Universal Sompo Claim Settlement Ratio
  • Check Claim Settlement Ratio
  • Importance of CSR
  • Explore the process of claim settlement
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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 is more of a hectic task. With more than 20 health insurance companies claiming to offer you the best services, selecting the best one for you and your family can be quite confusing.

Thus, before zeroing down on your choice of one health insurance company, it is important for you to check the company's claim settlement history.

This factor not only helps you to understand the company's performance but will also give you a sense of understanding and will smoothen the selection process.

In the section below, let us explore the Universal Sompo Claim Settlement Ratio, and discuss its importance:

Health Insurance Claim Settlement Ratio

What is the Universal Sompo Health Insurance Claim Settlement Ratio?

As per the IRDAI Annual Report of 2022-21, the Universal Sompo Claim Settlement Ratio is 94.00%. Take a look at the below table to explore the Universal Sompo claim settlement ratio: 

Health Insurance Companies

Status of Universal Sompo Health Insurance Claim Settlement ratio- 2020-21
Age Analysis of Number of Claims Paid (%) < 3 months 3 months to 6 months 6 months to <1 year 1 year to <3 year 3 years to <5 years 5 years
Claims Settled 94.00  4.30 1.23 0.35 0.09 0.040

Types of Universal Sompo Health Insurance Claims

There are two types of health insurance claims you can choose from

  • Cashless Claim
  • Reimbursement Claim

Let us get a better understanding of the Universal Sompo's Claim Settlement Process.

What are Cashless Claims?

Ever been in a medical emergency and ran out of money? Such an unforeseeable medical situation might rip a hole in your wallet, forcing you to wipe off all your savings on hospital costs! This is where a health insurance plan that offers cashless claim settlement comes in handy. In a cashless facility, your insurer covers the medical payment directly with the hospital, eliminating the need for you to pay the expenses first. 

Cashless Claim Filing Process

  • Get hospitalized in any of your nearest network hospitals.
  • Show your health card along with valid ID proof and fill in the details in the cashless request form.
  • Submit the form at the hospital insurance helpdesk.
  • The hospital will then verify the information provided and send the form to the company.
  • The company will verify the details and communicate its decision to you and the hospital. 
  • On acceptance, the company will directly settle the expenses with the hospital. 

What are Reimbursement Claims?

For a Reimbursement claim, you need to pay all hospital bills and expenditures out of pocket before filing a reimbursement claim. One is required to keep records of all hospital and pharmaceutical costs. The insurance company reimburses the policyholder/insured for their medical expenditures once the treatment is completed and the patient is released. The compensation is based on the insurance company receiving correct medical bills and expenditures.

Reimbursement Claim Filing Process

  • If by any chance you could not find a network hospital, you can still file for a reimbursement claim.
  • Intimate the insurer about the hospitalization at the earliest and pay the expenses post-discharge. 
  • Fill out the reimbursement form with the required details and submit it.
  • The insurer will ask you to submit the hospital bills, prescriptions, and receipts.
  • On successful completion of the verification procedure, the company will reimburse the amount in the claimant's registered account.

Why Is Claim Settlement Ratio Important?

The claim settlement ratio is one of the most useful parameters that showcases the number of claims settled by the company in a financial year. It is an important factor that helps you to evaluate how soon the company will settle your claims in the time of need. Before buying health insurance, one should always check the history of claims settled by that company.

Prospective buyers might use the claim settlement ratio to determine how well the insurance company honours their claims. It is recommended to check the claim settlement ratio of all the 

plans having the lowest premiums and highest benefits.

A higher health insurance claim settlement ratio indicates the company's financial performance and its ability to pay off the claims made by its customers.

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