Universal Sompo Health Insurance

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.

• Individual Health Insurance Policy
• Individual Personal Accident Policy
• Aapat Suraksha Bima Policy
• IOB Health Care Policy Plus
• Allahabad Bank Health Care Plus Policy
• K Bank Healthcare Plus
• Hospital Cash Insurance
• Saral Suraksha Bima
• Complete Health Care Insurance
• Senior Citizen Health Care

Individual Health Insurance Policy

1. Entry Age: Up to 55 yrs. 
2. Sum Assured: Up to Rs.5 lakhs 
3. 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. 
4. Premiums Based on age and chosen sum assured 

Individual Personal Accident Policy

1. This plan offers three options for coverage: 
2. Entry Age: 5 yrs. to 65 yrs. ( extended to 75 yrs. subject to premium loading) 18 yrs. above considered adult
3. Renewability: Lifetime 
4. Policy Period: 1 yr.Basis
5. Sum Assured: No.of times the annual income: Death - 10x; Wider - 5x; Comprehensive - 5x limited to Rs.5 lakhs 
6. CoverBasic Plan: Death; Wider Plan: Death, Permanent Disability; Comprehensive Plan: Death and Permanent Disability 
7. Death or Permanent Total Disablement - 100%;
8. Permanent Partial Disablement - As per schedule or as advised by medical professional;
9. Temporary Total Disablement - Lower of 1% of sum assured and Rs.5,000 weekly (104 wks max.)
10. Add-on covers- Medical Expenses: Lower of actuals or 40% of personal accident claim: Additional premium 25% of base premium 
11. Hospital Confinement Allowance: Rs.500 a day of hospitalisation (30 days max.); at additional premium of Rs.300 per insured member 
12. Premium loading applicable on renewal: 10% for insured members over 65 yrs.Premiums0.4% to 2% of sum assured depending on type of cover chosne; Single payment option only
13. Discounts- Family package: 10% to 15% depending on number of additional members 
14. Loyalty discount: 5% to 15% for renewal within 7 days of expiry
15. Benefits- Funeral costs: 1% of sum assured (max. Rs.2.500) 
16. Compensation for damaged clothing in the accident: Actuals (max.Rs1,000) 
17. Ambulance costs: Actuals (max. Rs.1,000) 
18. Children's education fund (in case of death, permanent total disablement): 5% of cumulative sum assured (max. Rs.15,000) 
19. Loss of employment: 2% of cumulative sum assured (max. Rs.25,000) 
20. Basic: Death 
21. Wider: Death, Permanent Disability 
22. Comprehensive: Death and Permanent Disability 

Aapat Suraksha Bima Policy

1. Basis: Single  
2. Insured Cover: Lumpsum payout; 
3. Critical Illness - Paralytic stroke; Cancer, Kidney Failure, Coronary Artery Disease, Major Organ 
4. Transplant: 100% paid to insured 30 days post-diagnosis 
5. Accidental Death: 100% of chosen sum assured paid to nominee/legal heir 
6. Permanent Total Disablement due to accident: 100% of chosen sum assured 
7. 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.  
8. 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 Age5 yrs. to 65 yrs. (children covered until 25 yrs. of age) 
9. 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)
10. Renewability Up to 80 yrs.  
11. Policy Period: 1 year  
12. Basis: Family floater  
13. Sum Assured: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh (chosen amount can be enhanced on renewal) 
14. Cover- Inpatient hospitalisation expenses including expenses on room rents, services of medical 
15. professionals, consumables, equipment and all else that forms a part of necessary treatment for admissible ailments 
16. Domiciliary hospitalisation 
17. Pre/Post-hospitalisation expenses: Up to 30 / 60 days 
18. Maternity expenses: Includes pre/post natal costs 
19. Ambulance charges: Up to Rs.1,000 - Cash Allowance: Rs.100 a day to parents accompanying a 
20. hospitalised child under 12 yrs.(max. Rs.1,000) 
21. Health check costs: Up to 1% of sum assured after 4 claim-free yrs. 
22. Funeral costs: Additional amount of Rs.1,000 
23. Copayment: 20% for insured members over 55 yrs.
24. Add-on covers : Personal Accident Cover, Additional premium payable; Covers proposer, spouse and up to 2 
25. children; Covers death due to accident in or outside India, Payout is based on sum assured 
26. Death of Proposer: 100%, Spouse: 50%, Children: 10% to 20%  Premiums Single installment payment 
27. Plan A - Rs.1,767 to Rs.14,511; Plan B - Rs.2,986 to Rs.24,518 
28. Depends on age and chosen sum assured 

Hospital Cash Insurance

1. Entry Age: 18 yrs. to 70 yrs.; children from 6 months upwards can be considered dependents up to the age of 25 yrs 
2. Renewability: Lifetime  
3. Medical Screening: Required above 55 yrs. (50% of screening costs are reimbursed) 
4. Policy Period: Life time  
5. Sum AssuredRs.90,000 to Rs.5.4 lakhs (chosen amount can be enhanced on renewal) 
6. Confinement: Daily cash up to Rs.3,000 a day Intensive Care
7. 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 
8. Premiums: Rs.188 to Rs.43,200 
9. Discounts- Long-term  
10. policy discount: 10% to 15% for policy period over 2 years paid in advance in a single installment  
11. 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. 

1. Entry Age: 18 yrs. to 65 yrs.; 10 yrs. to 25 yrs. for children if at least one parent is also covered concurrently 
2. Renewability: Lifetime 
3. 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)
4. 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)  
5. 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. 

