Universal Sompo
Complete Healthcare Basic
While you might not have access to a huge cover, the plan is reasonably comprehensive. It doesn't have any egregious conditions, covers outpatient consultations (upto 1% of the Sum Insured) and the plan doesn't make you wait too long before covering pre-existing diseases. All in all, a decent policy
What's good here?
You’ll never have to split the bill
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
You can pick any room you like
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Day Care treatments covered
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.
Covers Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will cover you fully, up to the sum insured.
Pre & Post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Free Health Checkups every year
If you’re planning on getting a full body checkup every year just to make sure you’re in fine working condition, the insurer will cover the costs.
What's bad here?
Has disease wise sub-limits
Your insurance cover won’t be fully available in case you are treated for Modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Your insurance cover won’t be fully available in case you are treated for Modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
What's okay here?
Reasonable waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Some Restoration Benefit
Once you exhaust your entire cover, you will have 100% of the cover restored, if you are hospitalized one more time in a bid to treat a different complication. In the same year, by the way.
Some coverage if you are forced to hospitalize at home
The insurer will pay up to 20% of the sum insured if you are forced to hospitalize at home due to a medical condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
Special Bonus for being healthy and not claiming insurance
Your sum insured increases by 10% each year, so long as you make no claims during this period. But before you get too ahead of yourself, do note that they’ll stop offering you the bonus when your sum insured increases by 50%. Also, the bonus amount will reduce at same rate each time you make a claim. But hey, it's still a bonus.
Doctor consultations covered
In the event, you are feeling sick and you want to visit your family physician for a general checkup, the insurer will cover the costs, up to a certain limit. In this case, it’s 1% of the sum insured max up to ₹2,500 annually. But remember, there is a 3 years of waiting period on the same before you can start availing this benefit.
Add-ons
Reduction in PED
This optional cover reduces the applicable pre-existing waiting period from 36 months to 12 months. If you are currently diagnosed with any condition and want to reduce the waiting period, it makes sense to opt for this add-on.
Hospital Cash
The insurer pays a lumpsum by adding a fixed sum (daily cash) every day until the day of discharge so you can deal with any potential loss in income during this time. The money will be reimbursed to you after you submit the required documents post-discharge, and while this looks like a neat benefit to have, we don’t recommend it since the benefit doesn’t compensate for the extra premium you pay.
Personal Accident cover
With this add-on, the insurance company will payout a lumpsum amount based on the cover chosen, in case the selected insured member encounters total or partial disablement or accidental death.
Extension Under Post-hospitalisation
With this add-on, you can increase the post-hospitalisation limit from 60 days to 120 days.
Sub-limits
With this add-on, insured members can add sub-limits for certain treatments and avail discounts on the premiums. This add-on is not recommended unless higher premiums are a concern.
Emergency Travelling Allowance
With this paid add-on, the insured member can claim for the travel expenses incurrred on ambulance or cab upto defined limits to reach the hospital during the travel.
Rest Cure, Rehabilitation and Respite Care
With this add-on, the insured members can get coverage for expenses related to rest, cure, rehabilitation and respite care (nurse care).
Organ Donor Enhancement
With this add-on, the insured member gets coverage upto defined limtis for expenses related to organ donor's treatment.
Medically Advised Support Devices
With this paid add-on, the insurer will cover the expenses related to medically prescribed prosthetics or artificial devices required for the treatment upto defined limits.
Home Care Treatment
With this paid add-on, the insurer will cover the expenses incurred for taking treatment at home upto defined limits.
Condition waiver under Restoration
With the add-on, restoration benefit is available for both same or different illness.
Wellness Benefit
With this paid add-on, the insurer will reward the insured members for maintaining a good health and overall well-being.
Consumables
With this add-on, you also get extended coverage for generally excluded items like syringes, gloves, PPE kits etc. upto ₹2000.
Critical Illness
With this add-on you get a lumpsum payment in the event you are diagnosed with critical illnesses outlined in the policy document.
Extension Under Pre-hospitalisation
With this add-on, you can increase the pre-hospitalisation limit from 30 days to 90 days.
Maternity Waiting Period Reduction
With this add-on, the insurance company will reduce the maternity waiting period from 3 years to 2 years.
Dental OPD Waiting Period Reduction
With this add-on, the insurance company will reduce the Dental OPD waiting period from 3 years to 2 years.
Second Opinion
With this paid add-on, the insured members get expenses reimbursed upto defined limits towards a second medical opinion for listed ailments per policy year.
Disease Management Program
With this paid add-on, the insured member will get assistance via the app/portal to manage their health in case of diagnosis of crucial ailments like diabetes, asthma, hypertension, etc.
Co-payment
This benefit helps to opt for co-payment between 10% to 50%.
Premium Waiver
With this paid add-on, the insurer will waive the renewal premiums for 4th year provided certain specific conditions are met.
Treatment in Tiered Network
With this add-on, the insurance company offers a 5% Discount if treatment is taken in Network hospitals. But applies 10% Co-Payment for the insured members if treatment is taken in a Non-Network Hospital.
Emergency Assistance Service
With this paid add-on, the insurer will cover the expenses related to the medical emergencies like Medical Evacuation, Medical Repatriation, Compassionate Visit, etc if the insured member is 150km or more away from the registered address.
Frequently Asked Questions
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