Universal Sompo General Insurance is the first Private Partnership in Indian General Insurance Industry, The joint venture has been capitalized with shareholders funds of over 230 cr. including share premium.
Universal Sompo General Insurance Highlights
| Features | Specifications |
| Network Hospitals | 5000+ |
| Waiting Period for Pre-existing Disease | 4 years |
| Incurred Claims Ratio | 70.91% |
| Number of Policies Issued | 162577 |
| Grievances Solved | 100.00% |
| Renewability | Lifetime |
The health insurance plans offered by the company are listed below. Each plan is further explained in terms of their most salient features.
- Individual Health Insurance Policy
- Individual Personal Accident Policy
- Aapat Suraksha Bima Policy
- IOB Health Care Policy Plus
- Allahabad Bank Health Care Plus Policy
- K Bank Healthcare Plus
- Hospital Cash Insurance
- Saral Suraksha Bima
- Complete Health Care Insurance
- Senior Citizen Health Care
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Individual Health Insurance Policy
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| Entry Age | Up to 55 yrs. |
| Sum Assured | Up to Rs.5 lakhs |
| Cover | Inpatient and domiciliary hospitalization expenses for treatment of illnesses and accidental fallouts; cover subject to sub-limits within the overall limit of the chosen sum assured. |
| Premiums | Based on age and chosen sum assured |
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Individual Personal Accident Policy
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This plan offers three options for coverage:
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- Basic: Death
- Wider: Death, Permanent Disability
- Comprehensive: Death and Permanent Disability
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| Entry Age | 5 yrs. to 65 yrs. ( extended to 75 yrs. subject to premium loading) 18 yrs. above considered adult |
| Renewability | Lifetime |
| Policy Period | 1 yr. |
| Basis | Individual or Family Package |
| Sum Assured | No.of times the annual income: Death – 10x; Wider – 5x; Comprehensive – 5x limited to Rs.5 lakhs |
| Cover | Basic Plan: Death; Wider Plan: Death, Permanent Disability; Comprehensive Plan: Death and Permanent Disability Death or Permanent Total Disablement – 100%; Permanent Partial Disablement – As per schedule or as advised by a medical professional; Temporary Total Disablement – Lower of 1% of sum assured and Rs.5,000 weekly (104 wks max.) |
| Add-on covers | – Medical Expenses: Lower of actuals or 40% of personal accident claim: Additional premium 25% of the base premium – Hospital Confinement Allowance: Rs.500 a day of hospitalization (30 days max.); an additional premium of Rs.300 per insured member Premium loading applicable on renewal: 10% for insured members over 65 yrs. |
| Premiums | 0.4% to 2% of sum assured depending on the type of cover chosen; Single payment option only |
| Discounts | – Family package: 10% to 15% depending on a number of additional members – Loyalty discount: 5% to 15% for renewal within 7 days of expiry |
| Benefits | – Funeral costs: 1% of sum assured (max. Rs.2.500) – Compensation for damaged clothing in the accident: Actuals (max.Rs1,000) – Ambulance costs: Actuals (max. Rs.1,000) – Children’s education fund (in case of death, permanent total disablement): 5% of cumulative sum assured (max. Rs.15,000) – Loss of employment: 2% of cumulative sum assured (max. Rs.25,000) |
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Aapat Suraksha Bima Policy
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| Basis | Single insured |
| Cover | Lumpsum payout; Critical Illness – Paralytic stroke; Cancer, Kidney Failure, Coronary Artery Disease, Major Organ Transplant: 100% paid to insured 30 days post-diagnosis Accidental Death: 100% of chosen sum assured paid to nominee/legal heir Permanent Total Disablement due to the accident: 100% of chosen sum assured |
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IOB Health Care Plus Policy, Allahabad Bank Health Care Plus Policy, K Bank Health Care Plus
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Offered to customers of Indian Overseas Bank, Allahabad Bank and Karnataka Bank holding a savings or current account.
