Universal Sompo Senior Citizen Health Insurance Plan
Universal Sompo Senior Citizen Health Insurance Plan - This is a health insurance plan that covers the hospitalization and medical expenses of an individual above the age of 60. The following are the features of the Senior Citizen Health Care plans:
- Medical expenses in case of hospitalization are covered, which include and are not limited to, room and boarding charges, diagnostic tests, anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of stent implants.
- Daycare procedures are covered
- Pre and post hospitalization expenses are also covered for 30 and 60 days respectively
- Domiciliary expenses are covered where medical treatment is required for a period that exceeds three days for illnesses that normally would be treated in a hospital/nursing home, but the insured individual is confined at home
- Cost of health check up after three claim-free years are covered
- A daily allowance is provided where 0.1% of the Sum Insured or Rs. 2500 (whichever is lower) is provided for each continuous and completed period of 24 hours of hospitalization
- Ambulance charges are reimbursed
- The expenses of an accompanying person is covered
- On the diagnosis of the following critical illnesses or surgical procedures, the Sum Insured is payable under the policy –
- Cancer of a specified severity
- Open chest CABG
- Kidney failure requiring frequent dialysis
- Stoke resulting in permanent symptoms
- Major organ/bone marrow transplant
- Multiple sclerosis with persisting symptoms
- A cumulative bonus of 5% is available if no claims are made, subject to a maximum of 10 claim-free years
- Policy terms of one to three years are available, when paying for two or three years, discounts on the premiums are available
- A family discount of 10% is applicable on the hospitalization premium when the customer opts to cover his or her spouse under the policy on individual sum insured basis.
- Sum insured options range from Rs. 1 lak to Rs. 5 lakhs
- The sum insured may be enhanced upon renewal
- A co-pay facility is available where the customer will bear a part of the percentage of the admissible claim amount. Co-payment will not reduce or effect the Sum Insured.
Eligibility - Universal Sompo Senior Citizen Health Insurance Plan
- The entry age is at least 60 years. The maximum entry age is 70 years
- There is lifetime renewability under this plan
- The plan covers an individual over the age of 60 years and his or her spouse.
Exclusions - Universal Sompo Senior Citizen Health Insurance Plan
The policy will not cover loss, damage, illnesses or diseases that arise due to the following:
- Pre-existing diseases will not be covered under this plan until 24 months have passed
- There is a waiting period of 24 months for the following medical expenses to be covered:
- Cataract
- Benign Prostatic Hypertrophy
- Myomectomy, Hysterectomy unless because of malignancy
- All types of Hernia, Hydrocele
- Fissures and/or Fistula in anus, hemorrhoids/piles
- Arthritis, gout, rheumatism and spinal disorders
- Sinusitis and related disorders
- Stones in the urinary and billiary systems
- Dilatation and curettage , Endometriosis
- All types of Skin and internal tumors/ cysts /nodules/ polyps of any kind including breast lumps unless malignant
- Dialysis required for chronic renal failure
- Surgery on tonsils, adenoids and sinuses
- Gastric and Duodenal erosions ulcers
- Deviated Nasal Septum
- Varicose Veins/ Varicose Ulcers
- Joint replacements unless due to accident
- Any loss resulting directly or indirectly, contributed or aggravated or prolonged by hormone replacement therapy
- Any experiment that is experimental in nature
- Cosmetic or aesthetic treatment are not covered
- Venereal diseases, intentional self harm and the use of intoxicating drugs or alcohol are not covered
- Dental treatment will not be covered
- Unrelated expenses and vitamins/nutritional expenses are not covered
- Hospitalization for the sole purpose of physiotherapy will not be covered
- Special nursing care, routine health checks or convalescence, custodial care, general debility, lethargy and rest cure are not covered.
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