Universal Sompo Health Insurance

Universal Sompo Health Insurance provides you all-round protection in today's world full of health-related difficulties. Health Insurance plans from Universal Sompo Health Insurance protects you and your family by providing financial support if a health crisis comes knocking at your doorstep.

Ranked 5th in the top 15 for providing non-life insurance products.

Universal Sompo General Insurance, has a variety of health plans like Complete Health, Corona Rakshak, Corona Kavach, Super Healthcare, Arogya Sanjeevani, Individual Health, Group Health Insurance, Janata Personal Accident Insurance and more. You get a host of benefits like No-Claim​ ​​Bonus, Cashless ​Hospitalization, low premium with amazing discounts, and tax savings u/s 80D of the Income Tax Act, 1961. You can also buy Universal Sompo Health Insurance Plan online easily. Universal Sompo has a countrywide presence with 86 branch offices, 4000+ Network Hospitals, and has settled more than 90% of the claims.

Features - Universal Sompo Health Insurance

  • Renewal : All the offered plans comes with lifelong renewable option. Thus, once the plan is opted can be renewed at same premium throughout the life.
  • Hospitalization Cover : Covers pre, post, in-patient hospitalization and other medical expenses.
  • Cashless Hospitalization Service : Offers cashless claim hospitalization services across the India.
  • Free Look-up Period : Offers free look up period, during which the policyholder can review the policy, and if the policyholder disagree with any of the terms and conditions can cancel the policy. However, the premium paid might be refunded after a deduction.

Benefits - Universal Sompo Health Insurance

  • Discounts : Universal Sompo Health Insurance provides a discount for multi-year plans.
  • Coverage : Offers coverage to cover whole family in a single policy.
  • Flexibility : Offers flexibility to make the premium payments, sum insured, coverage and plans.
  • No Claim Bonus : Offers no claim bonus for a claim-free year. The bonus is cumulative and can increases with the number of claim-free years.
  • Mediclaim settlement : Offers quick and hassle-free claim settlement services
  • Tax benefits : Save tax as per the Section 80C under the Income Tax Act.

Product Offered – Universal Sompo Health Insurance

Plans are offered by Universal Sompo Health Insurance:

Individual Health Insurance Plans:

Features:

  • This plan is for individuals and one can insure family members individually.
  • Covers hospitalization costs and domiciliary hospitalization due to illness and accidental injury during the policy period.
  • Covers in-patient hospitalization expenses, pre and post hospitalization expenses, domiciliary hospitalization, etc.
  • Domiciliary hospitalization benefit means medical treatment for a period exceeding 3 days for such illness which in the normal course require treatment in a hospital but actually carried at home because the condition of the patient does not allow to take to hospital or due to the lack of accommodation.
  • Pre-hospitalization - Covers incurred medical costs prior 30 days of hospitalization.
  • Post-hospitalization - Covers incurred medical costs within 60 days of discharge.
  • Costs incurred for the enlisted day care procedures that requires less than the 24 hours.
  • The coverage includes room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen and other medical treatment related expenses.
  • The premium of the health plan is calculated after considering the age of the insured and the sum insured selected.
  • Covers cost of organ transplanting expenses.
  • Covers Pre-existing diseases after 4 years of the policy issue date.
  • Tax Benefit under Section 80D of Income Tax Act.
  • Optional add-on cover for critical illness.
  • Offers in-claim process settlement management team.
  • Renew policy with Universal Sompo to receive cumulative bonus of 5% for every claim-free year.
  • Daily Cash benefit - An additional Daily Allowance amount equivalent to 0.1% of the Basic Sum Insured or Rs. 250/- per day whichever is less, for the duration of Hospitalization towards miscellaneous expenses is payable. The maximum amount payable under this extensions is limited to Rs 2500/ in a policy period.
Entry Age Min. 3 years and Max. 65 years The proposer/policyholder should be minimum 18 years of age.
Sum Insured offered Individual policy : Min. Rs.1 lakh and Max. Rs.5 lakh Family Floater : Min. Rs.2 lakh
Pre-medical tests Pre-medical tests are required if the age of the insured is above 45 years. The expenses is to be borne by the policyholder/insured.

