Universal Sompo Senior Citizen Health Care Plan

Universal Sompo Senior Citizen Health Care Plan

Universal Sompo Senior Citizen Health Care is policy that can be taken by a senior citizen who is above 60 years of age for covering himself/herself and his/her spouse. The policy covers hospitalization charges for the insured and also offers optional cover of critical illness occurring 90 days after the policy issue date.

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Key Features of Universal Sompo Senior Citizen Health Care Plan

• The policy consists of 2 sections consisting of Hospitalization and an optional section of Critical illness.
• The applicant or his/her spouse has to go undergo certain number of medical tests for purpose of consideration of proposal.
• If proposal is accepted, 50% of the costs incurred in conducting the tests shall be reimbursed.
• Only critical illness specified in the policy will be covered under the policy.
• The sum insured under both the sections need not be identical.
• Additional discount of 10% is given if you choose to cover your spouse under the policy on individual Sum Insured basis instead of floater basis.

Benefits of Universal Sompo Senior Citizen Health Care Plan

• Specified procedures/ surgeries requiring less than 24 hours of hospitalization would be covered under the policy.
• 25% sum insured per injury/illness for medical tests.
• 50% sum insured per injury/ illness for blood, oxygen, surgical appliances, diagnostic materials etc.
• Up to 2% sum insured per day if admitted in IC unit.
• Ambulance charges to the extent of 1% of sum insured or Rs 1500. 

Universal Sompo Senior Citizen Health Care Premium Details

*The above rates may change. Please check the policy wordings for more details. 

Universal Sompo Senior Citizen Health Care Policy Details

• Renewal - the policy is ordinarily renewable till 80 years of age except on grounds of fraud, moral hazard or misrepresentation.
• Cancellation - You may cancel this policy by sending a written notice to us. Retention premium for the period will be calculated based on following short period table and the balance will be refunded

• Continuity - In case company decides to withdraw Sampoorna Suraksha Bima Policy, option shall be available to migrate to nearest substitute product.
• Co-Payment - There is a cost sharing requirement applicable under this Policy in which you shall bear the percentage of the admissible claim amount specified in table below.

Sum Insured Enhancement- sum insured can be enhanced only upon renewal

TPA and Network Providers- For assisting you during claims related services we have engaged a Third Party Administrator and also tied-up with a lot of hospitals all over India for securing a cashless claims processing.

Region of cover- we shall pay for treatment confined to the Hospitals in India only.       

Loadings under Universal Sompo Senior Citizen Health Care Insurance Policy

• Loading based on location: load premium up to 10% if you are a resident of any one for the Tier 1 cities ( Delhi/NCR, Mumbai, Chennai etc,)
• Health status loading: load premium up to 100% under the Policy as under depending your health status. 

Exclusions in Universal Sompo Senior Citizen Health Care insurance

• Any condition, ailment, injury or related conditions for which the insured have been diagnosed, received medical treatment, had signs or symptoms, prior to the inception of the policy until 24 months from the date of inception.
• Medical expenses incurred by you on treatment of following illness until 24 months from the date of inception:
• Cataract
• Benign Prostatic Hypertrophy      
• All types of Hernia, Hydrocele
• Stones in the urinary and billiary systems
• All types of Skin and internal tumors
• Dialysis required for chronic renal failure
• Cosmetic, aesthetic, or related treatments will not be covered.
• Expenses arising from HIV or AIDS and related diseases.
• Any illness or disease contracted due to intake of alcohol or other addictive substances will not be covered.
• Treatments consisting of non-allopathic medicine are not covered under this policy.
• Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind. 

Documents Required to buy Universal Sompo Senior Citizen Health Care Insurance

To buy the policy, an ‘Application form/ proposal form’ is required to be filled. It should be submitted along with accurate medical history and the address proof. Medical examination may be required in some cases, based on the sum insured and the age of the person.

Eligibility to buy Universal Sompo Senior Citizen Health Care Insurance

• You must be above 60 years of age on last birthday under the Policy.
• Must be permanent resident of India.
• Maximum entry age under the policy for you and your spouse is restricted to 70 years. The renewals for the policy are provided for lifetime.