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Universal Sompo Senior Citizen Healthcare Plan

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Universal Sompo Senior Citizens Healthcare Plan Review

Universal Sompo’s Senior Citizen Healthcare Plan is a health insurance plan which has been designed for senior citizens. Thus, the plan exclusively provides health insurance coverage to senior citizens.


Highlights of the Universal Sompo Senior Citizens Healthcare Plan

  • Senior citizens above the age of 60 years can buy the plan. 
  • Lifelong renewability is allowed under the plan.
  • 50% of the cost of any pre-entrance medical check-up is reimbursed after the policy is issued.
  • The Sum Assured can be enhanced on renewals.
  • The policy offers attractive premium discounts.
  • The spouse can be included under the plan either on an individual basis or on floater basis.


Working of the Universal Sompo Senior Citizens Healthcare Plan

  • The policyholder chooses the Sum Assured and decides whether or not he wants to cover his spouse.
  • Pre-entrance medical examinations may be called for by the insurer and the examinations required would depend on the level of Sum Assured chosen by the proposer. 
  • The premium is then determined based on the above parameters.
  • On any contingency covered by the plan, compensation would be paid


Benefits and Features of Universal Sompo Senior Citizens Healthcare Plan

  • Hospital Benefit–Being a health insurance plan, a range of benefits are provided when the insured is hospitalized. Such benefits include the following:
Inpatient treatment expenses which include:
  • Room rent for normal hospitalization – lower of up to 1% of Sum Assured or actual cost 
  • Room rent for ICU hospitalization – lower of up to 2% of the Sum Assured or actual cost
In both the cases the overall limit is 25% of the Sum Assured per hospitalization or the actual cost whichever is lower
  • Fees of the surgeon, nurse, anesthesiologist or any medical practitioner – lower of up to 25% of the Sum Assured or actual cost
  • Charges for anesthesia, blood, oxygen or any things required in treatment -  lower of up to 50% of the Sum Assured or actual cost
Day care treatments
Pre-hospitalization for 30 days
Post-hospitalization for 60 days
Domiciliary hospitalization - Lower of up to 50% of the Sum Assured or actual cost
Cost of health check-up conducted once in 3 claim-free years – Lower of up to 1.25% of the Sum Assured or the actual cost
Daily Allowance – 0.1% of the Sum Assured up to a limit of Rs.250 per day would be paid as daily allowance in case of hospitalization of more than 24 hours. The total limit of this allowance is Rs.2500 per policy period.
Ambulance Charges – Lower of up to 1% of the Sum Assured or Rs.1500 or the actual cost incurred
Expenses for accompanying individual - Lower of up to 1% of the Sum Assured or the actual cost incurred
Specified sub-limits on specified treatments
 
  • Co-pay – Being a senior citizen policy, there is a co-payment clause under the plan. The clause states that in the event of any claim, a proportion of the claim amount would have to be paid by the proposer and the insurer would then settle the remaining claim. The proportion of claim borne by the proposer under the co-pay clause is as follows:
Hospitalization claims 10% of the claim amount
Claims due to pre-existing illnesses 20% except in case of Critical Illness benefit if opted for
Day care treatments 15% of the claim amount
Packages charges by hospitals Nil



 


Eligibility Criteria of Universal Sompo Senior Citizens Healthcare Plan

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 60 years 70 years
Plan tenure 1, 2 or 3 years
Premium payable Depends on the age and Sum Assured chosen
Sum Assured Rs.1 lakhs Rs.5 lakhs
Premium payment mode Annually
 


Additional Benefits of Universal Sompo Senior Citizens Healthcare Plan

  • Critical Illness Cover – The proposer can also opt for a critical illness benefit under the policy if required by paying an additional premium. If the insured is diagnosed with any of the covered critical illnesses, an additional amount equal to the Sum Assured chosen would be paid. The illnesses covered under this benefit are as follows:
    • Cancer of specified severity 
    • Open chest CABG
    • Kidney failure requiring regular dialysis
    • Stroke resulting in permanent symptoms
    • Major organ or bone marrow transplant
    • Multiple sclerosis with persisting symptoms. 
  • Premium rebates– The plan offers three types of rebates or discounts which are as follows:
    • Family Discount – If the spouse is covered under the plan on a floater basis, a discount of 10% in the annual premium is allowed. 
    • Long term policy discount – If the policy is taken for 2 or 3 years, a discount of 10% and 15% is allowed in the premium rate. The premium computation for this discount would be twice and thrice of the annual premium payable, respectively. 
  • Cumulative Bonus – For each year where the proposer has not made any claim in the policy, the Sum Assured is increased by 5% 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.
  • 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%



Premium Illustration

The following chart shows the sample premium rates payable by the proposer for different combinations of cover options, Sum Assured (SA) and age.



The table below gives a quick tabular reference to the above chart:
Age Individual cover for self Cover for self and spouse on Individual basis Cover for self and spouse on floater basis Critical illness Cover
SA - 2 lakhs SA - 5 lakhs SA - 2 lakhs SA - 5 lakhs SA - 2 lakhs SA - 5 lakhs SA - 2 lakhs SA - 5 lakhs
60-65 years 8,820 18,848 16,758 35,810 12,348 26,378 4,410 9,424
66-70 years 10,937 23,371 20,780 44,405 15,311 32,719 5,468 11,685
71-75 years 11,731 25,068 22,288 47,629 16,423 35,095 5,865 12,534



Exclusions in Universal Sompo Senior Citizens Healthcare Plan

  • Pre-existing illnesses are covered only after a continuous coverage period of 24 months.
  • 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. 
  • 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.


 
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