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Universal Sompo Health Insurance

Universal Sompo General Insurance Company is a private-public undertaking, which was founded in 2007. It is a joint collaboration between Dabur Investment Corporation, Indian Overseas Bank, Karnataka Bank, Allahabad, and Sompo Japan. Today it is considered as one of the best insurance service providers in India.

The main focus is to provide quality and comprehensive health insurance solutions to its customers. Universal Sompo health insurance plans are designed in a simple and affordable manner to meet the most of the insurance needs of its customers.

Universal Sompo Health Insurance at a Glance

Key Features Highlights
Network Hospitals 5000+
Waiting Period 4 years
Incurred Claims Ratio 70.91%
Renewability Lifelong

Key Features of Universal Sompo Health Insurance

Have a quick rundown of the salient features of Universal Sompo mediclaim policies-

  • Medical insurance plans come with lifetime renewability
  • Diversified plans available for individuals, families, groups, NGOs, students and the likewise
  • Tax benefit under Sec. 80D of the IT Act
  • The company has tie-ups with more than 5000 hospitals PAN India
  • Special plans for people working abroad/rural people/groups

Universal Sompo Health Insurance Plans Comparison Table

Plan Name Sum Assured (in Rs.) Age Criteria Pre-medical Test Waiting Period for pre-existing diseases
Individual Health Insurance Up to 5 lacs Up to 55 years After 45 years Not covered
Group Health Insurance Plan Up to 5 lacs Above 18 years Add-on cover
Individual Accident Policy Up to 5 lacs 18 to 65 years

20% loading applicable if enrolment age is between 65 & 75 years

Janta Personal Accident Insurance Proposer: 18 yrs. & above

Enrolment age: 5 to 65 years

Not applicable
Group Personal Accident Policy 18 years Not applicable
Aapat Suraksha Bima Policy Lump sum basis Not covered
Loan Secure Insurance Policy Up to 10 lacs 20 to 50 years After 55 years or if the sum assured is above Rs. 1 crore 48 months
Hospital Cash Insurance Policy 18 to 70 years After 55 years
Saral Suraksha Bima – Micro Insurance Policy Adults: 18 to 65 years
Dependent Children: 10 to 25 years
48 months
Sampoorna Suraksha Bima -Micro Insurance Policy Up to Rs.30,000 Adults: 18 to 65 years

Children: (if either of the parents is covered) – 91 days to 25 years

48 months
Universal Sompo Senior Citizen Health Insurance Plan 1 to 5 lacs Above 60 years Required 24 months
Complete Healthcare Insurance 1 to 10 lacs Adults: 18 to 70 years
Dependent Children: 10 to 25 years
36 months
Pravasi Bharatiya Bima Yojana Up to Rs. 10 lakhs 18 to 65 years After 45 years 48 months
Surva Vidyarthi Bima Yojana 3 to 65 years
Swarna Gramin Bima Yojana – Individual Between Rs. 50,000 and Rs. 2 lacs 18 to 65 years After 45 years Covered on payment of additional premium
Swarna Gramin Bima Yojana – Group Between Rs. 50,000 and Rs. 2 lacs Adults: 18 to 65 years
Dependent Children: above 6 months
After 45 years Covered on payment of additional premium
Critical Illness Insurance Plan Rs. 2.5 lacs to Rs. 20 lacs Min: 5 years
Max: 65 years
After 55 years 48 months

Types of Universal Sompo Health Insurance Plans

Here is a list of the Universal Sompo health insurance plans. Have a quick overview of the plans and their features-

