Universal Sompo Essential Privilege Plan

Brief Overview - Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

In the year 2007, Universal Sompo General Insurance Company Limited came into being. A collaboration between some prominent groups in India and abroad- Overseas Bank, Indian Bank, Karnataka Bank Ltd, Dabur Investment Corporation, and Sompo Japan Insurance Inc. with such a robust background, Universal Sompo has made a name for itself in the Indian insurance market and is making its way to soon become one of the most preferred insurance companies in the country. Today the company has its head office in Mumbai, with 17 Zonal Offices, 87 Branch Offices spread through the length and breadth of the country. 

The company also offers a huge variety of health insurance products for customers who come from all kinds of social and economic backgrounds. These plans offered by Universal Sompo are not only easy-to-understand but are also affordable. Complete Health Insurance has been a very important product that is one of the most wide-ranging health insurance plans available today. 

Universal Sompo concedes the value of a good health insurance plan and endeavours to support its customers in getting access to high-quality medical care. This plan encourages you to have a healthy way of living while taking care of the medical expenses that you might have to incur.

Let us take a look at the various aspects of Universal Sompo Complete Healthcare Insurance, which would help you in making the right decision.

Best Features of Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

1. Universal Sompo Complete Healthcare Insurance is a comprehensive health insurance plan that covers medical expenses
2. The Sum Insured options range from INR 1 lakh to INR 10 lakhs
3. The policy is available as Individual/ Family floater health insurance plan
4. The plan comes with a Restoration benefit
5. There are 3 Variants in this plan
   1. Basic- Sum Insured- INR 1 lakh to INR 2 lakhs
   2. Essential- Sum Insured- INR 3 lakhs to INR 5 lakhs
   3. Privilege- Sum Insured- INR 6 lakhs to INR 10 lakhs
6. No pre-policy medical screening required to purchase this plan
7. The policy has Inbuilt maternity and newborn baby cover
8. You can choose a policy term of 1 year/ 2 years/ 3 years
9. The plan offers maternity and newborn baby cover
10. Treatment for HIV AIDS is also covered

Benefits of Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

1. In-patient Benefits
   When you are hospitalised for a minimum of 24 hours the Universal Sompo Complete Healthcare Insurance would cover the room charges,  doctor,  anaesthesia,  blood,  operation theatre charges,  consumables and medicines.  without having to worry about the hospital bill you can concentrate on the treatment.
    
2. Ambulance Charges
   In case of an emergency, if you require an ambulance to get the insured member to the hospital, the ambulance charges shall be paid by the company depending on the plan chosen by you. The amount that would be covered depends on the plan variant opted. 
    
3. Restoration Benefit
   If your sum insured gets exhausted due to the treatments that you took under the Complete Healthcare policy, the sum insured will be reinstated including the cumulative bonus.
    
4. Pré-hospitalisation 
   Medical tests and investigations begin before the hospitalisation and so do the expenses, with the Complete Healthcare plan you would be covered for 30 days. The number of days can go up to 90 days if you inform the company 5 days in advance.
    
5. Post-hospitalisation
   Complete Healthcare covers the medical expenses that you may have to incur even after the discharge from the hospital. Under the policy, you will be covered for up to 60 days after your hospitalization. The number of days can go up to 90 days if you inform the company 5 days in advance.
    
6. Organ Donation
   Under this health insurance policy if you require an organ donation, the medical expenses would be covered. The expenses encouraged by the donor would also be covered.
    
7. Dental Treatment
   In case of an accidental injury that requires dental treatment, you would be eligible for the same under this plan.
    
8. Domiciliary Treatment
   Despite an illness, which would normally require hospitalisation, if hospitalisation was not possible, you would be covered for the treatment expenses incurred at home. 
    
9. Discounts
   The policy offers you discounts when you choose a longer policy tenure. You can also get a discount if you opt to buy the policy online. You can also avail discounts when you buy the policy for more members on an individual basis under a single policy.
    
