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Universal Sompo Health Insurance Claim Settlement

Universal Sompo Health Insurance 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 the claim process as simple and convenient as possible. It gives policyholders 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 the 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 a valid photo ID.
    • Show the card and valid photo ID at the insurance desk of the hospital and get the ‘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 the Universal Sompo-Health Office.
    • The insurer reviews the form, matches the details, and ensures the cashless admissibility as per Policy Terms and 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 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
  • 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 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

     

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

    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%.

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FAQs

  • Within how many days do I have to file a claim in Universal Sompo Health Insurance?

    The claim must be submitted in the 30 days after the hospitalisation. 

  • How much time does Universal Sompo take to settle claims?

    After receiving the relevant documents, Universal Sompo settles the bills within  7 working days. 

  • What is the maximum number of claims that can be made in a year in Universal Sompo health insurance policies?

    There is no limit on the number of claims allowed during a policy term. Claims can be made up to the limit of sum insured under the policy. 

  • How does Universal Sompo settle claims if I buy more than one health insurance policy?

    Each company pays a relatable proportion of the loss in case the claims are made. 

  • Within how many days do I have to file a claim in Universal Sompo Health Insurance?

    The claim must be submitted in the 30 days after the hospitalisation. 

User Reviews

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  • Reliable Health Protection

    InsuranceDekho is a reliable partner for health protection. Their Universal Sompo Health Insurance Policy is well-structured, and their claim settlement process is prompt. We've had a great experience with the InsuranceDekho team.

    R
    Universal Sompo
    By Raju Karhana
    On: Mar 14, 2024
  • Purchased at Ease

    It is very easy to buy health insurance plans from the InsuranceDekho website, I bought the Universal Sompo Health Insurance Plan policy from their website. The buying process was too simple and easy with no complications at all. I followed the mentioned steps and the process was done quickly. Loved the plan. 

    S
    Universal Sompo
    By Sanjay Parashar
    On: Mar 04, 2024
  • Afffordable Policy

    Thanks to the entire team at InsuranceDekho company for helping me purchase the Universal Sompo health insurance plan, the best health insurance policy. I appreciate the efforts of the customer support team. They helped me throughout the process.

    N
    Universal Sompo
    By Nikunj Gaur
    On: Jan 02, 2024
  • 7 days availability

    The InsuranceDekho website serves their customers all 7 days of the week which makes it convenient for the customers. I bought the Universal Sompo Health Insurance Policy. The plan is good in itself, and I am happy that I bought this plan.

    M
    Universal Sompo
    By Monika Agarwal
    On: Nov 24, 2023
  • Easy Renewal Process

    Renewing my Universal Sompo Health Insurance Policy with InsuranceDekho was a simple and quick process. The reminders they sent were helpful, and the renewal interface was user-friendly.

    K
    Universal Sompo
    By Kanupriya
    On: Nov 16, 2023

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