|Step I||Call the Health Helpline 1800 200 5142 and Intimate your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.|
|Step II||Visit Network hospital and show your Health Serve Card issued by the company along with Valid Photo ID proof and get ‘Cashless Request Form’ from Insurance helpdesk of the hospital.|
|Step III||Fill your details in the ‘Cashless Request Form’ & submit it to the Hospital Insurance helpdesk.|
|Step IV||Hospital verifies the patient details and sends duly filled Cashless Request Form by Fax to Universal Sompo-Health Office toll free fax 1800 200 9134.|
|Step V||Universal Sompo – Health will review and judge the admissibility of the Cashless Request as per Policy Terms &Conditions and the same will be communicated to you and hospital. You will be required to pay for expenses that are not payable as per the terms and condition of the policy.|
|Step I||Call our Health Helpline 1800 200 5142 or email at firstname.lastname@example.org and inform about your Claim within 24 hrs in case of emergency admission and 48 hrs prior to hospitalization in case of planned admission.|
|Step II||Visit hospital and undergo your treatment. Settle your hospitalization bill and collect all original documents after discharge from hospital.|
|Step III||Fill in Reimbursement Claim Form and submit all original documents to our below mention office for reimbursement:
Universal Sompo General Insurance Company Limited
Health Claims Management Office
5thFloor ,Assotech One
C-20/1 A, Block- C
Sector- 62, Noida
Uttar Pradesh, Pincode : 201309
|Step IV||On receipt of document your claim will processed as per Terms & Conditions of policy and the same will be communicated to you.|
It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals.
A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.
The health cards need to be renewed or re-issued during the policy tenure.
Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.
In case of a planned hospitalization or emergency services, use your Health ID Card at any of network hospitals and avail cashless service. In case the hospital is not listed in the network of hospital, then pay the cash and submit the claim to TPA for reimbursement with relevant documents and bills.
These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.
Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.
When you approach a hospital which is listed in the provider list of our network and disclose the health-card, hospital will pursue TPA for pre-authorization. Once the authorization is issued by TPA, you do not have to pay any money towards the covered services provided by the hospital. This is called as a cashless service.
TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant documents are submitted.
The claim must be filed within 30 days from the date of discharge from the Hospital or completion of treatment.
Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.
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