Universal Sompo Health Insurance Claim Settlement Ratio

(22 Reviews)
Highlights

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Back
Get insured from the comfort of your home
Get insured from the comfort of your home
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      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.

      Read More

      Universal Sompo Health Insurance at a Glance:

      Key Features

      Highlights

      Network Hospitals

      7700+

      Incurred Claim Ratio

      104.71

      Renewability

      Lifelong

      Waiting Period

      4 years

      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

      Health insurance articles

      Recent Articles
      Popular Articles
      Should You Buy a Super Top-up Health Insurance Policy?

      18 Jan 2023

      India is abuzz with a variety of health insurance plans to cater
      Read more
      6 Reasons Why Your Cashless Health Claims Can Get Denied

      18 Jan 2023

      Cashless claims are one of the most lucrative benefits of buying a
      Read more
      Check Out the Mandatory KYC Documents for Health Insurance

      30 Dec 2022

      The Insurance Regulatory & Development Authority of India
      Read more
      What to Look for in a Health Insurance for Cancer Plan?

      20 Dec 2022

      Cancer is one of the biggest demons that the world faces today
      Read more
      What are the Factors Affecting Health Insurance Premium?

      20 Dec 2022

      Demand for insurance products in India, especially health
      Read more
      What are the Normal Thyroid Stimulating Hormone (TSH) Levels as Per Age?
      The thyroid gland is an important gland responsible to produce the right amount of hormones for normal body
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      Income Tax Slab for Women: Guide to Exemptions and Rebates
      In India, every person who earns beyond a certain limit is liable to pay income tax to the government. The tax
      Read more
      Best Health Insurance Plans for Senior Citizens in 2023
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL