Claim Process – Universal Sompo General Insurance Company Limited

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4 Quick Ways to Initiate Your Claim

  • Insure claim process
    Submit Online
  • Insurer Support

    Toll Free - 1800-200-5142

    Email - healthserve@universalsompo.com

  • Submit at Nearest Branch
    Branch locator
  • Request Assistance
    Submit

Details Necessary to Intimate or Register Claim

To Register claim by calling on above contact point, you will need to provide the following information to the customer support executive:-

  • 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.

Once the claim is registered, the customer support executive will provide you

  • Emergency Cashless
  • Planned Cashless
  • Reimbursement

Points to Remember

  • 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.

List of Documents

Mandatory Documents

  • Copy of id card/Policy copy
  • Duly filled pre-auth form
  • KYC of insured
  • 1st consultation letter/Investigation reports (If Any)

Points to Remember

  • 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.

List of Documents

Mandatory Documents

  • Copy of id card/Policy copy
  • Duly filled pre-auth form
  • KYC of insured
  • 1st consultation letter/Investigation reports (If Any)

Points to Remember

  • 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.

List of Documents

List of claim submission documents are as below

  • 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
  • Points to remember

  • 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.

Garage List Required