  1. Group Health Insurance Policy – This plan is available for people between 18 and 75 years of age.
  2. Individual Health Insurance Plan- The covers both hospitalization expenses and domiciliary hospitalization expenses within India.
  3. Group Personal Accident Policy– The plan offers protection against an accident resulting in temporary disabilities, permanent disabilities, and death.
  4. Janta Personal Accident Insurance Plan- This plan offers coverage to a company’s employees, NGO members, Kisan credit card holders and bank depositors.
  5. Aapat Suraksha Bima Policy-Compensation is provided on a lump sum basis upon diagnosis of diseases like cancer, paralytic stroke, renal failure, organ transplant, and coronary artery disease.
  6. Hospital Cash Insurance Policy- This policy includes hospital cash benefit, ICU benefit and, convalescence benefit.
  7. Loan Secure Insurance Policy- This policy is designed to take off the burden of your loan in case of diagnosis of a major illness, accidental death or disabilities.
  8. Sampoorna Suraksha Bima (Micro Insurance Policy)-It covers the damage caused to your household contents due to fire, lightning, bushfire, natural and man-made calamities including terrorism.
  9. Saral Suraksha Bima (Micro Insurance Policy) – It covers the five specified critical Illnesses, permanent total disabilities and accidental death resulting from an accident.
  10. Senior Citizen Health Insurance Policy- You should be 60 years old to buy this policy. It covers hospitalization expenses, ambulance charges, and cost of health check-ups.
  11. Complete Healthcare Insurance- It is a comprehensive mediclaim policy that covers most of your medical expenses.
  12. Critical Illness Insurance Policy- The plan offers a wide range of sum assured from Rs. 2.5 lakhs to Rs. 20 lakhs. It covers the expenses incurred on critical illnesses and surgical procedures.
  13. Pravasi Bhartiya Bima Yojana- This insurance scheme is available to all Indians citizens between the age band of 18-65 years whilst stay abroad having a valid visa for the purpose of employment
  14. Swarna Gramin Bima Yojana (Individual) – This plan is designed for village dwellers to insure themselves or their families. NGOs can also buy this plan to cover their rural clientele on rural clientele.
  15. Surva Vidyarthi Bima Yojana- Universal Sompo medical insurance came up with this plan for schools/educational institution to insure their students. It covers the death and disabilities of the parents/student from an accident.
  16. Swarna Gramin Bima Yojana (Group) – This plan offers coverage to the rural groups. Thebenefits are similar to the individual plan. But the coverage is provided to a group of members.

Universal Sompo Health Insurance Claim Process

The company has a good claim settlement record with its customers. Universal Sompo follows a quick and hassle-free procedure for both cashless and reimbursement claims-

Universal Sompo Cashless Claim Procedure

Follow the below steps to get cashless healthcare treatment –

  • In case of an emergency hospitalization, call their helpline number and lodge your claim within twenty fours hours the hospitalization.
  • In case of a planned hospitalization, inform the insurer 48 hours prior to the hospital admission.
  • Visit a nearby network hospital and show the company health card number, along with your valid photo ID.
  • Collect the ‘Cashless Request Form’ from hospital /TPA desk
  • Fill the required details and give it to the TPA desk in the hospital
  • Hospital authority will verify the details and will send the filled ‘Cashless Request Form’ to the concerned insurer by Fax
  • Universal Sompo will review the request, approve or reject it as per the policy terms and conditions and you will be communicated about the same
  • You will need to pay the deductibles and any extra amount that is not covered in the policy.
  • You can check your claim status by using your claim reference number

Universal Sompo Reimbursement Claim Process

When you avail the treatment at a non-network hospital and pay the medical bills on your own, you can file for its reimbursement. Post-discharge from the hospital, this amount can be claimed from the insurer.

Below are the steps for filing reimbursement of your hospitalization expenses:

  • Call at their health helpline number 1800 200 5142 or email at healthserve[at]universalsompo.com.
  • Remember to lodge your claim within 24 hours in case of emergency admission and 48 hrs. prior to hospitalization, if it was planned in advance.
  • Get admitted and avail the treatment. Settle your bills and collect all the original documents when getting a discharge.
  • Fill the claim reimbursement form
  • Submit the form with all the original documents containing all the hospital bills at the registered address of the insurer
  • On receipt of all the documents, Universal sompo will process your claim as per the terms and conditions. Intimation will be sent to you regarding the same.

Information Required While Filing a Claim

  • Your contact details
  • Universal Sompo health insurance number and Membership ID no. mentioned on the Health Card
  • Name of the Patient
  • Nature of illness/accident
  • Date and time of loss in case of an accidental hospitalization or starting date of a symptom of disease in case of an ailment
  • Location of Loss/accident
  • Geographical details

Inclusions of Universal Sompo Health Insurance

1. Day-care treatment – The plan offers coverage to you for health treatments that do not require hospitalization for more than 24 hours. Taking an example of a colonoscopy test or even a cataract surgery, these are usually covered under this plan.

