Universal Sompo health Insurance Plans

Universal Sompo Health Insurance

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Universal Sompo Health Insurance provides coverage on hospitalization expenses, domiciliary hospitalization, accidental injury and provides several add on benefits.

Key Features of Universal Sompo Health Insurance

  • Room Rent: NIL capping on room rent across plans
  • Co-pay: 10% co-pay applicable for treatment in Non Network hospitals
  • Restoration Benefit: Upto 100% of Base Sum Insured per year

Universal Sompo Health Insurance Review

Universal Sompo Health Insurance
Number of lives covered *
Incurred Claims Ratio *
Universal Sompo Insurance tenure options
1 or 2 years options available
Claims Settlement Ratio 20-21**
List of network hospitals
5,000+ hospitals
Number of policies issued *
Maximum family floater coverage
Self, Spouse + 4 dependent children
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website
Universal Sompo General Insurance Company Limited, which is headquartered in Mumbai, is a private public joint venture in general insurance where two nationalized banks, namely Allahabad Bank and Indian Overseas Bank, one private sector bank namely Karnataka Bank Ltd, one FMCG namely Dabur Investment Corp and a leading general insurer from Japan namely Sompo Japan Nipponkoa Insurance Inc have formed a general insurance company. It is India's first Public - Private Partnership in General Insurance Industry. The Sompo Japan Nipponkoa Insurance Inc. is a leading Japanese insurance provider and is the largest property and casual insurance company in the country of Japan. Universal Sompo is a rapidly growing insurance provider in India. It started operations in India in the year 2007 when it received its Licence from the Indian Regulatory and Development Authority of India (IRDAI). In case of Health Insurance, the company offers a range of plans that are designed to meet all the requirements of the individual.

One of the awards the company has won in the past few years included the "Fintelekt-Insurance awards 2017" for the leadership in claim service in General Insurance industry for the financial year 2016-17.

Universal Sompo offers their health insurance customers the option of availing quality treatment at more than 4,000+ leading hospitals across the country. With an incurred claims ratio of 92.00%, they also covered 11.34 lac lives during the same year 2018-19, as per the data provided by IRDAI.

Universal Sompo General Insurance is today one of the fastest growing insurance players in India with a lot of focus on both retail and group insurance products. Today the Universal Sompo health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 4,000+. Most of the customer’s Universal Sompo’s health insurance reviews have been positively influencing the growth of their business year on year. One can also follow the Universal Sompo health insurance renewal link on eindiainsurance for renewal of their existing policies and if one needs to file a claim, all they need to do is to fill in the Universal Sompo health insurance claim form available on the same website.

Universal Sompo Health Insurance Products

Key Features:
  • The policy offers a wide coverage sum insured up to Rs.5, 00,000.

Key Features:
  • The policy offers a wide coverage sum insured up to Rs.5, 00,000.

Key Features:
  • Critical Illness Insurance Policy can help in reducing financial burden and concentrate on getting better treatment on diagnosis with Critical Illness.
Key Features:
  • On last birthday you must be over 60 years old to take a policy.
  • Must be a permanent resident of India
  • The maximum age for you and your spouse to qualify under the Regulation is limited to 70 years. However, the Policy renewals shall be provided for lifetime.
Key Features:
  • Universal Sompo 's Super Healthcare Insurance offers a higher Sum Insured with a deductible for claims that make Sum Insured more affordable than a regular Sum Insured policy.

Key Features:
  • Aapat Suraksha Bima Policy offers lump-sum insurance to protect the insured and/or the applicant against sudden and unforeseen expenditure (other than medical expenditure) on the diagnosis of the major diseases that are fulfilling.

Key Features:
  • An person may take the policy to protect him/herself and his/her family, i.e. spouse, dependent children up to age 25, and dependent parents.

Key Features:
  • An person may take the policy to protect him/herself and his/her family, i.e. Self, Spouse, Dependent Children, Mother, Father, Mother-in-law, and father-in-law between the age of 18 years and 65 years.

Key Features:
  • Minimum of Rs.50,000/- to Maximum of Rs.2,50,000/- (in the multiples of fifty thousand) on individual basis.

