Universal Sompo Swarna Gramin Bima Yojana (Group)

Universal Sompo’s Swarna Gramin Bima Yojana is a policy designed specifically for village dwellers in the country. The individual cover provides a combination of benefits for the primary insured as well as his/her family members. Its group variant provides similar benefits to customers, but this policy is mainly intended for organisations providing coverage for their rural clientele. For instance, a bank can take this cover to provide health insurance protection for its Kisan credit card holders. Similar to the individual cover, this policy comes with an affordable price tag.

Eligibility for Universal Sompo Swarna Gramin Bima Yojana (Group)

This policy cover can be taken by people who meet the following eligibility criteria:

• The proposer of the policy must be between 18 years and 65 years of age.
• Dependents can be enrolled in this cover from the age of 6 months.
• Lifelong renewability option is available for people who have entered this cover within the specified age limit.
• The family of the primary insured (maximum of 2 adults and 2 dependents) can also obtain benefits under this group insurance cover.

Features of Universal Sompo Swarna Gramin Bima Yojana (Group)

Some of the key features of Universal Sompo Swarna Gramin Bima Yojana (Group) can be listed as follows:

• The sum insured amount available for an individual policy member ranges between Rs.50,000 and Rs.2 lakh. Organisations are free to choose the preferred sum insured amount for their members.
• Pre-existing illnesses will not be covered under this policy for the first 48 months.
• Group discount is available based on the number of members enrolled under this policy. A maximum discount of 35% (for 500+ members) is available under this group policy.
• Tax relief is available for the premium amount paid as per Section 80D of the Income Tax Act.
• The maximum discount available under this cover (including the tax benefits) shall not exceed 40% of the premium charges.
• Premium loading up to 20% is applicable based on the occupational risk of the insured members. The risk level is classified into normal, medium, and heavy based on the occupation of workers.
• The location of the insured person may attract premium loading up to 10%.
• Customers are allowed a free look period of up to 15 days under this policy. During this time, customers can cancel the policy without incurring any costs (except for the taxes) if they are not satisfied with the terms.
• The sum insured amount can be enhanced by the insured during the time of policy renewal.
• The company allows portability options as per the regulations of the IRDAI. This must be intimated to the company at least 45 days in advance.
• A grace period of 30 days from the date of expiry is provided for policy renewal. However, there will not be any coverage for the days during which the premium is not paid.

Benefits of Universal Sompo Swarna Gramin Bima Yojana (Group)

Similar to the individual policy, the benefits offered under this cover can be classified into three different sections. Section A concerns personal accident coverage, Section B concerns critical illness coverage, and Section C focuses on providing hospital cash benefits. The benefits available under this cover can be given as follows:

Section A

Benefits	Extent of Coverage
Death of the insured or his/her family member	Lump sum payment of 100% of the sum insured amount
Permanent total disablement of the insured or his/her family member	Lump sum payment of 100% of the sum insured amount
Permanent partial disablement of the insured or his/her family member	Up to 50% of the sum insured amount (varies based on the severity of the damages)

Section B

Benefits	Extent of Coverage
Critical illness coverage	Coverage for the treatment of the named critical illness following diagnosis
Option 1	Cancer of specified severity First heart attack of specified severity Open chest coronary artery graft bypass Open heart replacement Coma of specified severity
Option 2 (includes option 1)	Kidney failure Stroke resulting in permanent symptoms Permanent paralysis of limb Multiple sclerosis with persisting symptoms
Option 3 (includes option 1 and option 2)	Major organ/bone marrow transplant Motor neuron disease with permanent symptoms

Section C

Benefits	Extent of Coverage
Daily cash following hospitalisation	Option 1: Rs.250 per day subject to a maximum of Rs.45,000 Option 2: Rs.500 per day subject to a maximum of Rs.90,000 Option 3: Rs.1,000 per day subject to a maximum of Rs.1.8 lakh
Daily cash for ICU hospitalisation (for a maximum of 7 days)	Double the cash benefits of regular hospitalisation

Hospital cash benefit can be chosen for 15, 30, 45, 90, and 180 days. Based on the number of days chosen, the coverage premium will change.

Exclusions of Universal Sompo Swarna Gramin Bima Yojana (Group)

The list of exclusions named under this group policy is similar to that of the individual policy. These exclusions can be listed as follows:

• Death or disability caused by self-injury, suicide, or suicide attempt
• Losses caused while under the influence of alcohol or drugs
• Injuries caused by emotional distress or mental insanity
• Death or disability resulting from childbirth and related complications
• Any claims arising out of participation in hazardous activities of extreme sports
• Congenital disease, anomalies, and birth defects
• Any claims related to sexually transmitted diseases, HIV, AIDS, etc.
• Any kind of cosmetic or aesthetic treatments
• Death or disability resulting from war perils, nuclear exposure, radiation, etc.
• Any kind of alternative treatment
• Hospitalisation for the purpose of diagnosis, physiotherapy, traction, etc.
• Any illness classified as an epidemic by the central or state government

Claim Procedure

The claim procedure begins with intimating the company about the unfortunate event. The insured can reach Universal Sompo’s customer care department and intimate the loss or damage resulting from an unfortunate event. After notifying the company, the supporting documents must be submitted to the company within a maximum of 30 days. The following documents and proofs may be requested by the company for various claims:

Section A

• Policy copy
• Police FIR
• Spot panchnama
• Death certificate or disability certificate (as applicable)
• Post mortem report (if applicable)
• Medical reports/investigation reports

Section B

• Copies of medical bills
• Pharmacy receipts and prescriptions
• Diagnostic reports
• Medical reports
• Discharge summary

Section C

• FIR copy
• Discharge certificate
• Medical records

After the submission of the above mentioned documents, the company will proceed with processing the claim request. The acceptance or rejection of the claim will be communicated to the insured within a maximum of 30 days from the submission of the last necessary document. If the claim is accepted, the settlement amount will be provided within 7 days.