Universal Sompo A Plus Health Insurance

Universal Sompo A Plus Health Insurance plan offers extensive health protection at an affordable cost. This plan covers the medical and surgical expenses of insured members. If, during the policy period, one or more insured individuals need to be hospitalised for the treatment of an illness or injury at a hospital or daycare center, following the advice of a qualified medical practitioner, the company will reimburse the expenses according to the coverage and sum insured mentioned in the policy schedule.

Key Features of Universal Sompo A Plus Health Insurance Plan

Mentioned below are the key features of this health insurance policy:

• Family-Focused: The policy can be bought for individuals or as a family floater. It covers up to 6 members, including the primary insured and 5 family members. The covered relationships include self, spouse, children, parents, siblings, in-laws, grandfather, grandmother, grandson, granddaughter, son-in-law, daughter-in-law, brother-in-law, sister-in-law, nephew, and niece.
• Diverse Plan Choices: The Universal Sompo A Plus plan boasts a trio of unique variants - Silver, Gold, and Diamond, catering to various health and lifestyle needs, so you can choose the one that aligns best with your circumstances.
• Policy Term: With Universal Sompo A Plus Plan, the Policy Term can be 1 year, 2 years & 3 years. The choice of policy term depends on the policyholder's preferences and convenience. Longer-term policies can provide continuity and reduce the hassle of frequent renewals, while shorter-term policies offer more flexibility for those who may want to reevaluate their insurance needs more frequently.
• Vast Network of Hospitals: Universal Sompo collaborates with a vast network of hospitals. This means that if you choose this plan, you'll have the advantage of accessing a wide range of hospitals where you can receive treatment without paying upfront.
• Outpatient Treatment Reimbursement (Only for Diamond Plan): This feature covers the expenses for medical treatment that doesn't require a hospital stay. The coverage applies either individually or for the entire family, depending on your policy type.
• Global Coverage (Only for Diamond Plan): This feature extends your insurance coverage to medical expenses incurred outside India, subject to specific conditions. Each claim will have a 10% deductible, meaning you'll pay a portion of the expenses yourself. Also, you can use only the basic sum insured and the cumulative bonus for this coverage.
• Psychiatric Illness Coverage: This feature provides coverage for medical expenses related to psychiatric illnesses. To be eligible, the first diagnosis and hospitalisation for a psychiatric illness must occur during the policy period. There may be waiting periods and sub-limits for specific psychiatric illnesses, which are specified in your policy schedule.

Variants of Universal Sompo A Plus Insurance Policy

The three different variants of Universal Sompo A Plus health insurance policy are:

Features	Silver	Gold	Diamond
Sum Insured	Rs. 5 Lakh to 1 Crore	Rs. 5 Lakh to 1 Crore	Rs. 5 Lakh to 1 Crore
In-Patient Hospitalisation	Upto Sum Insured	Upto Sum Insured	Upto Sum Insured
Pre-Hospitalisation	60 days	60 days	90 days
Post Hospitalisation	120 days	180 days	180 days
Day Care Procedures	547 days	547 days	547 days
AYUSH Treatment	Upto Sum Insured	Upto Sum Insured	Upto Sum Insured
Second Opinion	Covered up to Rs. 2500	Covered Upto Rs. 5000	Covered up to Rs. 10,000
Domiciliary Treatment	Upto Sum Insured	Upto Sum Insured	Upto Sum Insured
OPD Expenses	Not Covered	Not Covered	10% of Base Sum Insured, Maximum to Rs. 20,000
Global Cover	Not Covered	Not Covered	Upto Sum Insured
Ambulance Cover	Covered Upto Rs. 2500	Covered Upto Rs. 5000	Covered Upto Rs. 10,000
Organ Donar	Upto Sum Insured	Upto Sum Insured	Upto Sum Insured
Auto Restore Benefit	Upto Sum Insured	Upto Sum Insured	Upto Sum Insured

Here’s a brief description of each variant:

• Silver Plan: The Silver variant of the Universal Sompo A Plus Policy offers essential coverage, including in-patient hospitalisation expenses, pre-hospitalisation, and post-hospitalisation expenses, coverage for daycare procedures, AYUSH treatment, and more. It provides a reasonable level of protection with benefits such as ambulance coverage and second opinion support, making it a practical choice for those seeking basic healthcare coverage.
• Gold Plan: The Gold variant builds upon the Silver Plan, extending the coverage to include a longer pre-hospitalisation period, enhanced post-hospitalisation coverage, and higher limits for second opinion and ambulance expenses. It also introduces global coverage, ensuring you're protected even when seeking medical treatment abroad. This plan is a suitable option for those looking for more extensive healthcare benefits.
• Diamond Plan: The Diamond Plan offers the most comprehensive coverage among the three variants. It includes the longest pre-hospitalisation and post-hospitalisation coverage, substantial limits for second opinions and ambulance services, and a unique feature: coverage for Outpatient Department (OPD) expenses, covering a portion of non-hospital medical costs. This plan is ideal for individuals who want the highest level of health protection, including comprehensive outpatient support and extensive global coverage.

Eligibility Criteria of Universal Sompo A Plus Health Insurance Plan

The eligibility criteria for the Universal Sompo A Plus health insurance plan are as follows:

Parametres	Eligibility Criteria
Minimum entry age	Adults: 18 years Children:91 days
Maximum entry age	Adults – 75 years Children– 25 years
Policy duration	1, 2, and 3 years
Sum insured	Rs. 5 lakhs to Rs. 1 crore

Benefits of Universal Sompo A Plus Health Insurance Plan

The benefits of the Universal Sompo A Plus Heath Insurance Plan are as follows:

• Tailor-Made Plans: The Universal Sompo A Plus Plan offers customised options to suit your specific healthcare needs, ensuring you get the coverage that fits you best. It's not one-size-fits-all; you get to choose the coverage that matches your specific health needs.
• Flexible Sum Insured: This is like choosing the safety net for your health. You get to decide how big or small you want that safety net to be. If you feel comfortable with a lower amount, you can go for that. But if you want more protection and can afford it, you can choose a higher amount. It's like picking the right-sized shield that suits your wallet and your health needs.
• Wide Hospital Network: The plan provides access to a broad network of hospitals, making it convenient for you to receive medical care and services wherever and whenever needed.
• Affordable Premium: Premium is what you pay regularly for your insurance. Despite all the good things this plan offers, the price you pay is reasonable. It won't cost you too much, so you can get good healthcare without emptying your wallet.

Inclusions of Universal Sompo A Plus Health Insurance Plan

The Universal Sompo A Plus Health Insurance plan includes the following:

• In-patient Hospitalisation: Covers medical expenses incurred during hospital stays.
• Pre-hospitalisation Expenses: Includes medical costs for tests and consultations leading up to hospital admission.
• Post-hospitalisation Expenses: Takes care of medical expenses after discharge from the hospital.
• Daycare Procedures: Covers treatments that don't require overnight hospitalisation.
• AYUSH Treatment: Includes alternative therapies like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
• Domiciliary Hospitalisation: Covers medical treatment at home when hospitalisation isn't possible.
• Second Opinion: Provides the option to seek another medical opinion before making treatment decisions.
• Ambulance Cover: Offers financial support for ambulance services.
• OPD Expenses: Covers Outpatient Department Expenses, such as doctor visits and diagnostics.
• Global Cover: Extends coverage for medical expenses abroad.
• Organ Donor: Includes medical expenses related to organ transplants for donors.
• Psychiatric Illness: Covers 25% of the base sum insured for psychiatric treatment, up to a maximum of Rs. 5 lakhs.

Exclusions of Universal Sompo A Plus Health Insurance Plan

Exclusions of Universal Sompo A Plus policy are as follows:

• Diagnostic Tests: The coverage does not include diagnostic tests unless directly linked to your diagnosis and treatment.
• Non-medical Expenses: Excludes costs for non-medical appearance-altering procedures.
• Injuries During Adventurous Sports: No coverage for injuries during hazardous or adventure sports.
• Criminal Act Injuries: Expenses resulting from criminal acts aren't covered.
• Substance Abuse Treatment: Costs related to alcohol, drug, or other substance abuse treatment are excluded.
• Over-the-counter Supplements: Excludes over-the-counter supplements unless prescribed during hospitalisation.
• Minor Vision Correction Expenses: Expenses for minor vision correction (less than 7.5 diopters) are not covered.
• Sterility and Infertility Cost: Excludes costs related to sterility and infertility.
• Conflict-Related Injuries: Injuries due to war, invasion, rebellion, and related events are not covered.

