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Individual Health Insurance

Speedy Policy
ProcessInstant Policy can be bought online or through agents with minimum documentation without pre-medical checkup up to age of 45 years for healthy individuals

Sum Insured Rs 1 Lakh - Rs 5 Lakh
Wide Range of Sum Insured - Options ranging from Rs 1Lac to Rs 5 lac.Family floater cover for minimum Sum Insured of Rs 2 Lacs.

Entry Age
3 months to 65 years ( Proposer has to be an adult only)

Cashless facility
Cashless facilities at over 4000+ quality hospitals across India.

Speedy Claims
ProcessingPrompt settlement of both Cashless and Reimbursement claim.

Portability Benefits
We can cover portability of benefits to similar cover under indemnity plan subject to intimation of complete details by application atleast 45 days prior to the expiry of existing policy.

• Inpatient Treatment
Coverage for hospitalization of more than 24 hrs within India only. Expenses like room rent, consultation fee, surgeon's fee, medicines, diagnostic studies, anaesthesia, blood, oxygen, operation theatre charges etc covered while admitted in a hospital.24hrs TPA support for cashless hospitalization.
• Pre-hospitalization
Coverage for medical costs incurred upto 30 days prior to hospitalization. Expenses like consultation fee, medicines, and diagnostic studies incurred while diagnosing / treating any disease/illness for which further treatment is taken as an inpatient are covered in the period.
• Post-hospitalization
Coverage for medical costs incurred within 60 day of discharge from Hospital. Expenses such as consultation fee, physiotherapy charges, medicines incurred related to disease/accident for which hospitalization happened are covered .
• Day-care Procedures
Coverage for medical expenses that an insured person incurs for enlisted daycare procedures that requires less than 24 hours of hospitalization due to technological advancement
• Domiciliary Treatment
Coverage of Medical treatment actually taken at home for a period of more than 3 days under the following compelling circumstances, which in the normal course would require Hospitalization of Insured Person:
(a). Medical advices against shifting of the patient to an Hospital/Nursing Home due to his/her bad health condition.
(b). Non-availability of accommodation in the Hospital/Nursing Home.
• Daily Cash benefit
An additional Daily Allowance amount equivalent to 0.1% of the Basic Sum Insured or Rs. 250/- per day whichever is less, for the duration of Hospitalization towards miscellaneous expenses is payable. The maximum amount payable under this extensions is limited to Rs 2500/ in a policy period.
• Critical-illness Coverage (Add on/ Optional)
In case you have opted for additional cover against following 5 named Critical Illness and have paid additional premium.Your Sum insured for the treatment of the said disease/medical condition becomes double.
Paralytic Stroke
Chronic renal Failure
Coronary Artery Bypass
Major Organ Transplant-Kidney, lungs, pancreas, bone marrow
• Expenses for Organ Donor
Covers the cost of treatment for the organ donor as well at the time of organ transplant procedure
• Emergency Ambulance
Coverage of Emergency Medical expenses upto 1% of Basic Sum Insured subject to Maximum of Rs 1000.
• Health Check-up
Medical checkup expenses can be reimbursed once at the end of a block of every four claim free Policies bought from USGIC. The reimbursement shall not exceed the amount equal to 1% of the average Basic Sum Insured for the block of 4 years.
• Pre-existing Diseases
Pre-existing diseases are covered after continuous 4yrs of the policy cover with USGIC.
• Cumulative Bonus
Get Cumulative Bonus for every claim free year at from 5% of Basic Sum Insured. The Cumulative Bonus can be accumulated to a maximum of 30%.
• Tax Benefits
Save Tax under Sec 80D of Income Tax Act as per the following limits. Rs 15,000.00 - for premium payments towards policies on self, spouse and children
Rs 15,000.00 - for premium payment towards non-senior citizen dependent parents
Rs 20,000.00 - for premium payment towards senior citizen dependents.

  • All treatments within the first 30 days of cover except hospitalizations for accidental
  • injury. Certain diseases are excluded in the first year of the Policy.
  • Expenses essentially non-medical in nature.

  • Dental tre atments except warranted due to accident and taken as inpatient

  • Injury or diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy.

  • Cost of spectacles and contact lens or hearing aids

  • Any expense on treatment related to HIV, AIDS and all related medical conditions.

  • Expenses on treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these, including caesarean section and any infertility, sub fertility or assisted conception treatment.

  • Any expense on treatment of Insured Person as outpatient.

