Universal Sompo Surya Vidyarthi Bima Yojana

Universal Sompo’s Surya Vidyarthi Bima Yojana is an unconventional health insurance designed specifically for students of an education institution. This cover provides a combination of benefits for students that includes aspects of personal accident, medical insurance, property damages, etc. This policy can be taken by educational institutions such as schools to protect their students from various eventualities. Moreover, this cover also provides protection against the property damages sustained to their buildings. The benefits are offered in three different sections under this policy. Except for the personal accident coverage, the other benefits are completely optional under this policy.

Eligibility for Universal Sompo Surya Vidyarthi Bima Yojana

The following eligibility criteria applies to potential policyholders who wish to opt for Universal Sompo Surya Vidyarthi Bima Yojana:

• This policy coverage can be taken by students who have completed 3 years of age.
• The maximum entry age for staff members is capped at 65 years.
• The insured can opt for the sections of benefits based on their requirements. The premium amount is charged accordingly.

Features of Universal Sompo Surya Vidyarthi Bima Yojana

This policy comes with the following set of features:

• This policy provides coverage for death, disability, medical expenses, and property damages.
• The benefits available under the regular cover can be enhanced with the help of additional extensions.
• The insured can choose voluntary deductible and get premium discounts based on the level of deductible chosen. A maximum of 15% is provided for voluntary deductible discount.
• Group discount is offered if the number of members covered under a policy exceeds 100. A maximum of 30% discount can be availed based on the number of members enrolled under the cover.
• Additional discount (up to 10%) is provided if the school has fire extinguishing appliances installed in the property. This is applicable only if the fire cover is chosen.
• This policy offers up to 25% discount if the coverage is opted for “on premises basis”. This means that the company is liable to provide compensation only for losses sustained within the premises of the insured.
• The sum insured amount chosen at the time of enrollment can be enhanced at the time of renewal as per the discretion of the underwriter.
• Under the hospitalisation cover, pre-existing illnesses will not be covered for up to 48 months of continuous policy coverage.
• Any illnesses contracted within the first 30 days of commencement of the policy will not be covered under this policy.
• Pre hospitalisation medical expenses are covered for up to 30 days prior to the date of hospitalisation.
• Post hospitalisation medical expenses are covered for up to 60 days following discharge from the hospital.
• There are various sub limits set for expenses incurred for specific conditions. For instance, cataract treatment has a sub limit of Rs.10,000 per eye.
• There is a free look period of 15 days under this policy cover. During this time, the insured can return the policy without incurring any charges if the terms and conditions are not satisfactory.
• As per the IRDAI regulations, the company allows renewal grace period for up to 30 days from the date of expiry of the cover.

Benefits of Universal Sompo Surya Vidyarthi Bima Yojana

The benefits under Universal Sompo Surya Vidyarthi Bima Yojana is offered in three different sections. Section A is the personal accident cover, and it is mandatory for everyone subscribing to this cover. Section B offers medical insurance cover and Section C offers protection against fire and other property damages. These two sections can be taken based on one’s preference. The range of benefits available under this cover can be given as follows:

Section A

Benefits	Extent of Coverage
Death of the student’s parent	Lump sum payment of 100% of the sum insured amount
Permanent total disablement of the student’s parent	Lump sum payment of 100% of the sum insured amount
Permanent partial disablement of the student’s parent Loss of one eye Loss of one limb Other losses as mentioned in the policy schedule	Up to 50% of the sum insured amount
Loss of personal belongings (optional)	Coverage for loss or theft of personal belongings such as laptop
Loss or theft of pedal cycle (optional)	Available
Cost of study following the death of a parent (optional)	Cost reimbursed for tuition fees, textbooks, etc.
Emergency ambulance cover (optional)	Up to 2% of the sum insured given in multiples of Rs.500 or Rs.1,000
Compassionate visit (optional)	Up to 2% of the sum insured given in multiples of Rs.500 or Rs.1,000
Reimbursement of examination fees (optional)	Up to 1% of the sum insured if the student happens to miss an examination due to an accident

Section B

Benefits	Extent of Coverage
Coverage for hospitalisation expenses	Up to the sum insured limit

Section C

Benefits	Extent of Coverage
Fire cover	Losses caused by building, furniture, plant and machinery, fixtures, etc.
Staff secure (optional)	Death or disability caused to teaching or non-teaching staff members
Library books (optional)	Coverage for damages caused to library books within the educational institution

Exclusions of Universal Sompo Surya Vidyarthi Bima Yojana

The following list of exclusions apply to policyholders who have taken Universal Sompo Surya Vidyarthi Bima Yojana:

Section A

• Intentional self-injury, suicide, or suicide attempt
• Death or disability caused by childbirth, pregnancy, or related consequences
• Death or disability caused while under the influence of drugs or alcohol
• Losses caused by AIDS, HIV, or other sexually transmitted diseases
• Death or disability caused by war, invasion, or exposure to radioactive materials
• Death or disability caused due to participation in extreme sports or hazardous activities
• Death or disability caused while breaking the law with criminal intent

Section B

• Illnesses classified as an epidemic by the government
• Injuries caused by war or warlike activities
• Cost of external medical aids like spectacles, contact lens, hearing aids, etc.
• Any types of cosmetic or aesthetic treatments
• Dental treatments unless necessitated by an accident
• Convalescence, general debility, or run down condition
• Expenses for vitamins and tonics unless they form a part of treatment
• Expenses related to naturopathy treatment, unproven or experimental treatments, etc.
• Injury or disease caused by nuclear exposure
• Any non-medical expenses incurred during hospital stay

Section C

• The first 5% of each and every claim subject to a minimum of Rs.10,000
• Property losses caused by war or invasions
• Any losses caused by pollution or contamination
• Any losses caused due to riots or other malicious damages
• Any losses caused due to convulsions of nature

Claim Procedure

For all the claims mentioned above, the claim procedure starts with intimation to the company about the eventuality. All documents and proofs related to the claim must be submitted within a maximum of 30 days from the date of intimation. The following list of documents might be required by the company while filing the claim:

Section A

• Death certificate or disability certificate (whatever is applicable)
• FIR copy
• Panchnama
• Post mortem report (if applicable)
• Medical report
• Original bills

Section B

• Medical bills
• Diagnostic reports
• Discharge summary
• Original medical bills
• Cash receipts, prescriptions, etc.

Section C

• FIR copy
• Fire brigade report
• Final bills of repairs
• Suppliers’ invoice
• Rent agreement (if applicable)

Once these documents, the company will start the settlement process for the respective claims. The documents will be verified by the company or TPA. If the claim is accepted by the company, the settlement amount will be provided to the insured.