Universal Sompo Complete Healthcare Insurance Plan
Universal Sompo Complete Healthcare Insurance Plan Review
Universal Sompo’s Complete Healthcare Insurance Plan is a comprehensive health insurance plan which covers all healthcare related expenses and also provides additional coverage through attractive coverage features.
Lifelong renewability
Health and wellness services
No medical check-ups till 55 years of age
Compare this plan with other Health Plans
Key Features
Individual basis or floater basis
- The plan can be taken either on an individual basis or on floater basis.
Three plan options
- There are three plan options with varying Sum Assured levels and the policyholder can choose any option as per his choice.
Lifelong renewability.
- The plan promises lifelong renewability.
Treatments availed for HIV/AIDS
- Treatments availed for HIV/AIDS are also covered under the plan.
Sum Assured restoration
- The plan has Sum Assured restoration feature which restores the Sum Assured if it is exhausted in any policy year.
Sum Assured
- The Sum Assured can be enhanced on plan renewals
Health and wellness services
- Health and wellness services are offered by the plan
No medical check-ups till 55 years of age
- No medical check-ups till 55 years of age. The cost of any medical check-up conducted beyond this age would be shared by the company equally.
Premium Illustration
The following chart shows the sample premium rates payable by the proposer for different combinations of cover options, Sum Assured (SA) and members covered assuming the age of the eldest member to be 45 years.
The table below gives a quick tabular reference to the above chart:
| Members covered | Basic | Essential | Privilege | |||
| SA - 1 lakh | SA - 2 lakhs | SA - 4 lakhs | SA - 5 lakhs | SA - 8 lakhs | SA - 10 lakhs | |
| Individual | 2,349 | 2,484 | 5,292 | 6,484 | 8,073 | 11,671 |
| 2 adults | 2,805 | 2,967 | 6,403 | 7,672 | 13,607 | 19,365 |
| 2 adults + 2 children | 4,773 | 5,047 | 7,987 | 10,214 | 13,158 | 19,078 |
Benefits
Plan Benefits
- Being a health insurance plan, a range of benefits are provided under the plan the value of which depend on the plan variant selected. the table lists all the benefits provided by all the plan variants:
| Plan benefits | Variant - Basic | Variant – Essential | Variant – Privilege |
| Pre and post hospitalization | Covered | Covered | Covered |
| Inpatient hospitalization | Covered | Covered | Covered |
| Day care procedures | 141 treatments covered | 141 treatments covered | 141 treatments covered |
| Domiciliary treatment | Covered | Covered | Covered |
| Organ donor expenses | Covered | Covered | Covered |
| Ambulance cost | Lower of up to 1% of the Sum Insured or Rs.1000 | Lower of up to 1% of the Sum Insured or Rs.2000 | Lower of up to 1% of the Sum Insured or Rs.3000 |
| Accidental dental treatments | Up to 100% of the inpatient Sum Assured | Up to 100% of the inpatient Sum Assured | Up to 100% of the inpatient Sum Assured |
| AYUSH benefits | Covered | Covered | Covered |
| Daily cash for accompanying an insured child below 12 years of age | Not covered | Up to Rs.300 per day to a maximum of Rs.9000 | Up to Rs.500 per day up to a maximum of Rs.15,000 |
| Vaccination for post bite treatments | Lower of actuals or the Sum Assured chosen | Lower of actuals or the Sum Assured chosen | Lower of actuals or the Sum Assured chosen |
| Outpatient benefits: A) Outpatient consultations B) Diagnostic tests C) Dental treatments D) Spectacles, lenses and hearing aids |
Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.2500 | Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.5000 | Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.7500 |
| Convalescence benefit | Rs.10,000 per insured member if hospitalization exceeds 10 days | Rs.10,000 per insured member if hospitalization exceeds 10 days | Rs.10,000 per insured member if hospitalization exceeds 10 days |
| Maternity expenses | Not covered | Normal delivery – lower of actuals or Rs.15,000 Cesarean delivery – lower of actuals or Rs.25,000 which also includes pre and post-natal expenses up to Rs.2000 |
Normal delivery – lower of actuals or Rs.55,000 Cesarean delivery – lower of actuals or Rs.50,000 which also includes pre and post-natal expenses up to Rs.2000 |
| New born baby cover | Not covered | Up to the Sum Insured from first day till policy renewal or till baby reaches 91 days of age | Up to the Sum Insured from first day till policy renewal or till baby reaches 91 days of age |
| Restore benefit | Covered | Covered | Covered |
| PLHA cover | Not covered | Not covered | Covered |
| Health check-up | Once after 2 claim-free years for one member. In case of family floater plans for two members | Once after every claim-free year for one member or two members(family floater) | Once after every claim-free year for one member or two members(family floater) |
| Value added benefits : A) Dial a doctor B) Health Educational Library for People C) Second opinion D) Specialist consultation with 2 follow-up sessions E) Wellness package F) 24*7 customer service G) Newsletter |
All benefits are covered except second opinion and specialist consultation | Covered | Covered |
| Optional coverage options | |||
| Personal accident | Available | Available | Available |
| Critical Illness | Available | Available | Available |
| Hospital daily cash | Rs.200 per day | Rs.500 per day | Rs.1000 per day |
| Sub-limits applicability | Sub-limit A – 7.5% Sub-limit B – 5% |
Sub-limit A – 10% Sub-limit B – 7.5% Sub-limit C – 5% |
Sub-limit A – 10% Sub-limit B – 7.5% Sub-limit C – 5% |
| Treatment only in tied network | 5% discount and 10% co-pay | 5% discount and 10% co-pay | 5% discount and 10% co-pay |
Additional coverage options
The plan can be enhanced by opting for any additional coverage options from the list of 5 coverage options. The options are as follows:
- Personal Accident – An additional Sum Assured is paid if the insured faces accidental death or permanent total disablement due to accident.
