• Universal Sompo Senior Citizen Health Insurance Policy

    Health 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 is one of the general insurance companies in India that offers multiple insurance products in different domains. The company offers an extensive list of health insurance products for people of all age groups. Universal Sompo Senior Citizen Health Insurance is a policy specifically designed for the senior citizens in this country. This policy provides coverage against various potential health ailments commonly suffered by elderly people. This policy comes with a lot of flexible options, and it is worth considering if you are looking for a medical insurance cover for your elderly parents.

    Eligibility for Universal Sompo Senior Citizen Health Insurance Policy

    The following eligibility criteria applies to people who wish to enroll themselves in the Universal Sompo Senior Citizen Health Insurance Policy:

    • This policy is available only for people who have completed at least 60 years of age.
    • The maximum entry age for this policy cover is capped at 70 years.
    • Lifelong renewability option is available if a person has entered the policy within the specified age limit.

    Features of Universal Sompo Senior Citizen Health Insurance Policy

    Some of the notable features of Universal Sompo Senior Citizen Health Insurance Policy can be listed as follows:

    • This policy is available in multiple sum insured options ranging from Rs.1 lakh to Rs.5 lakh.
    • Mandatory health checkup is required for people who wish to enroll in this policy cover.
    • Different levels of medical examination are proposed by the company for potential policyholders. The sum insured limit available for a person is determined based on the type of medical examination undertaken.
    • Upon successful acceptance of a policy proposal, the company will reimburse 50% of the medical examination costs.
    • If the applicant had continuous medical insurance coverage for at least 3 years before applying for this cover, the company might waive the medical examination requirement.
    • Mandatory copayment is required under this policy cover. A 10% copayment is required for all hospitalisation claims. For pre-existing illnesses, a 15% copayment is required.
    • Sickness hospitalisation has a waiting period of 30 days from the date of inception of this policy cover.
    • The optional critical illness cover has an initial waiting period of 90 days from the date of commencement of this cover.
    • Pre-existing diseases will be covered after 24 months of continuous policy coverage.
    • There is a 2-year waiting period for specific conditions like cataract, benign prostatic hypertrophy, arthritis, sinusitis, hernia, hydrocele, etc.
    • Pre-hospitalisation and post-hospitalisation expenses are covered for up to 30 days and 60 days respectively.
    • Customers can choose policy terms from 1 to 3 years depending upon their convenience.
    • Premium discounts are provided based on the policy term chosen: 10% for 2 years and 15% for 3 years.
    • A family discount of 10% is available if the spouse of the primary insured is also covered in this policy.
    • The company offers portability option as per the regulations of the IRDAI. However, it must be notified at least 45 days before the date of renewal.
    • Customers can review the terms and conditions during the 15-day free look period and decide whether or not to continue with this policy.
    • The sum insured amount chosen at the time of enrollment can be enhanced during the time of renewal on condition that no prior claims have been made under this cover.
    • The premium charges paid for this policy is eligible for income tax relief as per Section 80D of the Income Tax Act.

    Benefits of Universal Sompo Senior Citizen Health Insurance Policy

    The range of benefits offered under Universal Sompo Senior Citizen Health Insurance Policy can be given as follows:

    Benefits Extent of Coverage
    Sub-limits for hospitalisation coverage Up to 1% of the sum insured for room rent and boarding Up to 2% of the sum insured for admission in ICU Up to 25% of the sum insured for medical practitioner, consultants, nursing fees, etc. Up to 50% of the sum insured for blood, oxygen, surgical appliances, etc.
    Day care treatment coverage Covered for all the listed procedures up to the sum insured limit (15% copayment shall be applicable)
    Domiciliary treatment coverage Up to 50% of the sum insured
    Cost of health check up Up to 1.25% of the sum insured amount after every 3 claim-free years
    Daily cash allowance Up to Rs.250 per day subject to a maximum of Rs.2,500 per period
    Emergency ambulance charges Up to 1% of the sum insured amount subject to a maximum of Rs.1,500
    Sub limits for specific conditions Cataract per eye - Rs.10,000 Hernia related surgery - Rs.20,000 Stone in urinary system - Rs.20,000 Knee ligament reconstruction surgery - Rs.40,000 (Refer to the policy document for the complete list)
    Cumulative bonus 5% increase in sum insured amount for every claim-free year subject to a maximum of 50% of the sum insured amount
    Critical illness coverage (optional) Lump sum payment of the sum insured amount following the first diagnosis of any of the named critical illness

    Exclusions of Universal Sompo Senior Citizen Health Insurance Policy

    The company is not liable to provide any compensation for the following list of exclusions:

    • Any kind of self-inflicted injury or suicide attempt
    • Illnesses or injuries caused by abuse of alcohol or drugs
    • Treatment for emotional distress or other mental health issues
    • Any loss related to hormone replacement therapy
    • Any kind of sexually transmitted diseases or venereal diseases
    • Congenital anomalies or any related complications
    • Illnesses or injuries caused while breaching the law with criminal intent
    • Injuries sustained while working in hazardous occupations
    • Injuries caused while participating in adventure sports
    • Injuries or illnesses resulting from war, nuclear exposure, radiation, etc.
    • Dental treatment or surgery unless necessitated by an accident
    • Cosmetic or aesthetic treatments of all kinds
    • Any kind of experimental or unproven treatment methods
    • Expenses related to weight control treatments or other optional procedures
    • Convalescence, general debility, rest cure, etc.
    • Expenses related to outpatient treatment (except for pre and post hospitalisation expenses)

    Claim Procedure

    The claim can be initiated by contacting the customer service department of the company. It is better to inform the company about the hospitalisation right away without any delay. During emergency hospitalisation, the claim can be notified within 24 hours of hospitalisation.

    The insured can initiate a cashless treatment claim by sending an authorisation request from the hospital. The customer care department of the insurer can guide you with the process. Once the authorisation form is sent along with the policy details, the insurer will verify the request and approve the same if it is valid.

    Reimbursement requests can be filed after discharge from the hospital. All documents related to the claim must be submitted within a maximum of 30 days from the date of intimation. These documents include original bills, medical reports, diagnostic reports, physician certificate, etc. The company promises to communicate the acceptance or rejection of a claim within 30 days of the receipt of all documents. Once the claim is accepted, the settlement amount will be provided within 7 days.

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