GIPSA, PPN and Empanelment in Health Insurance - Explained
GIPSA, PPN in GIPSA, Points to remember before opting GIPSA services, hospitals, empanelment
By Pazcare
October 5, 2022
Total estimated yearly premium
*only basic terms and conditions applied
₹ 100,000
₹ 5,000 per life
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Remember to use Universal Sompo group health insurance premium calculator to estimate the cost for your policy. Some factors that determine your premium are discussed.
Average age of employees
The average age of employees is one of the many things that is asked while calculating the premium amount of group health insurance.
Add-ons
The number of add-on benefits you include in the policy will impact the amount of premium as well.
Type of policy
There are three prominent types of insurance policies in the market. If you choose the one which covers only employees, the premium decided will be less. Similarly if you choose a policy that covers employees, spouse and their children, the insurance premium will increase because the coverage will increase. The insurance policy which covers employees, spouses, children, parents/in-laws will have the highest premium amongst these.
Primary location
The location of employees also plays an important role in deciding the premium. Tier 1 cities will have a higher premium as compared to tier 2 and tier 3 cities.
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OkayGroup health insurance companies in India
With the aim to provide world-class service to the customers, Universal Sompo General Insurance Ltd. was established in 2007. It is a joint venture between five institutions namely, Indian Bank, Indian Overseas Bank, Dabur Investment Corporation, Karnataka Bank Ltd., and Sompo Japan Insurance Inc.
Universal Sompo group health insurance has a customer-centric approach and its mission is to provide highly-efficient post-claim services to its customers. With a Japanese investor, they enhance their services by using a hybrid of Indian and Japanese technologies in their products. Additionally, they also have tie-ups with 3 banks to provide facilities.
With Pazcare, your Universal Sompo group health insurance will be seamless and hassle-free as you will be given an HRMS integrated dashboard. Through this dashboard, you will be able to add/ delete and manage your employees and their family members easily.
These simple steps allow you to purchase Universal Sompo group health insurance online at Pazcare.
For further information, write to us at support@getpaz.com or call our customer care at +91 78291 11300. Alternatively, connect with us on Whatsapp using the number +91 81973 79596.
Tailor-made plans
Universal Sompo group health insurance offers you tailor-made plans according to your preferences and choices.
Wide hospital network
Universal Sompo group health insurance has a wide hospital network with more than 4000+ network hospitals that provide quality cashless treatment.
Pre-hospitalization expenses
The pre-hospitalization expenses will be paid for by Universal Sompo group health insurance plan.
A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled to the number of claims made or requested in a financial year by the health insurance company. A higher claim settlement implies the credibility of the insurer.
A wide network hospital improves the chances of locating a network hospital near the employees. Your employees can avail of their Universal Sompo group health insurance from anywhere in the country as they have over 4000+ network hospitals. These hospitals provide best-quality medical treatment on cashless basis.
Also Read: Network & Non-Network Hospitals in 2022
Universal Sompo group health insurance cashless claim
With Universal Sompo group health insurance you can make a cashless claim using the following steps.
The cashless claim facilities are available at a network hospital only. Hence, get to the nearest network hospital for treatment.
The next step is to confirm your identity using the health insurance ID card or policy number, a valid photo ID like voter ID, driving license, etc, and the company ID at the hospital.
Once the ID proof is verified, the next step is to submit the pre-authorization form to Universal Sompo group health insurance. For emergency hospitalization, the form is submitted within 48 hours of hospitalization. In the case of planned hospitalization, it is submitted 3 days before the hospitalization.
After the form submission, Universal Sompo health insurance will review the cashless claim request and the network hospital will be notified about the claim decision. You will be notified through an email or a message.
Once all of this is done and the insurer accepts your claim request. The claim is settled directly with the network hospital according to the terms and conditions of your policy.
Universal Sompo group health insurance reimbursement claim
In case you get hospitalized at a non-network hospital, the reimbursement claim from Universal Sompo group health insurance can be done with the following steps.
The first step is to inform your insurer about the hospitalization. In case of emergency hospitalization, inform the insurer within 48 hours of hospitalization. While in the case of a planned hospitalization inform at least 3 days before the hospitalization.
After you get treated at a non-network hospital, settle all the bills on your own at the hospital.
After you settle all the bills, make sure you have all the original copies of all the required documents to file for a reimbursement claim.
The documents required to file a reimbursement claim
After collecting all the relevant documents, submit them to the nearest Universal Sompo health insurance branch within 15 days of discharge.
Once the documents are submitted, the insurer will review your documents and reject or approve the reimbursement claim request. This will be done as per the terms and conditions of your policy. Once approved, the claim will be settled in your bank account. You will be notified about the claim approval/rejection via SMS or your registered email.
You can also contact us at support@pazcare.com, to guide you through the whole process. We provide 24X7 claim assistance for your employees.
The Universal Sompo group health insurance policy can be renewed easily with Pazcare towards the end of your policy term. Following are the steps mentioned to renew your Universal Sompo group health insurance plan.
Step 1: Get in touch with Pazcare. Submit a form containing details like your name, name of the company, number of employees you wish to insure, work email address and phone number.
Step 2: Once the form is submitted, our consultants will get in touch with you. Since this is not a fresh policy, you will have to submit the following documents.
Step 3: You can choose to include add-ons to your existing policy like dental insurance riders, maternity insurance riders to your existing policy. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Universal Sompo group health insurance. These add-ons include wellness and therapy sessions, unlimited doctor consultations, comprehensive check-ups, and many more.
Step 4: Our consultants will get back to you with the competitive quotes for your Universal Sompo group health insurance. Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.
Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Universal Sompo group health insurance policy. The policy will be usually valid for a year after the renewal.
Step 6: In case, you are purchasing your Universal Sompo group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this period, our associate will get in touch with you and provide you with all the essential information to get started with your group health insurance.
We make sure that your Universal Sompo group health insurance experience will be seamless using our Pazcare dashboard. Your employees can access their policy using Pazcare’s employee app which is available on both the app store and the play store.
AYUSH treatment
AYUSH treatment and all the expenses related to the same will be borne by Universal Sompo group health insurance.
Domiciliary hospitalization
The domiciliary hospitalization, which is the treatment of a patient at his or her home which otherwise would have been done in the hospital, will be covered under Universal Sompo group health insurance.
Pre-hospitalization expenses
All the expenses incurred in pre-hospitalization will be covered by Universal Sompo group health insurance policy.
Post-hospitalization expenses
All the expenses incurred in post-hospitalization period will come under Universal Sompo group health insurance cover.
Hazardous or adventure sports
Any injury or illness while doing a hazardous or adventure sports will not be covered under Universal Sompo group health insurance.
Cosmetic or plastic surgery
Any claims made against the procedures for cosmetic or plastic surgery will not be entertained by Universal Sompo group health insurance.
Dietary supplements and substances
The use or purchase of any dietary supplements will not be covered by Universal Sompo group health insurance.
Sterility and infertility
The treatments done for sterility and fertility are excluded from Universal Sompo group health insurance policy.
Also Read: Waiting Period In Health Insurance
Zero waiting period
Unlike retail health insurance plans, Universal Sompo group health insurance has zero waiting period. Your employees can start availing of benefits from day 1 of their policy.
Family coverage
The dependent family members of the employees can easily be added to their Universal Sompo group health insurance plan.
Daycare procedures
Up to the limit of the sum insured, daycare procedures will be taken care of by your chosen Universal Sompo group health insurance plan.
Hospitalization expenses
The expenses incurred in hospitalization like ICU room, room rent, surgical appliances, surgeons, etc will be borne by Universal Sompo group health insurance.
Group health insurance companies in India
Why buy a group health insurance
policy online from Pazcare?
For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.
The customer care number of Universal Sompo group health insurance is 1800-22-4030.
You can apply for a claim from Universal Sompo group health insurance either through a cashless method or reimbursement. All the network hospitals provide cashless treatment.
Universal Sompo group health insurance offers Top-up and Super top-up features on the base insurance policy.
Restoration benefit is the restoration or refilling of the sum insured upon partial or complete exhaustion in a policy year.
Universal Sompo has a wide cashless network hospital list of around 4000+ hospitals PAN India.
24X7 customer assistance for queries, assistance and claim support
1800-22-4030
healthserve@universalsompo.com
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