Policy Deal -Claim Process – Universal Sompo General Insurance Company

Cashless is available only in network hospitals of Insurer.
Dully filled pre-authorization form is to be submitted along with copy of cards/policy.
Insurer approves part of expected expenses known as Initial approval.
During discharge, on submission of final bill, Insurer approves final amount.
Care should be taken to reply to any query, if raised during the process. Unreasonable & Non medical expenses are not payable.

Cashless is available only in network hospital of Insurer.
Insurer should be approached well on advance, minimum 48 hrs prior to hospitalization.
Dully filled pre-authorization form is to be submitted along with its consultation letter.
Insurer approves part of expected expenses known as Initial approval. During discharge, on submission of final bill, Insurer approves final amount.
Care should be taken to reply to any query, if raised during the process. Unreasonable & Non medical expenses are not payable.

Every claim should be intimated & file should be submitted within time, as non adherence can lead to delay in claim settlement.
The claim is decisioned only when all required & necessary documents are submitted.
NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
Pre hospitalization expenses may be claimed along with main hospitalization expenses.
Unreasonable & Non medical expenses are not payable.

Claim form consist of two parts (Part A to be filled by Insured and Part B to be filled by Hospital).
Xerox of Health Serve Card & Valid Photo ID proof of patient.
Original bills and receipts or prescriptions in support of any amount claimed
Original medical reports, Investigation reports, treatment papers, doctor reference slips
Original Discharge summary
Cancelled Cheque
Original Hospital Bill giving detailed break up of all expense heads mentioned in the bill
Original Advance or final receipts
NEFT Form along with Cancelled cheque for disbursement of payments through ECS
For accident Cases: MLC (Medico Legal Certificate) / FIR (First Information report) if available

Please retain copies of all the documents submitted to us for your future reference.
The above list of documents is indicative. In case of any further document requirement, Our Health Serve team will contact you on receipt of your claim documents by us.

Claim Process – Universal Sompo General Insurance Company Limited