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Universal Sompo Claim Settlement Ratio
Choosing an ideal health plan is a tedious task; however, choosing an ideal health insurance company can be even more challenging. With more than 20 health insurance companies claiming to offer the best services, selecting the right one for you and your family can be quite confusing.
Thus, before finalizing your choice of a health insurance company, you need to check the company’s claim settlement history.
This factor not only helps you understand the company’s performance but also provides clarity and simplifies the selection process.
In the section below, let us explore the Universal Sompo Claim Settlement Ratio and discuss its importance.
What Is the Universal Sompo Health Insurance Claim Settlement Ratio?
As per the IRDAI, the Universal Sompo Claim Settlement Ratio is 95.77%. Take a look at the table below to explore the Universal Sompo claim settlement ratio:
| Status of Universal Sompo Health Insurance Claim Settlement Ratio - 2021-22 | ||||||
|---|---|---|---|---|---|---|
| Age Analysis of Number of Claims Paid (%) | < 3 months | 3 months to 6 months | 6 months to <1 year | 1 year to <3 years | 3 years to <5 years | > 5 years |
| Claims Settled | 95.77 | 2.78 | 0.97 | 0.38 | 0.08 | 0.02 |
Types of Universal Sompo Health Insurance Claims
There are two types of health insurance claims you can choose from:
- Cashless Claim
- Reimbursement Claim
Let's understand Universal Sompo's claim settlement process in detail.
What Are Cashless Claims?
Medical emergencies can be financially draining, often leading to significant out-of-pocket expenses. A health insurance plan with cashless claim settlement can be very beneficial in such situations. With a cashless health insurance plan, your insurer directly settles medical bills with the hospital, eliminating the need for you to pay upfront.
Cashless Claim Filing Process
- Get hospitalized at any of Universal Sompo's network hospitals.
- Present your health card and valid ID proof, then complete the cashless request form.
- Submit the form to the hospital insurance helpdesk.
- The hospital verifies the information and sends the form to Universal Sompo.
- Universal Sompo verifies the details and communicates its decision to you and the hospital.
- Upon approval, Universal Sompo directly settles the expenses with the hospital.
What Are Reimbursement Claims?
For a reimbursement claim, you pay all hospital bills and expenditures out of pocket first. It is essential to keep records of all hospital and pharmaceutical costs. The insurance company reimburses the policyholder for medical expenditures after treatment and discharge. Reimbursement is processed upon the insurance company receiving all correct medical bills and expenditure proofs.
Reimbursement Claim Filing Process
- If you receive treatment at a non-network hospital, you can still file for a reimbursement claim.
- Inform Universal Sompo about the hospitalization as early as possible and pay the expenses post-discharge.
- Fill out the reimbursement form with the necessary details and submit it.
- Universal Sompo will request hospital bills, prescriptions, and receipts.
- Upon successful verification, Universal Sompo will reimburse the amount to the claimant's registered account.
Why Is the Claim Settlement Ratio Important?
The claim settlement ratio is one of the most useful parameters that indicates the percentage of claims settled by the company in a financial year. It is a crucial factor that helps you assess the company's efficiency in settling claims during your time of need. Before buying health insurance, always check the company's claim settlement history.
Prospective buyers can use the claim settlement ratio to determine how effectively the insurance company honors its claims. It is recommended to check the claim settlement ratio of all plans, especially when comparing those with competitive premiums and benefits.
A higher health insurance claim settlement ratio indicates the company's strong financial performance and its ability to efficiently settle claims made by its customers.
