| 8- Universal Health Insurance Policy from United India - Health Insurance Below Poverity Line (BPL) Families |
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| Source: Website of Universal Sompo General Insurance Company Limited |
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| SALIENT FEATURES OF THE POLICY |
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| (i) |
The UNIVERSAL HEALTH INSURANCE policy will be available to both Individuals as well as in Group. |
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| (ii) |
Each Insured should cover all eligible members (insured persons) under one group policy only. In other words different categories of eligible members shall not be allowed to be covered under different group policies. It is not permissible to issue any unnamed group policy. |
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| (iii) |
The Individual Policy will be issued in the name of the earning head of family with details of insured family members. The Group policy will be issued in the name of the Group/ Association/ Institution (called insured) with a schedule of names of the members including his/ her eligible family members(called Insured persons) forming part of the policy. |
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| COVERAGE |
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| Section – I HOSPITALISATION EXPENSES |
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| The policy covers reimbursement of Hospitalisation expenses for illness/ diseases suffered or injury sustained by the Insured Person. In the event of any claim becoming admissible under policy, the company through TPA will pay to the Hospital/ Nursing Home or Insured Person the amount of such expenses subject to limits as would fall under different heads mentioned below, as are reasonably and necessarily incurred in respect thereof anywhere in India by or on behalf of such Insured Person but not exceeding Sum Insured (all claims in aggregate) for that person as stated in the schedule in any one period of insurance. |
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| Hospitalisation Benefits |
Limits |
| (a) |
Room, Boarding Expenses as provided by the Hospital/ nursing home. If admitted in IC Unit |
Up to 0.5% of Sum Insured per day
Up to 1% of Sum Insured per day |
| (b) |
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses |
Up to 15% of Sum Insured per illness/ Injury |
| (c) |
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray Dialysis, Chemotherapy, Radiotherapy Cost of Pacemaker, Artificial Limbs & Cost of organs and similar expenses. |
Up to 15% of Sum Insured per illness/ Injury |
| (d) |
Maternity Benefit – ONE CHILD ONLY (with 12 months waiting period) |
Rs.2,500/- for normal delivery and Rs.5,000/- for caesarean delivery. |
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| N.B: |
(a) |
Company's Liability in respect of all claims including Maternity Benefit admitted during the period of Insurance shall not exceed the Sum Insured of Rs.30,000/- per person or family as mentioned in the schedule |
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(b) |
Total expenses incurred for any one illness is limited to Rs.15000/- (other than Maternity Benefit |
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| The Policy is extended to include one Maternity Benefit with liability under the Section being restricted to Rs.2,500/- for normal delivery and Rs.5,000/- for caesarean delivery. A waiting period of 12 months from inception of the policy is applicable. The above amount would also cover the medical expenses incurred in respect of new born child upto 3 months. However, this benefit is within the overall limit of Sum Insured of Rs.30,000/- |
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| This benefit is available only once to an insured person during the currency of the policy or its subsequent renewals. ie. only once during the life time of insured person. |
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| SECTION –II |
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| (a)PERSONAL ACCIDENT COVER TO EARNING HEAD |
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| If the Insured Person (earning head of the family) shall sustain any bodily injury resulting solely and directly from Accident caused by outward, violent and visible means, and if such injury shall within 6 calendar months (unless otherwise specified) of its occurrence lead to death then the Company shall pay to the Insured the sum as specified below : |
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| Death of Insured Person (earning head of the family) solely due to accident |
Rs.25,000/- |
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