Riders Available With Universal Sompo A Plus Health Insurance

The list of riders available with Universal Sompo A Plus plans is as follows:

• Pre-Existing Disease Waiting Period Waiver: This add-on cover is a valuable addition to your health insurance policy. It allows you to skip the waiting period that usually applies to pre-existing medical conditions. A pre-existing condition is one that you already have at the time of buying the insurance. Typically, insurance policies come with a waiting period during which claims related to pre-existing diseases are not accepted. This rider eliminates that waiting period, providing immediate coverage for your pre-existing conditions.
• Maternity Cover: The Maternity Cover is an add-on to your health insurance policy that covers the costs associated with pregnancy and childbirth. This can include hospitalisation expenses, pre and post-natal care, delivery charges, and sometimes even newborn baby care. It is a beneficial rider for expectant mothers or couples planning to have a child.
• Diabetes Day 1 Cover: If you have the Diamond Plan, this add-on covers the medical expenses for outpatient treatment of diabetes from day one, without any waiting period. This can include doctor consultations, medications, and tests related to diabetes management. It provides financial support for individuals with diabetes, ensuring immediate coverage for their condition.
• Hypertension Day 1 Cover: This add-on cover, available with the Diamond Plan, is designed to cover outpatient treatment expenses for hypertension from the very first day of the policy. It includes medical costs related to the management of high blood pressure, such as doctor consultations, medications, and diagnostic tests.
• Non-Medical Items: Non-Medical Items coverage is an add-on that extends the benefits of your health insurance policy to items or equipment necessary for your medical care but is not typically covered. This can include expenses for medical aids like crutches, wheelchairs, or specialised equipment.

Documents Required to Buy Universal Sompo A Plus Health Insurance Plan

To buy Universal Sompo A Plus Health Insurance, the following documents are required:

• A fully filled application form.
• A document to prove your identity, like your Aadhar card, passport, voter ID, or driver's license.
• A document confirming your age, such as a birth certificate, school leaving certificate, or passport.
• Proof of your address, like utility bills, a rental agreement, or your Aadhar card.
• Small-sized photos of yourself.
• In some cases, you might need to provide medical reports or health check-up reports before getting the insurance.
• Any extra documents the insurance company asks for during the application process.

How to Buy Universal Sompo A Plus Health Insurance Plan?

To get Universal Sompo A Plus health insurance from InsuranceDekho, follow these steps:

Step 1: Visit the Health Insurance section on the official InsuranceDekho website.

Step 2: Choose "Universal Sompo" from the list of Health Insurance Companies.

Step 3: Pick "Universal Sompo A Plus" from the health insurance plans available.

Step 4: Read through the terms and conditions in the Universal Sompo A Plus policy document carefully.

Step 5: Upload all the necessary documents to finish the Know Your Customer (KYC) process.

Step 6: After completing KYC, make your premium payment online.

Step 7: You'll get the policy document in your registered email.

Claim Process of Universal Sompo A Plus Insurance Plan

Universal Sompo A Plus insurance has two ways to make a claim: Cashless Claim and Reimbursement Claim.

Cashless Claim

• Visit a hospital in the Universal Sompo insurance network near you.
• Provide your Universal Sompo A Plus plan info and any needed details.
• Hand in the required documents and the insurance company will send a pre-authorisation form.
• Once they check your documents, the insurance company will pay your medical costs directly at the network hospital.

Reimbursement Claim

• Choose any nearby hospital and pay for your medical expenses.
• Request a reimbursement claim on the insurance company's website.
• Give them the Universal Sompo A Plus claim form and all the plan details.
• After approval by the insurance company, they will reimburse the policyholder.