Universal Sompo Gen - Senior Citizen Health Insurance Policy

The Policy can be taken by a Senior Citizen who is above 60 years of age for covering himself/ herself and his/her spouse.

Additional Benefits under the Policy
1. 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.
In case of claim under this section, the increased percentage will be reduced by 5% of sum insured at the next renewal. However, basic sum insured will be maintained and will not be reduced. Cumulative Bonus incurred in previous health insurance policies held by you with us or any of the Indian Insurers shall be allowed to be carried forward to this Policy.
2. 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 installment facility is available for payment of premium under the Policy.
3. 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.
4. Sum Insureds Options: The Policy provides Sum Insured starting from 1 Lakh to 5 Lakhs Rupees for each section Hospitalisation and Critical Illness.

A- Hospitalisation
The following benefits shall become payable under this section. The cover shall be available to both the Insured and his/ her spouse if covered under the Policy.
1- Inpatient Treatment
The Policy shall cover you for expenses incurred for each and every day of hospitalization under the policy.
2- 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)
3- Pre- Hospitalisation: - Relevant medical expenses incurred 30 days prior to your being hospitalized shall be covered under the Policy.
4- Post-Hospitalisation: - Relevant medical expenses incurred 60 days after your being discharged from hospital shall be covered under the Policy.
5- 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.
6- 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.
7- 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.
8- 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.
9- 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.
B - 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.
1- Cancer of specified severity
2- Open Chest CABG
3- Kidney Failure requiring regular dialysis
4- Stroke resulting in permanent symptoms
5- Major Organ /Bone Marrow Transplant
6- Multiple Sclerosis with persisting symptoms

1- You must be above 60 years of age on last birthday for taking a policy.
2-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.

1. We shall provide you a free look period under the policy. The free look period shall be applicable at the inception of the policy and:
1-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
2. If You have not made any claim during the free look period, You shall be entitled to
1- A refund of the premium paid less any expenses incurred by Us on Your medical examination and the stamp duty charges or;
2- where the risk has already commenced and the option of return of the policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;
3-Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period

Floater Benefit: With this extension, the Sum Insured under the mandatory section A- Hospitalisation shall be available on floater basis.

1. Any Illness, sickness or disease , other than the above specified Critical Illness.
Any Critical Illness of which, the signs or symptoms first occurred prior to or within Ninety (90) days following the Policy Issue Date unless due credit for such time bound exclusion has been accrued in previous similar health insurance policy from us or any of Indian insurers.
Any Critical Illness based on a diagnosis made by you or your immediate family member or anyone who is living in the same household as you or by a herbalists, acupuncturist or other non-traditional health care provider.