Daily Cash benefit:

An additional Daily Allowance amount is payable as equivalent to 0.1% of the Basic Sum Insured or Rs. 250/- per day whichever is less, for the duration of Hospitalization. The maximum amount payable is to Rs 2500/ in a policy period.

Optional add-on Critical Illness Cover:

It covers the following 5 Critical Illness:

  • Paralytic Stroke
  • Cancer
  • Chronic renal Failure
  • Coronary Artery Bypass
  • Major Organ Transplant-Kidney, lungs, pancreas, bone marrow

Exclusions:

Following are the policy exclusions:

  • Pre-existing diseases are not covered
  • Any expense on hospitalization or domiciliary hospitalization incurred on account of any illness during first 30 days from the date of commencement of an insurance cover is not covered. However, this exclusion shall not be applicable if Hospitalization is required on account of an accident
  • During the first year of the cover, the expense of treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis and related disorders not payable
  • Injury or disease directly or indirectly attributable to War, invasion, Act of Foreign enemy not payable
  • Circumcision unless necessary for treatment of a disease is excluded
  • Cost of spectacles, contact lenses, hearing aids are excluded
  • Dental treatment or surgery of any kind unless hospitalization is required is excluded
  • Venereal diseases, intentional self-injury and use of intoxicating drugs/alcohol are excluded
  • Any treatment directly or indirectly for treatment associated with AIDS
  • Cosmetic or aesthetic treatment is excluded
  • Voluntary termination of Pregnancy
  • Pregnancy and childbirth
  • Naturopathy Treatment

Health Insurance Plans for Individuals for the bank account holders of Indian Overseas Bank:

Features:

  • With this plan you can insure whole family in one policy.
  • Offers 1 year, 2 years, and 3 years, plan.
  • Discounts for long term plan - 5% for 2 year plan and 10% for 3 year plan.
  • Covers hospitalization costs and domiciliary hospitalization due to illness and accidental injury during the policy period.
  • Covers in-patient hospitalization expenses, pre and post hospitalization expenses, etc.
  • Pre-hospitalization - Covers incurred medical costs prior 30 days of hospitalization.
  • Post-hospitalization - Covers incurred medical costs within 60 days of discharge.
  • Costs incurred for the enlisted 141 day care procedures that requires less than the 24 hours.
  • The coverage includes room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen and other medical treatment related expenses.
  • Covers cost of organ transplanting expenses.
  • Tax Benefit under Section 80D of Income Tax Act.
  • Portability benefit
  • Lifelong renewability of the plan.
  • Offers free medical check-up after every 3 claim-free year. The medical check-up cost (up to 1% of the base sum insured) will be reimbursed.
Entry Age Min. 3 years and Max. 65 years The proposer/policyholder should be minimum 18 years of age.
Dependent age details The maximum age for dependent Male child: 21 years of age Female child: 25 years or till she marries, whichever is earlier. Children below 3 months can be covered with at least one parent under the Policy.
Sum Insured offered Min. Rs.50,000 and Max. Rs.5,00,000
Renewal Plans Offers one year, two year, and three years policy coverage period
Pre-medical tests Pre-medical tests are required if the age of the insured is above 50 years. The expenses is to be borne by the policyholder/insured

Additional benefit:

  • Out of Pocket expense: In case of hospitalization of children below 12 years, a lump sum amount of Rs. 1000/- is payable.
  • Ambulance Charges: Covers the expenses up to Rs. 1000/- per policy period.
  • Funeral expenses: Covers the cost of funeral expenses up to Rs.1000/ over and above the sum insured subject to the original illness/accident claim admitted under the policy in case of death in hospital.

Add-on Personal Accident Cover:

In this cover Parents are not covered.

