Universal Sompo Group Health Insurance

Universal Sompo Group Health Insurance

Claim settlement ratio (2019-20)

70.75%

Network hospitals

4000+

Total GHI lives insured (2020-21)

24.25 Lakhs

Total GHI claims incurred (2020-21)

199.79 Crores

TPA

External TPA

About Universal Sompo group health insurance

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. 

How to buy Universal Sompo group health insurance at Pazcare?

These simple steps allow you to purchase Universal Sompo group health insurance online at Pazcare.

  1. Visit https://www.pazcare.com/ and you will be able to see a ‘Get Quote’ button on the right.
  2. Click on the same and a form will appear. Fill in the required information - your name, work email, phone number, and the number of employees you wish to insure. 
  3. After submitting this form, our health insurance consultant will contact you within 24 hours. Tell us your requirements for a customized group health insurance policy. The information includes the type of policy, sum insured, and many more.
  4. After this we will get back to you with competitive quotes from Universal Sompo group health insurance and a few other insurers.
  5. After you decide on the insurer and accept the terms and conditions of the policy, the payment will be processed by you.
  6. The onboarding process is carried out within 24 hours of making the payment. 

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.

Why choose Universal Sompo group health insurance as your insurance partner?

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.

Universal Sompo group health insurance claim settlement ratio

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.

Financial Year Claim settlement ratio
2019-20 70.75%
2018-19 75.92%

Network hospitals of Universal Sompo group health insurance

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

Claim Universal Sompo group health insurance

Universal Sompo group health insurance cashless claim

With Universal Sompo group health insurance you can make a cashless claim using the following steps.

  1. Go to the nearest network hospital

The cashless claim facilities are available at a network hospital only. Hence, get to the nearest network hospital for treatment.

  1. Confirm your identity

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.

  1. Submitting the pre-authorization form

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. 

  1. Review of request

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.

  1. Claim settlement

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.

  1. Inform your insurance company

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.

  1. Settle the bills at the hospital

After you get treated at a non-network hospital, settle all the bills on your own at the hospital.

  1. Collect all the documents

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

  • A duly filled claim form
  • Policy copy/health insurance ID card
  • A valid unique identity card (Aadhar card, driving license, etc.)
  • All original medical bills and pharmacy bills, discharge summary, doctor consultation report and prescription papers.
  • A medical certificate specifying the duration, past medical history and treatment details signed by the doctor in charge.
  • For accidents, FIR or MLC (Medico-Legal Certificate) copy
  • Other relevant documents.
  1. Submit the documents

After collecting all the relevant documents, submit them to the nearest Universal Sompo health insurance branch within 15 days of discharge.

  1. Claim processing

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. 

Universal Sompo group health insurance renewal process

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.

  • Active data of the employees - name, age, gender
  • Claim analysis report
  • Claim dump report from the insurer/TPA
  • Policy copy

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. 

What is covered under your Universal Sompo group health insurance?

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. 

What is not covered under your Universal Sompo group health insurance?

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

Universal Sompo group health insurance benefits

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. 

Universal Sompo group health insurance premium

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. 

Check Out: Raheja QBE Group Health Insurance

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Universal Sompo group health insurance claim process

1

Intimate your insurer

Intimate your claim to the insurer within 48 hours, in case of an emergency and at least 3 days prior in case of a planned hospitalization.

2

Verify your identity

Provide the proof of identity - policy number/health insurance ID card, company ID and a valid unique govt. ID card.

3

Submit the pre-authorization form

Fill out the pre-authorization form and hand it over to the hospital.

4

Claim settlement

For any questions or assistance contact Pazcare at support@getpaz.com or call us at +91 78291 11300.

5

Contact us for assistance

For any questions or assistance contact Pazcare at support@getpaz.com or call us at +91 78291 11300.

1

Intimate your insurer

Intimate your insurer within 48 hours, in case of an emergency and at least 3 days prior in case of a planned hospitalization.

2

Settle your bills

Settle all your bills and collect the original copies of hospital bills, doctor consultation reports and other essential documents.

3

Submit the documents

Submit these original documents along with the claim form to the insurer.

4

Claim settlement

Once verified, the claim will be settled in your bank account directly.

5

Contact us for assistance

For any questions or assistance contact Pazcare at support@getpaz.com or call us at +91 78291 11300. We will guide you through the process.

Universal Sompo group health insurance reviews

4.1 / 5

Rating based on
(6596 reviews)

Rajasekhar

5 / 5

First time I enjoyed the wellness programs. It was super productive. Highly recommend!

Sinha

5 / 5

The entire claim process was super quick. Team coordinated well. Amazing work!

Bajrang

5 / 5

Customer support team were the most approachable ones and really made sure the journey was smooth. Great effort!

Anagha

4.5 / 5

The co-ordination among the team is commendable. The journey felt super easy. Highly recommend!

Sarlaksha

5 / 5

Loved all the offerings from Pazcare. The team is also super easy to work with. Overall, great experience.

Raj Singh

5 / 5

Pazcare portal is super easy to use with amazing UI/UX design. Good work guys!

4.6 / 5

Rating based on
(3023 reviews)

Sinha

5 / 5

The entire claim process was super quick. Team coordinated well. Amazing work!

4.4 / 5

Rating based on
(2193 reviews)

Bajrang

5 / 5

Customer support team were the most approachable ones and really made sure the journey was smooth. Great effort!

4.8 / 5

Rating based on
(913 reviews)

Anagha

4.5 / 5

The co-ordination among the team is commendable. The journey felt super easy. Highly recommend!

Sarlaksha

5 / 5

Loved all the offerings from Pazcare. The team is also super easy to work with. Overall, great experience.

4.2 / 5

Rating based on
(1267 reviews)

Raj Singh

5 / 5

Pazcare portal is super easy to use with amazing UI/UX design. Good work guys!

Why buy a group health insurance
policy online from Pazcare?

  • Choose the suitable policy with our consulting approach
  • Custom-made plan with health and mental wellness add-ons
  • The tech-enabled Pazcare dashboard to manage endorsements
  • Integrate the dashboard with your HRMS tool

Universal Sompo group health insurance customer care number

For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.

Universal Sompo group health insurance

Frequently asked questions around Universal Sompo group health insurance

What is the customer care number of Universal Sompo group health insurance?

The customer care number of Universal Sompo group health insurance is 1800-22-4030.

How to claim Universal Sompo group health insurance?

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. 

Can the sum insured be increased in Universal Sompo group health insurance?

Universal Sompo group health insurance offers Top-up and Super top-up features on the base insurance policy.

What is the restoration benefit?

Restoration benefit is the restoration or refilling of the sum insured upon partial or complete exhaustion in a policy year.

How many network hospitals does Universal Sompo have?

Universal Sompo has a wide cashless network hospital list of around 4000+ hospitals PAN India.