Universal Sompo Swarna Gramin Bima Yojana (Individual)

General insurance company Universal Sompo is renowned for its diverse range of products in multiple domains. The company has a range of health insurance products ideal for people with different requirements. Universal Sompo’s Swarna Gramin Bima Yojana (Individual) is a policy designed exclusively for village dwellers in the country. This policy provides coverage for personal accident losses, critical illnesses, and daily cash expenses incurred during hospital stay. This policy comes with an affordable price tag to ensure that the rural population gets easy access to adequate insurance coverage against various health hazards.

Eligibility for Universal Sompo Swarna Gramin Bima Yojana (Individual)

People who meet the following eligibility criteria can apply for Universal Sompo Swarna Gramin Bima Yojana (Individual):

• The proposer of this policy must be between the age of 18 years and 65 years.
• Dependent children can be covered from the age of 6 months.
• Lifelong renewability option is available for policyholders once they have entered this cover.
• A maximum of 2 adults and 2 dependent children can be enrolled in the same policy on a family floater basis.

Features of Universal Sompo Swarna Gramin Bima Yojana (Individual)

This policy comes with the following list of features:

• This policy is available in multiple sum insured options ranging from Rs.50,000 to Rs.2 lakh for both personal accident cover and critical illness cover.
• For people over the age of 45, the company requires pre-insurance medical examination before enrollment. If the proposal is accepted, the company will reimburse 50% of the medical examination costs.
• The policy period can be 1, 2, or 3 years depending upon the preference of policyholders.
• Long-term discount of 10% and 15% is available for 2 and 3 year policy terms respectively.
• Based on the number of family members included in the policy, it is possible to obtain family discount up to 10%.
• Pre-existing illnesses are covered only after 48 months of continuous policy coverage.
• Premium loading up to 20% shall be applicable based on the occupational risk of the individual applying for the policy. For instance, workers involved in electrical installations are categorized as ‘heavy risk’ members and they must pay an additional 20% on premiums.
• Premium loading up to 10% shall be applicable based on the location of the individual applying for the policy.
• The sum insured amount chosen at the time of enrollment can be enhanced at the time of renewal subject to the discretion of the underwriter.
• During the 15-day free look period, customers can review the terms of the cover and cancel it if they are not satisfied with it.
• The company allows a grace period of 30 days from the date of expiry to renew this policy cover.
• The insurer allows portability to and from other insurers in the market. To proceed with the portability option, the company must be notified at least 45 days before the date of renewal.
• As per Section 80D of the Income Tax Act, the premium charges paid for this policy is eligible for income tax relief.

Benefits of Universal Sompo Swarna Gramin Bima Yojana (Individual)

The benefits offered by Universal Sompo Swarna Gramin Bima Yojana (Individual) can be classified into three different sections. Section A applies to personal accident coverage, and it provides benefits against death and disability. Section B provides critical illness coverage and Section C provides daily cash during hospital stay. The range of benefits can be given as follows:

Section A: Personal Accident

Benefits	Extent of Coverage
Death of the insured or his/her family members	Lump sum payment of 100% of the sum insured amount
Permanent total disablement of the insured or his/her family members	Lump sum payment of 125% of the sum insured amount
Permanent partial disablement resulting from an accident	Up to 50% of the sum insured amount

Section B: Critical Illness

Benefits	Extent of Coverage
Diagnosis of critical illness	Coverage for treatment expenses up to the sum insured limit
Option 1	Cancer of specified severity First heart attack Coronary artery bypass graft Open heart replacement Coma of specified severity
Option 2 (includes all illnesses covered under option 1)	Multiple sclerosis with persisting symptoms Stroke resulting in permanent symptoms Permanent paralysis of limbs Kidney failure
Option 3 (includes option 1 and option 2)	Motor neuron disease with permanent symptoms Major organ or bone marrow transplant

For option 2 and option 3, a premium loading of 25% and 40% on the basic charges will be applicable.

Section C: Hospital Cash

Benefits	Extent of Coverage
Daily cash benefit for hospitalisation exceeding 2 days or more	Option 1 - Rs.250 per day (max. Rs.45,000) Option 2 - Rs.500 per day (max. Rs.90,000) Option 3 - Rs.1,000 per day (max. Rs.1.8 lakh)
Daily cash for ICU admission (for up to 7 days max.)	Double the cash benefits offered under regular coverage

Daily cash benefit can be chosen for 15, 30, 45, 90, or 180 days as per one’s requirement. The premium charges for this cover vary accordingly.

Exclusions of Universal Sompo Swarna Gramin Bima Yojana (Individual)

The following list of general exclusions apply to policyholders who opt for this coverage:

• Any claims made under more than one section during a specific policy period
• Death or disability arising out of childbirth or related complications
• Intentional self-injury, suicide, or suicide attempt
• Death or disability caused while under the influence of drugs or alcohol
• Any claims arising out of participation in criminal activities
• Claims attributable to war, invasion, and exposure to nuclear materials
• Any kind of sexually transmitted diseases including HIV and AIDS
• Any treatment that is purely experimental in nature
• Dental treatment or surgery unless caused by an accident
• Hospitalisation for the purpose of diagnosis, traction, physiotherapy, etc.
• Alternative treatments of all kinds
• Cosmetic or aesthetic treatments of all kinds
• Claims arising out of participation in hazardous activities or extreme sports
• Any illness classified as an epidemic by the government of India
• Special nursing care, routine health check ups, convalescence, general debility, etc.

Claim Procedure

Following an unfortunate event, claim intimation must be made to the company immediately. The insured can contact the company’s customer service department to notify about the claim request. Once the claim request has been filed, the documents proofs related to the claim must be submitted within 30 days. The following list of proofs may be required by the insurer:

Section A

• Policy copy
• Police FIR
• Spot panchnama
• Death certificate (if applicable)
• Disability certificate (if applicable)
• Medical report/original medical bills

Section B

• Original medical bills
• Treatment reports
• Diagnostic reports
• Treatment provided

Section C

• Copies of cash bills
• Discharge summary
• Complete medical records

After the submission of all the documents, the company will verify the request and provide its reply within a maximum of 30 days. If the claim is accepted by the company, the settlement amount will be provided within a maximum of 7 days.