Universal Sompo health Insurance Plans

Arogya Sanjeevani health insurance

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Highlights of Universal Sompo Arogya Sanjeevani Policy

  • Affordable Policy:Highly beneficial and affordable health insurance policy
  • Flexible Policy:Policy can be taken on Individual and Floater basis
  • Day Care Procedures:All Day care Procedures covered
  • Ayush Cover:AYUSH Treatment covered
  • Modern Treatment Cover:Modern Treatments are covered – Upto 50% of the Sum Insured.
  • Policy Term:One year

Universal Sompo Health Insurance Review

Universal Sompo Health Insurance
Number of lives covered *
1,137,000
Incurred Claims Ratio *
92.00%
Universal Sompo Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio 20-21**
95.31%
List of network hospitals
5,000+ hospitals
Number of policies issued *
267,221
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 Arogya Sanjeevani Policy benefits

  • Features
  • Coverages
  • Terms and conditions
  • How to buy
  • Claims
  • Cancellation
  • Exclusions

Key features of Universal Sompo Arogya Sanjeevani Policy

Feature Description
Sum Assured Minimum Sum Assured is ₹ 1 Lac
Maximum Sum Assured is ₹ 5 Lacs
(Sum Assured can be opted for in multiples of ₹50,000)
Minimum & Maximum Entry Age for Principal Assured Adult
  • Minimum Entry Age is 18 years
  • Maximum Entry Age is 65 years
Children
  • Minimum Entry Age is 3 months
  • Maximum Entry Age is 25 years
Policy Term 1 year
Policy Type Individual Plan / Family Floater Plan
Hospitalisation Benefit Limits
  • For hospitalization expenses like room, boarding, nursing expenses up to 2% of Sum Assured or a maximum of ₹5,000 per day.
  • ICU/ICCU expenses will also be provided up to 5% of sum assured or a maximum of ₹10,000 per day
  • Ambulance Charges upto ₹2,000 per hospitalisation
  • Sub-limits of cataract surgery are equal to actual expenses i.e. 25% sum assured or ₹4 lacs, whichever is lower.
Pre & Post Hospitalization Pre Hospitalization expenses upto – 30 days
Post Hospitalization expenses upto – 60 days
Initial Waiting Period 30 days waiting period. No claim will be paid in first 30 days after buying policy
Specific Waiting Period 24 months - Benign ENT disorders, Sinus, Cataract and age-related eye illnesses, Non-infective arthritis, tympanoplasty, Polyps, Gastric ulcer, Rheumatism, Gout, Tonsillectomy, Mastoidectomy, cysts, Spinal diseases except for accidental cases
48 months - Joint replacement treatment unless it is from an accident, Osteoporosis, etc
48 months - Pre-Existing Disease (pre-existing disease or medical condition)
Co-payment Co-pay fixed at 5% for all ages/sum insureds in this policy
AYUSH Treatment AYUSH treatments are covered
(AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy)
NCB (No Claim Bonus) NCB (No Claim Bonus) of 5% for each year up to 50% of the sum assured is covered.
Other Policy Benefits
Family Members that can be covered under Floater Plan The policyholder can include dependents, such as their legally wedded spouse, parents, dependent children (including legally adopted children) and parents-in-law.
Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage
Cashless Benefit Yes, Cashless Treatment is available under this policy at the respective insurance company’s Network Hospitals
Premium Payment Frequency Premiums can be paid on a Monthly, Quarterly, Half-yearly and Annual basis.
Renewability Lifetime Renewability available on this policy
Portability The policy offers the Portability option to other health insurance companies
Daycare Treatment It covers the expenses arising out of any day care treatment procedures
Specific Coverages under this Policy
Modern Treatment Methods
(Covered upto 50% of the Sum Insured)
  1. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)
  2. Balloon Sinuplasty
  3. Deep Brain Stimulation
  4. Oral Chemotherapy
  5. Immunotherapy – Monoclonal Antibody to be given as injection
  6. Intra Vitreal injections
  7. Robotic surgeries
  8. Stereotactic radio surgeries
  9. Bronchial Thermoplasty
  10. Vaporization of the prostrate (Green laser treatment or holmium laser treatment)
  11. IONM – (Intra Operative Neuro Monitoring)
  12. Stem Cell Therapy - Hematopoietic stem cells for bone marrow transplant for haematological conditions to be cover
Plastic Surgery and Dental Treatment Expenses The cost of any dental or plastic surgery treatment taken as a result of an illness or injury is covered under this policy


