Overview
The Universal Sompo Complete Healthcare Essential plan offers sum insured options from ₹3 lakhs to ₹5 lakhs, providing comprehensive coverage. It includes outpatient consultation coverage up to 1% of the sum insured and maternity benefits, making it suitable for individuals and small families. The plan features no co-payment and no room rent restrictions, and has a relatively moderate waiting period for pre-existing diseases, balancing affordability with essential health protection. However, this plan does have sublimits on modern treatments and domiciliary coverage, which is a significant downside.
Experts Review
Written by Nikhil Nair
Senior Writer
The Universal Sompo Complete Healthcare Essential plan is a well-rounded health insurance product catering to those seeking moderate coverage (₹3-5 lakhs) with a good mix of benefits. Its key features include outpatient consultation coverage of up to 1% of the sum insured, which is not common in many plans at this level, and maternity benefits, making it attractive for families planning to have children. The plan also offers no co-payment and no room rent limits, allowing insured members the freedom to choose a hospital room without additional costs.
Compared to the Basic variant, the Essential plan offers higher sum insured options and maternity coverage, which the Basic plan does not provide. Both plans cover modern treatments and AYUSH therapies, but the Essential plan’s broader sum insured range and outpatient benefits offer better overall value.
However, the sum insured may not be sufficient for high-cost treatments in metro cities, and the waiting period for pre-existing diseases is three years, with an add-on to reduce it to 12 months. There’s also an add-on for consumables coverage, but only up to ₹2,000. Premiums are slightly higher than the Basic plan, by roughly 10-15%, reflecting enhanced benefits.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No significant drawbacks found.
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
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto ₹25,000 and make you wait 3 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
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.
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
Increase the pre-hospitalisation limit from 30 days to 90 days.
Extension Under Post-hospitalisation
Increase the post-hospitalisation limit from 60 days to 120 days.
Maternity Waiting Period Reduction
Reduce the maternity waiting period from 3 years to 2 years.
Sub-limits
Apply sub-limits for certain treatments and avail discounts on the premiums.
Dental OPD Waiting Period Reduction
Reduce 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 limits for expenses related to organ donor's treatment.
Medically Advised Support Devices
Covers the 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.
Customer Reviews
M
Manoj
Provides necessary benefits for common health issues.
N
Neha
A good balance between coverage and cost.
U
Umesh
Waiting periods might be a concern.
L
Leena
Offers essential healthcare coverage, a step up from basic.
S
Sameer
Still lacks some advanced features.
Q
Qasim
A practical option for essential health needs.
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Frequently Asked Questions
Does Complete Healthcare Essential 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.
- Maternity and Newborn Waiting Period: There’s a 3-year waiting period before you can make claims related to pregnancy and childbirth.
Does Complete Healthcare Essential have room rent restrictions?
Does Complete Healthcare Essential offer a restoration benefit?
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