Universal Sompo Health Insurance Claim Settlement

Universal Sompo Health Insurance

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Highlights

4,000+ Network Hospitals

2,67,221 Policies Issued

Lifelong Renewability

75.92% Claim Settlement Ratio

In-House Claim Management

Coronavirus (COVID-19) Cover

Claim Settlement of Universal Sompo Health Insurance

Universal Sompo settles claims in a speedy and efficient manner. So, it is easier for you to get cashless claim services and claim reimbursements. A leading general insurance company in India, Universal Sompo is committed to helping customers manage their risks today and tomorrow and making claim process as simple and convenient as possible. It gives policyholders the priority and makes the claim settlement customer-friendly. Further, Universal Sompo can help you settle the claim as soon as possible. You can get all the claims settled by either for cashless hospitalisation or reimbursement.

  • Claim Process for Cashless Treatment

    In case of cashless hospitalisation, you don’t need to pay even a single penny to the hospital. However, cashless treatment is available only in network hospitals. Follow the step-by-step guides for a cashless claim settlement process at Universal Sompo:

    • Before anything else, search for a Universal Sompo network hospital in a city where you want to get cashless treatment
    • Intimate Universal Sompo within 24 hours (emergency hospitalisation) and 48 hours before admission in planned hospitalisation.
    • While visiting the hospital, carry the Health Serve Card issued by Universal Sompo and valid photo ID.
    • Show the card and valid photo ID at the insurance desk of the hospital and get ‘Cashless Request Form.'
    • Fill in the form with the correct details and submit it to the Hospital Insurance helpdesk.
    • After verifying the details, the hospital sends the form to Universal Sompo-Health Office.
    • The insurer reviews the form, matches the details, ensures the cashless admissibility as per Policy Terms &Conditions.
    • On getting assured that you’re eligible for cashless treatment, the insurer gives approval.
  • Reimbursement Treatment

    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 for 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 in planned hospitalisation.
    • Get admission to any hospital for and avail the treatment.
    • Settle your hospital bill. Collect all original documents from the hospital after discharge.
    • The documents are medical reports, invoices, discharge summary, discharge certificate, 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 & 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
  • Documents Needed

    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 if 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

    If any doubt about the claim settlement process of Universal Sompo, contact InsuranceDekho at 1800-1205-698.  

  • Incurred Claim Ratio (ICR) of Universal Sompo Health Insurance

    The Incurred Claim Ratio (ICR) of an insurance company indicates their performance. It helps customers understand what they can expect from the insurance company. The ICR of Universal Somo is 92%.

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