Expenses Covered under Universal Sompo Arogya Sanjeevani Policy

  • Pre & Post Hospitalization Expenses
    This policy will cover all the pre-hospitalization expenses (upto 30 days) and post-hospitalization expenses (upto 60 days) following an emergency illness or accidental injury.
  • ICU Charges
    The Arogya Sanjeevani policy pays ICU/ICCU expenses be provided up to 5% of sum assured or a maximum of ₹10,000 per day.
  • Room Rent
    It covers the room rent of the hospital to up to a maximum of ₹5,000 per day.
  • Ambulance Services
    It covers the cost of ambulance services up to a maximum of ₹2000 per hospitalization.
  • Cataract Surgery
    It also covers the cost of cataract surgery upto a maximum of ₹40,000 or 25% of the sum insured amount, whichever is less for each eye.
  • Coronavirus (COID-19) Expenses
    It covers any expenses incurred on hospitalization/treatment due to contracting COVID-19 or coronavirus disease.
  • AYUSH Treatment
    AYUSH treatments are covered at recognised medical centres. (AYUSH means all treatments related to Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, Homeopathy).
  • New Age/ Modern Treatment
    This policy also covers the cost of modern/ new age treatment up to a maximum of 50% of the sum insured amount. The list of illnesses are in the table above.

Terms and Conditions of Universal Sompo Arogya Sanjeevani Policy

  • Sum Assured
    This policy offers the multiple sum assured options from ₹1 lac to ₹5 lacs in the multiple of ₹50,000. The sum assured is available on both individual and family floater basis.
  • Policy Duration
    This policy scheme offers policy term option of one year and is renewable on a lifetime basis.
  • Co-payment
    For insureds of all age categories and sum insureds, this policy offers a standard co-payment option of 5% of the incurred claims amount payable at the time of settlement.
  • Cumulative Bonus
    Arogya Sanjeevani policy also provides a bonus of 5% on the total sum insured amount for every claim-free year that is passed by the insured, and this is accumulated upto a maximum of 50% of the sum insured as a bonus.
  • Frequency of Premium Payment
    The premium for this policy can be paid on a monthly, half-yearly, quarterly, and annual basis.
  • Portability
    Arogya Sanjeevani policy is easily portable from one insurance company depending on the requirements of the insured.
  • Grace Period
    For annual premium payment, 30 days grace period is allowed and for other modes (monthly, quarterly, half yearly) of premium payment 15 days grace period is allowed.
  • Free Look Period
    The policy has a Free Look period of 15 days, within which the insure can cancel the policy and expect a full refund.

How can one buy the Universal Sompo Arogya Sanjeevani Policy?

Perhaps the easiest way to purchase a Arogya Sanjeevani health insurance policy will be online because the IRDAI has allowed insurance companies to issue the Arogya Sanjeevani electronically to the policyholders. This means that the insurance company can only share a online pdf document as an insurance policy to the insured unlike all other insurance plans currently in the Indian market. The simple process to be followed is:
  • Go online to a comparison website like eindiainsurance
  • Compare the quotes across all the insurance companies – Importantly since all insurance companies, will be offering exactly the same set of benefits for this plan, the individual can compare the premiums and also review the financial parameters of the insurance company while making a final decision
  • Fill up the Arogya Sanjeevani proposal form of the respective insurance company
  • Make a payment directly online through the payment gateway and then the policy will get issued by the respective insurance company

Moreover, the IRDAI has also directed all health insurance companies to provide a certificate of insurance to each policyholder for the benefits, terms and conditions of their Arogya Sanjeevani policy.

