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Universal Sompo Individual Personal Accident Policy

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Universal Sompo Individual Personal Accident Policy Review

Universal Sompo’s Individual Personal Accident Policy is a general insurance accidental policy which covers the individual against any bodily injury from a personal accident.


Highlights of the Universal Sompo Individual Personal Accident Policy

  • This is a Personal Accident policy which comes in three variants of Basic Cover, Wider Cover and Comprehensive Cover. 
  • Basic Cover covers death due to accident, Wider Cover covers against death, permanent total disablement and permanent partial disablement and Comprehensive Cover covers death, permanent total disablement, permanent partial disablement and temporary total disablement. 
  • Besides the above-mentioned coverage options, additional coverage is also provided under the plan.
  • The policyholder has the option to choose from 2 optional plan extensions for increasing the coverage.
  • The plan is renewable lifelong and the subsequent premiums are not loaded for any previous claims. 
  • The Sum Assured can be enhanced at any renewal.
  • Cumulative bonus is provided for every claim-free year.


Working of the Universal Sompo Individual Personal Accident Policy

  • The policyholder chooses the Capital Sum Assured and the plan option.
  • The premium is then determined based on the above two parameters.
  • On any contingency, the compensation would be paid depending on the nature of the injury and the coverage availed.


Benefits and Features of Universal Sompo Individual Personal Accident Policy

  • Compensation Benefit –Compensation is paid to the insured or his nominee, as the case maybe, depending on the nature of injury sustained due to the accident and the Capital Sum Assured chosen by the policyholder. The table shows the benefits payable, expressed as a percentage of the Capital Sum Assured, corresponding to the nature of the injury:
Nature of injury/loss Compensation payable (as a % of Sum Assured)
Death and Permanent Total Disablement 100%
Partial disablement:
Loss of sight of one eye 50%
Loss of one limb 50%
Loss of all toes 20%
Both phalanges 5%
One phalanx 2%
If more than one toe lost 1% for each toe
Both ears 50%
Loss of hearing in one ear 15%
Loss of speech 50%
Loss of four fingers and thumb of one hand 40%
Loss of four fingers 35%
Loss of thumb – both phalanges 25%
Loss of thumb – one phalanx 10%
Loss of 3/2/1 phalanges of index finger 10% / 8% / 4%
Loss of 3/2/1 phalanges of middle finger 6% / 4% / 2%
Loss of 3/2/1 phalanges of ring finger 5% / 4% / 2%
Loss of 3/2/1 phalanges of little finger 4% / 3% / 2%
Loss of 1st or 2nd / 3rd/4th/ or 5th metacarpals 3% / 2%
Any other permanent partial disablement Depends on the assessment of the Medical Practitioner appointed by the company
Temporary Total Disablement 1% of the Capital Sum Assured or Rs.5000 whichever is lower for a maximum of 104 weeks.
 
  • Additional Benefits – Besides providing the above-mentioned compensation benefit, the plan also covers various other related expenses as stated in the table below:
Nature of benefit Compensation paid
Transportation cost for carrying the dead body to home and funeral charges 1% of Capital Sum Assured or Rs.2500 whichever is lower
Cost of clothing damaged in the accident Actual expenses up to a maximum of Rs.1000
Ambulance charges Actual expenses up to a maximum of Rs.1000
Education Fund in case of death or total permanent disablement for dependent children 5% of the Capital Sum Assured up to a maximum of Rs.15,000
Loss of employment 2% of the Capital Sum Assured up to a maximum of Rs.25,000
 
  • Cumulative Bonus – If no claim is made in any policy year and the plan is renewed, a cumulative bonus would be paid by the company. Under this bonus, the Capital Sum Assured would be increased by 5% at the same rate of premium. This increment would continue for every claim-free year subject to a maximum increment of 50% of the Capital Sum Assured.


Eligibility Criteria of Universal Sompo Individual Personal Accident Policy

The plan can be bought only by Resident Indians. The other eligibility criteria of the plan includes:
  Minimum Maximum
Entry age (Last Birthday) of the insured 5 years 65 years. Individual above 65 can buy the policy by paying an additional premium of 20%.
Entry age (Last Birthday) of the proposer 18 years 75 years
Plan tenure 12 months or 1 years
Premium payable Depends on the Capital Sum Assured and coverage option selected.
Capital Sum Assured Basic Cover – 10 times the annual income 
Wider Cover – 5 times the annual income
Comprehensive Cover – 5 times the annual income subject to a maximum of Rs.5 lakhs
Premium payment mode Annually
 


Additional Benefits of Universal Sompo Individual Personal Accident Policy

  • Extensions– Two optional extensions are available with the policy for increasing the scope of coverage. These extensions are as mentioned below:
    • Medical expenses extension – Any reasonable medical expenses incurred as a result of an accident in case of any injury, death or disablement would be compensated by the company. The amount of such compensation would be lower of the actual expenses incurred or 40% of the Personal Accident Claim paid. The additional premium payable for this extension would be 25% of the base Personal Accident Premium. An additional 10% loading would be levied if the extension is opted beyond 65 years of age. 
    • Hospital Confinement Allowance – If the accidental injury, death or disablement results in hospitalization of the insured, a daily allowance of Rs.500 would be paid under this extension subject to a maximum of 30 days. The additional premium payable for this feature would be Rs.300 per person insured. An additional 10% loading would be levied if the extension is opted beyond 65 years of age.
  • Premium rebates– The plan offers two types of rebates or discounts which are as follows:
    • Family Discount –If more than 3 family members (spouse, children and dependent parents) are covered, a premium discount of 10% is given. This discount increases to 12.50% and 15% for more than 4 and more than 5 members respectively. 
    • Loyalty Discount – If the policy is renewed within 7 days of its expiry, a loyalty discount is given which is 5% in the first year, 10% in the second year and 15% in the third year. 
  • 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 –Either the insurer or the insured can cancel the policy by sending a 15-day notice. On cancellation, the premium after being adjusted for the pro-rated cover would be refunded back to the policyholder. The amount of premium retained would depend on the period of risk for which the policy was in-force. The rate of premium retained corresponding to the risk period is mentioned in the table below. The remaining premium is refunded.
Period of risk the policy covered Premium refunded
Up to 1 month 25% of the annual premium
Up to 3 months 50% of the annual premium
Up to 6 months 75% of the annual premium
Beyond 6 months 100% of the annual premium



Premium Rate

The premium under the plan would depend on the Capital Sum Assured, the plan option selected and the nature of the injury sustained. Here is the table showing the applicable premium rates:
Cover Option Category
Normal Heavy Very Heavy
Basic 0.40% 0.60% 0.90%
Wider 0.85% 1.25% 1.95%
Comprehensive 1.40% 2.00% Not to be covered.



Exclusions in Universal Sompo Individual Personal Accident Policy

  • Natural death, compensation in more than one benefits in the same disablement period, any type of payment after the claim is paid, claim exceeding the Capital Sum Assured would be excluded. 
  • Death, injury or disablement 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, STD or HIV would also be excluded.


 

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