Universal Sompo General Insurance Network Hospitals

Universal Sompo General Insurance Company is one of the leading insurance companies which provide a variety of health insurance products to its customers. There are number of network hospitals in agreement with the insurance company to provide cashless hospitalisation facilities to its customers. You can get in touch with the insurance company by visiting their official website or paying a visit to its nearest branch to know about the network hospitals nearest to you. 

What are the benefits of choosing a Universal Sompo General Insurance network hospital? 

Universal Sompo General Insurance Company customers can avail the cashless hospitalisation facility offered by the insurer. You can get admitted to any network hospital without any hassle and enjoy the benefits provided by your policy. You do not have to worry about paying your medical bills, as the overall expenses are directly settled by the insurance company. 

What procedures are covered under Universal Sompo General Insurance cashless claim facility? 

A Universal Sompo health insurance plan provides coverage against different types of medical conditions when you get admitted to a network hospital. However, the coverage for certain types of medical conditions may differ from plan to plan. We will have a look at some of the procedures and conditions for which you can be offered coverage: 

• Cancer 
• First heart attack 
• Open heart replacement or Repair of heart valves 
• Open chest CABG 
• Kidney failure 
• Coma 
• Major organ or bone marrow transplant 
• Stroke which results in you getting diagnosed with permanent symptoms 
• If you are paralysed permanently. 
• Motor neurone diseases 
• If you meet with an accident 

Under Universal Sompo General Insurance plans, certain day-care procedures are also covered by the insurance company. We will have a look at some of the day-care procedures which are covered by the insurance company: 

• Microsurgical surgeries on the middle ear 
• Other types of operations on the middle and internal ears 
• Operations on the skin 
• Operations on the tongue 
• Operations on the nose 
• Operations on the salivary glands and ducts 
• Eye-related operations 
• Mouth and face-related operations 
• Tonsil operations 
• Operations on the scrotum and tunica vaginalis testis 
• Testes operations 
• Breast operations 
• Operations performed on the female sexual organs 
• Other operations such as Cancer Chemotherapy, Lithotripsy, etc. 

What procedures are not covered under Universal Sompo General Insurance cashless claim facility? 

There are certain conditions that are not covered under a Universal Sompo General Insurance plan. Some of the exclusions that you must be aware of are: 

• Pre-existing diseases 
• Any medical condition diagnosed during the first 30 days of the commencement of the policy. 
• Injuries or diseases caused due to war 
• Medical conditions such as cataract, piles, sinusitis, benign prostatic hypertrophy, etc. are not covered during the first policy year 
• Circumcision 
• Cost of spectacles, lenses, hearing aid, etc. 
• Venereal injuries, injuries caused due to intake of alcohol or drugs, or injuries caused to yourself intentionally 
• Dental surgery and treatment 
• HIV/AIDS 
• Cosmetic surgeries and treatment 
• Pregnancy 
• If pregnancy is terminated voluntarily 
• Naturopathy treatment 

How do you file a claim at a Universal Sompo General Insurance network hospital? 

The process for filing a claim at a Universal Sompo General Insurance network hospital is given below: 

• You will have to call the health helpline number of the insurance company which is 1800 200 5142 and initiate the claim process within 24 hours if there is an emergency admission and 48 hours prior to the planned hospitalisation. 
• The next step involves you visiting the network hospital. You will have to carry the Health Serve Card issued to you by the insurance company, and a valid ID proof which you will have to furnish to the insurance helpdesk.  
• You will get a ‘Cashless Request Form’ from the helpdesk. Fill the form ensuring that all the details mentioned are correct and submit it to the helpdesk. 
• The form will be verified by the hospital which will also include verifying the patient details. The hospital, after verifying the details will send the form to the insurance company via the toll-free fax number 1800 200 9134. 
• The insurance company will check and review the admissibility of the form in accordance with the terms and conditions under the plan. Once the insurer is satisfied with the details provided by you, it will initiate the claim process. However, you will have to pay for the expenses which are not payable as per the terms and conditions mentioned under the plan. 

Frequently asked questions (FAQs) 

1. What are network hospitals? 

Network hospitals are the hospitals which agree with the insurance company to provide cashless facility to its customers. 

2. Where can I get the list of network hospitals? 

You receive the list of network hospitals when you are issued the health card by the third-party administrator (TPA). However, you must bear in mind that this list is subject to change. You can also find the list of network hospitals on the official website of the third-party administrator. 

3. What do you mean by cashless service? 

When you get admitted to a network hospital, the medical expenses incurred during the treatment of the patient is settled directly by the insurance company. You do not have to pay out of your pocket and then wait for the insurer to reimburse the amount. 

4. Within how many days should I submit the request for the claim? 

You must submit the request for a claim within 30 days of the date on which the person got discharged from the hospital. 

5. What are the documents I will need to submit while filing a claim? 

The documents that you will need to submit while filing for a claim are: 

• The claim form which must be filled by you. You must ensure that all the details mentioned in the form are correct. 
• Discharge certificate, original bills issued by the hospital. 
• Original bills and receipts issued by chemists and pharmacists. 
• Practitioner, laboratory bills. 
• You will have to submit information and evidence from the medical who attended the patient.