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Universal Sompo Health Insurance Claim Settlement

The Universal Sompo Health Insurance claim settlement ratio is very high and the company prides itself on providing speedy and efficient claim processes. The organization provides both cashless claims and reimbursement claims to all its policyholders.

Universal Sompo is a leading general insurance provider in India. The organization has aimed to help all customers manage their medical risks today and in the future. This makes the claim process quite simple and convenient.

Universal Sompo keeps its policyholder as the priority and ensures that everything is handled in a customer-friendly manner. The company also settles all claim requests as soon as possible. Today, we’ll try to understand more about the Universal Sompo health insurance claim settlement ratio and process.

The Claim Process for Cashless Treatment

The Universal Sompo car insurance claim settlement ratio is quite high. However, you might also like to know that Universal Sompo offers cashless hospitalization services. In case of cashless hospitalization, the policyholder will not be required to pay a single penny to the hospital.

The cashless treatment facility is only available in Universal Sompo network hospitals. The steps that one needs to follow for applying for a cashless claim settlement process are:

  • Look for a Universal Sompo network hospital in your city
  • Intimate the Universal Sompo claim department within 24 hours in case of emergency hospitalization and in case of planned hospitalization this intimation should be done 48 hours before admission
  • Carry the Health Serve Card issued by Universal Some while visiting the hospital
  • Show a valid photo ID card and the Health Serve Card at the insurance desk of the hospital
  • Get a cashless request form and fill it
  • Submit the form at the hospital insurance helpdesk
  • After verifying the details, the cashless request form will be sent to the Universal Sompo health office
  • The insurer will review the form, match the details, and provide cashless admissibility according to the terms and conditions of the policy
  • The policyholder will provide an official approval to the policyholder

The Claim Process for Reimbursement Treatment

The Universal Sompo health insurance claim settlement ratio also included data for reimbursement treatment claims. And the steps that one needs to follow for applying a reimbursement treatment claim through in-house claim management are:

  • The reimbursement facility of Universal Sompo allows policyholders to get the treatment done at any non-network hospital without worrying about money
  • The expenses should be paid by the policyholder before applying for a reimbursement claim
  • The health insurance company should be informed 24 hours in advance in case of an emergency hospitalization
  • In case of planned hospitalization, the insurer should be notified at least 48 hours in advance
  • Get admission into a hospital and avail the treatment
  • Settle the hospital bill
  • Collect all the original documents from the hospital after the insured has been discharged

Policyholders can also apply for reimbursement claims through the TPA. To do this, the policyholder needs to call the TPA helpline number. This helpline number should be mentioned in the health card as soon as the claim occurs. While intimating regarding the claim, the policyholder will also have to furnish several personal details, including contact numbers and membership ID.

Universal Sompo Health Insurance Claim Documents

All the documents that policyholders need to submit while applying for reimbursement or cashless claim are:

  • Original investigation reports
  • Final hospital discharge summary
  • FIR or post-mortem report, if required
  • Pharmacy bills
  • Prescription
  • Canceled cheque
  • NEFT details
  • Original bills
  • Original receipts
  • Discharge report
  • Indoor case papers
  • Duly-filled claim form
  • Original hospital bills
  • A valid photo ID proof
  • Treating doctor’s report
  • Original consultation notes
  • Nature of operation performed
  • Surgeon’s bill and receipt
  • Test reports
  • Attending doctor’s or surgeon’s report

The Universal Sompo Health Insurance Claim Settlement Ratio

The Universal Sompo Health Insurance claim settlement ratio indicates the performance of the company. This ratio was measured at 92% for the financial year of 2018 – 2019. This shows that the company is doing very well in terms of its overall performance.

The Health Insurance Plans Offered by Universal Sompo

Now, let’s talk about the different health insurance policies that are offered by Universal Sompo. A list of these policies has been prepared and that list is mentioned below,

  • Universal Sompo Individual Health Insurance

The Universal Sompo health insurance policy is quite simple and is available for both individuals and families. The policy provides basic health insurance coverage up to the sum insured value of INR 5 lakh.

  • Universal Sompo Senior Citizen Health Insurance Policy

The Universal Sompo senior citizen health insurance policy is made for individuals over the age of 60 years. The policy provides several hospitalization benefits, day care procedures, daily allowance, and domiciliary treatments. Free health checkups are provided after every three years. The Universal Sompo health insurance claim settlement ratio for this policy is very good.

  • Universal Sompo Complete Health Care Insurance

The Universal Sompo complete health care insurance is a comprehensive health plan that covers the entire family. Individual options are also provided with this policy. There are three variants in this policy, including basic, essential, and privilege.

  • Universal Sompo Hospital Cash Insurance Policy

The Universal Sompo hospital cash insurance policy is available for both individuals and the entire family. There are three types of benefits that are provided with this policy. These benefits are fixed lump sum, the fixed amount payable, and convalescence benefit.

  • Universal Sompo Critical Illness Insurance Plan

The Universal Sompo critical illness insurance plan provides fixed health benefits for 11 critical illnesses. The critical illnesses are specified in advance in the policy documents. The plan is available in both individual and family options.

  • Universal Sompo Individual Accident Policy

The Universal Sompo individual accident policy provides protection against accidental injuries to the insured. The policy comes with three coverage options, including accidental death, permanent total disability, and partial disability.

Reviews and Ratings

  • Best Decision by Preeti Bhatti (4 stars / 5 stars)

I bought the Universal Sompo Hospital Cash insurance policy recently. And I’m very happy with my purchase. This is the best health insurance policy in the market and the payment gateway is completely secure. The customer department is also very good.

  • Great Inclusions by Mala Kumari (5 stars / 5 stars)

I have always wanted to get a health insurance policy that would provide me and my entire family with complete protection. And I have finally got that because of Universal Sompo. The coverage provided by this is excellent.


Within how many days does the Universal Sompo health insurance claim need to be submitted to the company?

The claim should be submitted within 30 days after being discharged from the hospital.

How long does it take for Universal Sompo to settle a claim request?

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

If I buy more than one health insurance policy, then how will Universal Sompo settle claims?

Universal Sompo pays a relatable proportion of the loss in case of claims are made.

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