1. Entry Age: Adults - 18 yrs. to 70 yrs. 
2. Dependent children - 90 days to 25 yrs. (individual); 1 day to 25 yrs. (floater) 
3. Renewability: Lifetime 
4. Policy Period: 1 yr. to 3 yrs. 
5. Basis: Individual and Family Floater 
6. (Family = 2 adults; 1 adult + up to 3 children; 2 adults + up to 4 children) 
7. Sum AssuredRs.1 lakh to Rs.2 lakhs (Basic); Rs.3 lakhs to Rs.5 lakhs (Essential); Rs.6 lakhs to Rs.10 lakhs 
8. (Privilege); All in increments of Rs.1 lakh. 
9. (chosen amount can be enhanced upon renewal subject to there being no claims made) 
10. No-claim Bonus: 10% to 50% enhancement of sum assured (portable) 
11. Cover- Inpatient hospitalisation (over 24 hrs.) includes boarding, services of medical professionals, cost of required equipment and consumables used for treatment 
12. 141 day care procedures 
13. Domiciliary hospitalisation (over 3 days) 
14. Pre/Post-hospitalisation expenses: Up to 30/60 days 
15. Organ donor's hospitalisation expenses 
16. Ambulance charges 
17. Dental treatment required as a result of an accident 
18. AYUSH (Ayurveda, Unani, Sidha, Homeopathy) treatment 
19. Daily cash allowance to accompany a hospitalised child (over 3 days) 
20. Vaccinations for treatment of bites 
21. Specified outpatient expenses (after 3 policy yrs.): Diagnostic tests, non-cosmetic dental treatment, pair 
22. of spectacles or contact lenses, consultation 
23. Convalescence benefits (one-time): Rs.10,000 for hospitalisation over 10 days 
24. Maternity /newborn expenses: Includes pre/post-natal costs 
25. HIV/AIDS treatment: fo life-threatening conditions 
26. Add-on covers: Personal Accident, Critical Illness, Hospital Cash, Sub-limit waiver, Treatment at non-network hospitals. 
27. Additional premium charged to each insured member to enhance coverage, premium discounts apply for all insured members collectively for waiver of sub-limits. 
28. PremiumsRs.1,215 to Rs.51,546 (individual) 
29. Rs.1,774 to Rs.79,016 (family floater) 
30. Premiums depend on the sum assured, the chosen plan, and the age of the insured members.
31. The family size is considered for policies on a floater basis Discounts 
32. 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) 
33. Benefits: Health-checks after specified number of claim-free yrs. 
34. Reinstatement of sum assured. 

Senior Citizen Health Care

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

1. Entry Age: 60 yrs. to 70 yrs. 
2. Renewability: Lifetime 
3. 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) 
4. Not required if previously covered for 3 yrs. (claim-free ) 
5. Policy Period: 1 yr., 2 yrs. or 3 yrs. 
6. Basis: Individual or Floater (Floater option applies to hospitalisation cover only)  
7. Sum Assured Hospitalisation: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh 
8. Critical Illness: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh 
9. No-claim Bonus: 5% to 50% enhancement in chosen sum assured on renewal after a claim-free year 
10. CoverHospitalisation - Inpatient hospitalisation expenses based on the following sub-limits: 
11. Room rent: Lower of actuals or 1% of sum assured (per day) 
12. ICU charges: Lower of actuals or 2% of sum assured (per day) 
13. Overall limit for the above is 25% of sum assured per ailment 
14. Tests for blood sugar, glucose, SGPT, ECG, Cholesterol, Creatinine, Urine etc.: Up to 25% of sum assured per ailment 
15. Anaesthesia, blood, oxygen, OT charges, surgical equipment and other items of similar nature: up to 7% of sum assured 
16. Medicines, drugs, X-ray, Dialysis, pacemaker, prosthesis etc.: up to 50% of sum assured per ailment - Day care treatment 
17. Pre/Post-hospitalisation expenses: Up to 30 / 60 days respectively 
18. Domiciliary hospitalisation: Actuals limited to 50% of sum assured 
19. Health check expenses: up to 1.25% of sum assured 
20. Cash Allowance: 0.1% of sum assured up to Rs.250 per day (max. 2,5000) 
21. Expenses for person accompanying hospitalised patients: Actuals limited to 1% of sum assured 
22. Critical Illness: Cancer, Open chest CABG, Renal failure, Stroke, Major organ/bone marrow transplant, MS. Payout as per chosen sum assured upon diagnosis 
23. Premiums Hospitalisation: Rs.4,358 to Rs.68,171 (loading 40% on floater basis) 
24. Critical Illness: Rs.2,179 to Rs.24,347 
25. 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 
26. 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 Customer Care

Established in the year 2007, Universal Sompo is among India's leading insurance providers. The company was formed following a multi-partnership between two Indian nationalized banks - namely Indian Overseas Bank and Allahabad Bank, private sector bank - Karnataka Bank Ltd., an FMCG - Dabur Investment Corp. and a leading Japanese general insurer - Sompo Japan Nipponkoa Insurance Inc. The partnership was unique like no other as it was the country's first ever public-private partnership in the general insurance sector. Universal Sompo offers a wide range of insurance products which include health insurance, motor insurance, home insurance, travel insurance, student travel insurance and two-wheeler insurance.

Fully aware that insurance, as a business, can only thrive on quality customer support, Universal Sompo strives to provide the same to its customers via various easy to connect channels. Universal Sompo General Insurance has set up a highly trained customer care team which is well equipped to cater to a wide range of customer queries and requests regarding health insurance policies. Policyholders can get in touch with the customer support team not only via the toll-free helpline number, but also via email. in addition to the customer care, policyholders can also get in touch with insurance agents at the insurer's head office. Alternately, they can also write a mail to the insurer's headquarters for swift response. In addition to the online mediums, customers can also walk in to a Universal Sompo registered branch which is located in multiple metro cities across India.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.