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  • Universal Sompo Health Insurance

    Universal Sompo Health Insurance
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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    Universal Sompo General Insurance is the first Private Partnership in Indian General Insurance Industry, The joint venture has been capitalized with shareholders funds of over 230 cr. including share premium. Sompo Japan Insurance Inc. Headquartered in Tokyo, is a Fortune 500 Company with a capital of 70 billion yen. Universal Sompo General Insurance offers Health & Critical Illness, Personal Accident & Disability, Home, Motor and Property insurance. The Company received the Licence and Certificate of Registration from Insurance Regulatory and Development Authority in November 2007.


    Universal Sompo Health Insurance at a Glance

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    Coverage for your most loved ones

    Total members covered

    Coverage for a maximum of 6 family members with up to 2 adults and 4 children

    You get a choice of coverage tenure

    Pre and Post Hospitalization cover

    Medical expenses covered for 30 days before your hospitalization and 60 days for post hospitalization for related medical expenses

    The next best thing to having a doc in the family

    Health Check-ups

    Free health check after 4 completed Policy years

    * For a family health cover product.

    Critical Factors of the Plan

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    Not a paisa goes from your own pocket!

    Co-Pay

    10%, if treatment is taken in non-tied network.

    You?re covered for any future medical expenses

    Life long renewable

    Lifetime Renewability

    Get essential cover for existing ailments

    Pre-existing Diseases

    Any pre-existing condition will be covered after a waiting period of 4 year

    Hospital room rent determines your treatment bill

    Room Rent

    Sub limit per day for normal room expenses:1.0% of Basic Sum Insured

    *These Features may be included as part of different products and are subject to the insurer's terms & conditions.

    Additional Features of Universal Sompo Health Insurance

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    Good health offers multiple rewards

    Get Cumulative Bonus for every claim free year at from 5% of Basic Sum Insured. The Cumulative Bonus can be accumulated to a maximum of 30%.

    The world is your healthcare oyster

    Cashless facilities at over 5000+ quality hospitals across India.

    *These add-ons may be included as part of different products and are subject to the insurer's terms & conditions.

    Overview

    Universal Sompo General Insurance Co. Ltd. is the first company in the Indian general insurance industry formed through a public-private pairing. Its founders comprise 4 leading companies from the Indian banking and FMCG space and Sompo Japan Insurance Inc. from Japan.


    USGI began operations in 2007 and has since grown to be well-known for its customer-oriented products which are developed based on flexibility and personalisation.


    The Indian founders bring to the table large, established customer-bases and extensive distribution channels with in-depth local market knowledge.


    Sompo Japan Insurance Inc., headquartered in Tokyo, is a Fortune 500 company that has made its mark in over 27 countries worldwide. It brings to USGI strong product knowledge and brand equity in the field of insurance.


    USGI has an impressive product portfolio catering to individuals, SMEs and large corporates. Their numerous health insurance policies are customised to suit the requirements of both individuals and their families. These basic plans can be topped-up to make coverage more comprehensive with add-on covers.


    The health insurance plans offered by the company are listed below. Each plan is further explained in terms of their most salient features.

    1. Individual Health Insurance Policy
    2. Individual Personal Accident Policy
    3. Aapat Suraksha Bima Policy
    4. IOB Health Care Policy Plus
    5. Allahabad Bank Health Care Plus Policy
    6. K Bank Healthcare Plus
    7. Hospital Cash Insurance
    8. Saral Suraksha Bima
    9. Complete Health Care Insurance
    10. Senior Citizen Health Care

    Why Compare Universal Sompo Health Insurance Plans on BankBazaar?

