Universal Sompo- Health Claim Management
Cashless Hospitalization Process
“Cashless facility” is a facility extended by the insurer to the insured where the payments of the costs of treatment undergone by the insured in accordance with the policy terms and conditions are directly made to the network provider by the insurer to the extent Cashless/ Pre-authorization approved
The insured or the network service provider seeks an approval and guarantee of payment from the insurer before the hospitalization for planned treatment and during Hospitalization for emergency treatment
You can avail the cashless hospitalization facility in any of our Network Hospital. Click here to Search Network Hospital.
Follow below steps to avail Cashless facility through our In house Health Claims Management:
Call our 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 and get ‘Cashless Request Form’ from Insurance helpdesk of the hospital
Fill your 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 willreview and judge the admissibility of the Cashless Request as per Policy Terms &Conditions and the same will be communicated to you and hospital. You will be required to pay for expenses that are not payable as per the terms and condition of the policy.
Reimbursement Claim Process
Reimbursement claim is when the expenses incurred during Hospitalization or bills of Hospitalization are directly settled by the Insured with the Hospital and post discharge from Hospital claimed by the Insured from the Insurer for reimbursement.
Follow below steps to lodge your Health Insurance Claim through our In house Health Claims Management:
Call our Health Helpline 1800 200 5142 or email at email@example.com and inform about your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.
Visit hospital and undergo your treatment. Settle your hospitalization bill and collect all original documents after discharge from hospital
Fill in Reimbursement Claim Form and submit all original documents to our below mention office for reimbursement.
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
Click Here for list of documents to be submitted.
On receipt of document your claim will processed as per Terms & Conditions of policy and the same will be communicated to you.
Claim process to be followed to avail services through TPA (Third Party Administrator)
As soon as a claim occurs, please intimate to the TPA Help line/Toll free number as mentioned in your Health Card. For cashless hospital and more information kindly visit our TPA web site link mentioned below.
Our TPA will be glad to provide you services with a smile within the overall terms and conditions of your MEDICLAIM policy. Our TPA will provide you the following claims services:
- "Cashless Service" at all our Network Providers for all eligible ailments/conditions.
- Processing and settlement of claims under the MEDICLAIM policy with a time bound approach.
- 24 hours Call Centre Service.
Following information needs to be furnished by you while intimating a claim:
- Your Contact Numbers
- Policy Number and Membership ID number (as reflecting on the Health Card)
- Name of Insured person who is Sick or Injured,
- Nature of Sickness/Accident,
- Date & Time of Loss in case of accident, commencement date of symptom of disease in case of sickness,
- Location of Loss,
- Place & contact details of the Insured Person.