Universal Sompo General Insurance Limited was established in 2007 with the aim of providing world-class service to customers. It is a joint venture between five institutions i.e., Indian Overseas Bank, Indian Bank, Sompo Japan Insurance Inc., Dabur Investment Corporation, and Karnataka Bank Ltd.
Universal Sompo Group Health Insurance has a customer-centric approach and aims 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 technology in their products. Apart from this, they have also tied up with 3 banks to provide facilities.
Key highlights of Universal Sompo Group Health Insurance
Group Health Insurance Policy of Universal Sompo GIC Limited is offered to groups comprising members of manufacturing and trading sectors/social sectors and society/organization/club/association. The policy is designed to pay the hospitalization expenditures and hospitalization benefits to the insured person if he/she suffers from any illness or accidental injury during the policy period.
Universal Sompo Health Insurance Review
Universal Sompo Health Insurance Review
| Number of lives covered * | 1,137,000 |
| Incurred Claims Ratio * | 97.00% |
| List of network hospitals | 5,000+ hospitals |
| Universal Sompo Insurance tenure options | 1 or 2 years options available |
| Maximum family floater coverage | Self, Spouse + 4 dependent children |
| Claims Settlement Ratio 20-21** | 65.04% |
| Number of lives covered * | 2,425,322 |
| Number of policies issued * | 2,75,370 |
According to IRDAI report for 2020-21
According to NL25 data publicized on the Insurance Company website
Universal Sompo group health insurance benefits
Zero waiting period
Unlike retail health insurance schemes, Universal Sompo Group Health Insurance has zero waiting period. Your employees can start getting benefits from day 1 of their policy.
Family Coverage
Employees’ dependent family members can be easily added to their Universal Sompo group health insurance plan.
Daycare procedures
Daycare procedures will be covered by your chosen Universal Sompo Group Health Insurance Plan, up to the sum insured limit.
Hospitalization expenditures
Hospitalization expenses such as ICU room, room rent, surgical equipment, surgeon, etc. will be endured by Universal Sompo.
Eligibility of Universal Sompo Group Health Insurance
- Enrollment age under the policy ranges from 5 years to 70 years. Children aged 3 months to 5 years can be covered provided one or both parents are covered simultaneously.
- Proposers must be 18 years or above.
- An individual can cover himself/herself and his/her spouse, dependent children up to 23 years of age, and/or dependent parents/dependent in-laws under the policy.
- Renewal under the policy will be given for a lifetime.
- The company may ask the insured to undergo a medical examination if he is above 45 years of age.
- If their proposal is accepted then 50% of the cost of the medical examination will be reimbursed by us.
Inclusions
- Only treatment in hospitals/nursing homes are covered in India
- Coverage includes room charges, boarding charges, nursing charges, surgeon/specialist fees, charges for blood, oxygen, etc.
- Domiciliary hospitalization benefit means Medical treatment for more than 3 days for such illness which in the ordinary course requires hospital treatment but is actually received whilst confined at home in India since (1) the condition of the patient is such that he cannot be taken to the hospital or (2) the patient cannot be taken to the hospital due to lack of accommodation.
- The indemnity provided by the policy is limited to the sum assured and the prescribed sub-limit is calculated based on the age of the insured, family size, and the sum assured chosen.
- Maximum coverage is Rs 5 lacs.
Add-on Cover
The following additional covers can also opt on payment of an additional premium which shall depend upon the group size & its profile.
- Critical Illness Cover (Cancer/Paralytic stroke/Coronary Artery Bypass/Chronic renal failure/Transplant of organs –
a) Kidney
b) Bone Marrow
c) Pancreas
d) Lung
Liver Transplant, NB is not covered under this extension.
- Hospital Cash Cover – is inbuilt cover
- Maternity Benefit Cover
- Family Floater
- Pre-existing
- By opting for an add-on, the coverage for such named critical illness is double the basic sum assured.
Exclusions
Policy is subject to the following Exclusions:
- Pre-existing diseases, unless covered by paying an additional premium.
- Any expense on hospitalization or domiciliary hospitalization incurred on account of any illness contracted during the first 30 days from the date of commencement of an insurance cover is not covered. However, this exclusion will not apply if the accident requires hospitalization.
- During the first year of the cover, the expense of treatment of diseases such as Cataracts, Benign Prostatic Hypertrophy, Hysterectomy, Piles, Sinusitis, and related disorders is not payable.
- Injury or disease directly or indirectly attributable to War, invasion, or Act of Foreign enemy not payable.
- Circumcision is excluded unless necessary to treat a disease.
- Excludes the cost of contact lenses, glasses, and hearing aids.
- Hospitalization is not required except for dentistry or any type of surgery.
