Universal Sompo Complete Healthcare Health Insurance

About Universal Sompo Complete Healthcare Health Insurance

Universal Sompo’s Complete Health Insurance plan is offered on both individual and family floater basis. The plan is designed to pay the insured person’s hospitalisation expenses, in-patient treatment, AYUSH expenses, and a lot more. The Universal Sompo Complete Health Insurance plan is available in three variants, Plus, Premiere, and Executive. Read on to find out all about the Universal Sompo Complete Health Insurance plan.

Universal Sompo Complete Health Insurance Plan at a Glance

Family and Individual

Reduction in PED Waiting Period, Consumable Cover, Daily Hospital Cash cover

Plus, Premier, Executive

Extensive family plan, Value-added services, OPD dental treatment, etc

In-patient treatment, Daycare procedures, AYUSH, etc

Weight-control treatment, Infertility treatment, etc

Key Features of Universal Sompo Complete Health Insurance Plan

Some of the key features of the Universal Sompo Complete Health Insurance plan are as follows:

• Extensive Family Plan: As already stated, the Universal Sompo Complete Health Insurance is a family as well as an individual plan. If you choose the family option, you can get coverage for up to 6 members which can also be increased up to 20, depending on your requirements.

• Policy Period: The policy term of the Universal Sompo Complete Health Insurance plan can be either 1, 2, or 3 years. The policyholder can also enjoy lifelong renewability with the Universal Sompo Complete Health Insurance plan.

• Value Added Services: With the Universal Sompo Complete Health Insurance plan, you can also enjoy the benefit of value-added services. This includes second e-opinion coverage, telephonic consultations, a health educational library, and a lot more.

• Out-patient Dental Treatment: The Universal Sompo Complete Health Insurance plan also provides coverage for outpatient treatment. Any dental treatment will thus be covered under this.

Eligibility Criteria of Universal Sompo Complete Health Insurance Plan

Listed below are the eligibility criteria for the Universal Sompo Insurance's Complete Healthcare Plan:

Parametres

Eligibility Criteria

Minimum entry age of the proposer

Maximum entry age of the proposer

Minimum entry age of the child

Minimum entry age of the child

Benefits of Buying Universal Sompo Complete Health Insurance Plan

The Universal Sompo Complete Health Insurance Plan offers a bunch of benefits such as those listed below:

• Variants: The Universal Sompo Complete Health Insurance Plan is available in three different variants, Plus, Premiere, and Executive. While most of the coverage offered under all of the three variants are same, there are a few differences. For instance, the Plus variant has a sum insured between Rs.15-20 lakhs, the Premier has between Rs.25-30 lakhs, and the Executive variant has a sum insured between Rs.40-50 lakhs.

• Basic Coverage: The Universal Sompo Complete Health Insurance Plan provides coverage for in-patient treatment, daycare procedures, pre and post hospitalisation, domiciliary treatment, organ donor expenses, AYUSH benefits, outpatient dental treatment, and a lot more. The coverage offered is dependent on the sum insured you have opted for with your Universal Sompo Complete Health Insurance Plan. The best part is that all of these coverage is available at very affordable premiums.

• Mother and Child Care Benefit: The Universal Sompo Complete Health Insurance Plan provides coverage for the delivery-related expenses of a newborn child. It includes both cesarean and normal delivery. The pre and post-natal expenses are also included along with newborn baby cover. The newborn baby cover is offered till the expiry of the policy term or when the child turns 91 years old or whichever is earlier.

• Health Check-ups: The Universal Sompo Complete Health Insurance Plan also provides coverage for preventive health check-ups. The annual health check-up benefit is applicable for all the members covered under the Universal Sompo Complete Health Insurance Plan.

• Global Coverage: With the Universal Sompo Complete Health Insurance Plan, you can also enjoy global coverage. This means that if you require hospitalisation outside the country, then all the expenses will be covered under the Universal Sompo Complete Health Insurance Plan.