10. AYUSH Benefits
    The policy also covers you for alternative treatments that you take under inpatient hospitalization treatments of Ayurveda, Unani, Sidha and Homeopathy. The expenses up to the sum insured are covered.
     
11. Daily Allowance for Attendant
    In case your child has to be admitted to the hospital for more than 72 hours and you stay in the hospital as his/her attendant, you will receive a daily allowance to meet the non-medical expenses that may be incurred by you. The insured child should be below the age of 12 years to be eligible for this benefit. This benefit is available for Essential and Privilege variants only. 
     
12. Animal Bite
    If you get bitten by an animal, your Universal Sompo Health Insurance would cover the medical expenses for the vaccination and immunization taken as post-bite treatment. 
     
13. General Medical Issues
    Most Health Insurance plans do not cover everyday wellbeing. However, with Universal Sompo complete health insurance plan you will be covered for:
    1. Diagnostic Tests
    2. Outpatient dental treatment
    3. Spectacle, contact lenses, hearing aid
    4. Outpatient consultation
        
14. Convalescence Benefit
    A serious illness can lead you and your family to a financial setback. Your Universal Sompo Complete Healthcare  Insurance understands this. When you get hospitalized for over ten days, you receive a convalescence benefit of INR 10,000. This benefit can be received once during the policy year.
     
15. Maternity and Newborn Baby Cover
    The medical expenses that are associated with pregnancy and childbirth which include normal and cesarean delivery are covered under the Essential and Privilege variants only. These types of maternity health insurance plans also cover pre and postnatal expenses. Your newborn baby would also be covered for medical treatments till it is 91 days old.
     
16. Cumulative Bonus
    In case you do not claim the policy term, your sum insured would be increased by 10%. This is subject to a maximum of 50% increase. 
     
17. Lifelong Renewability
    With this plan, you can opt for a lifetime of renewability, which means you would not have to go through the hassle of renewals and you would not be denied renewal based on your age. 
     
18. Value-added Services 
    Universal Sompo offers you the following services:
    1. Health & Wellbeing Services
    2. Dial-a-Doctor
    3. Health Education Library for People
    4. Second Opinion
    5. Newsletters

Plan Details of Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan) 

• Waiting Period
  There are certain treatments that have a waiting period, such as:
  • Pre-Existing Diseases are covered only after a period of 36 months
  • There is a waiting period of 12 months of continuous coverage for the listed treatments surgeries and conditions
  • Maternity and child care benefits have a waiting period of 36 months
  • Out-patient treatments are covered only after a period of 36 months of break-free coverage
• Free Look Period
  You are given a period of 15 days from the date of purchase of the policy to review its terms and conditions. In case you have any objections, you have the option of returning the policy.  You would have to request a cancellation stating the reason for the same. 

What is not Covered in Universal Sompo Complete Healthcare Insurance ( Universal Sompo Essential Privilege Plan) ?

Despite the wide coverage, there are certain situations and circumstances that are not covered under Universal Sompo policies. Given below is an indicative list of exclusions under the Universal Sompo Complete Healthcare Insurance plan. For an exhaustive list, it is recommended that you refer to the policy document.

1. Investigations and evaluations not related to current treatment
2. Expenses on rehabilitation and respite care
3. Surgical treatment of obesity or weight control
4. Change of gender treatments
5. Cosmetic or plastic surgery unless required after an accidental injury
6. Participation in dangerous adventure sports
7. Participation in malicious or illegal activities
8. Treatments that are taken in a hospital or by a medical practitioner excluded by the health insurance company
9. Treatment required due to abuse of alcoholism for any other intoxicant
10. Expenses related to sterility and infertility

Renewal Process - Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

Renewing your health insurance policy should be considered to be a priority.  An expired policy would not fetch you any benefits and you would have to bear all the medical expenses from your pocket. By not renewing your policy on time you will lose out on all the bonuses and accounts that you may have accumulated during the claim-free policy years.
Renew your policy there are two ways that you can follow: 

• Online Method 
  To renew your policy online, you can visit the company website and go to your policy by entering your policy number,  registered mobile number and your date of birth. You can also renew your policy through an insurance aggregator website. The payment can be made through net banking, credit or debit card or through an e-wallet. 
   