Key Features:
  • Corona Kavach policy shall be offered with a policy term of 3 ½ months, 6 ½ months and 9 ½ months

Universal Sompo health insurance – Overview

  • Features
  • Ho to buy
  • Claims procedure
  • Exclusions

Features of Universal Sompo Health Insurance Plans

  • This Policy covers persons in the age group 91 days to 70 years, with the proposer necessarily being an adult.
  • In-patient treatment includes Hospital room rent or boarding expenses, nursing, Intensive Care Unit charges Operation Theatre charges, Medical Practitioner’s charges, fees of Surgeon, Anaesthetist, Qualified Nurse, Specialists, the cost of diagnostic tests, medicines, drugs, blood, oxygen, the cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure. A minimum period of 24 consecutive hours hospitalization as in-patient is must.
  • Pre & Post Hospitalization Cover : Covers relevant medical expenses incurred upto 30 days before hospitalization or day care treatment and 60 days post hospitalization for treatment of Disease, Illness contracted or Injury sustained.
  • Organ Donor Expenses : Covers hospitalization expenses for Medical treatment of the organ donor for harvesting the organ
  • AYUSH Treatment Expenses
  • Automatic Restoration of Sum Insured upto 100% of Base Sum insured
  • Domiciliary Treatment - Coverage of Medical treatment actually taken at home for a period of more than 3 days under the following compelling circumstances, which in the normal course would require Hospitalization of Insured Person
  • Critical-illness Coverage (Add on/ Optional)
    • In case you have opted for additional cover against following 5 named Critical Illness and have paid additional premium.Your Sum insured for the treatment of the said disease/medical condition becomes double.
      • First Heart Attack - Of Specified Severity
      • Cancer of specified severity
      • Open Chest CABG
      • Open Heart Replacement Or Repair Of Heart Valves
      • Coma Of Specified Severity
      • Kidney Failure requiring regular dialysis
      • Major Organ /Bone Marrow Transplant
      • Stroke resulting in permanent symptoms
      • Kidney Failure requiring regular dialysis
      • Permanent Paralysis Of Limbs
      • Motor Neurone Disease With Permanent Symptoms
  • Emergency Ambulance - Coverage of Emergency Medical expenses upto 1% of Basic Sum Insured subject to Maximum of Rs 1000.
  • Health Check-up - Medical checkup expenses can be reimbursed once at the end of a block of every four claim free Policies bought from USGIC. The reimbursement shall not exceed the amount equal to 1% of the average Basic Sum Insured for the block of 4 years.
  • Hospital Cash - When you avail this option, we shall provide you with daily cash for each day that you are hospitalised when your hospitalisation exceeds 3 days.
  • Maternity with New Born Baby Cover
  • This benefit is available only under a Family Floater Policy
  • This benefit is available for Insured / Insured’s spouse provided both are covered under the same Policy.

Why Should a customer opt for Universal Sompo General ?

  • Their Mission
    • World class services and products to all their Customers
    • Growth along with Customer Centric Approach
    • Highly efficient post claim services to all our customers.
  • Value Added Services
    • Wellness is a lifelong path, and the journey is different for each individual — whether they are healthy, at risk of disease or injury, managing a chronic condition or experiencing a major health event.
  • Policy Issuance Support
    • Policy will be delivered right to one’s email and whats app number. In case of any problem in policy issuance, they will take care of resolving the issue and delivering the policy right away in your inbox and get everything ready for you.
  • Claim Assistance
    • Get full claim assistance, Just call them on our Toll-free 1800 22 4030 / 1800 200 4030 and they will take care of the rest.
  • Policy Vault
    • All your policies in one place - Universal Sompo is the way ahead on the Digital Insurance journey. They take care of all one’s insurance needs.

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.

Follow below steps to avail Cashless facility through our In house Health Claims Management:
Step I Call the 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.
Step II 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.
Step III Fill your details in the ‘Cashless Request Form’ & submit it to the Hospital Insurance helpdesk.
Step IV 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.
Step V Universal Sompo – Health will review 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:
Step I Call our Health Helpline 1800 200 5142 or email at healthserve@universalsompo.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.
Step II Visit hospital and undergo your treatment. Settle your hospitalization bill and collect all original documents after discharge from hospital.
Step III 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
Step IV 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. 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.