    • Individual Health Insurance Policy

    • Entry Age Up to 55 yrs.
      Sum Assured Up to Rs.5 lakhs
      Cover Inpatient and domiciliary hospitalisation expenses for treatment of illnesses and accidental fallouts; cover subject to sub-limits within the overall limit of the chosen sum assured.
      Premiums Based on age and chosen sum assured
    • Individual Personal Accident Policy

    • This plan offers three options for coverage:

      • Basic: Death
      • Wider: Death, Permanent Disability
      • Comprehensive: Death and Permanent Disability

      Entry Age 5 yrs. to 65 yrs. ( extended to 75 yrs. subject to premium loading) 18 yrs. above considered adult
      Renewability Lifetime
      Policy Period 1 yr.
      Basis Individual or Family Package
      Sum Assured No.of times the annual income: Death - 10x; Wider - 5x; Comprehensive - 5x limited to Rs.5 lakhs
      Cover Basic Plan: Death; Wider Plan: Death, Permanent Disability; Comprehensive Plan: Death and Permanent Disability
      Death or Permanent Total Disablement - 100%;
      Permanent Partial Disablement - As per schedule or as advised by medical professional;
      Temporary Total Disablement - Lower of 1% of sum assured and Rs.5,000 weekly (104 wks max.)
      Add-on covers - Medical Expenses: Lower of actuals or 40% of personal accident claim: Additional premium 25% of base premium
      - Hospital Confinement Allowance: Rs.500 a day of hospitalisation (30 days max.); at additional premium of Rs.300 per insured member
      Premium loading applicable on renewal: 10% for insured members over 65 yrs.
      Premiums 0.4% to 2% of sum assured depending on type of cover chosne; Single payment option only
      Discounts - Family package: 10% to 15% depending on number of additional members
      - Loyalty discount: 5% to 15% for renewal within 7 days of expiry
      Benefits - Funeral costs: 1% of sum assured (max. Rs.2.500)
      - Compensation for damaged clothing in the accident: Actuals (max.Rs1,000)
      - Ambulance costs: Actuals (max. Rs.1,000)
      - Children’s education fund (in case of death, permanent total disablement): 5% of cumulative sum assured (max. Rs.15,000)
      - Loss of employment: 2% of cumulative sum assured (max. Rs.25,000)
    • Aapat Suraksha Bima Policy

    • Basis Single insured
      Cover Lumpsum payout;
      Critical Illness - Paralytic stroke; Cancer, Kidney Failure, Coronary Artery Disease, Major Organ
      Transplant: 100% paid to insured 30 days post-diagnosis
      Accidental Death: 100% of chosen sum assured paid to nominee/legal heir
      Permanent Total Disablement due to accident: 100% of chosen sum assured
    • IOB Health Care Plus Policy, Allahabad Bank Health Care Plus Policy, K Bank Health Care Plus

    • Offered to customers of Indian Overseas Bank, Allahabad Bank and Karnataka Bank holding a savings or current account.

      There are two plans under this policy possessing similar features but differing in coverage. Plan A (self, spouse, children) / Plan B (self, spouse, children, parents)

      Entry Age 5 yrs. to 65 yrs. (children covered until 25 yrs. of age)
      3 months for children, if at least one parent is also covered under this policy
      Medical Screening Required for those above 50 yrs. (50% screening costs reimbursed on passing)
      Renewability Up to 80 yrs.
      Policy Period 1 year
      Basis Family floater
      Sum Assured Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh (chosen amount can be enhanced on renewal)
      Cover - Inpatient hospitalisation expenses including expenses on room rents, services of medical
      professionals, consumables, equipment and all else that forms a part of necessary treatment for
      admissible ailments
      - Domiciliary hospitalisation
      - Pre/Post-hospitalisation expenses: Up to 30 / 60 days
      - Maternity expenses: Includes pre/post natal costs
      - Ambulance charges: Up to Rs.1,000 - Cash Allowance: Rs.100 a day to parents accompanying a
      hospitalised child under 12 yrs.(max. Rs.1,000)
      - Health check costs: Up to 1% of sum assured after 4 claim-free yrs.
      - Funeral costs: Additional amount of Rs.1,000

