Universal Sompo Health Insurance Claim Settlement

Through In-House Claim Management

With the reimbursement facility of Universal Sompo, you can get treatment at any non-network hospital. However, you have to pay the expenses incurred during hospitalisation or bills of hospitalisation from your own pocket and claim reimbursement at Universal Sompo. Follow the step-by-step guides for the reimbursement claim settlement process at Universal Sompo:

• Inform the health insurance company within 24 hours in an emergency. However, the insurer must be notified 48 hours before planned hospitalisation.
• Get admission to any hospital and avail the treatment.
• Settle your hospital bill. Collect all original documents from the hospital after discharge.
• The documents are medical reports, invoices, discharge summaries, discharge certificates, all test reports, etc.  

Through TPA

Call the TPA helpline number mentioned in your health card as soon as the claim occurs. While intimating the claim, you need to furnish the following information:

• Contact numbers
• Membership ID number
• Policy number
• Nature of sickness/accident
• Date and time of loss in case of an accident
• Name of the Insured patient
• Contact details of the insured person
• Starting date of disease symptoms in case of sickness

​All the documents except the patient’s valid ID proof should be submitted in original form:

• Original investigation reports
• Final hospital discharge summary
• FIR or post-mortem report it happened
• Pharmacy bills along with the prescription
• Canceled cheque or NEFT details for payment
• Original bills, receipts, and discharge report
• Indoor case papers and duly filled claim form
• Original hospital bills and a valid photo ID proof
• Treating doctor's report, and original consultation notes
• Nature of operation performed and surgeon's bill and receipt
• Test reports along with attending doctor’s or surgeon’s report

The Incurred Claim Ratio (ICR) of an insurance company indicates its performance. It helps customers understand what they can expect from the insurance company. The Universal Sompo health insurance claim settlement ratio for FY 2018-19 is 92%.