The Sum Insured as under shall be applicable as below:

Insured Person % of Sum Insured
In case of Death of Account Holder 100% of the Sum Insured
In case of Death of Spouse 50% of the Sum Insured
In case of Death of Children above 12 years of age 20% of the Sum Insured
In case of Death of Children up to 12 years of age 10% of the Sum Insured

Exclusions:

Following are the policy exclusions:

  • Any treatment within first 30 days of cover except any accidental injury.
  • Any Pre-existing diseases will not be covered for first 48 months.
  • Any expense on treatment related to HIV, AIDS Human T-Cell Lymphotropic Viruses types III (III-LB-III) or Lymphadenopathy Associated viruses (LAV) or the Mutant derivatives or Variations Deficiency Syndrome and all related medical condition.
  • Dental treatment or surgery of any kind unless requiring hospitalization.
  • Cost of spectacles and contact lens or hearing aids.
  • Any expense on treatment of Insured Person as outpatient in a Hospital.
  • Injury or Diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operation.
  • Any expense under Domiciliary Hospitalization
  • War, Rebellion, Revolution, Terrorism acts, Nuclear weapon induced treatment or taking active part in Riot, Strike, malicious acts.
  • Pre and post-natal expenses excluded unless incurred as inpatient in a hospital
  • Voluntary medical termination of pregnancy during first 12 weeks from the date of conception

Complete Health Insurance Plans

Features:

  • With this plan you can insure whole family in one policy.
  • Select Individual or as family floater
  • Offers 3 variants - Basic, Essential or Privilege. the sum assured varies with the plan.
Plan Sum Insured
Basic Rs. 1 lakh to Rs. 2 lakh
Essential Rs. 3 lakh to Rs. 5 lakh
Privilege Rs. 5 lakh to Rs. 10 lakh
  • Covers hospitalization costs and domiciliary hospitalization due to illness and accidental injury during the policy period.
  • Covers in-patient hospitalization expenses, pre and post hospitalization expenses, etc.
  • Pre-hospitalization - Covers incurred medical costs prior 30 days of hospitalization.
  • Post-hospitalization - Covers incurred medical costs within 60 days of discharge.
  • Costs incurred for the enlisted 141 day care procedures that requires less than the 24 hours.
  • The coverage includes room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen and other medical treatment related expenses.
  • Covers cost of organ transplant, organ transplant expenses.
  • Expenses of Dental Treatment: In case of accident, dental treatment is covered.
  • Ambulance Charges: Covers the ambulance cost if the claim is approved, maximum expense restricted as per the plan opted.
  • Ayush Benefit: Medical expenses due to the in-patient treatment under Ayurvedic, Unani, Sidha, Homeopathy is covered.
  • Daily Cash for Accompanying an Insured Child: A daily cash amount for one accompanying adult for each complete period of 24 hours if Hospitalization exceeds 72 hours and the insured child is aged 12 years or less.
  • Out-patient treatment: Expenses up to of 50% of the charges incurred as an out-patient, provided the treatment is taken from a Network Medical Practitioner.
  • Convalescence Benefit: A lump sum amount provided minimum period of 10 consecutive days.
  • Mother and Child care Benefit: Covers the medical treatment expenses associated with routine pregnancy, complicated, and caesarean deliveries, and new born baby care from the 1st day till 91 days.
  • Tax Benefit under Section 80D of Income Tax Act.
  • Portability benefit
  • Lifelong renewability of the plan.
  • Offers free medical check-up after every 3 claim-free year. The medical check-up cost (up to 1% of the base sum insured) will be reimbursed.
Entry Age Min. 3 years and Max. 55 years The proposer/policyholder should be minimum 18 years of age.
Dependent age detail The maximum age for dependent Male child: 21 years of age Female child: 25 years or till she marries, whichever is earlier. Children below 3 months can be covered with at least one parent under the Policy.
Sum Insured offered Min. Rs.50,000 and Max. Rs.5,00,000
Renewal Plans Offers one year, two year, and three years policy coverage period
Pre-medical tests Pre-medical tests are required if the age of the insured is above 55 years. The expenses is to be borne by the policyholder/insured.

Additional benefit

  • Restore Benefit: Automatic restore of the exhausted sum insured for the same policy year after the claim approval.

  • Cover before People Living with HIV/AIDS (PLHA): Covers the cost in-patient hospitalization for the treatment and on the diagnosis of HIV/AIDS.

Renewal Benefits

  • Cumulative Bonus: On renewal of the policy without break, there will be an increase in the sum insured by 10% in case of every claim-free year, but shall not exceed the maximum limit of cumulative 50% of the base sum insured. in the case of a family floater, the sum insured will only increase for the insured members with a claim-free year.

  • Health Check-up: Offers free health check up on completion of claim-free years. The health check up will be done by the Universal Sompo empanelled service providers.