      Copayment: 20% for insured members over 55 yrs.
      Add-on covers Personal Accident Cover: Additional premium payable; Covers proposer, spouse and up to 2
      children; Covers death due to accident in or outside India, Payout is based on sum assured - Death of
      Proposer: 100%, Spouse: 50%, Children: 10% to 20%
      Premiums Single installment payment
      Plan A - Rs.1,767 to Rs.14,511; Plan B - Rs.2,986 to Rs.24,518
      Depends on age and chosen sum assured
    • Hospital Cash Insurance

    • Entry Age 18 yrs. to 70 yrs.; children from 6 months upwards can be considered dependents up to the age of 25 yrs
      Renewability Lifetime
      Medical Screening Required above 55 yrs. (50% of screening costs are reimbursed)
      Policy Period Lifetime
      Sum Assured Rs.90,000 to Rs.5.4 lakhs (chosen amount can be enhanced on renewal)
      Cover Hospital Confinement: Daily cash up to Rs.3,000 a day Intensive Care Benefits: Twice the chosen sum assured Convalescence Benefits: Rs.10,000 for hospitalisation exceeding 21 days (provided hospital cash option chosen is below 30 days) Hospital cash options: 15, 30, 45, 60, 90 or 180 days
      Premiums Rs.188 to Rs.43,200
      Discounts - Long-term policy discount: 10% to 15% for policy period over 2 years paid in advance in a single installment - Family Discount: 5% - Group Discount
    • Saral Suraksha Bima

    • This policy gives customers a lumpsum payment on diagnosis of specified critical illnesses or accidental death/total permanent disablement (TPD). Although offered primarily to groups it can also be taken out by individuals subject to acceptance.


      Entry Age 18 yrs. to 65 yrs.; 10 yrs. to 25 yrs. for children if at least one parent is also covered concurrently
      Renewability Lifetime
      Sum Assured Critical Illness - Rs.10,000, Rs.20,000 or Rs.25,000 Personal Accident - Rs.20,000, Rs.40,000 or Rs.50,000 (chosen amount can be enhanced on renewal)
      Cover Critical Illness: Stroke, Cancer, Kidney failure, Open chest CABG, Major organ/bone marrow transplant Death and TPD due to accident: 100% of sum assured (50% in case of loss of sight in only one eye or loss of only one limb)
      Premiums Rs.141 to Rs.290
    • Complete Health Care Insurance

    • This policy comes with three sub-plans each with different levels of coverage. They are the Basic Plan, Essential Plan and the Privilege Plan.


      Entry Age Adults - 18 yrs. to 70 yrs.
      Dependent children - 90 days to 25 yrs. (individual); 1 day to 25 yrs. (floater)
      Renewability Lifetime
      Policy Period 1 yr. to 3 yrs.
      Basis Individual and Family Floater
      (Family = 2 adults; 1 adult + up to 3 children; 2 adults + up to 4 children)
      Sum Assured Rs.1 lakh to Rs.2 lakhs (Basic); Rs.3 lakhs to Rs.5 lakhs (Essential); Rs.6 lakhs to Rs.10 lakhs
      (Privilege); All in increments of Rs.1 lakh.
      (chosen amount can be enhanced upon renewal subject to there being no claims made)
      No-claim Bonus: 10% to 50% enhancement of sum assured (portable)
      Cover - Inpatient hospitalisation (over 24 hrs.) includes boarding, services of medical professionals, cost of
      required equipment and consumables used for treatment
      - 141 day care procedures
      - Domiciliary hospitalisation (over 3 days)
      - Pre/Post-hospitalisation expenses: Up to 30/60 days
      - Organ donor’s hospitalisation expenses
      - Ambulance charges
      - Dental treatment required as a result of an accident
      - AYUSH (Ayurveda, Unani, Sidha, Homeopathy) treatment
      - Daily cash allowance to accompany a hospitalised child (over 3 days)
      - Vaccinations for treatment of bites
      - Specified outpatient expenses (after 3 policy yrs.): Diagnostic tests, non-cosmetic dental treatment, pair
      of spectacles or contact lenses, consultation
      - Convalescence benefits (one-time): Rs.10,000 for hospitalisation over 10 days
      - Maternity /newborn expenses: Includes pre/post-natal costs
      - HIV/AIDS treatment: fo life-threatening conditions
      Add-on covers Personal Accident, Critical Illness, Hospital Cash, Sub-limit waiver, Treatment at non-network hospitals.
      Additional premium charged to each insured member to enhance coverage, premium discounts apply for
      all insured members collectively for waiver of sub-limits.
      Premiums Rs.1,215 to Rs.51,546 (individual)
      Rs.1,774 to Rs.79,016 (family floater)