- Venereal diseases, intentional self-injury, and use of intoxicating drugs/alcohol are excluded.
- Any treatment directly or indirectly related to the treatment of AIDS.
- Cosmetic or aesthetic treatment is excluded.
- Voluntary termination of Pregnancy.
- Pregnancy and childbirth.
- Naturopathy Treatment.
Pre – Acceptance Medical Check-Ups
The Company may require the submission of Medical Reports for ECG and Blood Sugar (Fasting & PP) for acceptance of your proposal if you are above 45 years. This requirement will only be for fresh Proposals when the Sum Insured is enhanced at the time of renewal or when there is a break in insurance for more than 15 days.
You can use the Universal Sompo group health insurance premium calculator to estimate the cost of your policy. Some factors that determine your premium are discussed.
The average age of Employees
The average age of the employees is one of the many factors asked while computing the premium amount of group health insurance.
Add-ons
The number of add-on benefits you include in the policy will also affect the premium amount.
Type of policy
There are three main types of insurance policies in the market. If you choose one that only covers employees, the premium determined will be lower. Similarly, if you choose a policy that covers employees, spouses, 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 among these.
Primary Location
The residence of employees also plays an essential role in determining the premium. The premium for Tier 1 cities will be more premium compared to Tier 2 and Tier 3 cities.
Why should you go for Universal Sompo group health insurance as your insurance?
Tailor-made plans
Universal Sompo Group Health Insurance provides you with schemes tailored to your choices and preferences.
Wide hospital network
Universal Sompo 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 the Universal Sompo group health insurance plan.
Universal Sompo group health insurance claim settlement ratio
Health insurance claim settlement ratio (CSR) is the ratio between the number of claims made or requested by a health insurance company in a financial year and the number of claims settled. A high claim settlement indicates the credibility of the insurance company.
| Financial Year | Claim settlement ratio |
| 2019-20 | 70.75% |
| 2018-19 | 75.92% |
Network hospitals of Universal Sompo group health insurance
A large network hospital improves the chances of finding a network hospital close to the workforce. 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 the best-quality medical treatment on a cashless basis.
Claim Universal Sompo group health insurance
Universal Sompo group health insurance cashless claim
With Universal Sompo Group Health Insurance you can claim cashless using the below-mentioned steps:
1. Go to the nearest network hospital – Cashless claim facilities are available only in-network hospitals. Therefore, visit the closest network hospital for treatment.
2. Confirm your identity – The next step is to confirm your individuality using the policy number or health insurance ID card, a valid photo ID like a driving license, voter ID, etc, and the company ID at the hospital.
3. Submitting the pre-authorization form – Once the verification of the ID proof is complete, the next step will be to submit the pre-authorization form to Universal Sompo. For emergency hospitalization, you will have to submit the form within 48 hours of hospitalization. For planned hospitalization, the pre-authorization form is to be submitted 3 days prior to the hospitalization.
4. Review of request – After submitting the form, Universal Sompo Health Insurance will review the cashless claim request and the network hospital will be informed of the claim decision. You will be notified by email or message.
5. Claim settlement – Once all this is completed and the insurer approves your claim request, the claims will be settled directly with network hospitals as per the terms and conditions of your policy.
Universal Sompo group health insurance reimbursement claim
If you are hospitalized in a non-network hospital, reimbursement from Universal Sompo Group Health Insurance can be claimed with the following steps:
1. Inform your insurance company – For emergency hospitalization, notify the insurer within 48 hours of hospitalization. While in the case of a planned hospitalization, you will have to inform at least 3 days prior to the hospitalization.
2. Settle the bills at the hospital – After completion of the treatment at a non-network hospital, settle all hospital bills yourself.
3. Collect all the documents – After you have settled all the bills, make sure you have all the original copies of all the necessary documents to file for the reimbursement claim.
The documents required to file a reimbursement claim:
- A duly filled claim form
- Policy copy/health insurance ID card
- A valid ID proof (Driving license, Aadhar card, etc.)
- All original pharmacy bills and medical bills, doctor consultation report, discharge summary, and prescription papers.
- A medical certificate stating the duration, past medical history, and information of treatment signed by the doctor in charge.
- For accidents, FIR or MLC (Medico-Legal Certificate) copy
- Other relevant documents.
4. Submit the documents – After gathering all the applicable documents, submit them to the closest branch of Universal Sompo health insurance within 15 days of discharge.
5. Claim processing – After submission of the documents, the insurer will examine your documents and will make a decision regarding the rejection or approval of the reimbursement claim request. This will be done in accordance with the terms and conditions of your policy. After approval, the claim will be settled in your registered bank account. You will be informed about claim approval/rejection through your registered email or SMS.