Riders Available with Universal Sompo Complete Health Insurance Plan

Some of the optional riders you can include in your Universal Sompo Complete Health Insurance Plan are as follows:

• Personal Accident Cover: This add-on provides coverage to the policyholder in case of accidental death, or permanent disablement due to an accident.

• Critical Illness Cover: This add-on provides coverage for critical illness as listed on the policy document. This includes heart attack, cancer, paralysis, and others.

• Hospital Daily Cash: With this add-on, you can get coverage for daily hospital expenses.

• Consumable Cover: This includes coverage for non-consumables as listed on the policy document.

• Pre-existing Waiting Period Waiver: With this add-on, you can get the waiting period for pre-existing medical conditions waived off.

Variants Available with Universal Sompo Complete Health Insurance Plan

There are three variants you can include in your Universal Sompo Complete Health Insurance plan such as Plus, Premier, and Executive. In the section below, listed below are the few differences between the three:

Parametres

Plus

Premier

Executive

Up to Rs. 1,50,000

Inclusions and Exclusions of Universal Sompo Complete Health Insurance Plan

Inclusions:

• In-patient Treatment: This includes room rent expenses, nursing, ICU, diagnostic procedures, etc
• Daycare Procedures: All the daycare procedures listed on the policy document are covered
• Pre-hospitalisation Expenses: Covered for up to 30 days
• Post-hospitalisation Expenses: Covered for up to 60 days
• Domiciliary Hospitalisation: All the expenses related to treatment at home is covered under this
• AYUSH Treatment: Up to the sum insured
• Organ donor: Organ donor expenses are covered up to the sum insured
• Vaccination: Up to the sum insured
• Dental Out-patient Treatment: Up to the SI

Exclusions:

• Obesity or weight control treatment
• Rest cure or rehabilitation and respite care
• Change of gender treatment
• Cosmetic or plastic surgery
• Any injury due to involvement in adventure activities
• Breach of law
• Any unproven treatment
• Sterility or infertility treatment
• Dietary supplement expenses

Documents Required to Buy Universal Sompo Complete Health Insurance

Listed below are the documents required to buy the Universal Sompo Complete Health Insurance plan:

• A duly-filled proposal form
• Aadhaar card
• Pan card
• Income proof
• Bank account details
• Pre-existing medical report
• Previous health insurance company

How to Buy Universal Sompo Complete Health Insurance Plan?

Here are the steps in which you can buy this Universal Sompo Health Insurance plan:

• Visit the “Health Insurance” section on the official InsuranceDekho website.
• Choose "Universal Sompo Health Insurance" from the list of health insurance companies.
• Then, select "Complete" from the available health insurance plans.
• Read the policy documents carefully
• Upload all the necessary documents to complete the KYC process
• After finishing the KYC process, pay the premium online
• Finally, you will receive the policy document in your registered email

Claim Process of Universal Sompo Complete Health Insurance Plan

There are two types of claims you can raise with Universal Sompo Complete Health Insurance plan, cashless claim and reimbursement claim. Under a cashless claim, your medical bills will be directly settled by the insurance company. On the other hand, in a reimbursement claim, the medical expenses incurred will be later reimbursed by the insurance company.

Cashless Claim

• Get the treatment at any network hospital associated with Universal Sompo Health Insurance.
• Inform the insurer about the hospitalization
• Download the pre-authorization form from the company’s official website.
• Duly fill out the pre-authorization form and attach all the documents to it.
• Submit the form to the insurer. Universal Sompo will verify the information and documents submitted by you.
• Once the verification process is complete, an insurer will either process or reject your claim request.

