Senior Citizen health insurance

Eligibility Criteria of Universal Sompo Senior Citizen health insurance

• You must be above 60 years of age on last birthday for taking a policy.
• Must be a permanent resident of India
• Maximum entry age under the Policy for you and your spouse is restricted to 70 years. The renewals under the Policy shall, however, be provided for lifetime.

Pre Policy Medical Check Up

SL. No	List of Medical tests	Sum Insured limits
1	Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine	Rs 1,00,000
2	Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG	Rs 2,00,000 and Rs 3,00,000
3	Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG, Lipid Profile, Stress test or 2D Echo, Kidney Function Test Complete Physical test by a physician	Rs 4,00,000 and Rs. 5,00,000

Coverages of Universal Sompo Senior Citizen health insurance

• Inpatient Treatment:The Policy shall cover you for expenses incurred subject to limits as per below for each and every day of hospitalization under the policy.

  SL. No	Hospitalisation	Sum Insured limits
  1	(i)Room, Boarding expenses a provided by the Hospital/Nursing Home (ii) If admitted in IC Unit	i)Up to 1% of Sum Insured or actuals whichever is less per day ii)Up to 2% of Sum Insured per day or actuals whichever is less of the S.I. per illness/injury or actuals whichever is less
  2	Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses	Up to 25% of Sum Insured per illness/ Injury or actuals whichever is less
  3	Anaesthesia, Blood, Oxygen, OT charges, Surgical appliances(any disposable surgical consumables subject to upper limit of 7% of Sum Insured), Medicines, drugs, Diagnostic material X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of stent implants	Up to 50% of Sum Insured per illness/Injury or actuals whichever is less

  
  
• Day Care Procedures/ Surgeries: Specified Procedures / Surgeries requiring less than 24 hours of hospitalization would be covered under the Policy.( Please see annexure for complete details)
• Pre- Hospitalisation: Relevant medical expenses incurred 30 days prior to your being hospitalized shall be covered under the Policy.
• Post-Hospitalisation: Relevant medical expenses incurred 60 days after your being discharged from hospital shall be covered under the Policy.
• Domiciliary Hospitalisation: expenses incurred on availing medical treatment at home which otherwise would have required hospitalisation .The Sum Insured under this benefit shall be limited to 50% of SI or the actual amount incurred whichever is less under the Policy.
• Cost of Health Check-up: the charges incurred for medical check-up once in a block of every 3 claims free years up to 1.25% of the average Sum Insured or the actual amount incurred whichever is less. In case of floater policies, the limit of 1.25% shall be for the two family members covered under the Policy.
• Daily Allowance: 0.1% of Sum Insured or Rs 250 whichever is less, as a Daily Allowance, for each continuous and completed period of 24 hours of Hospitalisation subject to a maximum of Rs 2500 shall be covered under the Policy.
• Ambulance Charges: Ambulance charges incurred for engaging an ambulance for transferring yourself to a hospital to the extent of 1% of SI or Rs. 1500 or the actual amount incurred in such transportation shall be payable under the Policy.
• Expenses of accompanying person: Expenses incurred up to 1% of Sum Insured or the actual amount incurred whichever is less for the person accompanying you shall be payable under the policy.
• Critical Illness (Optional) You also have the option of covering listed Critical Illnesses and/ or Surgical Procedures under the Policy.On diagnosis or undergoing of below mentioned Critical Illness or Surgical Procedure, the Sum Insured opted under this section shall become payable under the Policy. The Sum Insured under this section shall be in addition to hospitalisation sum insured:
  • Cancer of specified severity
  • Open Chest CABG
  • Kidney Failure requiring regular dialysis
  • Stroke resulting in permanent symptoms
  • Major Organ /Bone Marrow Transplant
  • Multiple Sclerosis with persisting symptoms

Other Coverages

• Cumulative Bonus: Subject to no claims and continuous renewal of the Policy with us, the Sum Insured under the Policy under Section A “Hospitalisation” shall be increased by 5% subject to maximum of 10 such non claim years.
• Long Term Policy: Policy terms 1 year to 3 years are available under the policy. The following discounts will be offered if the Policy is taken by paying the appropriate premium for 2 years/ 3 years at once. No instalment facility is available for payment of premium under the Policy.
• Duration of policy: Premium to be charged
  • 2 years - 2 year premium in advance less 10% discount
  • 3 years - 3 year premium in advance less 15% discount
• Family discount: A family discount of 10% shall be applicable on hospitalisation premium when you opt for covering your spouse under the policy on individual Sum Insured basis. This discount shall not be applicable when your Spouse is covered under the Policy on Floater Sum Insured basis.
• Free Look – up Period: You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable
• Waiting Period:
  • A mandatory waiting period of 30 days will apply to all claims
  • Pre-existing diseases will not be covered until 24 months of continuous coverage have elapsed, since inception of the first Policy with Us; but:
  • Specific Waiting Period : Any Medical Expenses incurred by You on treatment of following Illnesses within the first two (2) consecutive years of Period of Insurance Start Date:

Exclusions of Universal Sompo Senior Citizen health insurance

• From intentional self-injury, suicide or attempted suicide.
• Whilst under the influence of liquor or drugs or other intoxicants.
• Emotional distress
• Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
• Directly or indirectly, caused by venereal disease, AIDS or insanity.
• Arising or resulting from committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanour or civil commotion.
• Whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports and the like.
• Due to war or ionising radiation or nuclear perils.
• Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.
• Congenital anomalies or any complications or conditions arising therefrom;
• Any loss resulting directly or indirectly, contributed or aggravated or prolonged by hormone replacement therapy,
• Any treatment not performed by a Physician or any treatment that is purely of experimental nature/ Unproven
• Circumcision, cosmetic or aesthetic treatments of any description change of life surgery or treatment, plastic surgery (unless necessary for the treatment of Illness or accidental Bodily Injury as a direct result of the insured event and performed within 6 months of the same).
• Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
• Naval or military operations of the armed forces or airforce and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like.
• All kind of Alternate Treatment
• Cosmetic or plastic surgery or any elective surgery or cosmetic procedure that improve physical appearance, surgical and non-surgical treatment of obesity (including morbid obesity) and weight control programs, or treatment of an optional nature;
• Special nursing care, routine health checks or convalescence, Custodial Care, general debility, lethargy, rest cure;

Disclaimer:“For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”