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Universal Sompo Health Insurance Claim Settlement

199 reviews Rate This
Claim Settlement Ratio70.75%
In-House Claim SettlementAvailable
Network Hospitals4,000+
Starting Premium for Rs. 5 lakhs SIRs. 475/month

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Claim Settlement of Universal Sompo Health Insurance

Universal Sompo settles claims in a speedy and efficient manner. So, it is easier for you to get cashless claim services and claim reimbursements. A leading general insurance company in India, Universal Sompo is committed to helping customers manage their risks today and tomorrow and making claim process as simple and convenient as possible. It gives policyholders the priority and makes the claim settlement customer-friendly. Further, Universal Sompo can help you settle the claim as soon as possible. You can get all the claims settled by either for cashless hospitalisation or reimbursement.

  • Claim Process for Cashless Treatment

    In case of cashless hospitalisation, you don’t need to pay even a single penny to the hospital. However, cashless treatment is available only in network hospitals. Follow the step-by-step guides for a cashless claim settlement process at Universal Sompo:

    • Before anything else, search for a Universal Sompo network hospital in a city where you want to get cashless treatment
    • Intimate Universal Sompo within 24 hours (emergency hospitalisation) and 48 hours before admission in planned hospitalisation.
    • While visiting the hospital, carry the Health Serve Card issued by Universal Sompo and valid photo ID.
    • Show the card and valid photo ID at the insurance desk of the hospital and get ‘Cashless Request Form.'
    • Fill in the form with the correct details and submit it to the Hospital Insurance helpdesk.
    • After verifying the details, the hospital sends the form to Universal Sompo-Health Office.
    • The insurer reviews the form, matches the details, ensures the cashless admissibility as per Policy Terms and Conditions.
    • On getting assured that you’re eligible for cashless treatment, the insurer gives approval.
  • Reimbursement Treatment

    Through In-House Claim Management

    With the reimbursement facility of Universal Sompo, you can get treatment at any non-network hospital. However, you have to pay the expenses incurred during hospitalisation or bills of hospitalisation from your own pocket and claim for reimbursement at Universal Sompo. Follow the step-by-step guides for the reimbursement claim settlement process at Universal Sompo:

    • Inform the health insurance company within 24 hours in an emergency. However, the insurer must be notified 48 hours before in planned hospitalisation.
    • Get admission to any hospital for and avail the treatment.
    • Settle your hospital bill. Collect all original documents from the hospital after discharge.
    • The documents are medical reports, invoices, discharge summary, discharge certificate, all test reports, etc.  

    Through TPA

    Call the TPA helpline number mentioned in your health card as soon as the claim occurs. While intimating the claim, you need to furnish the following information:

    • Contact numbers
    • Membership ID number
    • Policy number
    • Nature of sickness/accident
    • Date and time oflLoss in case of an accident
    • Name of the Insured patient
    • Contact details of the insured person
    • Starting date of disease symptoms in case of sickness
  • Documents Needed

    All the documents except the patient’s valid ID proof should be submitted in original form:

    • Original investigation reports
    • Final hospital discharge summary
    • FIR or post-mortem report if happened
    • Pharmacy bills along with the prescription
    • Canceled cheque or NEFT details for payment
    • Original bills, receipts, and discharge report
    • Indoor case papers and duly-filled claim form
    • Original hospital bills and a valid photo ID proof
    • Treating doctor's report, and original consultation notes
    • Nature of operation performed and surgeon's bill and receipt
    • Test reports along with attending doctor’s or surgeon’s report


  • Incurred Claim Ratio (ICR) of Universal Sompo Health Insurance

    The Incurred Claim Ratio (ICR) of an insurance company indicates their performance. It helps customers understand what they can expect from the insurance company. The ICR of Universal Sompo for FY 2018-19 is 92%.

Save Tax upto ₹75000*
Under Section 80D

*Tax benefits are subject to changes in Income Tax Act.

Universal Sompo Health Insurance User Reviews

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  • InsuranceDekho offers some of the most affordable health insurance plans I've come across. With the low premiu...

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    Universal Sompo
    By Imaan Aulakh
    On: Oct 16, 2023
  • I recently had to make a claim for my Universal Sompo Health Insurance Policy, and InsuranceDekho processed it...

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    Universal Sompo
    By Shruti Shukla
    On: Sep 08, 2023
  • At InsuranceDekho, it was easy to fill a quote. I wanted to buy a reliable health insurance policy at the port...

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    Universal Sompo
    By Vandana Garg
    On: Aug 23, 2023
  • Universal Sompo Health Insurance Policy was the most suitable health insurance policy for me out of the ones d...

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    Universal Sompo
    By Anuradha Kashyap
    On: Aug 11, 2023
  • The entire team at InsuranceDekho is the best I have ever come across. I had a great experience while getting ...

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    Universal Sompo
    By Bharti Sen
    On: Aug 07, 2023
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Universal Sompo Health Insurance Contact Details

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Claim Process at Universal Sompo Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 72 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 72 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

1872 Universal Sompo Cashless Network Hospitals in India

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Universal Sompo Health Insurance Claim Settlement FAQs

  • Within how many days do I have to file a claim in Universal Sompo Health Insurance?

    The claim must be submitted in the 30 days after the hospitalisation. 

  • How much time does Universal Sompo take to settle claims?

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

  • What is the maximum number of claims that can be made in a year in Universal Sompo health insurance policies?

    There is no limit on the number of claims allowed during a policy term. Claims can be made up to the limit of sum insured under the policy. 

  • How does Universal Sompo settle claims if I buy more than one health insurance policy?

    Each company pays a relatable proportion of the loss in case the claims are made. 

  • Within how many days do I have to file a claim in Universal Sompo Health Insurance?

    The claim must be submitted in the 30 days after the hospitalisation. 

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