Value Added Benefits

  • Dial-a-Doctor: Facility to seek medical advice through the telephonic or online mode by contacting on the specified helpline number.

  • Health Educational Library for People (HELP): Get access health education library, which is a dedicated online medical knowledge base. it has a special features like Ask a health expert, Live Chat and Online health Guides and Videos.

  • Second Opinion: At times when we do need a second opinion before proceeding further with any medical treatments. Get a second opinion when if you are doubtful about the ailment, treatment, surgery, or treat a health problem that is not an emergency. You can take a second opinion once in the policy year.

  • Specialist Consultation with Two follow up session: Offers a service of arranging a Specialist e-Consultation. Moreover, provides two follow up sessions in case of any chronic condition.

  • Wellness Package: Offer vouchers, for availing certain health services and products.

  • 24x7 Customer Service: The Universal Sompo offers 24x7 assistance to their customers through Universal Sompo Customer Service Centre.

  • Newsletter: Receive a monthly newsletter. The newsletter comes with dieting tips, nutritional information and other similar health related information.

Product Options

  • Personal Accident: Available on paying up of extra premium. Provides sum insured as mentioned in the policy wordings.

  • Critical Illness: Available on paying up of extra premium. Provides sum insured on diagnosis of any of the critical illness as mentioned in the policy wordings. But not payable if diagnosed within 90 days of policy issue.

  • Hospital Daily Cash: A daily cash amount will be payable if the claim is approved and the insured is hospitalized per day provided the treatment is as In-patient for an eligible medical condition.

  • Sub limits: If you avail this option, you agree that in lieu of the discount offered, the medical expenses incurred during hospitalization would be limited upto the pre-declared amount as mentioned in the policy and depending on the treatment.

  • Treatment in Tiered Network: If you avail this option, you agree that If you are hospitalized in a hospital other than the authorised network hospital then, you shall bear 10% of the claim payable and the liability, if any, shall only be in excess of that sum. The company ensures that discount of 5% if treatment is taken in tiered network and 10% copay if treatment is taken in non-tiered network.

Exclusions:

Waiting Periods

Except for accidental hospitalization, here are the specific waiting period:

  • 1 year for any Illnesses and Treatments
  • 3 years in case of Maternity and Childcare Benefit
  • 3 years for any Out-patient Treatment

Senior Citizen Health Insurance Policy

Features:

  • Only for people above 60 years of the age.
  • Maximum age for the entry to opt for this plan is 70 years. However, the renewal is for lifetime.
  • Offers sum insured from Rs.1 lakh to Rs.5 lakh.
  • Medical Examination is necessary before the plan approval. On acceptance of the proposal 50% of the costs of the medical tests will be reimbursed.
  • Offers this plan under floater basis also.

Here’s the list of tests:

Medical Tests Sum Insured Limits
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine Rs.1,00,000
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG Rs.2,00,000 and Rs.3,00,000
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG, Lipid Profile, Stress test or 2D Echo, Kidney Function Test Complete Physical test by a physician Rs.4,00,000 and Rs.5,00,000
  • Covers hospitalization costs and other medical treatment related costs.
  • Covers in-patient hospitalization expenses, pre and post hospitalization expenses, etc.
  • Pre-hospitalization - Covers incurred medical costs prior 30 days of hospitalization.
  • Post-hospitalization - Covers incurred medical costs within 60 days of discharge.
  • Costs incurred for the enlisted 141 day care procedures that requires less than the 24 hours.
  • The coverage includes room, boarding expenses, nursing expenses, surgeon / specialist fees, charges for blood, oxygen and other medical treatment related expenses.
  • Covers cost of organ transplant, organ transplant expenses.
  • Offers optional critical illness cover.
  • Daily Allowance:- 0.1% of Sum Insured or Rs 250 whichever is less, as a Daily Allowance, for each continuous and completed period of 24 hours of Hospitalisation subject to a maximum of Rs 2500 shall be covered under the Policy.
  • Ambulance Charges:up to 1% of SI or Rs. 1500 or the actual amount incurred.
  • Up to 1% of Sum Insured or the actual amount incurred whichever is less for the person accompanying the insured under the policy.
  • Offers sub limits for several medical treatments such as cataract per eye, other eye surgery, stone in urinary system, hernia, etc. as per the list and sum insured mentioned in the policy wordings.
  • This plan comes with co-pay requirements and loadings for people living in the tier 1 cities.