Universal Sompo General Insurance Co Ltd
For Travel Claims
  • Assistance Partner / TPA: Falck India Pvt Ltd
  • Call at: Toll-Free Numbers for assistance18775367264 / Alternate +91 1244498766
  • Fax at: +91 1244006674
  • Email at: UniversalSompo@falck.com
  • Write at: Falck India Pvt Ltd, Upper Floor, The Peach Tree, Block – C, Sushant Lok – I Sector 43, Gurugram, Haryana – 122015
  • Website: www.falck.com

Some Do’s & Dont’s for Travel Claims
DO'S DONT's
Do make sure you take out your insurance before you travel. Don't think that buying travel insurance is an unnecessary extra expense on top of your holiday cost.
Do make sure that you have disclosed any pre-existing medical conditions to your insurer when you take out the policy (including yourself and your dependent family). Don't arrange your own evacuations/repatriation unless your life is in danger without it and you and your companions cannot talk to the insurer in time.
Do ensure that you take all documentation of your travel policy with you on holiday, especially the emergency assistance telephone number. Don't keep your properties, travel documents unattended.
DO contact the Assistance & claim-settling Co. for assistance and inform immediately, with full details. The insured can contact Falck India Pvt Ltd which will provide emergency assistance and claims administration services guidance. Don't get admitted in a hospital merely for investigation, evaluation or health checkups- It will not be approved.
In extreme emergency medical conditions prohibiting getting in touch with assistance co., get admitted to the nearest facility/hospital. Request your representative to contact the assistance and claim settling co for further process. Don't forget to record the details of damage caused to any property or injury to anyone involved..
For reimbursement claim please intimate ASAP to Falck India Pvt Ltd via fax/ email and seek documentation advice before return from abroad. Don't claim the following expenses:- Telephone/fax , food and beverages , documentation charges
DO keep all Original bills and receipts, travel documents, original medical reports for easy process of reimbursement claim. Don't panic, If you receive a bill or notice from a provider or collection agency, simply forward it to Falck India Pvt Ltd by the quickest means possible (fax or e-mail), and to take action directly with the provider.
In case of loss of passport, the police authorities to be informed, contact the nearest Indian embassy for further guidelines? Don't admit any liability without written consent of Falck India Pvt Ltd to any party in what so ever form.
In case of Out Patient treatment (OPD) kindly forward the original papers to Falck India Pvt Ltd Haryana office. Don't be reckless and always safeguard yourself from unhealthy event or circumstance as if the insurance is not in force.
Do take and keep detailed notes of all conversations with insurance company representatives, and get names, phone numbers, and job titles of people you speak with.
DO be honest and forthcoming with your insurer. Even if it is embarrassing, it is better if your insurer knows all the facts. Failing to be candid with your insurer might invalidate your policy or cause a denial of coverage.
Please send claim papers for reimbursement cases within 30 days from the date of return to India.

For Health Claims (Both Cashless & Reimbursement)
  • Call at: Health Helpline 1800 200 5142 or
  • Email at: healthserve@universalsompo.com
  • Fax at: Toll Free fax 1800 200 9134
  • Write at: Universal Sompo General Insurance Company Limited, Health Claims Management
    Office, 5thFloor ,Assotech One, C-20/1 A, Block- C, Sector- 62, Noida
    Uttar Pradesh201309

Please note to inform the Insurer / TPA about your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.
If unable to reach Universal Sompo Health Claims at the contact details above, you can also
  • Email Duly Filled i-CLAIM template: contactclaims@universalsompo.com
  • Call Universal Sompo at: Toll Free Numbers1-800-22-4030 (For MTNL & BSNL Lines), 1-800-200-4030 (For Reliance & others)
  • Call Centre Helpline Numbers: +91-22-27639800 / +91-22-39133700