Exclusions under Universal Sompo Health Plan

The major exclusions under health insurance policy are:
  • Specific Waiting Periods : The Illnesses and treatments listed below will be covered subject to a waiting period of 1 years as long as in the second Policy Year has been insured under this Policy continuously and without any break:
    • Illnesses
      • Arthritis if non-infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant.
      • Treatments
        • Benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; Surgery of gallbladder and bile duct unless necessitated by malignancy; Surgery of genito urinary system unless necessitated by malignancy; Surgery of benign prostatic hypertrophy; Surgery of hernia; Surgery of hydrocele; Surgery for prolapsed inter vertebral disk; Surgery of varicose veins and varicose ulcers; Surgery on tonsils and sinuses; Surgery for nasal septum deviation.
  • However, a waiting period of 1 year will not apply if You were insured continuously and without interruption for at least 1 year under any Our or other Indian insurer’s individual health insurance Policy for the reimbursement of medical costs for inpatient treatment in a Hospital.
    • Maternity and Childcare Benefit Waiting Period of 3 years
      • The expenses covered under benefit n) Maternity and Childcare benefit shall be excluded for a period of 3 years unless You were insured continuously and without interruption for at least 3 years under any other Indian insurer’s or Our individual health insurance Policy for reimbursement of medical costs for delivery of child in a Hospital.
      • Out-patient Treatment Waiting Period of 3 years : The expenses covered under benefit l) Out – Patient treatment shall be excluded for a period of 3 years unless You were insured continuously and without interruption for at least 3 years under any other Indian insurer’s or Our individual health insurance Policy for reimbursement of medical costs incurred by You as an Out-patient in a Hospital or Out-patient Treatment centre.
  • If You renew with Us or transfer from any other insurer and increase the Sum Insured (other than as a result of the application of Cumulative Bonus) upon Renewal with Us), then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased.
  • You will be given the Portability credit of the waiting period based on the number of years of continuous and uninterrupted insurance cover
  • Pre-existing diseases, illness, or injury. Health insurance benefits will not be available for any condition(s) as defined in the policy, until 48 months of continuous coverage have elapsed, since the inception of the first policy with the Company
  • Any benefit under critical illness within the first 30 days of inception of the policy for the first year. This exclusion doesn't apply for subsequent renewals with the Company without a break.
  • Medical expenses incurred for treatment undertaken for disease or illness and/or for critical illness within 30 days of the inception date of health insurance policy. This exclusion doesn't apply for subsequent renewals with the Company without a break.
  • Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations and inoculation of any kind, issuing of medical certificates and examinations as to suitability for employment or travel.
  • Vitamins and tonics unless forming part of treatment for the disease, illness, or injury.
  • Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by the Medical Practitioner
  • Prostheses, corrective devices, and medical appliances, which are not required intra-operatively or for the disease/ illness/ injury for which the Insured / Insured Person was hospitalized
  • Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment.
  • Costs of donor screening or treatment, unless specifically covered and specified in the Schedule to this Policy.
  • Naturopathy treatment.
  • Any treatment received outside India.

Universal Sompo Health Insurance FAQ’s

It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals.

A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.

The health cards need to be renewed or re-issued during the policy tenure.

Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.

In case of a planned hospitalization or emergency services, use your Health ID Card at any of network hospitals and avail cashless service. In case the hospital is not listed in the network of hospital, then pay the cash and submit the claim to TPA for reimbursement with relevant documents and bills.

These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.

Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.

When you approach a hospital which is listed in the provider list of our network and disclose the health-card, hospital will pursue TPA for pre-authorization. Once the authorization is issued by TPA, you do not have to pay any money towards the covered services provided by the hospital. This is called as a cashless service.

It is a hospital request to TPA to confirm the pay ability of your illness.
  • In case of planned hospitalization: Please contact your TPA helpline-Which is mentioned on the Health Identity Card. Obtain approval from the TPA.
  • In case of emergency hospitalization: Family to contact TPA help-line as mentioned in the policy.

TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant documents are submitted.

The claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment.

Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022