Additional benefit

  • Cumulative Bonus: increase in the base sum insured by 5% for every claim-free year, subject to the maximum upto 10 years.

  • Discounts for long-term policy: Discounts if opted for 2 or 3 years of policy term. For 2 years of policy with advanced premium you get a discount up to 10% and 15% for a 3 year policy.

  • Family Discount: A family discount of 10% on individual basis, this discount is not available under floater plan.

  • Portability: You can port your plan from other authorised insurer to Universal Sompo.

  • Free Look-up period: You get a free look-up period of 15 days from the date of receipt. And on cancellation of the plan during the free look-up period, the premium with deduction of medical examination costs or any other costs incurred during this period will be refunded.

Exclusions:

Waiting Periods

Except for accidental hospitalization, here are the specific waiting period:

  • 2 years for any pre-existing disease.
  • 2 years for specific treatments as mentioned in the policy.
  • 30 days for any illness or treatment other than the pre-existing disease and specific treatments.

Hospital Cash Insurance Policy

Features:

  • This plan is for individuals, family members, and dependent children up to the age of 25 years.
  • Minimum entry age of the proposer is 18 years, and for dependent children is 6 months while the maximum entry age is up to 70 years.
  • No pre-medical tests up to the age of 55 years. Medical tests after the age of 55 years is necessary before plan approval. On acceptance of the proposal 50% of the costs of the medical tests will be reimbursed.
  • Hospital Benefit: Offers 6 variants as hospital benefit under this plan, starting from Rs.500/day up to Rs.3000/day.
  • Option to choose the fixed number of days to get the benefit.You can choose to cover Hospital Cash for a fixed no of 15, 30, 45, 60, 90 or 180 days as per your requirement.
  • Intensive Care Benefit: Depending on the option chosen from the six variants, the benefits is doubled if the insured is admitted in ICU.
  • Convalescence Benefit: If the insured person is hospitalized for more than 21 days, a convalescence benefit of Rs 10,000 shall become payable. But shall not be payable if the period is selected as 30 days or above.

Additional benefit

  • Discounts for long-term policy: Discounts if opted for 2 or 3 years of policy term. For 2 years of policy with advanced premium you get a discount up to 10% and 15% for a 3 year policy.

  • Family Discount: Get Family discount of 5% towards the total premium of the policy.

  • Portability: You can port your plan from other authorised insurer to Universal Sompo.

  • Free Look-up period: You get a free look-up period of 15 days from the date of receipt. And on cancellation of the plan during the free look-up period, the premium with deduction of medical examination costs or any other costs incurred during this period will be refunded.

Exclusions:

Waiting Periods

Except for accidental hospitalization, here are the specific waiting period:

  • 4 years for any pre-existing disease.
  • 1 year for specific treatments as mentioned in the policy.

Critical Illness Insurance Policy

Features:

  • This plan can opted for individual, family members - only on individual basis.
  • Minimum entry age of the proposer is 18 years, and the maximum entry age is up to 65 years. The minimum entry age to get insured under this plan is 5 years of age and the maximum is 65 years.
  • The coverage shall be up to the sum insured.
  • Critical Illnesses and Surgical Procedure Covered under this plan are:
    • Cancer of specified severity
    • First Heart Attack of specified severity
    • Open Chest CABG
    • Open Heart Replacement
    • Coma of Specified Severity
    • Kidney Failure requiring regular dialysis
    • Stroke resulting in permanent symptoms
    • Major Organ /Bone Marrow Transplant
    • Motor Neurone Disease with Permanent Symptoms
    • Permanent Paralysis of Limbs
    • Multiple Sclerosis with persisting symptoms
  • The sum insured can be Rs.2.5 lakh to up to Rs.20 lakh.
  • An occupational loading may be done depending on the occupation of the insured. Occupation with medium risk will be asked 15% loading and occupation with heavy risk will be asked 20% loading.
  • The insured diagnosed with any of the listed critical illness need to survive for 30 days to receive plan benefits.
  • Medical tests is necessary before the plan approval. On acceptance of the proposal 50% of the costs of the medical tests will be reimbursed.