2. Pre-hospitalization charges – Medical expenses incurred on blood tests, x-ray, and other medical checkups that are required before hospitalization, are also taken care off.

3. In-patient hospitalization charges– All the hospitalization expenses that are claimed by the policyholder are covered.  All the family members that are insured under the plan, their expenses are covered in case of hospitalization for more than 24 hours.

4. Post-hospitalization charges – The cost incurred on medicines, health check-ups that are done to ascertain the health of the patient after the discharge from the hospital, are also covered under the health insurance plan.

5. Ambulance charges – This amount varies from plan to plan, but emergency ambulance charges are recompensed in most of the plans.

6. Restoration Benefit – It is just like a ‘magical backup’ to reinstate the entire sum insured. If you happen to exhaust the entire sum insured by making claims over the time, it is refilled automatically to cover the next hospitalization, which may occur during the policy term.

Exclusions of Universal Sompo Health Insurance

  • Any claim arising within the waiting period will not be covered until it is an accidental case
  • Anyone who is on artificial life support, or is in non-recoverable health condition
  • Any consequential treatment resulting from an aesthetic treatment, any surgery or plastic surgery
  • Any treatment for sexually transmitted diseases or related to fertility problems
  • Any treatment that is carried out due to mental disorders, physiological illnesses or as a symptom of depressants
  • Illness or damage resulting due to consumption of alcohol, intoxicating drugs or tobacco
  • Medical expenses on routine check-up are not compensated
  • Any gender change surgery is beyond the scope of coverage
  • Expenses incurred on OPD treatment are excluded
  • Cost of medical treatment undertaken overseas
  • Any loss or damage arising due to self-inflicted injuries and suicidal attempts cannot be claimed
  • Any Illness or Injury resulting due to the breach of conduct or law by the policyholder, or with the intentions of war, destruction, crime, rebellion, mutiny, attacks, usage of weapons, detainment is not processed
  • Pregnancy-related treatment including abortion, childbirth, miscarriage, or any sorts of complications are generally excluded from the family health plan

Benefits of Universal Sompo Health Insurance

The company provides comprehensive medical insurance plans at an affordable cost to meet most of your insurance needs. Here’s an overview of the advantages of buying a Universal Sompo mediclaim policy-

  • Cashless medical treatment can be availed across the country
  • Pre and post hospitalization expenses are recompensed
  • Universal Sompo medical insurance plans also cover the day-care procedures
  • Individual/family floater and group plans are available
  • The insurer offers a free-look period of 15 days during which you can terminate the policy
  • Free medical check-up facility is provided after 4 years of policy term
  • Most of the plans come with lifetime renewability
  • Pre-existing illnesses are also covered after completion of the waiting period

Universal Sompo Health Insurance Renewal

Universal Sompo medical insurance plans can be renewed online in a simple and convenient manner.  The steps for online renewal are as follows-

  • Visit the official website of Universal Sompo
  • Enter the renewal details such as your policy number
  • You’ll be redirected to a page which will ask you fill your policy options and number of the policy
  • Next step is to view the summary and calculate the premium online
  • If you’re okay with the offering, then pay the premium through the available payment options like Credit Card/Debit Card/Net Banking and enjoy the policy benefit uninterrupted.

Universal Sompo Health Insurance Calculation

The premium for Universal Sompo mediclaim policies is calculated on the basis of the coverage type, policy term, number of members covered, add-on benefits, no-claim-bonus, geographical location, age etc.

You can also calculate the premium by using a Universal Sompo health insurance premium calculator. All you need to do is enter the following details to know the cost of premium-

  • Email id
  • City
  • Name of the policyholder
  • Sum Insured
  • Date of birth
  • Members to be covered

You will get the medical insurance quotation within seconds of providing the above details. Moreover, it is suggested that you go through the Universal Sompo medical insurance reviews online and then make your decision.