  • Naturopathy treatment

  • Cosmetic treatment unless required due to an accident
  • 1.1. What Does the Policy Cover?
    The Policy covers you and your dependent’s health-related expenses right from consultation leading to hospitalization for covered treatment to the Post-Hospitalization.
    1.2. Who can be covered under the Policy?
    You and your dependants can be covered under the Policy. Dependents aged 91 days and above can be covered subject to the maximum age being 60 years.
    1.3. What are the eligibility criteria to get covered under the Policy?
    A. The proposer should be minimum of 18 years of age. B. Children’s can be covered under the Policy if any one of the Parents is covered.
    1.4. What is the duration of the Policy?
    The Policy is valid for one year.
    1.5. Do I have option of covers to choose from?
    There are two Plans for this Product • Individual Plan: Provides coverage on Individual Sum Insured basis • Floater Plan: Covers the whole family under one single sum insured
    1.6. What is a Family Floater Plan

    A Family Floater is a policy with one single sum insured floating on all insured members of the family available to take care of the hospitalization expenses of your entire family. Any one or all members combined could claim in a policy year subject to our total liability not exceeding the family floater sum insured.
    1.7. Why should I take a Family Floater Health Plan if I already have health insurance from my employer, or if my family and I are already covered by my corporate?
    Your employer will cover your medical expenses only as long as you are in his services. If you change your job or even start your own business you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Family Floater Health Insurance policy will come to your rescue. Family Floater Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.
    1.8. Is the premium exempted from Income Tax?
    The premium up to Rs 15,000 paid for self and dependants is exempt under Section 80D of the IT Act. The exemption up to Rs 20,000 is available if Premium is paid by a senior citizen.
    1.9. Do I have to undergo any Pre insurance medical examination?
    Medical examination is required for those aged 45 years and above while taking the Policy with Universal Sompo for the first time.
    1.10. Who pays for the Pre insurance medical examination?
    The expenses for Medical examination are to be borne by you.
    1.11. Are Pre-existing diseases covered under the Policy
    Pre Existing diseases are covered under the Policy after 4 continuous Policy years with Universal Sompo subject to no break in Insurance.
    1.12. What do you mean by pre-existing disease or conditions?
    Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/or were diagnosed, and / or received medical advice /treatment, within 48 months prior to Your first policy with us.
    1.13. What are the other benefits if I buy this Policy?
    Following benefits are available upto the limits defined in the Policy without any extra charge. Medical Practitioner/Consultant fees upto 25% of Sum Insured Pre Hospitalization expenses for 30 days prior to Hospitalization Post Hospitalization expenses for 60 days post hospitalization Day Care Procedures both on Cash less and Reimbursement basis Domiciliary Treatment expenses for upto 20% of the Sum Insured Daily Allowance 0.1% of the Basic Sum Insured or Rs. 250/- per day whichever is less subject to maximum of 2500/- Ambulance Charges 1% of Basic Sum Insured subject to maximum of 1000/- each Claim Health Check up Covered at the end of every Four Claims free Policies with USGI. The reimbursement will be for Actual Expenses or 1% of the average Basic Sum Insured whichever is less
    1.14. What are Pre and Post hospitalization expenses
    Pre and Post hospitalization expenses - covered for all relevant medical expenses incurred 30 days prior to hospitalization and expenses incurred during 60 days after hospitalization. By RELEVANT EXPENSES we mean all expenses pertaining to the disease for which he/she is hospitalized. For Example: A person maybe required to undergo certain diagnostic tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses on the tests and medicines 30 days prior to hospitalization for that particular disease are covered. RELEVANT EXPENSES for post hospitalization period of upto 60 days after being discharged from the hospital, e.g. the subsequent follow up consultations with specialists, medicines and test expenses are related to the treatment.
    1.15. Do I have option of amounts for which I can buy this Insurance for myself and /or my Family?
    You can opt for the Sum Insured ranging from 1 lac to 5 lacs for you or your family ie both on Individual sum insured basis or on family floater basis. We recommend a minimum Sum Insured of Rs. 2 lacs for Family floater cover.
    1.16. What benefits do I get if I renew the Policy with Universal Sompo?
    If you renew your Policy with us, you earn Cumulative Bonus of 5% for every claim free year along with continuity benefits and the option to get a free health check after 4 completed Policy years with Us subject to limits..
    1.17. Does the Policy have any exclusions?
