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Universal Sompo Health Insurance Claim

When was the last time you sat down with your health insurance policy paper and went through it diligently? Do you know how to claim the insured amount in case things go downhill? The majority of the policyholders commit this mistake. Just buying a health insurance plan is not enough. You need to be acquainted with each of the clauses of the policy. Not every health insurance company can offer the best coverage to the policyholders. You need to be careful with your choice and select a reputed insurer like Universal Sompo company. 

Unlike other insurers, Universal Sompo is renowned for its swift and hassle-free claim process. Besides, the insurer has a customer-centric approach and that’s why they offer round-the-clock assistance as well. With a health claim settlement ratio of about 111.23% and a pan India presence, Universal Sompo has been the leading choice of policyholders. Let’s understand its claim filing processes so that you can reap the maximum benefits of your Universal Sompo health insurance.

How To File A Claim With Universal Sompo?

Cashless Claim (Through In-house Health Claims Management)

If you are looking for a cashless facility through in-house health claims management, then ensure that you follow the below-given steps-

  • You are required to visit any cashless hospital and inform them about the patient. Do not forget to carry the Health Serve Card as well as a photo ID proof. The hospital authority will share a “Cashless request form.” You can collect it from the insurance help desk.
  • Next, go through the Cashless request form carefully and fill out the necessary details. Hand it over to the insurance help desk of the hospital.
  • They will cross check the form and fax it to Universal Sompo health office.
  • If the patient is opting for planned hospitalisation, the policyholder needs to inform the insurer at least 48 hours before the hospitalisation. And in case of emergency hospitalisation, you get the time frame of 24 hours within hospitalisation of the patient. You can simply connect with Universal Sompo over phone call (1800 200 5142) in order to intimate them about the claim.
  • The insurer will then evaluate the form and cross check the eligibility of the cashless claim request. If things go right as per the terms and conditions of your policy paper, Universal Sompo- Health will get in touc with you and the hospital. They will settle the expenses directly with the network hospital.

Reimbursement Claim (Through in-House Health Claims Management)

Want to opt for the reimbursement facility? Try these below-mentioned steps!

  • Visit any nearby hospital and admit the patient. Pay for all the hospitalisation and medical expenses from your own pocket. Keep all the bills, reports and discharge papers secure.
  • Call Universal Sompo at 1800 200 5142 o inform them about the hospitalisation. If it is a case of planned hospitalisation, then you need to inform the insurer at least 2 days prior to seeking admission in the hospital. And for urgent hospitalisation, you have to intimate the insurer within 24 hours of seeking admission. You can even drop a mail to share the details (healthserve@universalsompo.com).
  • Next, you will have to fill out the reimbursement claim form. Submit the same along with all the original documents at the below-given address:

Universal Sompo General Insurance Company Limited

Health Claims Management Office

5thFloor, Assotech One

C-20/1 A, Block- C

Sector- 62, Noida

Uttar Pradesh, Pincode:201309

  • Universal Sompo will go through all the documents, reviw your claim and reimburse the amount if things fall in place as per the terms and conditions of the policy.

Claim Processing Through a TPA

  • You are required to inform the TPA using a Toll-free/helpline number. You can avail this number from your health card.
  • You can find further details on the official website of the TPA.
  • You can enjoy multiple services such as cashless facility, 24×7 assistance and quick processing and settlement of claims.
  • Share the below-mentioned details with the TPA while filing for the claim:
    1. Policy number
    2. Membership ID number
    3. Contact number
    4. Name of the patient
    5. Name of the health condition
    6. Location of loss in case of accident
    7. Date and time of loss in case of accident
    8. Starting date of health condition in case of illness
    9. Address and contact details of the insured person.

How To Download Your Claims Form?

Not sure from where to download the claim form? Let us help!

  • First of all, visit the official website of Universal Sompo insurance company.
  • At the top, you will see the “Products” tab. Click on it!
  • You will see a box opens up which carries multiple options such as motor insurance, and travel insurance. Government insurance and so on. Choose the health insurance option.
  • As you keep scrolling down, just above the footer you will come across multiple clickable options. At the extreme right, under the heading of “Claims”, you will find the option of “claim forms.” Click on the same.
  • A new page will open up from where you can easily download different forms such as claim intimation form, cashless request form, health claim form, and so on.

How Can You Keep a Track Of Your Universal Sompo Health Claim?

Tracking your health insurance claim has never been so easy before!

  • Simply visit the official website of Universal Sompo and click on the “Products” tab.
  • Select “Health Insurance” and keep scrolling down.
  • Once you reach the footer of the page, you can see the option “Claims.”
  • Under this heading you will see another sub-head, namely, track claims.
  • Click on it and page will open up on your screen. Fill in the details and click on the submit button. You will soon get the status of your health claim on your screen.

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