Reimbursement Claim

• Visit any nearby hospital
• Inform the insurance company in case of both planned and unplanned hospitalisation
• Pay for medical bills and treatment costs from your own pocket.
• Go to the official website of Universal Sompo to download the claim application form.
• Fill out the claim form thoroughly
• Attach all the necessary documents to the form and submit them to your insurance provider
• Universal Sompo Health Insurance will assess the documents you submitted.
• Once all the documents have been approved, your claim request will be settled by the insurance company

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Key Inclusions and Exclusions of the Plan

What's Included

• Charges for blood, oxygen are covered
• Expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees are included
• Medical expenses in case of hospitalisation are covered
• Cashless hospitalisation at any of the company’s network hospitals
• Domiciliary hospitalisation expenses are covered under the policy

What's Not Included

• Expense on treatment of diseases such as cataract, piles, sinusitis and related disorders are not covered during the first year of the policy
• Pre-existing diseases are not covered
• Injury or disease directly or indirectly attributable to war, invasion, act of foreign enemy are not payable
• Pregnancy and childbirth are not covered
• Cost of spectacles, contact lenses, hearing aids are excluded

Complete Healthcare Insurance Plan Details

11505 Universal Sompo Cashless Network Hospitals in India

Choose Universal Sompo Plan for

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Complete Healthcare Insurance User Reviews

Filing a health insurance claim for my Universal Sompo- Complete Healthcare Insurance with InsuranceDeko is straightforward and efficient. They make an already stressful situation easier to handle. Read More

I bought a good health insurance plan that covers me for any critical illness. I chose Universal Sompo- Complete Healthcare Insurance. The plan has its own unique features and benefits. I bought this plan from the InsuranceDekho website. Read More

Within just three easy steps, I could issue Universal Sompo’s Complete Healthcare Insurance plan. I landed on InsuranceDekho and got my free health quotes offered by multiple insurance companies. I compared the quotes to find the best deal. Finally, I paid for the plan using my credit card. Read More

All the health insurance policies on InsuranceDekho have the widest coverage and optimum benefits, yet the prices offered are reasonable. When I was navigating through the website, this feature convinced me the most. I chose the platform to buy ICICI Lombard’s Complete Health Insurance Plan. Read More

Complete healthcare by universal sompo is a plan that anyone can buy at anytime in the lifetime. The best thing is that it covers add on benefits which the policyholders can pay a little extra for and buy. Like critical illness cover, personal accident cover, hospital daily cash, sub-limits, treatment only in tiered hospital. Read More

Add-ons to Enhance Benefits

Critical Illness Cover

If you opt for add-on cover against critical illness and have paid an additional premium, then the company will pay for reasonable and customary charges incurred on expenses as listed under ‘What We cover’ up to an additional Sum Insured limit equal to his/her Basic Sum Insured. The additional sum insured available for a critical illness under this optional extension cover will not qualify for a cumulative bonus or for the limit for daily allowance, ambulance expenses and cost of health check-up.

Personal Accident

Under this add-on, a lump sum amount is paid for death resulting from accidental bolidy injury within 12 months from date of accident or a lump sum amount is paid for permanent total disability conditions such as loss of eyesight, loss of limbs, etc. resulting from an accident within 12 months from date of accident.

Hospital Daily Cash

This optional benefit provides daily cash for each day of hospitalisation , if the hospitalisation exceeds 3 days.

Sub-limits

With this optional benefit, you can choose to restrict your defined illness/disease up to a specified limit and earn discounts on doing so.

Treatment only in Tiered Hospital

This add-on offers you a discount if you choose to take treatment in a network hospital. On doing so, you can avail 5% discount on the premium. On the other hand, if the treatment is taken in a non-network hospital, 10% co-payment is levied under the policy.

Universal Sompo Complete Healthcare Insurance Expert Review

Expert Review

As living a healthy lifestyle is essential, similarly being covered under a comprehensive health insurance plan that offers you complete coverage under all circumstances is essential too. Good news is that Universal Sompo has come up with such a plan by the name of Complete Healthcare Insurance. Available in 3 variants viz., Individual, Essential and Privilege Plans, Universal Sompo Complete Healthcare Plan is a policy that fulfills everyone’s needs. No problem as the sum insured options start at Rs. 1 Lakh and go up till Rs. 10 Lakh for Individual as well as Family Floater basis. Also, anyone aged between 18 years to 70 years can seek coverage under this policy for 1 year to 3 years. Not leaving behind dependent children, they can also be covered up to 25 years of age. Which means, this policy not only allows you to cover individuals but also allows you to cover your extended family under a single plan. Apart from this, the plan gives you 5 options where you can enhance your cover or waive according to your needs. These are-Critical Illness, Personal Accident, Hospital Cash, Sublimit and Treatment in a tiered Network. There is still more to this policy - No co-pay, deductible, excess at any age or any place.