Here’s the list of tests:

Medical Tests Sum Insured Limits
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine Rs.2,50,000
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG Rs.5,00,000, Rs.7,50,000 and Rs.10,00,000
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG, Lipid Profile, Complete Physical test by a physician Rs.12,50,000 and Rs.15,00,000
Complete Blood Sugar, Urine, Routine Blood Group, ESR, Fasting Blood, Glucose, S Cholesterol, SGPT, Creatinine, ECG, Lipid Profile, Stress test or 2D Echo, Kidney Function Test Complete Physical test by a physician Rs.17,50,000 and Rs.20,00,000

Additional benefit:

  • Discounts for long-term policy: Discounts if opted for 2 or 3 years of policy term. For 2 years of policy with advanced premium you get a discount up to 10% and 15% for a 3 year policy.

  • Portability: You can port your plan from other authorised insurer to Universal Sompo.

  • Free Look-up period: You get a free look-up period of 15 days from the date of receipt. And on cancellation of the plan during the free look-up period, the premium with deduction of medical examination costs or any other costs incurred during this period will be refunded.

Exclusion

  • Waiting Period : 90 days after the policy issue date or last commencement date.

Individual Accident Policy

Features:

  • Minimum entry age of the proposer is 18 years. The minimum entry age for the insured is 5 years of age and the maximum entry age is up to 65 years without loading. For insured aged between 65 years to 75 years may be accepted with 20% loading on the premium.
  • Offer three types of coverage -
    • Basic Cover - covers Death only.
    • Wider Cover - covers Death, Permanent Total and Partial Disablement.
    • Comprehensive Cover - covers Death, Permanent Total and Partial Disablement, and Temporary Total Disablement
  • The compensation benefits depends upon the nature of injury and the base sum insured.
  • For accidents resulting in death or permanent total disablement, compensation will be equivalent to the full sum insured.
  • For permanent partial disablement the compensation will depend on the nature of injury.
  • In case of temporary total disablement, the compensation will be 1% of sum insured or Rs 5000/- whichever is less per week, subjected to the maximum period of 104 weeks, shall be payable.
Transportation cost for carriage of dead body to Home including funeral charges. 1% of capital sum insured or Rs.2,500/- whichever is lower.
Cost of clothing damaged in the accident and liability for disablement. Actual expenses subject to maximum of Rs.1000/
Ambulance charges for transportation of Insured person to hospital following accident Subject to maximum of Rs.1000/
Education Fund In the event of death, or permanent total disablement, a compensation towards education fund for dependent children 5% of capital sum insured subject to a maximum of Rs.15000/-
Loss of Employment In the event of accident leading to loss of employment as a consequence of Permanent Total Disability 2% of capital sum insured subject to a maximum of Rs.25000/-

Additional benefit

  • Medical Expenses Extension: Cover the medical expenses due an accident resulting in the bodily injury, death or disablement. The compensation is restricted to 40% of personal accident claim or actual medical expenses whichever is less.

  • Hospital Confinement Allowance: Daily allowance of Rs.500/day to a maximum of 30 days.

  • Family Discount: More than 3 family members 10% discount. More than 4 family members 12.50% discount and more than 5 family members 15% discount.

  • Portability: You can port your plan from other authorised insurer to Universal Sompo.

  • Free Look-up period: You get a free look-up period of 15 days from the date of receipt. And on cancellation of the plan during the free look-up period, the premium with deduction of medical examination costs or any other costs incurred during this period will be refunded.

Exclusions:

Waiting Periods Except for accidental hospitalization, here are the specific waiting period:

  • 4 years for any pre-existing disease.
  • 1 year for specific treatments as mentioned in the policy.

Group Policy offered by Universal Sompo

  • Group Health Insurance Policy
  • Group Personal Accident Policy
  • Janta Personal Accident Policy

Universal Sompo Health Insurance - Claim Process

Claim Process:

  • The first and foremost step is to inform and lodge a claim by contacting Universal Sompo Health Insurance on the Toll Free number - 1800 200 5142.
  • Keep all your documents and details ready:
    • Your contact details
    • Name of the Insured
    • Policy number
    • Date and time of problem
    • Nature of problem

Contact Details:

Lodge claim at Universal Sompo by contacting them at 1800 200 5142.

