Overview
The Universal Sompo Complete Healthcare Basic plan is a reasonably comprehensive health insurance policy, offering sum insured options of only ₹1 lakh or ₹2 lakhs, which is extremely limiting. Unique to this plan are outpatient consultation coverage (up to 1% of the sum insured) and a relatively short waiting period for pre-existing diseases. The plan also offers restoration of the sum insured and domiciliary hospitalization, making it a balanced choice for individuals and families seeking essential health coverage.
Experts Review
Written by Nikhil Nair
Senior Writer
The Universal Sompo Complete Healthcare Basic plan offers a solid balance of coverage and affordability, making it a decent option for those who do not require very high sum insured limits. Its key feature is the inclusion of outpatient consultation coverage (up to 1% of the sum insured), which is uncommon in basic health plans and provides additional value for routine medical needs. The policy also features restoration of the sum insured once per policy year, enhancing protection for multiple hospitalizations.
However, the sum insured limits are modest, which may not be sufficient for high-cost treatments in metropolitan cities. At the same time, the plan does not impose egregious conditions and has an option to reduce the waiting period for pre-existing conditions from the standard 3 years to just 1 year. Still, they may be slightly higher (around 5-10%) than those of some peers offering similar coverage. There’s also an option for consumables coverage, but only up to ₹1,000.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
Universal Sompo
Key Insights
Founded
2007
Universal Sompo was established 18 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% claims settled in 30 Days
Universal Sompo settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
5,000+
Universal Sompo has a limited network of 5,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
6 complaints per 10,000 claims registered
Universal Sompo maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment between 10% and 50% to reduce premiums.
Customisable
Get 5% discount on premiums with 10% Co-payment for the insured members if treatment is taken in Non-Tiered Network Hospitals.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 1 year.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Customisable
Increases the pre-hospitalisation limit from 30 days to 90 days.
Customisable
Increases the post-hospitalisation limit from 60 days to 120 days.
Add-ons
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 1 year.
Consumables
Recommended
Covers list of 68 non-medical items as per list I upto ₹2000.
Condition waiver under Restoration
Recommended
Restores the cover once a year up to 100% of the sum insured for any illness.
Hospital Cash
Hospital cash benefit paid out as defined in policy schedule if hospitalization is at least 3 days.
Critical Illness
Paid out as a lump sum amount for 11 listed Critical illnesses up to defined limits.
Personal Accident Cover
Paid out as a lump sum amount for Accidental Death, Total Permanent Disability and Permanent Partial Disability up to defined limits.
Voluntary Co-Payment
Choose a co-payment between 10% and 50% to reduce premiums.
Treatment in Tiered Network
Get 5% discount on premiums with 10% Co-payment for the insured members if treatment is taken in Non-Tiered Network Hospitals.
Extension Under Pre-hospitalisation
Increases the pre-hospitalisation limit from 30 days to 90 days.
Extension Under Post-hospitalisation
Increases the post-hospitalisation limit from 60 days to 120 days.
Sub-limits
Apply sub-limits for certain treatments and avail discounts on the premiums.
Dental OPD Waiting Period Reduction
Reduces the Dental OPD waiting period from 3 years to 2 years.
Emergency Travelling Allowance
Claim for the travel expenses incurrred on ambulance or cab upto defined limits to reach the hospital during the travel.
Second Opinion
Get expenses reimbursed upto defined limits towards a second medical opinion for listed ailments per policy year.
Rest Cure, Rehabilitation and Respite Care
Get coverage for expenses related to rest, cure, rehabilitation and respite care (nurse care).
Disease Management Program
Get assistance via the app/portal to manage their health in case of diagnosis of crucial ailments like diabetes, asthma, hypertension, etc.
Organ Donor Enhancement
Get coverage upto defined limtis for expenses related to organ donor's treatment.
Medically Advised Support Devices
Get coverage for expenses related to medically prescribed prosthetics or artificial devices required for the treatment upto defined limits.
Premium Waiver
Waives the renewal premiums for 4th year provided certain specific conditions are met.
Home Care Treatment
Cover the expenses incurred for taking treatment at home upto defined limits.
Emergency Assistance Service
Cover the expenses related to the medical emergencies like Medical Evacuation, Medical Repatriation, Compassionate Visit, etc if the insured member is 150km or more away from the registered address.
Wellness Benefit
Rewards the insured members for maintaining a good health and overall well-being.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 1 years.
Arthritis (if non-infective)
Calculus diseases of gall bladder and urogenital system
Cataract
Fissure/fistula in anus
Hemorrhoids
Waiting Period
30 days Initial waiting period
1 years Specific illness waiting period
3 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. The specific illness waiting period is better than usual, and you also get the flexibility to bring down the PED waiting period to 1 year for all diseases.
What's missing in the policy
Maternity benefits not offered.
Customer Reviews
B
Bindiya
Provides basic healthcare coverage as the name suggests.
C
Chetan
A simple and affordable plan for essential needs.
D
Divya
Covers the fundamental aspects of healthcare.
K
Kamal
Doesn't include many important benefits.
I
Ishan
Very limited coverage, not suitable for comprehensive needs.
G
Gautam
A no-frills health insurance option.
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Frequently Asked Questions
Does Complete Healthcare Basic have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Complete Healthcare Basic have room rent restrictions?
Does Complete Healthcare Basic offer a restoration benefit?
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