Major Attractions

• Vaccination expenses
• 141 daycare procedures covered
• Emergency ambulance charges are covered
• 10% No Claim Bonus provided subject to a maximum of 50%
• Domiciliary hospitalisation cover for a treatment exceeding 3 days of hospitalisation
• Convalescence benefit of Rs. 10,000 once in a policy year in case you are seriously ill
• Dental treatment costs arising due to accident, treatment of which has been taken in a hospital as an in-patient
• 30 days pre-hospitalisation cover. If the hospitalisation is intimated 5 days before hospitalisation, then it is covered for 60 days
• 60 days post-hospitalisation cover is provided. If the hospitalisation is intimated 5 days in advance, then these expenses are covered until 90 days after the discharge from hospital

What’s More?

• The policy is renewable for lifetime
• Hassle-free claim settlement procedure
• Cashless hospitalisation in-network hospitals
• Tax benefits under Section 80D of the Income Tax Act 1961

Conclusion

Considering the countless benefits provided by Universal Sompo through this plan, it seems to be a perfect product to cover an individual or the entire family. To get this policy issued quickly and with utmost transparency, you should buy it online. It is a preferred one because offline transactions have higher chances of misinterpretation of information and may even cost you more time and money. So, make the deal worthy by going online soon.

Universal Sompo Complete Healthcare Insurance Brochure

• 1.49 MB
• PDF Document
• Apr 04, 2019

Claim Process at Universal Sompo Health Insurance

• Network Hospital
• Non-Network Hospital

Claim Assistance

Claim Intimation

Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 72 hours prior to admission.

Claim Processing

Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.

Claim Settlement

Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.

Claim Assistance

Claim Intimation

Emergency hospitalisation needs intimation within 72 hours and for planned hospitalisation intimate within 48 hours prior to admission.

Claim Processing

Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.

Claim Settlement

FAQs on Complete Healthcare Insurance Health Insurance Plan

What is the sum assured in Universal Sompo’s Complete Healthcare Insurance policy?

The sum assured is provided for up to Rs. 10 Lakh in Universal Sompo’s Complete Healthcare Insurance policy.

What is the age criteria for Universal Sompo’s Complete Health Insurance policy?

What is the cashless claim procedure for Universal Sompo’s Complete Healthcare Insurance policy?

Follow the below steps to get cashless healthcare treatment: 1. In case of an emergency hospitalisation, call their helpline number and lodge your claim within 24 hours of hospitalisation. 2. In case of a planned hospitalisation, inform the insurer 48 hours prior to the hospital admission. 3. Visit a nearby network hospital and show the company's health card number, along with your valid photo ID. 4. Collect the ‘Cashless Request Form’ from hospital/TPA desk. 5. Fill in the required details and give it to the TPA desk in the hospital. 6. Hospital authority will verify the details and will send the filled ‘Cashless Request Form’ to the concerned insurer by fax. 7. Universal Sompo will review the request, approve or reject it as per the policy terms and conditions and you will be communicated about the same. 8. You will need to pay the deductibles and any extra amount that is not covered in the policy. 9. You can check your claim status by using your claim reference number.

What is the reimbursement claim process in Universal Sompo’s Complete Healthcare Insurance?