Why Universal Sompo Health Insurance?

Universal Sompo offers a number of policies to choose from. Moreover, you can make customization in your health insurance plan based on the number of family members you want to include, the city in which you want to take the treatment, the type of critical illnesses you want to cover, No claim bonus, network hospitals etc.

Documents Required for Universal Sompo Health Insurance Claims

You need to furnish the following documents while claiming your Universal Sompo mediclaim policy-

  • For Claims Related to Hospitalization-
  • Completely filled claim form
  • Hospital bills, discharge certificate and receipts (in original)
  • Chemist bills with doctor’s prescription
  • Evidence of the treatment from Doctor/Laboratory /Hospital/Chemist as required
  1. For Claims Related to Permanent total /partial disabilities
  • Universal Sompo medical insurance claim form
  • Police FIR/ Panchnama ( in original)
  • Discharge card from the hospital
  • Hospitalization Report
  • Certificate of Disability (stating the degree of disability) from the Doctor recognized by a Govt.
  • In case of loss of employment (Termination letter from the hospital is required)
  1. For Death Claims
  • Duly filled & signed claim form
  • Post-mortem report
  • Original FIR/Panchnama
  • Death Certificate

Universal Sompo Health Insurance FAQs

Q1. Can I renew Universal Sompo Health Insurance plan online?

You can easily renew Universal Sompo mediclaim policy online from the insurer’s site.

Q2. How useful is the Universal Sompo health card?

This card has all the details related to the TPA. While taking admission to a network hospital, this card is required.  Moreover, you can call on any of the numbers mentioned on the card for any queries, assistance, and clarifications.

Q3. What is the benefit of taking treatment in a hospital registered with Universal Sompo?

The foremost condition to avail cashless treatment is that the insured must have availed the treatment from a network hospital. It means the cost of treatment is directly settled by the insurance company with the hospital authority. The insured can avail the list of Universal Sompo health insurance network hospitals in the policy document.

The entire process is done through a pre-authorization approved by the insurer. You only need to fill the form asking for a pre-authorization approval. After verifying the form, the insurer will approve the request, and after that, you can avail cashless treatment. If in case, the insurer rejects the application; then you should proceed with the treatment by paying the bills initially and filing a claim later on.

Q4. Is there any time limit to file the claim?

Yes, it is essential that you file the claim within 30 days of the treatment or getting a discharge from the hospital.

Q5. How long will Universal Sompo take to settle my hospital bills?

Usually, the insurer settles the bills within seven working days of receiving all the necessary documents.

Q6. What is the benefit of getting a Universal Sompo Senior Citizen Health Insurance Policy?

This plan is for people between the age group of 60 and 70 years.  The sum assured amount ranges between Rs. 1 lac to Rs. 5 Lacs. However, the list of compensation provided is as follows-

  • Hospitalization expenses including room rent, nursing costs, ICU costs up to 25% of SI
  • 50% reimbursement of medical tests
  • Specified critical illnesses
  • Cost of the surgeon, specialists, medical practitioners up to 25% of SI
  • Cost of anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, X-ray, dialysis, chemotherapy, radiotherapy, the expense of pacemaker etc. up to a limit of 50% of SI
  • Ambulance fees
  • Cost of the accompanying person
  • Daily allowance perks

Furthermore, you can get a long-term policy discount and cumulative bonus.

Q7. What diseases are covered in the Universal Sompo Critical Illness Plan?

You can get coverage against the following illnesses-

  • Cancer of specified severity
  • First severe heart attack
  • Open Chest CABG
  • Open Heart transplant
  • Severe Coma
  • Kidney Failure that requires routine dialysis
  • Stroke causing permanent symptoms
  • Major organ transplant
  • Motor Neurone Disease with Permanent Symptoms
  • Permanent Paralysis of Limbs
  • Multiple Sclerosis with existing symptoms

Q8. What happens if I cancel my Universal Sompo mediclaim policy?

Upon cancellation, your insurance will cease to exist from the date of cancellation of the plan. In addition, the premium will also be refunded as per short period cancellation rates. Please read the policy wordings for further details.