• Offline Method 
  To renew your policy offline, you can physically visit an office branch. Fill in the documents and make the payment.  You can ask for a health card from the company executives.  You can make the due premium via cheque or demand draft.  The policy can also be renewed through a trusted insurance agent.  

Claim Process - Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

When you are advised of hospitalization by a doctor, you must notify the company at the earliest.  You can call customer care on 1800 200 5142, or write them an email at contactus@universalsompo.com, or intimate the claim online through the company website.  Click https://www.universalsompo.com/ClaimIntimation/ to reach the page directly. If you have downloaded the company mobile app on your phone, you can intimate a claim through that too. 

• Cashless Claim
  To avail of the cashless health insurance treatment facility, you have to intimate your claim within 24 hours in case of emergency hospitalisation and 48 hours prior to admission in case of a planned hospitalisation. 
  At the hospital, you would be required to submit your Health Serve Card. You would also have to submit the pre-authorization form along with the Claim Form. Once the paperwork and policy details are verified by the TPA and the company, your treatment will begin. The medical bill of the treatment will be paid by the insurance company up to your sum insured. Keep in mind that the uncovered expenses would be paid from your pocket. 
   
• Reimbursement Claim
  Even if you did not take treatment at a network hospital, you can still make a claim. Remember that in case of emergency hospitalization you have to inform the company within 24 hours of hospitalisation or before the insured member’s discharge from the hospital.  If you are seeking planned hospitalisation then you have to inform the company 48 hours in advance.
  To make a reimbursement claim, you would have to first clear the hospitalisation bills yourself. Post the discharge from the hospital,  you can claim the money spent on the treatment. 
   
• Documents Required

1. Health Serve Card issued by Company, along with KYC papers
2. Valid Photo ID Card
3. Policy Papers
4. Name and address of the Insured person
5. Nature of Illness and the Treatment required
6. All diagnostic and pathological Reports
7. Doctor’s Consultation Papers
8. Contact Details of Doctor and the Hospital
9. Duly filled and signed Claim Form
10. NEFT details and Cancelled Cheque
11. Original discharge summary
12. All bills, receipts issued by the hospital
13. Original ambulance receipt, if used
14. Police FIR or Medico-Legal Certificate in case of accidental injuries

Network Hospitals - Universal Sompo Health Insurance

A network hospital is a hospital or a health care centre that is enlisted by the insurance company or by the TPA. At a network hospital, you have the facility of cashless treatment. The medical bills are paid by the company directly, and you are saved from the hassle and anxiety of running around at the last minute to manage funds for the treatment.  The expenses up to your sum insured will be borne by the company. 

Universal Sompo has a wide network of hospitals spread across the length and breadth of the country.  You can seek quality treatment for yourself as well as your loved ones. 

Review of Universal Sompo Complete Healthcare Insurance (Universal Sompo Essential Privilege Plan)

Over the years, Universal Sompo Insurance Company has become a prominent stakeholder in the health insurance sector. The company has won many awards and accolades for its efficient and quick claim service.  With more than 80 branch offices throughout the country and a network of over 4,000 hospitals, the Universal Sompo offers easy and convenient access to all its customers.
The Complete Healthcare Insurance plan is an all-inclusive health insurance plan that offers comprehensive coverage. The reinstatement of the sum insured is a striking benefit of the plan that can help you in arranging finances for your hospitalisation even when you have exhausted the base sum insured. The plan comes with the option of lifelong renewability and thus you do not have to worry about medical expenses once you cross the age of 65 years. There are multiple benefits that are in-built in this policy and make it a policy worth considering. 

Universal Sompo Insurance Company Limited - Customer Care Details