      Premiums depend on the sum assured, the chosen plan, and the age of the insured members. The family
      size is considered for policies on a floater basis
      Discounts Premium discounts:
      - If sub-limits are opted for - if treatment is availed at a non-network hospital on a copayment basis - one-
      time premium payment for long-tenor policies - opting for electronic policies - covering additional
      family members under one policy on individual basis (5% - 10% for up to 5 additional members)
      Benefits Health-checks after specified number of claim-free yrs.
      Reinstatement of sum assured.
    • Senior Citizen Health Care

    • A plan directed towards meeting healthcare needs of senior citizens and their spouses.


      Entry Age 60 yrs. to 70 yrs.
      Renewability Lifetime
      Medical Screening Depends on the proposer’s health status; type of tests required to be done depends on the chosen sum assured (50% of screening costs will be reimbursed on acceptance)
      Not required if previously covered for 3 yrs. (claim-free )
      Policy Period 1 yr., 2 yrs. or 3 yrs.
      Basis Individual or Floater (Floater option applies to hospitalisation cover only)
      Sum Assured Hospitalisation: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh
      Critical Illness: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh
      No-claim Bonus: 5% to 50% enhancement in chosen sum assured on renewal after a claim-free year
      Cover Hospitalisation - Inpatient hospitalisation expenses based on the following sub-limits:
      Room rent: Lower of actuals or 1% of sum assured (per day)
      ICU charges: Lower of actuals or 2% of sum assured (per day)
      Overall limit for the above is 25% of sum assured per ailment
      - Tests for blood sugar, glucose, SGPT, ECG, Cholesterol, Creatinine, Urine etc.: Up to 25% of sum assured per ailment
      - Anaesthesia, blood, oxygen, OT charges, surgical equipment and other items of similar nature: up to 7% of sum assured
      - Medicines, drugs, X-ray, Dialysis, pacemaker, prosthesis etc.: up to 50% of sum assured per ailment - Day care treatment
      - Pre/Post-hospitalisation expenses: Up to 30 / 60 days respectively
      - Domiciliary hospitalisation: Actuals limited to 50% of sum assured
      - Health check expenses: up to 1.25% of sum assured
      - Cash Allowance: 0.1% of sum assured up to Rs.250 per day (max. 2,5000)
      - Expenses for person accompanying hospitalised patients: Actuals limited to 1% of sum assured
      Add-on covers Critical Illness
      Cancer, Open chest CABG, Renal failure,Stroke, Major organ/bone marrow transplant, MS. Payout as per chosen sum assured upon diagnosis
      Premiums Hospitalisation: Rs.4,358 to Rs.68,171 (loading 40% on floater basis)
      Critical Illness: Rs.2,179 to Rs.24,347
      Premium loading applies depending on location and health status: 10% to 100%
      Discounts - Long-Tenor Policy: 10% to 15% for policy periods 2 yrs. or 3 yrs.;for single installment advance payment
      - Family Discount: 10% on premium for hospitalisation cover for additional member i.e. spouse individual basis

    Along with the information provided herein, proposers should also be aware of the various terms and conditions that go with each contract. The general and specific exclusions should be given due attention so as to ensure informed choices are made at the outset.


