Super Healthcare Insurance

Eligibility Criteria of Universal Sompo Super Healthcare Insurance

• Individuals and families
• Members covered under any Medical expenses (Hospitalization) policy. This policy covers the medical expenses in excess of the specified deductible amount.
• Members who do not have any Health policy can also opt for this policy; the expenses up to the deductible limit have to be borne by the member.
• Who can be covered as dependants under Policy?
  • Family Floater Sum Insured Basis: Self, Spouse, 4 dependent Children can be covered under single Sum Insured. The premium shall be calculated as per the highest age of the family member.(Maximum 6 persons can covered under floater plan)
  • Individual Sum Insured Basis: Self, spouse, dependent children, brother, sister, dependent parent, grandparents, grandchildren, mother-in-law, father-in-law, son-in-law, daughter-in-law, dependent brother-in-law and dependent sister-in-law, Niece and Nephew.

Policy Tenure

The Policy can be taken for 1 year/ 2 Years/ 3 Years

Key Features

• Entry age up to 80 years
• No medical test up to 65 years
• Maternity covered after 9 months of policy start date
• Sum Insured up to ₹ INR 1 CR
• Age and discount eligibility for children up to 30 years

What is the minimum and maximum entry age?

• Minimum entry age:
  • Proposer/Adults - 18 yrs
  • Dependent Children - 91 days
• Maximum entry age: (Adult) 80 years
• Maximum entry age for dependent children is 30 years

Coverages of Universal Sompo Super Healthcare Insurance

			Top Up		Super Top Up
			Plan 2	Plan 3	Gold	Diamond	Platinum
1	Sum Insured Options		2, 3, 5, 7, 10 Lacs	5, 7, 10, 15, 20 Lacs	2, 3, 5, 7, 10 Lacs	3, 5, 7, 10, 15, 20 Lacs	10, 15, 20, 30, 50, 100 Lakhs
2	Deductible		3,4, 5 Lacs	6,7,8,9,10 Lacs	3,4 5 Lacs	6,7,8,9,10 Lacs	10, 15, 20,30, 40 Lacs
3	Deductible Applicable		Per admissible claim basis	Per admissible claim basis	Per policy year basis	Per policy year basis	Per policy year basis
4	Inpatient Hospitalization	Minimum 24 Hrs. hospitalisation as an In-patient	Covered	Covered	Covered	Covered	Covered
5	Day Care	Treatment Medical Expenses for day care treatment/ surgical procedures, taken as an inpatient for less than 24 hours in a Hospital or day care centre but not in the outpatient department(399+)	Covered	Covered	Covered	Covered	Covered
6	Pre Hospitalisation	Medical expenses incurred prior to the covered Hospitalization	30	60	60	90	120
7	Post Hospitalisation	Medical expenses incurred after to the covered Hospitalization	60	90	90	120	150
8	Room Rent	Amount charged by a Hospital towards Room and Boarding expenses and includes the associated medical expenses.	Actual expenses or up to the Sum Insured	Actual expenses or up to the Sum Insured	Actual expenses or up to the Sum Insured	Actual expenses or up to the Sum Insured	Actual expenses or up to the Sum Insured
9	Domiciliary Hospitalisation	The Company will pay for the medical expenses incurred by Insured member(s) for medical treatment taken at home which would otherwise have required Hospitalization	up to the Sum Insured	up to the Sum Insured	up to the Sum Insured	up to the Sum Insured	up to the Sum Insured
10	Organ Donor	Medical Expenses for a successful organ transplant including pre transplant medical test for legitimate donor and harvesting the organ, up to SI.	Covered	Covered	N/A	Covered	Covered
11	Ambulance Expenses		Actuals or maximum up to ₹ INR 2000	Actuals or maximum up to ₹ INR 3000	Actuals or maximum up to ₹ INR 3000	Actuals or maximum up to ₹ INR 3500	Actuals or maximum up to ₹ INR 4000
12	AYUSH Benefit		Covered up to the Sum Insured	Covered up to the Sum Insured	N/A	Covered up to the Sum Insured	Covered up to the Sum Insured
13	Automatic Restoration	100% of Base Annual Sum Insured	Available	Available	N/A	Available	Available
14	Bariatric Surgery Cover	Coverage for reasonable and customary expenses for Bariatric Surgery	N/A	N/A	N/A	Covered – 3 lacs	Covered – 5 lacs
15	Emergency Assistance Services		Available	Available	N/A	Available	Available
16	Cumulative Bonus	20% increase in SI for every claims free year subject to maximum of 100%.The increased SI shall be decreased by 20% in event of claim.	Covered	Covered	Covered	Covered	Covered
17	Health Check-Up		For every renewal, we will provide free health check-up for insured member in our empanelled hospitals/diagnostic centre, irrespective of the claims.	Covered	Covered	Covered	Covered

Exclusions of Universal Sompo Super Healthcare Insurance

• Any treatment arising from or traceable to any fertility, infertility, sub fertility or assisted conception procedure or sterilization, birth control procedures, hormone replacement therapy, contraceptive supplies, or services including complications arising due to supplying services or Assisted Reproductive Technology
• Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is practicing outside the discipline for which he is licensed or any kind of self-medication.
• Charges incurred in connection with cost of spectacles and contact lenses, hearing aids, routine eye and ear examinations, laser surgery for correction of refractory errors, dentures, artificial teeth and all other similar external appliances and /or devices whether for diagnosis or treatment.
• Experimental, investigational or unproven treatments which are not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness for which confinement is required at a Hospital. Any Illness or treatment which is a result or consequence of undergoing such experimental or unproven treatment.
• Any expenses incurred on prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, walkers, belts, collars, caps, splints, braces, stockings of any kind, diabetic footwear, glucometer/thermometer, crutches, ambulatory devices, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.P.A.D) and oxygen concentrator or asthmatic condition, cost of cochlear implants.
• Any procedure, investigation, treatment related to sleep disorder or sleep apnea syndrome, general debility, convalescence, cure, rest cure, health hydros, nature cure clinics, sanatorium treatment, rehabilitation measures, private duty nursing (unless covered under the Policy), respite care, custodial care or any treatment in an establishment that is not a Hospital.
• Aesthetic treatment, cosmetic surgery/implants or plastic surgery or related treatment of any description, including any complication arising from these treatments, other than as may be necessitated due to an Injury or Burns.
• Any treatment / surgery for change of sex or gender reassignments including any complication arising from these treatments.
• Circumcision unless necessary for treatment of an Illness not excluded hereunder or as may be necessitated due to an accident
• All preventive care, vaccination including inoculation and immunizations (except in case of post-bite treatment or when it is medically necessary and part of the treatment), vitamins and tonics.
• Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or Reload of the previous state of health
• Non-allopathic treatment except for the AYUSH Coverage.
• War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence,
• Act of self-destruction or self-inflicted, attempted suicide or suicide while sane or insane or Illness or Injury attributable to consumption, use, misuse or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any Hospitalisation primarily for investigation and / or diagnosis purpose.

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