Compare Universal Sompo vs Oriental Health Insurance Plans
| Universal Sompo | Oriental | |
|---|---|---|
| Claims Settlement Ratio ** | 95.31% | 99.48% |
| Number of Lives Covered * | 11,37,000 | 3,03,25,000 |
| Network Hospitals | 4,000 + | 4,300 + |
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| Complete Healthcare | Arogya Sanjeevani | Individual Mediclaim | Happy Floater | Arogya Sanjeevani |
| In-patient Treatment | ||||
| Covered | Covered | Covered | Covered | Covered |
| Room Rent | ||||
| Covered | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day | Not exceeding 1% of the sum insured per day | Silver & Gold: 1% of the sum insured per day Diamond: Rs.10,000 and 0.5% of the sum insured above Rs.10 lakhs per day |
2% of the sum insured subject to maximum of Rs.5,000 per day |
| ICU Charges | ||||
| Covered | Up to 5% of the sum insured subject to maximum of Rs.10,000 per day | Not exceeding 2% of the Sum Insured per day | Silver & Gold: 2% of the sum insured per day Diamond: Rs.20,000 and 1% of the sum insured above Rs.10 lakhs per day |
Up to 5% of sum insured subject to maximum of Rs.10,000 per day |
| Pre-hospitalization | ||||
| 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital |
| Post-hospitalization | ||||
| 60 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital |
| Day Care Procedures | ||||
| 141 day care expenses covered | Covered | Covered | Covered | Covered |
| Domiciliary Treatment | ||||
| Covered | Not Covered | Covered up to sum insured | Covered up to sum insured | Not Covered |
| Emergency Ambulance | ||||
Basic: Up to 1% of sum insured or Rs.1,000 or actuals whichever is less Essential: Up to 1% of sum insured or Rs.2,000 or actuals whichever is less Privilege: Up to 1% of sum insured or Rs.3,000 or actuals whichever is less |
Subject to a maximum of Rs.2,000 per hospitalisation | Rs.2,000 or 1% of the sum insured not exceeding Rs.4,000 | Silver: Rs.1,000 per illness and 1% of the sum insured subject to maximum Rs.3,000 per policy period Gold: Rs.2,000 per illness and Rs.6,000 per policy period Diamond: Rs.3,000 per illness and Rs.8,000 per policy period |
Rs.2,000 per hospitalisation |
| Dental Treatment | ||||
| Up to 100% of In-patient treatment sum insured (In case of accident) |
Dental treatment necessitated due to disease or injury | Not Covered | Not Covered | Dental treatment, necessitated due to disease or injury |
| Bariatric Surgery | ||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Ayush Benefit | ||||
| Covered up to sum insured | Covered | Covered | Covered | Covered |
| Maternity Benefits | ||||
Basic: Not Covered Essential: Normal Delivery: Up to Rs.15,000 or actuals whichever is less Caesarean Delivery: Up to Rs 25,000 (including pre and post natal expenses up to Rs.2,000) or actuals whichever is less Privilege: Normal Delivery: Up to Rs.25,000 or actuals whichever is less Caesarean Delivery: Up to Rs.50,000 (including pre and post natal expenses up to Rs.2,000) or actuals whichever is less (waiting period: 3 years) |
Not Covered | Not Covered | Silver & Gold: Not Covered Diamond: COvered up to 2.5% of the sum insured |
Not Covered |
| New Born baby cover | ||||
Basic: Not Covered Essential & Privilege: Up to Basic sum insured from 1st Day till expiry of Policy or the child is 91 days old whichever is earlier |
Not Covered | Not Covered | Silver & Gold: Not Covered Diamond: Covered up to 2.5% of the sum insured up to 90 days from the date of birth |
Not Covered |
| Daily Cash for Accompanying an Insured Child | ||||
Basic: Not Covered Essential: Rs.300 per day subject to maximum of Rs.9,000 Privilege: Rs.500 per day subject to maximum of Rs.15,000 |
Not Covered | Not Covered | Not Covered | Not Covered |
| Organ Donor Expenses | ||||
| Covered | Not Covered | Covered | Lumpsum payment of 10% of the sum insured. | Not Covered |
| Vaccination (In case of post bite treatment) | ||||
| Up to 100% of In-patient Treatment Sum Insured or actuals whichever is less | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | ||||
Individual: 1 Coupon at the end of every claims two continuous claims free year Family Floater: 2 Coupon at the end of every claims two continuous claims free year |
Not Covered | Not Covered | Not Covered | Not Covered |
| Hospital daily allowance | ||||
Basic: Rs.200 per day Essential: Rs.500 per day Privilege: Rs.1,000 per day (Hospitalisation exceeds 3 days for a maximum number of 7 days) |
Not Covered | 0.1% of the sum insured per day subject to maximum of 6 days per insured person | Silver: Not Covered Gold: 0.1% of Sum Insured (Rs.600 to RS.1,000) per day of Hospitalisation,subject to a maximum compensation for 10 days per Illness. Overall liability of the Company during the Policy Period will be limited to 1.5% of the Sum Insured Diamond: 0.1% of Sum Insured (Rs.1,200 to RS.2,000) per day of Hospitalisation,subject to a maximum compensation for 10 days per Illness. Overall liability of the Company during the Policy Period will be limited to 1.5% of the Sum Insured |
Not Covered |
| Co-pay | ||||
| 10% co-pay applicable for treatment in Non Network hospitals | 5% Co pay applicable on all claims | Option of voluntary Co-pay of 10% or 20% with premium reduction | Mandatory Co-pay of 10% up to 70years / Additional 20% above 70 years | 5% Co pay applicable on all claims |
| Pre-existing diseases coverage | ||||
| Covered after 3 years of continuous coverage | Covered after a waiting period of 4 years | Covered after 4 years of continuous coverage | Covered after 4 years of continuous coverage | Covered after 4 years of continuous coverage |
| Restore Benefit | ||||
| Up to 100% of Base Sum Insured per year | Not Covered | NIL Restoration benefit | NIL Restoration benefit | NIL Restoration benefit |
| General waiting period | ||||
| 30 days | 30 days | 30 days | 30 days | 30 days |
| Renewal Benefit / Cumulative Bonus | ||||
| 10% every year, maximum up to 50% of sum insured | 5% for every claim free year up to 50% of sum insured | Not Covered | Not Covered | 5% for every claim free year up to 50% of sum insured |
| Emergency Air Ambulance | ||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Available sum insured options | ||||
Basic: Rs.1 & 2 Lakhs Essential: Rs.3 to 5 Lakhs Privilege: Rs.6 to 10 Lakhs |
Rs.1 to 5 Lakhs | Rs.1 to 10 Lakhs | Silver: Rs.2 to 5 Lakhs Gold: Rs.6 to 10 Lakhs Diamond: Rs.12 to 20 Lakhs |
Rs.1 to 5 Lakhs |
| Policy can be purchased for | ||||
| 1/2/3 years | 1 year | 1/2/3 years | 1/2/3 years | 1 year |
| Eligibility criteria | ||||
| Adults from 18 to 70 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) |
| Renewability | ||||
| Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life |
| Claims loading | ||||
| No Loading | No Loading | Loading | No Loading | No Loading |
| Portablity(At the time of renewal) | ||||
| Yes | Yes | Yes | Yes | Yes |
| Tax Benefits Limit | ||||
| Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D |
