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Universal Sompo Health Insurance

Universal Sompo is a general insurance company which offers various general insurance plans and health insurance is among one of them. In the health insurance category, the company offers a range of health products which are beneficial for the customers. The plans offer a wide scope of coverage features and the premium rates are also affordable. Health products offered by the company are of different types. Individuals can find personal accident plans, individual and family floater health plans, group health plans, fixed benefit health plans, loan protection plans and also micro insurance health insurance plans. Therefore, in the health insurance segment, Universal Sompo has a wide variety of plans for suiting the needs of every customer.

Key Advantages and Benefits of Universal Sompo Health Insurance Plans

The main advantages of Universal Sompo's health insurance plans can be understood from the following key points:

  • Plans are offered for individuals and also for families on a floater basis.
  • There are various personal accident plans too which cover accidental death, accidental total and partial disablement.
  • Micro health insurance products are also available with the company.
  • Critical illness plan is also available which covers critical illnesses and pays a lump sum benefit in case of diagnosis of any covered illness.
  • Senior citizen health insurance plans provide coverage for senior citizens at affordable premium rates.
  • Loan secure policy takes care of the outstanding loan in case the insured faces a medical contingency.

List of Universal Sompo Health Insurance Policies

As stated earlier, Universal Sompo offers a range of health insurance plans. Here is a list of all the policies offered by the company:

Individual health insurance

This policy covers individuals on a single sum insured basis. Families can also be covered under the plan. The plan covers both inpatient hospitalisation as well as domiciliary hospitalisation. Coverage is allowed for up to Rs.5 lakhs to individuals aged up to 55 years. Pre-entrance medical check-ups are required if the insured is 45 years and older. An additional critical illness cover is also available under the plan. This cover can be bought by paying an additional premium. Pre-existing illnesses are not covered under the plan. For handling claims, there is an in-house claim management team of the company which helps in getting the claims settled quickly.

Group health insurance policy

As the name suggests, this policy covers a group of individuals under a single plan. Employer employee groups or any other registered groups can buy this policy. Inpatient and domiciliary hospitalisation are covered under the plan. The premium depends on the size of the group and the age of the insured members. Sum insured is allowed up to Rs.5 lakhs. Various add-ons are available at an additional premium like coverage for critical illnesses, maternity benefit, pre-existing illnesses, etc. Hospital cash benefit is allowed to each member for each day of hospitalisation.

Individual accident policy

This is a personal accident health insurance plan meant for individuals. The policy comes in three different coverage options. The basic cover covers accidental deaths only. In wider cover, accidental death, permanent total and permanent partial disablements are covered. In the comprehensive cover, accidental death, permanent total and permanent partial disablements and temporary total disablements are covered. Individuals aged 5 years to 65 years can be insured under the plan. Optional extensions as well as other coverage features are also available under the plan.

Janta Personal Accident Insurance

This is also a personal accident policy for both individuals and families. Coverage is allowed from age 5 years to 25 years. The policy covers death due to an accident, permanent total disablement and temporary total disablement. There are various discounts available under the plan. For group coverage where the number of insured members is 26 and above, discounts ranging from 5% to 25% of the premium are available. There are other discounts based on the nature of claim and for not incurring very high claims in a policy year.

Group personal accident policy

This policy covers a group of individuals. Three coverage variants are available of Basic, Wider and Comprehensive. Dependent family members of the insured members can also be covered under the first two variants. Besides covering accidental deaths and disablements, the policy also covers transportation costs, cost of clothing, ambulance charges, education fund and loss of employment. Medical expenses extension and hospital allowance extension covers are available as optional coverage features.

Aapat Suraksha Bima Policy

This policy provides a unique coverage against accidental death, disablements and critical illnesses. The policy, thus, is a combination of critical illness insurance and personal accident insurance. The plan pays the sum insured in one lump sum if the insured meets with an accidental death, becomes permanently disabled due to an accident or gets diagnosed with any one among the five covered critical illnesses. The illnesses covered include paralytic stroke, cancer, renal failure, coronary artery disease and major organ transplant.

