Universal Sompo Health Insurance Claim Settlement Ratio

Universal Sompo Health Insurance Claim Settlement Ratio

The company has a good claim settlement record with its customers. Universal Sompo follows a quick and hassle-free procedure for both cashless and reimbursement claims. The health claim settlement ratio of the insurance company is 93%, which means that the capability of the insurer to settle your claims is quite good. A health claim ratio is an indicator of how good the insurance company is in settling the claim of its customers. If you have a Universal Sompo health insurance policy you can check out more about the claim procedures and the documents required at the time of claim settlement.

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Universal Sompo Health Insurance at a Glance:

Claim Process of Universal Sompo Health Insurance

You can file a claim for both cashless treatment and reimbursement. If you avail of cashless claims you can get the direct settlement of bills, and if you file for reimbursement, then the insurer will compensate the expenses incurred.

Cashless Claim Procedure

Follow the below steps to get cashless healthcare treatment -

• In case of emergency hospitalization, call their helpline number and lodge your claim within twenty-four hours of the hospitalization
• In case of planned hospitalization, inform the insurer 48 hours prior to the hospital admission.
• Visit a nearby network hospital and show the universal Sompo health card number, along with your valid photo ID
• Collect the ‘Cashless Request Form’ from the hospital /TPA desk
• Fill in the required details and give them to the TPA desk in the hospital
• The hospital will verify the details and will fax the filled ‘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 and will inform you about the same
• You only need to pay the deductibles
• To check the claim status you can use your claim reference number 

Universal Sompo Reimbursement Claim Process

If the treatment was taken in the non-network hospital then you need to pay the medical bills on your own, and file for its reimbursement. Once you get discharged from the hospital, you can claim this amount from the insurer.

Below are the steps for filing reimbursement of your hospitalization expenses:

• Remember to lodge your claim within 24 hours in case of emergency admission and 48 hours before hospitalization, if it was planned
• Get admitted to the hospital and avail the treatment. Settle your bills and collect all the original documents when getting a discharge
• Fill the claim reimbursement form
• Submit the form with all the original documents containing all the hospital bills at the registered address of the insurer
• Once all the documents are received, your claim request will be processed and you will receive the intimation

Information Required While Filing a Claim

• Your contact details
• Universal Sompo health insurancenumber and Membership ID no. 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 Loss/accident
• Geographical details

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 claim form 
• Hospital bills, discharge certificate and 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

• Hospitalization Report

• Certificate of Disability (stating the degree of disability) from the Doctor recognized by a Govt.

• In case of loss of employment (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 us at care@policybazaar.com or speak to our health claim experts at 1800-208-8787