- Critical illness – 11 critical illnesses are covered under this option and on diagnosis of any of the illness covered the option pays an additional Sum Assured in lump sum.
- Hospital Daily Cash – In case of this option, if the hospitalization exceeds a period of 3 continuous days, a daily allowance is paid to the policyholder.
- Sub-limits – On voluntarily choosing sub-limits on specified illnesses, the plan offers a premium discount.
- Treatment in tiered hospital – If the policyholder agrees to avail treatments only at the partnered hospitals of the insurer and bears 10% of the incurred claim, a 5% premium discount is allowed.
Premium rebates
The plan offers three types of rebates or discounts which are as follows:
- Family Discount – If family members are included in the cover a premium discount is allowed. The discount depends on the number of members covered and is as follows:
2-3 members – 5%
4 to 5 members – 7%
More than 5 members – 10% - Long term policy discount – If the policy is taken for 2 or 3 years, a discount of 5% and 7.5% is allowed in the premium rate.
- Online discount – For buying the policy online and availing an ePolicy, a discount of Rs.110 is allowed.
Cumulative Bonus
For each year where the proposer has not made any claim in the policy, the Sum Assured is increased by 10% subject to a maximum of 50% increment in the Sum Assured.
Portability
If the proposer wants to port his existing health insurance plan taken from another company to this plan, he can do so. Such portability should be requested at least 45 days before the expiry of the previous policy which is being ported.
Free Look Period
A cooling off period or a free look period of 15 days is granted to the policyholder after the policy issuance to review the policy terms and conditions. If found unsatisfactory, the plan can be cancelled within this period and the premium paid would be refunded after deducting the relevant mortality charge, service tax, cess and stamp duty paid.
Grace Period
A grace period of 30 days is allowed for paying the premium after the due date during which the policy cover continues.
Plan cancellation
- The company can cancel the policy on grounds of fraud, misrepresentation or non-disclosure. In this case premiums paid are not refunded. The proposer can also cancel the policy if he wants and in this case premiums would be refunded after deducting the coverage cost for the period for which the policy was in force and other expenses. The proportion of premium refunded in a cancelled policy is as follows:
| Coverage period | Within 1 month | Within 1-3 months | Within 3-6 months | Within 6-12 months | In the 2nd year | In the 3rd year |
| 1 year | 75% | 50% | 25% | 0% | NA | NA |
| 2 years | 75% | 65% | 50% | 25% | 0% | NA |
| 3 years | 75% | 70% | 60% | 45% | 11% | 0% |
How it works
- The policyholder chooses the plan option and the Sum Assured and decides whether he wants an individual plan or a floater one.
- There are three plan types with different Sum Assured levels which are as follows:
| Plan Types | Sum Assured under Individual and Floater Basis |
| Basic | Rs.1 and Rs.2 lakhs |
| Essential | Rs.3 lakhs, Rs.4 lakhs and Rs.5 lakhs |
| Privilege | Rs.6 lakhs to Rs.10 lakhs |
- Under the floater plan option, a maximum of 6 members can be covered in any combination of adults and children.
- Members who can be covered under the floater basis include self, spouse, son, daughter-in-law, daughter, father, mother, brother, sister, father-in-law, mother-in-law, grandparents and grandchildren.
- The premium is then determined based on the above parameters.
- On any contingency covered by the plan, compensation would be paid
Eligibility
The plan can be bought only by permanent Resident Indians. Individuals can buy the policy for themselves and their spouse and the plan is renewable throughout the insured’s lifetime. The other eligibility criteria of the plan include:
| Minimum | Maximum | |
| Entry age (Last Birthday) of the insured | Policyholder and other adults – 18 years Dependent Children – 91 days Children in case of floater plan – 1 day |
70 years Dependent children – 25 years |
| Plan tenure | 1, 2 or 3 years | |
| Premium payable | Depends on the age and Sum Assured chosen | |
| Sum Assured | Rs.1 lakhs | Rs.10 lakhs |
| Premium payment mode | Annually | |
Exclusions
- Pre-existing illnesses are covered only after a continuous coverage period of 36months.
- Specific treatments like cataract, hernia, fistula, joint replacement, etc. are not covered in the first two years of the policy.
- Hospitalization within the first 30 days of the policy is excluded.
- Maternity related coverage is available after 3 policy years.
- Outpatient treatments would be covered only after a continuous period of 3 years.
- Epidemic ailments and debilitating ailments are excluded.
- Hospitalization due to suicide or self-inflicted injury, alcohol or drug abuse, participation in hazardous sports and activities, criminal act, war, commotion, consequential loss, pregnancy and related causes, defense related operations, curative treatments, aviation, radioactive contamination, circumcision, cosmetic treatments, STD or HIV, etc. would also be excluded.
- For the Critical Illness benefit, if opted, any illness occurring within the first 90 days of the policy would be excluded.