When you avail the treatment at a non-network hospital and pay the medical bills on your own, you can file for its reimbursement. Post-discharge from the hospital, this amount can be claimed from the insurer. Below are the steps for filing reimbursement of your hospitalisation expenses: 1. Call at their health helpline number 1800-200-5142 or email at healthserve@universalsompo.com. 2. Remember to lodge your claim within 24 hours in case of emergency admission and 48 hours prior to hospitalisation in case of planned hospitalisation 3. Get admitted and avail the treatment. Settle your bills and collect all the original documents when getting discharge. 4. Fill the claim reimbursement form 5. Submit the form with all the original documents containing all the hospital bills at the registered address of the insurer 6. On receipt of all the documents, Universal Sompo will process your claim as per the terms and conditions. Intimation will be sent to you regarding the same.

What is the information required while filing a claim in Universal Sompo’s Complete Healthcare Insurance?

When you avail the treatment at a non-network hospital and pay the medical bills on your own, you can file for its reimbursement. Post-discharge from the hospital, this amount can be claimed from the Following details are required by the policyholders: 1. Your contact details 2. Universal Sompo health insurance number and membership ID number mentioned on the Health Card 3. Name of the patient 4. Nature of illness/accident 5. Date and time of loss in case of an accidental hospitalisation or starting date of a symptom of disease in case of an ailment 6. Location of loss/accident 7. Geographical details

What is the eligibility for Universal Sompo’s Complete Healthcare Insurance plan?

What all is covered under Universal Sompo’s Complete Healthcare Insurance plan?

Complete Healthcare Insurance Plan covers the hospitalisation expenses of the individual with the following features: 1. Cashless hospitalisation at any of the company’s network hospitals. 2. In-patient hospitalisation expenses are covered. 3. Domiciliary hospitalisation benefit means medical treatment for a period exceeding 3 days for such illness, which in the normal course require treatment in a hospital but actually taken whilst confined at home in India since the condition of the patient is such that he cannot be removed to a hospital or the patient cannot be removed to the hospital for lack of accommodation. 4. Subject to a clean proposal form, medical tests are waived off up to the age of 45 years. Above the age of 45 years, medical tests are mandatory and 50% of the test charges are reimbursed to the customer. 5. Additional cover may be purchased by the customer to cover certain critical illnesses. 6. Maximum coverage under Individual Health Insurance plan is of Rs. 5 Lakh. 7. Coverage also includes expenses incurred on room rent charges, boarding charges, nursing, surgeon/specialist fees, charges for blood, oxygen, etc.

What are the exclusions in Universal Sompo’s Complete Healthcare Insurance Plan?

The policy does not cover loss, damage, illnesses or diseases that arise due to the following: 1. Pre-existing diseases will not be covered under this plan. 2. Any expense on hospitalisation or domiciliary hospitalisation incurred due to any illness contracted during the first 30 days from the date of commencement of the insurance. However, this exclusion is not applicable if hospitalisation is required because of an accident. 3. During the first year of the cover, the expense on treatment of diseases such as cataract, benign prostatic hypertrophy, hysterectomy, piles, sinusitis, and related disorders are not covered. 4. Injury or disease directly or indirectly attributable to war, invasion, act of foreign enemy not payable. 5. Circumcision unless necessary of a disease is excluded. 6. Cost of spectacles, contact lenses, hearing aids are excluded. 7. Dental treatment or surgery of any kind unless hospitalisation is required is excluded. 8. Any treatment directly or indirectly for treatment associated with AIDS. 9. Cosmetic or aesthetic treatment are not covered. 10. Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered. 11. Voluntary termination of pregnancy. 12. Pregnancy and childbirth. 13. Naturopathy treatment.

Can I renew Universal Sompo’s Complete Healthcare Insurance plan online?

You can easily renew Universal Sompo’s Complete Healthcare Insurance plan online from the insurer’s site.

What happens if I cancel my Universal Sompo’s Complete Healthcare Insurance Policy?

Upon cancellation, your insurance will cease to exist from the date of cancellation of the plan. In addition, the premium will also be refunded as per short period cancellation rates. Please read the policy wordings for further details.

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