Universal Sompo Health Insurance Claim Settlement Ratio

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      Universal Sompo Health Insurance Claim Settlement Ratio

      Universal Sompo health insurance claim settlement ratio indicates how good the insurance company is in settling the claims of its customers. The higher is the claim settlement ratio, the more is the likelihood of your claims getting paid. Usually, a claim settlement ratio of above 85% is considered good.

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      The health insurance claim settlement ratio of the Universal Sompo General Insurance Company is 87.8% for FY 2021-22. This means that the capability of the insurer to settle your claims is quite good. Moreover, the insurer follows a quick and hassle-free procedure to raise claims.

      Claim Process of Universal Sompo Health Insurance

      Policyholders can file both cashless and reimbursement claims. Given below is the procedure to file a Universal Sompo health insurance claim:

      Cashless Claim Procedure:

      Follow the below steps to file a cashless claim with Universal Sompo health insurance:

      • In case of emergency hospitalization, call the insurer’s helpline number and lodge your claim within 24 hours. In case of planned hospitalization, inform the insurer at least 48 hours prior to the hospital admission.
      • Show your Universal Sompo health card along with your valid photo ID at the network hospital.
      • Collect the ‘Cashless Request Form’ from the hospital /TPA desk, fill in the required details and give them back to the TPA desk in the hospital.
      • The hospital will verify the details and fax the filled-in ‘Cashless Request Form’ to the insurer.
      • The insurance company will review your claim request and give approval or rejection as per the policy terms and conditions.
      • During hospital discharge, you need to pay the deductibles and expenses not covered by the insurer.
      • The hospital will share all the documents and bills with the insurer.
      • Universal Sompo General Insurance Company will cross-check the documents and pay the bill amount to the hospital.

      Universal Sompo Reimbursement Claim Process:

      Below are the steps for filing a Universal Sompo health insurance reimbursement claim:

      • Lodge your claim with the insurer within 24 hours in case of emergency admission and at least 48 hours before hospitalization in case of planned hospitalization.
      • Avail treatment at the hospital and settle all your bills while getting discharged. Remember to collect all the original documents from the hospital when getting a discharge.
      • Fill out the claim reimbursement form and submit it with all the original documents to the insurer.
      • Once all the documents are received by the insurer, your claim request will be processed after review.
      • You will receive the intimation, and the claim amount will paid to your bank account.

      Information Required While Filing a Universal Sompo Health Insurance Claim

      The following information may be required while raising a Universal Sompo health insurance claim:

      • Contact details of the policyholder
      • Universal Sompo health insurance number and membership ID mentioned on the health card
      • Name of the patient
      • Nature of illness/accident
      • Date and time of loss in case of an accidental hospitalization or starting date of a symptom of disease in case of an ailment
      • Location of accident

      Documents Required for Universal Sompo Health Insurance Claims

      You need to furnish the following documents while claiming your Universal Sompo health insurance policy:

      For Claims Related to Hospitalization:

      • Completely filled out claim form
      • Hospital bills, discharge certificate and payment receipts (in original)
      • Chemist bills with doctor’s prescription
      • Evidence of the treatment from Doctor/Laboratory /Hospital/Chemist as required

      For Claims Related to Permanent Total/Partial Disabilities:

      • Universal Sompo medical insurance claim form
      • Police FIR/Panchnama (in original)
      • Discharge card from the hospital
      • Medical reports
      • Certificate of Disability (stating the degree of disability) from the recognized doctor
      • In case of loss of employment, a termination letter from the hospital is required.

      For Death Claims:

      • Duly filled & signed claim form
      • Post-mortem report
      • Original FIR/Panchnama
      • Death Certificate

      For more details, please write to Policybazaar.com at care@policybazaar.com or speak to our health claim experts at 1800-208-8787.

      Policybazaar exclusive benefits
      • 30 minutes claim support*(In 120+ cities)
      • Relationship manager For every customer
      • 24*7 claims assistance In 30 mins. guaranteed*
      • Instant policy issuance No medical tests*
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30-minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881. Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. As per the Insurance guidelines, you are allowed to cancel the policy with-in 15 days from the date of Issuance of policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

      ~Source: Google Review Rating available on:- http://bit.ly/3J20bXZ

      ##On ground claim assistance is available in 114 cities

      Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

      STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.

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