Policy Cancellation and Refunds

The insured can cancel the policy at anytime during the policy year, subject to following refund options:
Time of Cancellation % of Premium Refund
Free Look Period 100% refund
30 days 75% refund
31 days – 3 months 50% refund
3 months – 6 months 25% refund
> 6 months NIL Refund


Exclusions under the Universal Sompo Arogya Sanjeevani Health Insurance Plan

The Arogya Sanjeevani health insurance policy excludes the following treatments:
  • Maternity Expenses - Cost of treatment related to pregnancy and child birth
  • Domiciliary hospitalization - Domiciliary hospitalization expenses
  • Outpatient Treatment – Policy covers only expenses incurred during Inpatient treatment (atleast 24 hours hospitalisation)
  • Adventure/ Hazardous Sports – Active Participation in a hazardous activities including scuba diving, rock climbing, sky diving, parasailing, deep-sea diving, mountaineering, etc, as a professional
  • Cosmetic or Plastic Surgery – Unnecessary expenses for cosmetic/plastic surgery following an accident, burn injury, other medically necessary treatment
  • Diagnostic or Investigative Tests - Diagnostic or Investigative tests done by the insured which are elective in nature
  • Alcohol/ Drug addiction- Treatment following addiction of alcohol or drug/substance abuse
  • Bed Rest or Rehabilitation Expenses
  • Expenses for Treatment of Sterility or Infertility
  • Claims due to a Nuclear Attack or War/ War-like situation
  • Expenses incurred for Weight Control/ Obesity Treatment
  • Any Treatment received by the insured outside the boundaries of India
  • Expenses relating to surgery or treatment of Gender change
Please review the Terms & Conditions/Policy Wordings for the complete list of exclusions under the Arogya Sanjeevani policy.

FAQ’s on Universal Sompo Arogya Sanjeevani Insurance

Arogya Sanjeevani is a health insurance policy that protects one at the time of hospitalization following an accident or sickness. It’s a newly launched health insurance policy with standard features which is to be offered by all health insurance companies in India starting from 1st April, 2020 onwards.

Yes, under the Family Floater variance of the Arogya Sanjeevani Policy, one can get coverage for themselves, their legally wedded spouse, dependent children, parents, parents in laws. One can also choose to buy individual policies for each of these family members. Note that any children who are above 18 yrs and financially independent will not be eligible for family floater coverage.

The eligibility criteria is as follows for the Entry age of the Primary Insured:
  • Adult
    • Minimum Entry Age is 18 years
    • Maximum Entry Age is 65 years
  • Children
    • Minimum Entry Age is 3 months
    • Maximum Entry Age is 25 years

The sum insured options available under the Arogya Sanjeevani plan range from ₹1 lac to ₹5 lacs with multiples of ₹50,000.

The coverage is as follows:
  • Pre Hospitalization expenses upto – 30 days
  • Post Hospitalization expenses upto – 60 days

Yes, this plan covers treatment related to Coronavirus, subject to the expenses not being incurred during the initial waiting period under the policy.

All day care treatments are covered under this plan.

No, while the IRDAI has allowed the insurance companies the flexibility to charge premium according to it’s portfolio and claims experience, the premium charged will however be the same for the insurance companies across India.

Arogya Sanjeevani policy comes with a policy term of one year only, but renewable on a lifetime basis.

Yes, even NRIs (Non-Resident Indians) can buy Arogya Sanjeevani policy. Although the customer needs to be in India at the time of policy buying and should pay the premium in Indian currency through an Indian bank account. Importantly, expenses incurred only for treatment in India will be paid under this policy.

Yes. You can port your existing health insurance policy into Arogya Sanjeevani.

The Arogya Sanjeevani policy comes with a co-pay of 5%, which means that at the time of claim settlement, the insured will need to pay 5% of the claims amount towards the settlement. This is irrespective of the age of the insured.

Arogya Sanjeevani policy also provides a bonus of 5% on the total sum insured amount for every claim-free year that is passed by the insured, and this is accumulated upto a maximum of 50% of the sum insured as a bonus.

Prospectus

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Proposal form

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Policy wordings

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