    Key exclusions under the Policy are as below. o Claims due to pre existing diseases. o Expenses on dental and cosmetic surgeries. o Cost of spectacles, contact lenses etc. o Any expense on treatment related to HIV, AIDS and all related medical conditions. o Expenses related to Pregnancy or child birth o Any expenses or treatment as an outpatient in the hospital
    2. Claims related queries
    2.1. How can I claim the expenses under the policy?
    You can enjoy cashless services or seek reimbursement of the hospitalization expenses incurred.
    2.2. What is a ‘cashless’ claim?
    In a Cashless claim the insured does not have to pay any deposit or any fees while getting admission into a Hospital or while taking a discharge for the covered services .The Cashless service is available only at the Hospital or clinic listed on the network of the Third Party Administrator (TPA) under the Policy. The charges for the covered services are paid directly by the insurer to the medical service provider through the process of ‘Authorization.
    2.3. What is a reimbursement claim?
    In a reimbursement claim the insured has to pay upfront for the services of the provider at time of discharge from the hospital and seek reimbursement from the Insurer for the covered services.
    2.4. Is cashless facility available at all the hospital?
    The cashless facilities are available only at the hospitals which are on network of the TPA
    2.5. What is the procedure for availing cashless benefit?
    When you are admitted to the network hospital you need to show the card issued by Universal Sompo Card through the TPA to the treating doctor. The Network Hospital would contact the responsible TPA mentioned on the card) and fill up the pre-authorisation form. Then it would send the same to TPA with estimation of expenses. The TPA checks the policy conditions and sum-insured and approves the estimate authorizes the Cashless treatment for covered expenses.
    2.6. Are there any charges by the hospital, which are not reimbursable and hence have to be paid by me even after “Cashless Service” has been authorized for treatment in the network hospitals?
    Yes, essentially Non medical expenses are not reimbursable and have to be paid by you even though you have been authorized for “Cashless Service” at the Network Hospitals. Some of the charges are enumerated below:
    • Registration/Admission charges
    • Attendant/Visitor pass charges
    • Special nursing charges not authorized by the attending doctor
    • Service charges not forming a part of the room rent
    • Charges for extra bed for attendant etc.
    • Bed retaining charges
    • Charges for TV, Laundry etc.
    • Telephone/Fax charges
    • Food and Beverages for attendants and visitors Toiletries etc.
    • Purchase of Medicines not related to the treatment
    • Stationery, Xerox or certifying charges.
    2.7. Who is a Third Party Administrator (TPA)
    TPA is engaged by us to provide you services like Card issuance, Cashless claims services, claim reimbursement etc. For our Policy, TPA is TTK Healthcare Services Pvt. Ltd.
    2.8. How do I find out which doctors or hospitals are part of your network?
    You can get this information from the "Welcome Kit" which will come along with the policy. You can also call the toll free number provided in the insurance policy or have a look at the `Find a Network Hospital` tool on the TPAs webpage.
    2.9. How do you claim a reimbursement?
    You have to submit all the original bills, discharge summary, documents, claim form and photocopy of the Universal Sompo ID card to the regional Third-Party-Administrator (TPA) office, mentioned on the ID card and the User Guide. The claim will be reimbursed after verification of the records and cross checking if the expenses /ailment/disease stands covered under terms and conditions of the policy.
    2.10 What details should I provide while intimating the Claims?
    You should provide us following details of Claim.
    • Insured’s name
    • Name, age, gender of beneficiary
    • Policy number
    • Name & designation of the caller
    • Brief on the medical condition leading to hospitalization
    • Name of treating doctor
    • Date of admission in the hospital
    2.11 What documents are to be submitted in case of a reimbursement claim?
    Following documents shall be essential in the event of a Claim for reimbursement of hospitalization expenses.
    • Claim Intimation
    • Policy copy
    • Duly filled Claim Form
    • Discharge summary issued by hospital
    • Diagnostic reports prescribed by the doctor duly supported by summary of findings
    • Medical bills /cash memos
    • Any other documents as and when requested by the claim settling authority


    Policy Wordings
    Proposal Form
    Claims form

    ProcessInstant Policy can be bought online or through agents with minimum documentation without pre-medical checkup up to age of 45 years for healthy individuals



    Regd & Corp Office : Universal Sompo General Insurance Co Ltd. Unit No 401, 4th Floor,Sangam Complex, 127,
    Andheri Kurla Road,Andheri (E), Mumbai- 400059. Tel : 022-29211800, Fax : 022-29211844
    Insurance is the subject matter of solicitation. IRDA Registration Number - 134. Control Number -ENG/WBHP/CHG/150/Mar2013.
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