Universal Sompo Health Insurance Claim Settlement Ratio, Process, Form

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.

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.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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