Loan secure insurance policy

The policy is a unique health insurance plan designed for loan borrowers. Individuals aged 20 years till 50 years, who have a loan to their names can buy this policy. There are various coverage features under the plan. The first segment of the policy covers up to 18 major and critical illnesses depending on the plan variant selected. If the insured is diagnosed with any of the covered illness, the sum insured is paid in one lump sum. The second segment covers accidental deaths and permanent total disablements. Under segment three, the financial loss suffered due to loss of job is covered. The policy pays up to three loan instalments in case of loss of job due to specified perils. The insured can choose either a fixed sum insured or a sum insured on a reducing balance method to match the loan amount.

Hospital cash insurance policy

This is a fixed benefit health insurance plan which pays a daily benefit in case the insured is hospitalised for more than 24 hours. Individuals aged 18 years to 70 years can buy the policy. Even dependent children can be covered if they are 6 months old and above. There are six benefit options to choose from. The individual can choose a daily amount ranging from Rs.500 per day to Rs.3000 per day of hospitalisation. Maximum benefit is paid for up to 180 days depending on the plan variant selected. There is also an ICU benefit and a convalescence benefit under the plan.

Saral Suraksha bima

This is a micro health insurance product. The plan is meant for individuals living in the rural areas who cannot afford high health insurance coverage and premiums. The policy covers five critical illnesses, accidental death and accidental permanent total disablement. Sum insured for critical illness is allowed from Rs.10, 000 to Rs.25, 000. In case of personal accident contingencies, the available sum insured levels are Rs.20, 000, Rs.40, 000 and Rs.50, 000. Pre-existing illnesses are covered after a continuous period of 48 months and there is a waiting period of 90 days for critical illnesses. Illnesses incurred within the first 90 days of buying the policy would not be covered.

Smapoorna Suraksha Bima

This again is a micro insurance health product which caters to the healthcare requirements of the rural population of India. The policy covers damages to the house and its contents due to specified perils. Burglary theft is also covered by the plan. The third segment of the plan covers personal accident. Under this cover, accidental deaths and permanent disablements are covered under two variants. Other coverage features are also inbuilt in the personal accident cover like cost of transportation, cost of clothing, ambulance charges, education fund, etc.

Senior citizen health insurance policy

This health plan is meant for senior citizens who are 60 years and above. Senior citizens can buy this policy for themselves and their spouses too. The maximum entry age is limited to 70 years. Sum insured is allowed for up to Rs.5 lakhs. Inpatient hospitalisation expenses, pre and post hospitalisation, daily hospital allowance, etc. are covered under the plan. There is also a critical illness cover which covers six major illnesses and pays a lump sum benefit on diagnosis of any one illness.

Complete healthcare insurance

This is one of the best health insurance plans offered by Universal Sompo. The plan covers the entire family under its scope of coverage. Besides providing coverage for inpatient hospitalisation and other medical expenses, the plan also covers expenses incurred on an outpatient basis. There are other value added services offered by the plan too. There are three coverage variants and the policyholder can choose any variant as per his requirement. The sum insured is automatically restored if it is exhausted in a policy year. Thirteen family relationships can be covered under the plan. Moreover, the plan has inbuilt coverage features for maternity and also allows HIV positive individuals to be covered under its scope. The available policy tenure is 1, 2 and 3 years while the sum insured levels depend on the plan variant selected. The sum insured starts from Rs.1 lakh and goes up to Rs.10 lakhs. A maximum of two adults and 4 children can be covered under the family floater variant of the plan.


This is a specially designed policy for emigrants whose passports have ECR required. Individuals aged 18 to 65 years can buy this policy. Coverage is available when individuals stay abroad for employment related reasons. Dependent children, parents and spouse can also be covered under then plan. Coverage is granted for accidental death, accidental disablement, transportation of the attendant in case of accidental injuries, hospitalisation expenses, maternity related expenses, day care treatments, employment related contingencies, repatriation expenses and legal costs incurred. Coverage for personal accident contingencies is allowed for Rs.10 lakhs and the policy is issued for a period of 2 years and 3 years.


This policy is designed for schools and educational institutions. They can take this policy for the protection of their children. Students and school staff aged 3 years to 65 years can be covered under the plan. The coverage under the plan is divided into various sections. Under Section A, accidental death, permanent total disablement and permanent partial disablement of the student and/or the parent is covered. Under Section B, medical coverage is allowed for specified illnesses and treatments. Section C provides coverage against fire. Losses incurred due to fire and related perils are covered under this section. All the sections have corresponding additional coverage features called extensions. The policyholder can choose any extension as required by paying an additional premium.


This is a rural health insurance policy for an individual. The individual and his family can be covered under the plan. Individuals aged 18 years to 65 years can buy the plan. For dependent children, the minimum entry age is 6 months. Coverage is allowed for personal accident, critical illness and hospital cash in different coverage levels. The policyholder can choose any coverage level based on his requirements.

SwarnaGraminBimaYojana (Group)

This is a group health plan for the rural sector. The coverage features are same as provided under the above plan. The only difference is that a group of individuals are covered under the plan. NGOs, financial institutions and banks can take this policy for their rural groups. The plan allows coverage variants under hospital cash and critical illness cover. Policyholders can choose a suitable coverage variant as per their requirements. Pre-existing illnesses can also be covered under the plan if an additional premium is paid. In that case, pre-existing illnesses would be covered from the start of then policy.

Critical illness insurance policy

This is a fixed benefit health insurance plan which covers critical illnesses. The policy can be taken for covering family members including spouse, dependent children, dependent parents, and parents-in-law. The coverage is, however, allowed on an individual sum insured basis. Entry age is 18 years to 65 years while dependent children can be covered from 5 years onwards. Eleven critical illnesses are covered under the plan. The tenure available is 2 years and 3 years. If the policy is bought for a longer tenure, a discount is allowed. The discount is 10% for a 2-year policy and 15% for a 3-year policy. Sum insured levels available under the plan are from Rs.2 lakhs and up to Rs.20 lakhs.

Universal Sompo Health Insurance Network Hospitals

To avail cashless claim settlement under the health insurance plans, policyholders are advised to visit the networked hospitals of the company for availing medical treatments. If treatments are availed at networked hospitals, the claim is settled directly with the hospital and policyholders do not have to undertake any burden. Universal Sompo is tied up with thousands of hospitals across India for cashless settlements. Policyholders can locate the nearest hospital by visiting the company's website or by speaking with the company's customer care representatives.

Eligibility for Universal Sompo Health Insurance Policy

Universal Sompo's health insurance policies can be bought by individuals who fulfil the required eligibility criteria mentioned in the policies. These criteria differ across different plans. Some common eligibility criteria include the following:

  • The proposer must be at least 18 years old to propose for buying a policy.
  • Pre-acceptance health check-ups might be required if the insured members are above a specified age or if the sum insured chosen under the policy is substantial.
  • Dependent children can be covered under the plan provided either of the parents are also being covered.
  • Group health plans are meant for members of recognised groups. Other individuals cannot buy these plans.

Claim Process of Universal Sompo Health Insurance Policy

The health insurance claim process of Universal Sompo's health insurance policies is simple as the company handles the claims through its in-house claim management team. The process is as follows:

  • Inform the insurer of the claim within a specified time.
  • Fill the pre-authorisation form and submit it to the insurance company for approval.
  • Once the claim is approved it would be paid by the company. In case of cashless treatments, the claim would be settled directly with the hospital. In case of reimbursement, the policyholder would bear the expenses and then get them reimbursed from the insurance company after discharge.

Claim Reimbursement Procedure of Universal Sompo Health Insurance Policy

Reimbursement claims are said to occur when the insured does not avail treatments at a networked hospital. In that case, the policyholder should bear the medical costs himself. Thereafter the costs are reimbursed. Here is the process of reimbursement claims:

  • Inform the insurance company upon hospitalisation.
  • Pay the medical costs as they incur.
  • After being discharged from the hospital, collect the Discharge Certificate.
  • Submit this discharge certificate with the filled in claim form. All the original medical bills and reports are also to be submitted to the insurance company.
  • Once the company assesses the documents and the claim form, the claim would be reimbursed.

How to Apply for Universal Sompo Health Insurance Online

Universal Sompo'shealth insurance plans can be bought online simply by visiting the company's website and choosing the plan suiting the policyholder's requirements. The online mode allows policyholders to understand the plan's features, calculate the premium rate and then buy the plan from the comfort of their homes or offices. The entire online purchase process is simple, easy and convenient.

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