Email – healthserve@universalsompo.com

HEALTH INSURANCE - CLAIM PROCESS

Here’s the step-by-step process to lodge a claim. Understand Do’s and Don’ts’ to ensure your claim gets approved.

Note:

For any claim to be processed and approved you need to lodge a claim by intimating the company.

Case 1: If it is a Planned Hospitalization If you are planning to go for a planned hospitalization, it is necessary to intimate the company 48hrs prior to the hospitalization.

Case 2: In case of an Emergency Hospitalization In case of an emergency hospitalization, it is important to intimate the company within 24hrs from the time of hospitalization.

Health insurance policy issued by Universal Sompo Health Insurance provides: Cashless and Reimbursement claim services.

Cashless Claim Process:

In cashless service, Universal Sompo will directly pay all the medical bills as per the policy’s terms and conditions on approval of claim.

Steps to avail cashless claim settlement process:

  • Intimate the company on Health Helpline 1800 200 5142 and Intimate your claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.
  • Visit Network hospital and show your Health Serve Card issued by the company along with Valid Photo ID proof.
  • Get ‘Cashless Request Form’ from Insurance helpdesk of the hospital.
  • Fill up the details in the ‘Cashless Request Form’ & submit it to the Hospital Insurance helpdesk.
  • Hospital verifies the patient details and sends duly filled Cashless Request Form by Fax to Universal Sompo-Health Office toll free fax 1800 200 9134.
  • Universal Sompo – Health will review the claim and on approval the same will be communicated. Important documents and details to be provided at the time of claim:
  • Policy Number, Policyholder’s/ Insured’s Name
  • Contact Details of the Claimant/ Policyholder
  • Name of the Insured/ Claimant
  • Hospital Details
  • Nature of Ailment/Details of the Accident (Commencement date of the symptoms & related details)

Reimbursement Claim Process:

The policyholder needs to pay all the cost first and later Universal Sompo Health Insurance will reimburse. The entire medical expenses bill are required to be submitted to get the reimbursement. In case of a reimbursement process, it is not mandatory to get treated in the Universal Sompo Health Insurance Authorized Hospital. The treatment can be carried out in any registered hospital.

Steps to be followed in case of reimbursement claim settlement:

  • Call Health Helpline 1800 200 5142 or email at healthserve@universalsompo.com and inform within 24hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned hospitalization.
  • After treatment, settle hospitalization bill and collect all original documents after discharge from hospital.
  • Fill in Reimbursement Claim Form and submit all original documents to:

Universal Sompo General Insurance Company Limited

Health Claims Management Office

5th Floor, Assotech One

C-20/1 A, Block- C

Sector- 62, Noida

Uttar Pradesh,

Pincode:201309

  • Once the claim form is received, the claim will be judged as per the terms and conditions of the policy. On approval of the claim, the same will be communicated.

Important documents and details to be provided to get reimbursement:

  • Claim Form duly signed by the Insured
  • Photocopy of ID Card
  • Photocopy of policy certificate
  • Original discharge card/summary, Original hospital bills
  • For consolidated amounts, a detailed breakup of the amount
  • All investigation reports and bills in original supported by a note from the attending doctor/surgeon recommending such investigations
  • Surgeon’s certificate stating nature of surgery performed, bill and paid receipt
  • Attending doctors/consultants/specialists/anesthetists bill, receipt and certificate
  • ECS Form

Personal Accident Claim Process

  1. In case of any accidental death or disability, the company should be informed immediately at 1800 22 4030.
  2. The company’s executive would guide the insured with the required process. Relevant documents would have to be submitted for making a claim.

Review of Universal Sompo Health Insurance

Universal Sompo Health Insurance offers a wide range of health insurance policies. policies are pocket-friendly and at the same time ensures you stay covered. You can customised plan with respect premium and coverage. It’s time to shield yourself and your family against the increasing medical treatment costs. Unless found the claim to be a fraud case, Universal Sompo ensures that every claim that is lodged is settled. Universal Sompo could be in your preferred option when you are scouting for an insurer on the basis of pre and post sales services.