretion of the insured.
• This is a micro insurance cover that comes with an affordable price tag. Premium for this policy is priced at Rs.275 and Rs.375 (excluding taxes) for 2 and 3 year terms respectively.
• Pre-existing diseases are not covered for up to 48 months of continuous policy coverage.
• Any sickness hospitalisation claims made within the first 30 days of the commencement of the policy will not be covered.
• Conditions like cataract, hernia, hydrocele, congenital internal disease, sinusitis, gallbladder stones, varicose veins, etc. will not be covered for the first one year of the policy.
• This policy covers maternity expenses incurred by the policyholders for up to 2 children during the policy period.
• For those with entry age over 45 years, the company requires a pre-insurance medical examination before enrollment.
• There is a free look period of 15 days for policyholders to review the terms and conditions of this policy.
• The premium amount paid for this policy is eligible for tax relief as per Section 80D of the Income Tax Act.

Benefits of Universal Sompo Pravasi Bharatiya Bima Yojana

This micro insurance policy comes with 5 different types of benefits based on the level of coverage chosen by the insured person - personal accident coverage, transportation and airfare coverage for attendant, hospitalisation coverage, employment contingencies & repatriation expenses, and legal costs. The fixed benefits available under Universal Sompo Pravasi Bharatiya Bima Yojana can be given as follows:

Exclusions of Universal Sompo Pravasi Bharatiya Bima Yojana

Universal Sompo is not liable to provide any compensation for the following list of exclusions:

• People travelling abroad against the advice of a physician
• Injuries sustained in a profession/country different from what was originally declared at the time of enrollment
• Injuries sustained in a country against which the Republic of India has imposed travel restrictions
• Death or injury resulting from war or internal conflict in the country of employment
• Claims arising after the expiry of passport or visa of the insured person
• Any claims related to mental stress, anxiety, depression, or stress
• Any claims related to intentional self-injury, suicide, or suicide attempt
• Death or injury caused while under the influence of alcohol or drugs
• Claims related to sexually transmitted diseases and venereal diseases
• Claims related to consequential loss
• Any loss caused due to participation in criminal activities or other unlawful acts
• Any loss caused by exposure to nuclear materials or other toxic waste
• Air travel except as a passenger in a recognized airline traveling in scheduled routes
• Death or injury resulting from participation in extreme sports or other dangerous activities
• Any claims made 12 months after the death of the insured person
• Any claims filed after 90 days after completion of the journey
• Any legal costs involved in the transportation of mortal remains
• Any reimbursements claimed without the proof of original tickets
• All non-medical expenses incurred during the time of hospital stay
• Cost of external medical aids such as spectacles, hearing aids, etc.
• Dental treatment unless caused by an accident
• Any expenses related to travel or transportation
• Expenses incurred for non-allopathic medical treatments such as naturopathy
• Legal expenses not certified by the appropriate ministry of the country of employment
• Any legal or employment related claims not certified Indian Mission/Post abroad
• Any day care treatment expenses other than the ones listed in the policy document

Claim Procedure

For accident claims, the company must be intimated within 14 days from the date of the eventuality. Sickness hospitalisation claims must be intimated within 7 days from the date of hospitalisation.

Personal accident claims: Death or disability resulting from an accident requires submission of proofs to the company within a reasonable period. The following documents must be submitted to the insurer following personal accident claims:

• Police report
• Death certificate
• Post mortem report
• Medical treatments undertaken (for disability)
• Certificate of disability from a physician

Once these documents are submitted to the insurer, the claim settlement process will begin. The insurer will evaluate the validity of the submitted documents before providing the settlement amount.

Hospitalisation claims: Cashless treatment facility is available in the network hospitals for hospitalisation claims. To avail this facility, it is necessary to intimate the company 48 hours ahead of planned hospitalisation or within 24 hours of emergency hospitalisation. Pre authorisation form can be obtained from the hospital counter. The authorisation form, along with the policy details, can be faxed to the third-party administrator (TPA) from the hospital. The TPA will verify the request and approve the cashless treatment request.

Reimbursement claims can be filed within 30 days from the date of discharge from the hospital. While filing reimbursement requests, it is necessary to submit the following list of documents to the insurer:

• Original bills
• Cash receipts
• Medical certificates
• Diagnostic reports
• Prescriptions
• Any other documents requested by the insurer

Once these documents are submitted, the insurer or TPA will process the claim request. Once the claim is validated, the company will provide the settlement amount.

Other claims: Transportation claims require necessary proofs and related documents. The cost of transportation must be provided in the form of bills and receipts. For airfare related claims, original air tickets, other receipts, and copy of passport must be submitted while filing the claim. Claims related to legal costs, employment contingencies, and repatriation costs must include a certificate from the India Mission/Post abroad. Legal cost related claims must also have a certificate from the appropriate ministry in the country of employment.

Claim settlement: The insured can file claim requests for any of the above mentioned claims. Once the request has been filed, the company will provide its response regarding the acceptance or rejection of the claim within a maximum of 30 days. In case of rejection, the company will provide the reason for rejection. Upon acceptance of the claim, the settlement amount will be provided within a maximum of 7 days.