Universal Sompo A Plus Health Insurance Policy
Universal Sompo brings A Plus Health Insurance which comes with the most comprehensive health coverage at an affordable price. It covers the cost of an insured member’s medical and surgical expenses. If during the policy period, one or more Insured Person(s) is required to be hospitalized for treatment of an Illness or Injury at a Hospital/Day Care Centre, following the Medical Advice of a duly qualified Medical Practitioner, the Company shall indemnify, expenses towards the Coverages & Sum insured as mentioned in the policy schedule. To know more about this policy, have a look at the following mentions.
|Age at entry|
Minimum – 18 years
Maximum – 75 years
Minimum – 91 days
Maximum – 25 years
|Type of policy||Individual and family floater basis|
|Maximum number of members under a family floater plan||6|
|Policy term||1, 2, and 3 years|
|Sum insured||Rs. 5 lakhs to Rs. 1 crore|
Coverage of Universal Sompo A-Plus Health Insurance Plan
The following table gives glimpses of the plan.
|In-patient hospitalization||Up to the sum insured|
|Pre-hospitalization expenses||60 days||60 days||90 days|
|Post-hospitalization expenses||120 days||180 days||180 days|
|Daycare procedures||547 days|
|AYUSH treatment||Up to the sum insured|
|Domiciliary hospitalization||Up to the sum insured|
|Second opinion||Covered up to Rs. 2500||Covered up to Rs. 5000||Covered up to Rs. 10000|
|Ambulance cover||Up to Rs. 2500||Up to Rs. 5000||Up to Rs. 10000|
|Auto restore benefit||Up to the sum insured|
|OPD expenses||Not covered||Not covered||10% of the sum insured, maximum Rs. 20000|
|Global cover||Not covered||Not covered||Up to the sum insured|
|Organ donor||Up to the sum insured|
|Psychiatric illness||25% of base sum insured, maximum up to Rs. 5 lakhs|
Benefits of Universal Sompo A Plus Health Insurance Policy
This policy has come up with a sack full of benefits and facilities. The important mentions are as follows.
Auto Restore Benefit:
The company will restore the Sum insured up to 100% of the Base Sum Insured in the event of complete or partial utilization of the Base Sum Insured due to any claim admitted during the Policy Year, irrespective of the utilization of the Cumulative Bonus.
Global Cover (ONLY FOR Diamond plan):
The policy will pay the Medical Expenses incurred outside India under the below-given Sections and Covers wherever opted and as mentioned on the Schedule of Coverage in the Policy Schedule. Global Cover is applicable subject to the following terms and
- A Deductible of 10% on the Sum Insured will apply for expenses under all the respective covers separately for each claim.
- The payment of any claim under this benefit will be in Indian Rupees based on the rate of exchange as on the date of invoice, published by the Reserve Bank of India (RBI), and shall be used for conversion of foreign currency into Indian Rupees for claims payment.
- Only the basic sum insured, along with the Cumulative Bonus, can be used for this Coverage.
The company will provide the below services, which will be available when the Insured/Insured member(s) is/are more than 150 kilometers away from their residential address as provided in the Proposal Form. The services would be provided by the company /through our appointed Service provider, with prior intimation and acceptance by the Company.
- Medical Consultation, Evaluation, and Referral
- Medical Monitoring and Case Management
- Emergency Medical Evacuation
- Medical Repatriation (Transportation)
- Compassionate Visit
The Company offers a comprehensive program to maintain the health and overall well-being of the insured person. The insured person is provided with individual access to a web-based Health portal at the Company’s website and/or a Wellness mobile application by the Company where he/she can perform various healthcare activities as listed below.
- Health Risk Assessment (HRA)
- Electronic Health Records
- Health Screening
- Wellness Reward Program
Diabetes Day 1 cover (ONLY FOR Diamond plan, Add-on cover):
The company will Pay (Aged 18 years and above) for the Medical Expenses under Outpatient treatment for Diabetes up to the Sum Insured, mentioned in the Policy Schedule. This treatment can be availed at the company’s Network Providers and Empanelled Service Providers (such as Outpatient clinics or Physicians /Diagnostic centers)) for chronic conditions that as Diabetes.
Hypertension Day 1 Cover (ONLY FOR Diamond plan, Add-on cover):
The company will pay you (Aged 18 years and above) for the Medical Expenses under Outpatient treatment for Hypertension up to the Sum Insured, mentioned in the Policy Schedule. This treatment can be availed at the Network Providers and Empanelled Service Providers (such as Outpatient clinics or Physicians /Diagnostic centers) for chronic conditions that as Hypertension.
Key Exclusions of A Plus Health Insurance Policy by Universal Sompo
The Company shall not be liable to make any payment under the policy in respect of any expenses incurred in connection with or in respect of:
- Expenses related to any admission are primarily for diagnostics and evaluation purposes.
- Any diagnostic expenses that are not related or not incidental to the current diagnosis and treatment.
- Expenses related to any admission are primarily for diagnostics and evaluation purposes. Any diagnostic related to any admission is primarily for enforced bed rest and not for receiving treatment.
- Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s), or Cancer or as part of medical treatment.
- Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
- Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
- Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed on its website/notified to the policyholders are not admissible.