    One should also note that services charges and other levies are applicable as per the law.

    Universal Sompo Health Insurance FAQs

    1. Why do I need a health card?
    2. Health cards are identity cards issued by the insurer to all policyholders. With this card, customers can avail cashless facilities at one of the network hospitals of Universal Sompo. This card will contain details of the Third Party Administrator (TPA). When required, the TPA can be called for clarifications, queries, or other types of assistance. Also, this card has to be produced when getting treated at a network hospital.


    3. Can you specify pre-existing diseases?
    4. All injuries, ailments, or conditions that the customer suffered from/was diagnosed with/received treatment for, prior to buying a health insurance policy from Universal Sompo Health Insurance.


    5. Which of my family members can be covered under a single policy (family floater)?
    6. Immediate family members can avail family coverage:

      • Spouse
      • Dependent parents of age up to 70 years
      • Dependent children above 3 months and under 23 years, including adopted children, stepchildren, or unmarried children who are financially dependent on the insured.

    7. How does the claim process work?
    8. Both emergency and planned hospitalization are covered by cashless services at network hospitals on producing the company health card. At non-network hospitals, the amount should be paid upfront to the hospital, and this will be later reimbursed to the policyholder on producing the relevant bills and documents.


    9. What do you mean by cashless hospitalization?
    10. On producing your health card at any network hospital of Universal Sompo, the hospital will contact the respective TPA for authorization. When this pre-authorization has been issued, the hospital will provide treatment without cash being paid by the insured for any treatment/procedure. Hence, cashless service.


    11. What do you mean by pre-authorization?
    12. Pre-authorization is the request from a network hospital to the Third Party Administrator for confirming the release of funds on your behalf, in case of cashless hospitalization. Whenever you are looking at planned hospitalization, the TPA should be informed beforehand through the contact details provided on the health card.


    13. What is the list of documents to be produced at the time of filing claims?
      • Claim form
      • Hospital receipts, bills, and discharge card/certificate in original.
      • Prescription and original receipts from chemists.
      • Evidence and information from respective medical practitioner/laboratory/chemist/hospital.

    14. Do Universal Sompo health insurance policies cover cosmetic procedures?
    15. No. Aesthetic and cosmetic treatments of all types, and plastic surgeries except those arising out of treatment requirement for a disease or injury, are not covered.


    16. How many policies can a person buy or hold?
    17. Each policyholder can have any number of policies at the same time. The final claim amounts are divided proportionately among different companies/plans depending on the cover each plan provides.


    18. In case the policyholder dies during the course of treatment, who stands to receive the claim amount?
    19. For cashless treatments, the amount is settled directly with the hospital. In other cases, the appointed nominee will receive the claim amount. If no one has been nominated, then a succession certificate of law will be required for disbursing the funds.


    20. Is there any difference between Critical Illness Riders or Critical Illness policies and Health Insurance?
    21. Health insurance denotes the reimbursements made against medical expenses. Critical Illness policies (Aapat Suraksha from Universal Sompo) are benefit policies, wherein the insurance company will pay lump sum to the policyholder in the event a specified critical illness is contracted by the insured.


    22. What happens on cancellation of a policy?
    23. On policy cancellation of Universal Sompo health insurance, the cover ceases to exist for the policyholder. The premiums are refunded according to the applicable interest rates.


    Examples of Network Hospitals in Major Cities

    CITY NAME OF HOSPITAL
    DELHI GANDHI NURSING HOME
    MUMBAI BELLEVUE MULTI SPECIALITY HOSPITAL PVT. LTD.
    KOLKATA APOLLO GLENEAGLE HOSPITAL LIMITED
    BANGALORE ARUNODAYA HOSPITALS
    CHENNAI ANJAKHA HOSPITAL

    *Disclaimer - This is not an exhaustive list but an indicative representation of hospitals that form a part of the company's wider network.


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