There are two plans under this policy possessing similar features but differing in coverage. Plan A (self, spouse, children) / Plan B (self, spouse, children, parents)
| Entry Age | 5 yrs. to 65 yrs. (children covered until 25 yrs. of age) 3 months for children, if at least one parent is also covered under this policy |
| Medical Screening | Required for those above 50 yrs. (50% screening costs reimbursed on passing) |
| Renewability | Up to 80 yrs. |
| Policy Period | 1 year |
| Basis | Family floater |
| Sum Assured | Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh (chosen amount can be enhanced on renewal) |
| Cover | – Inpatient hospitalization expenses including expenses on room rents, services of medical professionals, consumables, equipment and all else that forms a part of necessary treatment for admissible ailments – Domiciliary hospitalization – Pre/Post-hospitalisation expenses: Up to 30 / 60 days – Maternity expenses: Includes pre/postnatal costs – Ambulance charges: Up to Rs.1,000 – Cash Allowance: Rs.100 a day to parents accompanying a hospitalised child under 12 yrs.(max. Rs.1,000) – Health check costs: Up to 1% of sum assured after 4 claim-free yrs. – Funeral costs: Additional amount of Rs.1,000Copayment: 20% for insured members over 55 yrs. |
| Add-on covers | Personal Accident Cover: Additional premium payable; Covers proposer, spouse and up to 2 children; Covers death due to accident in or outside India, Payout is based on sum assured – Death of Proposer: 100%, Spouse: 50%, Children: 10% to 20% |
| Premiums | Single installment payment Plan A – Rs.1,767 to Rs.14,511; Plan B – Rs.2,986 to Rs.24,518 Depends on age and chosen sum assured |
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Hospital Cash Insurance
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| Entry Age | 18 yrs. to 70 yrs.; children from 6 months upwards can be considered dependents up to the age of 25 yrs |
| Renewability | Lifetime |
| Medical Screening | Required above 55 yrs. (50% of screening costs are reimbursed) |
| Policy Period | Lifetime |
| Sum Assured | Rs.90,000 to Rs.5.4 lakhs (chosen amount can be enhanced on renewal) |
| Cover | Hospital Confinement: Daily cash up to Rs.3,000 a day Intensive Care Benefits: Twice the chosen sum assured Convalescence Benefits: Rs.10,000 for hospitalization exceeding 21 days (provided hospital cash option chosen is below 30 days) Hospital cash options: 15, 30, 45, 60, 90 or 180 days |
| Premiums | Rs.188 to Rs.43,200 |
| Discounts | – Long-term policy discount: 10% to 15% for policy period over 2 years paid in advance in a single installment – Family Discount: 5% – Group Discount |
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Saral Suraksha Bima
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This policy gives customers a lump sum payment on diagnosis of specified critical illnesses or accidental death/total permanent disablement (TPD). Although offered primarily to groups it can also be taken out by individuals subject to acceptance.
| Entry Age | 18 yrs. to 65 yrs.; 10 yrs. to 25 yrs. for children, if at least one parent is also covered concurrently |
| Renewability | Lifetime |
| Sum Assured | Critical Illness – Rs.10,000, Rs.20,000 or Rs.25,000 Personal Accident – Rs.20,000, Rs.40,000 or Rs.50,000 (chosen amount can be enhanced on renewal) |
| Cover | Critical Illness: Stroke, Cancer, Kidney failure, Open chest CABG, Major organ/bone marrow transplant Death and TPD due to accident: 100% of sum assured (50% in case of loss of sight in only one eye or loss of only one limb) |
| Premiums | Rs.141 to Rs.290 |
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Complete Health Care Insurance
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This policy comes with three sub-plans each with different levels of coverage. They are the Basic Plan, Essential Plan and the Privilege Plan.
