Universal Sompo health Insurance Plans

Aapat Suraksha Bima Health Insurance

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Aapat Suraksha Bima undertakes to pay a lump sum amount as selected by the proposer at inception on happening of an eventuality mentioned in the Policy. The Policy pays one time payment equal to the sum insured on conclusive diagnosis of existence of any of the five critical illnesses ,or occurrence of accidental death and/or permanent total disablement resulting from an accident.

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Universal Sompo Health Insurance
Number of lives covered *
Incurred Claims Ratio *
Universal Sompo Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio 20-21**
List of network hospitals
5,000+ hospitals
Number of policies issued *
Maximum family floater coverage
Self, Spouse + 4 dependent children
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Universal Sompo Aapat Suraksha Bima Health Insurance benefits

  • Coverages
  • Exclusions

Section I - Critical Illness

Compensation to the extent of sum insured against the person, if detected/ diagnosed for the first time during the Policy period as suffering from the following Critical Illnesses:
  • Paralytic Stroke: Damage of a portion of the brain due to vascular causes such as:
    • Cerebral Haemorrhage
    • Cerebral Thrombosis
    • Cerebral Embolism leading to
      • Total disability
      • Partial disability but of permanent nature
      • Disability resulting in a neurological deficit for more than six months.
  • Cancer: Disease manifested by the presence of a malignant tumor characterized by the uncontrolledgrowth and spread of malignant cells and invasion of tissue. The term ‘Cancer’ also includesLeukaemia and malignant disease of the lymphatic system such as Hodgkin’s disease. Any noninvasivecancer in situ and all skin cancers except invasive malignant melanoma are excluded.
  • End Stage Renal failure: The end stage renal failure as chronic irreversible failure of either of Kidneys to function, as a resultof which regular renal dialysis has to be instituted.
  • Coronary Artery Disease: Narrowing or blockage of coronary arteries affecting blood circulation to cardiac muscles, which requires the Insured Person to undergo surgery by means of coronary artery bypass graft/Angioplasty. This necessity of surgery must have been proven by coronary angiography.
  • Major Organ Transplant: Human to human transplant from a donor to the Insured Person of one or more of the following organs:
    • Kidney
    • Lung
    • Pancreas
    • Bone Marrow
  • The transplantation of all other organs, parts of organ or any other tissue transplant is excluded.The Insured Person must be required to undergo actual transplantation within 6 months of the firstdiagnoses as certified by Medical Practitioner.

Section II – Personal Accident

Bodily injury directly resulting to the death or Permanent Total disablement of Insured Person as specified in Table of Benefits as below:
1. Death 100
2. Loss of
Loss of sight (both eyes) 100
Physical separation of or loss of ability to use both hands or both feet 100
Physical separation of or loss of ability to use one hand and/ or both feet 100
Loss of sight of one eye and physical separation of or loss of ability to use either one hand or one foot 100
3. Loss of
a. Sight of one eye 50
b. Physical separation of or use of ability to use one hand or one foot 50
4. Permanent Total and Absolute Disablement 100

Exclusions of Universal Sompo Aapat Suraksha Bima Health Insurance

  • Pre-existing Diseases: Any condition ,ailment or injury or related condition(s) forwhich You had signs or symptoms and/orWere diagnosed ,and / or received medicaladvice /treatment ,within 48 months prior toYour first Policy with Us.
  • Any Critical Illness, which incepts or manifestduring the first 90 days from the date ofcommencement of the Policy.
  • Death within 30 days following the diagnosis ofthe Critical Illness
  • Any Critical Illness which arises or is causedby any one of the following:
    • Dry addiction, alcoholism, smoking ofmore than 30 cigarettes/cigars orequivalent intake of tobacco in a day andany complication, consequences arisingthere from.
    • Any Insured person suffering from HumanT.Cell Lymphotropic Virus Type III (HTLVIII)or Lymphadinopathy AssociatedViruses (LAV) or the Mutant derivatives orVariations Deficiency Syndrome or anySyndrome or a condition of similar kindreferred to as AIDS. The onus shallalways be on Insured Person to show anyevent was not caused by or did not arisethrough AIDS or HIV.
  • Any Insured Person under 5 or aged 55 yearsor more.
  • Any claim if a Critical Illness is caused directlyor indirectly or contributed to by or arisingfrom:
    • Ionizing Radiation or contamination byradioactivity from any nuclear fuel orfrom any nuclear waste fromcombustion of nuclear fuel or nuclearweapon materials.
    • War, Invasion, Act of foreign enemy,Hostilities, Civil war, Rebellion,Revolution, Insurrection, Mutiny,Military or usurped Power, Seizure,Capture, Arrest, Restraints andDetainments of all kinds, Princes ofwhatever nation conditions or qualityso ever.
  • Payment under Accidental Benefits arisingout of the following:
    • Committing or attempting suicide,intentional self-injury.
    • Whilst under influence of intoxicatingliquor.
    • Drug addiction or alcoholism.
    • Whilst engaged in any adventuroussports.
    • Committing any breach of law withcriminal intent.
    • War, invasion, act of foreign enemy,hostilities (whether war be declaredor not) civil war, rebellion, revolution,insurrection, mutiny military orusurped power, confiscation, seizure,capture, assault, restraint,nationalization, civil commotion orloot or pillage in connection herewith.
    • Ionizing radiation or contamination byradioactivity from any nuclear fuel orfrom any nuclear waste from thecombustion of nuclear fuel. For thepurpose of this exclusion, combustionshall include any self sustainingprocess of nuclear fission.
    • The radioactive, toxic, explosive orthe hazardous properties of anynuclear assembly or nuclearcomponent.
Disclaimer:“For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”

Universal Sompo Health Insurance FAQ’s

To avoid misunderstandings, you must read the information supplied when taking up your cover. If you are unsure about any aspect, you should contact our sales representative. We aim to provide a high level of service to all our clients but occasionally things can go wrong. When this happens we will do what we can to put things right. If you have a complaint about our service or the administration of your policy, please contact us in the first instance by telephoning our Customer Care or by emailing us or writing to us. The details of the various reach points are given in the Contact Us. We will aim to resolve your complaint over the telephone within 24 hours of receipt of your compliant.

Claim Settlement ratio is the ratio of claims settled against claims reported during thce year. Universal Sompo health insurance claim settlement ratio is 92% for FY 2018-19.

Health insurance covers you and your family against expenses incurred in a medical emergency. With medical bills on the rise, insurance helps in reducing the financial burden during hospitalization. Also, the cases of critical illnesses and lifestyle-related ailments have increased rapidly. Health insurance allows you to be better prepared for such events. The premium that you pay for your health insurance is eligible for tax deduction under Section 80D of the Income Tax Act.

The premium payable on your health insurance policy is based on the following factors:
  • Sum insured option is chosen
  • The number of family members to be covered
  • The age of the senior most person in the family to be covered
  • The type of policy you opt for - Basic, Premium, Optimum, Smart Super Health Insurance Policy


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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022