Universal Sompo Complete Healthcare Essential vs United India Individual Platinum Plan
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Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Complete Healthcare Essential is sold by Universal Sompo and Individual Platinum Plan is sold by United India. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Complete Healthcare Essential is specifically designed for Maternity. However, Individual Platinum Plan is quite basic. It offers little protection and it's a generic policy that anybody could pick off the shelf. So in many ways, you're comparing apples and oranges here.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That's something you'll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let's start with Complete Healthcare Essential. The product comes from Universal Sompo's stable:
Universal Sompo General Insurance Company is a public-private venture floated by two nationalized banks (Indian Overseas Bank and Allahabad Bank), one private bank (Karnataka Bank), an FMCG giant (Dabur Investment Corporation), and a well-known Japanese insurance firm (Sompo Japan Nipponkoa Insurance Incorporation).
The insurer also sells 135 IRDAI approved products and boasts over 15,000 network hospitals with a claim settlement ratio of 89%. Needless to say, the company isn’t exactly stellar when it comes to processing claims.
Individual Platinum Plan meanwhile comes from United India's stable:
United India General Insurance company is an amalgamation of 22 different entities. The insurer has played an integral part in underwriting numerous government insurance schemes like - Maharashtra Government’s Mahathma Jyothiba Phule Jan Arogya Yojana Health Insurance Scheme (2020) & Prime Minister Suraksha Bima Yojana.
However, since it is a government-owned insurance firm, it’s not the most nimble insurance company out there.
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Universal Sompo Complete Healthcare Essential vs United India Individual Platinum Plan
Compare Insurances Insurance Parameters Recommended Not Recommended | Universal Sompo Complete Healthcare Essential | United India Individual Platinum Plan |
|---|---|---|
| Network hospitals | 15000 | 4000 |
| Claim settlement ratio (avg. of last 3 years) | 89% | 95% |
| Co-payment | No | No |
| Room rent | Any Room | Any Room (up to 1% of sum insured) |
| Disease sub-limit | Yes | No |
| Pre existing diseases waiting | 3 years | - |
| Pre/Post hospitalization | 30/60 days | 30/60 days |
| No claim bonus | 10% per year (up to 50%) | |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness after complete exhaustion of sum insured) | |
| Health check-up | Once every year | Once every 3 years |
| Maternity | Available (up to ₹25,000 after 3 years) | |
| Out Patient Department | Up to ₹5,000 (Annually) | |
| Day care |
Insurer Comparison
Universal Sompo settles 89% of the claims it receives, while United India settles 95%. Ditto looks for a claim settlement ratio of 90% and above. United India clears that comfortably, while Universal Sompo sits just short of it, which is worth weighing alongside the rest of the comparison.
What is the Claim Settlement Ratio (CSR)?
The Claim Settlement Ratio tells you what percentage of health insurance claims an insurer settled during a given year, out of the total claims it received. A CSR of 93% means the insurer paid out 93 claims for every 100 filed. Ditto uses a 3-year average to smooth out year-on-year fluctuations, and recommends insurers at 90% or above — anything below 85% is a red flag.
Incurred Claims Ratio
Universal Sompo pays out ₹95 in claims for every ₹100 it collects as premium. United India pays out ₹99. Ditto considers 55%-85% a healthy band. Universal Sompo sits above it, which can point to an unsustainable payout rate and future premium hikes. Unlike the claim settlement ratio, a higher incurred claims ratio is not automatically better.
What is the Incurred Claims Ratio (ICR)?
The Incurred Claims Ratio tells you how much of every rupee collected as premium was paid back to customers as claims. An ICR of 70% means the insurer paid out ₹70 in claims for every ₹100 of premium collected. Unlike CSR, a very high ICR is not necessarily good — it can point to an unsustainable payout rate and future premium hikes, while a very low ICR can indicate an insurer that is overly restrictive in settling claims. Ditto looks for an ICR between 55% and 85%.
For every 10,000 claims processed, Universal Sompo received 5 complaints and United India received 16. Fewer complaints usually mean smoother claim processing and better servicing, so Universal Sompo has the edge on this metric. Ditto looks for under 20 complaints per 10,000 claims from general insurers, and under 40 from standalone health insurers, since their claims are more complex.
What is the complaint volume?
Complaint volume shows how many customers formally complained per 10,000 claims processed. Fewer complaints generally mean smoother claim processing and better customer support. General insurers and Standalone Health Insurers (SAHIs) are judged against different baselines because SAHIs handle only health claims, which are more complex — Ditto looks for below 20 complaints for general insurers and below 40 for standalone health insurers.
Universal Sompo has 15,000 network hospitals and United India has 4,000. Ditto recommends a network of 10,000+ hospitals. A bigger network makes it easier to find cashless treatment near you, but it counts for little if your preferred hospitals are not on the list — so check that before you decide.
What are network hospitals?
Network hospitals are the hospitals an insurer has tied up with, where it settles bills directly so you get cashless treatment instead of paying out of pocket and claiming reimbursement later. The larger the network, the easier it is to find cashless treatment near you. Ditto recommends a network of 10,000+ hospitals, but a large network matters little if your preferred hospitals are not on it — always check.
Track Record
Universal Sompo has been operating since 2007 (19 years) and United India since 1938 (88 years). Both have the 10+ years of history Ditto looks for, which means there is enough data to judge how they behave at scale rather than just early on.
Why does the insurer’s track record matter?
India’s insurance sector was privatised in 2000, so most private players have been operating for 20-25 years. A company with just 3-4 years of data gives you very little to judge it on — numbers can look excellent early on and deteriorate sharply as the insurer scales. Ditto considers 10+ years ideal, and under 5 years a reason to proceed with caution.
Feature Comparison
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Complete Healthcare Essential doesn’t impose a co-payment clause. And neither does Individual Platinum Plan.
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, you can pick any room you want with Complete Healthcare Essential but Individual Platinum Plan only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured.
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Complete Healthcare Essential imposes disease-wise sub-limits on modern treatments whereas Individual Platinum Plan doesn’t impose a disease wise sub-limit.
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. In this case, Complete Healthcare Essential imposes a waiting period of 3 years on pre-existing diseases while Individual Platinum Plan extends a waiting period of null years on existing conditions.
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Complete Healthcare Essential covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Individual Platinum Plan covers expenses incurred 30 days before hospitalization and expenses incurred 60 after hospitalization, although there may be different sub-limits
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Complete Healthcare Essential offers a no-claim bonus whereas Individual Platinum Plan doesn’t offer a no-claim bonus.
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Complete Healthcare Essential offers domiciliary cover. And Individual Platinum Plan also coves domiciliary expenses.
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Complete Healthcare Essential covers Ayush procedures and Individual Platinum Plan also extends coverage for Ayush treatments.
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, however, Complete Healthcare Essential offers maternity cover whereas Individual Platinum Plan doesn’t offer protection for maternity-related hospitalizations.
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Complete Healthcare Essential offers OPD cover whereas Individual Platinum Plan doesn’t offer OPD protection.
Final Conclusion
If you're specifically looking to buy a policy for Maternity, Complete Healthcare Essential makes a lot of sense. But considering Universal Sompo has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that United India has to offer, if the policy is made available to you.
Other Universal Sompo Complete Healthcare Essential Comparisons
Other United India Individual Platinum Plan Comparisons
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