| Entry Age | Adults – 18 yrs. to 70 yrs. Dependent children – 90 days to 25 yrs. (individual); 1 day to 25 yrs. (floater) |
| Renewability | Lifetime |
| Policy Period | 1 yr. to 3 yrs. |
| Basis | Individual and Family Floater (Family = 2 adults; 1 adult + up to 3 children; 2 adults + up to 4 children) |
| Sum Assured | Rs.1 lakh to Rs.2 lakhs (Basic); Rs.3 lakhs to Rs.5 lakhs (Essential); Rs.6 lakhs to Rs.10 lakhs (Privilege); All in increments of Rs.1 lakh. (chosen amount can be enhanced upon renewal subject to there being no claims made) No-claim Bonus: 10% to 50% enhancement of sum assured (portable) |
| Cover | – Inpatient hospitalization (over 24 hrs.) includes boarding, services of medical professionals, cost of required equipment and consumables used for treatment – 141 daycare procedures – Domiciliary hospitalization (over 3 days) – Pre/Post-hospitalisation expenses: Up to 30/60 days – Organ donor’s hospitalisation expenses – Ambulance charges – Dental treatment required as a result of an accident – AYUSH (Ayurveda, Unani, Siddha, Homeopathy) treatment – Daily cash allowance to accompany a hospitalized child (over 3 days) – Vaccinations for treatment of bites – Specified outpatient expenses (after 3 policy yrs.): Diagnostic tests, non-cosmetic dental treatment, pair of spectacles or contact lenses, consultation – Convalescence benefits (one-time): Rs.10,000 for hospitalisation over 10 days – Maternity /newborn expenses: Includes pre/post-natal costs – HIV/AIDS treatment: for life-threatening conditions |
| Add-on covers | Personal Accident, Critical Illness, Hospital Cash, Sub-limit waiver, Treatment at non-network hospitals. Additional premium charged to each insured member to enhance coverage, premium discounts apply for all insured members collectively for waiver of sub-limits. |
| Premiums | Rs.1,215 to Rs.51,546 (individual) Rs.1,774 to Rs.79,016 (family floater)Premiums depend on the sum assured, the chosen plan, and the age of the insured members. The family size is considered for policies on a floater basis |
| Discounts | Premium discounts: – If sub-limits are opted for – if treatment is availed at a non-network hospital on a copayment basis – one- time premium payment for long-tenor policies – opting for electronic policies – covering additional family members under one policy on individual basis (5% – 10% for up to 5 additional members) |
| Benefits | Health-checks after a specified number of claim-free yrs. Reinstatement of sum assured. |
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Senior Citizen Health Care
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A plan directed towards meeting healthcare needs of senior citizens and their spouses.
| Entry Age | 60 yrs. to 70 yrs. |
| Renewability | Lifetime |
| Medical Screening | Depends on the proposer’s health status; type of tests required to be done depends on the chosen sum assured (50% of screening costs will be reimbursed on acceptance) Not required if previously covered for 3 yrs. (claim-free ) |
| Policy Period | 1 yr., 2 yrs. or 3 yrs. |
| Basis | Individual or Floater (Floater option applies to hospitalization cover only) |
| Sum Assured | Hospitalisation: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh Critical Illness: Rs.1 lakh to Rs.5 lakhs, in increments of Rs.1 lakh No-claim Bonus: 5% to 50% enhancement in chosen sum assured on renewal after a claim-free year |
| Cover | Hospitalisation – Inpatient hospitalization expenses based on the following sub-limits: Room rent: Lower of actuals or 1% of sum assured (per day) ICU charges: Lower of actuals or 2% of sum assured (per day) Overall limit for the above is 25% of sum assured per ailment – Tests for blood sugar, glucose, SGPT, ECG, Cholesterol, Creatinine, Urine etc.: Up to 25% of sum assured per ailment – Anaesthesia, blood, oxygen, OT charges, surgical equipment and other items of similar nature: up to 7% of sum assured – Medicines, drugs, X-ray, Dialysis, pacemaker, prosthesis etc.: up to 50% of sum assured per ailment – Day care treatment – Pre/Post-hospitalisation expenses: Up to 30 / 60 days respectively – Domiciliary hospitalization: Actuals limited to 50% of sum assured – Health check expenses: up to 1.25% of sum assured – Cash Allowance: 0.1% of sum assured up to Rs.250 per day (max. 2,5000) – Expenses for a person accompanying hospitalized patients: Actuals limited to 1% of sum assured |
| Add-on covers | Critical Illness Cancer, Open chest CABG, Renal failure, Stroke, Major organ/bone marrow transplant, MS. Payout as per chosen sum assured upon diagnosis |
| Premiums | Hospitalisation: Rs.4,358 to Rs.68,171 (loading 40% on floater basis) Critical Illness: Rs.2,179 to Rs.24,347 Premium loading applies depending on location and health status: 10% to 100% |
| Discounts | – Long-Tenor Policy: 10% to 15% for policy periods 2 yrs. or 3 yrs.; for single installment advance payment – Family Discount: 10% on the premium for hospitalization cover for additional member i.e. spouse individual basis |