- Treatment for, Alcoholism, drug or substance abuse, or any addictive condition and consequences thereof.
- Treatments received in health hydros, nature cure clinics, spas, or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
- Dietary supplements and substances that can be purchased without a prescription, including but not limited to Vitamins, minerals, and organic substances, unless prescribed by a medical practitioner as part of a hospitalization claim or day care procedure.
- Expenses related to the treatment for correction of eyesight due to refractive error less than 7.5 dioptres.
- Expenses related to any unproven treatment, services, and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures, or supplies that lack significant medical documentation to support their effectiveness.
- Expenses related to sterility and infertility. This includes:
- War (whether declared or not) and war-like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints, and detainment of all kinds.
Buying Process of A Plus Health Insurance Policy by Universal Sompo
One can easily buy this policy by following the below easy steps.
- Go to the official website of Universal Sompo General Insurance Company.
- On the homepage, there will be the Buy Now tab. Click on that.
- Select the Health option. Under that, the A Plus Health Insurance option will be there.
- Select the policy and click on the Buy Now option.
- On the next page, fill in the blanks with the required information. Put all the data carefully, and click on the Get Quote option.
- On the basis of the given details, the premium amount will be calculated. Check the details twice carefully.
- If satisfied, pay the premium amount online safely to buy this plan.
- Upon successful payment, download the policy document for better convenience.
Claim process of Universal Sompo A Plus Health Insurance Plan
The company offers both cashless and reimbursement claim processes. Both the procedures are discussed below.
Cashless Claim Procedure:
- Intimate the insurer as soon as the incident happens. For planned hospitalization, inform 48 hours prior to the hospitalization, and for emergency hospitalization, intimate the insurer within 24 hours of the hospitalization.
- Visit the nearest network hospital of the company, show your Health Serve Card issued by the company along with valid photo ID proof, and get a cashless request form from the insurance helpdesk of the hospital.
- Fill in the details in the cashless request form correctly, and submit it to the hospital insurance desk.
- The hospital verifies the patient details and sends a duly filled cashless request form by mail to the Universal Sompo Health Team.
- The company will review and judge the admissibility of the cashless request as per the policy terms and conditions and the same will be communicated to the insured person and the hospital.
- The insured person will be required to pay for expenses that are not payable as per the terms and conditions of the policy.
Reimbursement Claim Procedure:
- Get admitted to a non-network hospital of the company.
- Intimate the insurer about the hospitalization.
- Avail of the medical treatments.
- After discharge submit all the required documents to the company.
- The company will verify the documents, and if no discrepancy is found, the company will settle the claim amount with the insured person within the stipulated time period.
Frequently Asked Questions
The child would be ported to an individual policy (having a separate Sum Insured) and treated as an adult Insured Person, upon attaining 25 years of age, at the time of renewal.
The following are the renewal benefits:
- Cumulative Bonus: In case no claim has been made by any insured person, we will increase the base sum insured as per the variant opted, provided the Policy is renewed continuously:
|20% of Base Sum Insured, Maximum to 100% per Renewal||50% of Base Sum Insured, Maximum to 100% per Renewal||50% of Base Sum Insured, Maximum to 200% per Renewal|
- Preventive Health Check-up: We will reimburse the cost of a Preventive Health Check-up, up to the limits specified below as per the plan of the Insured Person who was covered during the previous Policy Year. This Cover does NOT carry forward if it is not claimed and shall not be provided if the Policy is not Renewed further. The mentioned limits are applicable for each Insured Person per Policy Year in the case of Individual Policy and cumulatively for all Insured Persons per Policy Year in the case of Family Floater Policy.
|Preventive Health Checkup every claim-free Year up to Rs.1000||Preventive Health Checkup every claim-free Year up to Rs.2500||Preventive Health Check every Year up to Rs.5000|
Yes, you can. On payment of additional premium, the waiting period applicable to all Pre-Existing Diseases for each Insured Person before benefits are payable under the Policy is modified to 12 Months. This is an add-on cover.
Under certain circumstances such as declaration(s) in the proposal form or if you or any of the applicants are/are above 55 years of age, the company may ask you to undergo certain medical check-ups to help them understand your health condition in a better way.
There are multiple discounts available under the Universal Sompo A Plus Health Insurance Policy, such as.
- Family Discount: Discount on applicable premium, if more than 2 family members are covered on an Individual Sum Insured basis in the same policy. This discount is available on Fresh as well as on Renewal of the Policy.
- Women Discount: 5% discount on the applicable premium for customers approaching the Company directly without any intermediary.
- Long-Term Discount: Applicable when the policy term is beyond one year
- Employee or Promoter Companies Employee Discount: 15% discount on the applicable premium for employees of the promoter companies of the company. The discount passes on the expense savings following a direct mode of policy issuance without any intermediation to the customer.
- Donor Discount: 2.5% discount on the applicable premium if the insured has pledged for organ donation in accordance with the Transplantation of Human Organ and Tissues Act, 1994. The discount is provided to create public awareness about and promote organ donation.
- Health Life Combi Discount: For the Health and Life Combi proposal, an additional 2.5% discount on the premium will be offered. The maximum discount applicable is 35%.