Overview

Universal Sompo Health Insurance offers a simple health insurance portfolio and a wide network of hospitals. However, claim settlement ratios have shown considerable variation over the years. While customer service ratings remain strong, waiting periods deserve a closer look before you buy. 

Key Highlights

  • Network Hospitals: A cashless network of over 15,000 hospitals across India makes access to treatment convenient nationwide.
  • Claim Ratios: The 3-year (FY 2023–25) incurred claims ratio averaged 95.24%. Meanwhile, the claim settlement ratio shows huge variation every year, settling at 84.12% in FY 2025-26, with a 3-year average of 88.91% (FY 2024-26). 
  • Waiting Periods: Pre-existing diseases typically carry a 3-year waiting period across most plans, and maternity cover, where offered, ranges from 9 months to 3 years.
  • Before You Buy: Use the official hospital locator to confirm cashless access near you and compare rates against other insurers before deciding.

Not every health insurer offers dozens of plans. 

Universal Sompo offers a fairly simple portfolio of health insurance plans, backed by shareholders including Indian Bank, Indian Overseas Bank, Karnataka Bank, the Dabur Group, and Japan-based Sompo Insurance. 

While a smaller product portfolio can make choosing a policy easier, the real test is whether the insurer backs it up with reliable claims support, solid coverage, and genuine value for money.

In this Universal Sompo Health Insurance review, we break down its plans, claim settlement track record, hospital network, renewal process, customer support, and the drawbacks you should know before making a decision.

Not sure if Universal Sompo Health Insurance is the right fit for you? Book a free call or chat with us on WhatsApp.

Universal Sompo Health Insurance: Performance and Claim Metrics

MetricsUniversal SompoIndustry AverageKey Insights
Claim Settlement Ratio88.91%92.02%Slightly below both the industry average and Ditto's 90% benchmark, indicating scope for improvement in claim settlement performance.
Incurred Claims Ratio95.24%81.88%Well above the ideal range (55% to 85%), indicating that most of the collected premiums are paid out, pointing toward a lack of financial stability.
Complaints per 10,000 Claims5.1929.35Significantly lower than the industry average, suggesting comparatively smooth customer experiences. 
Annual Health Insurance Business (in Crore)₹1,013 crore₹4,504 croreSmaller health insurance business than the industry average, reflecting a relatively modest market presence. 
Cashless Hospital Network15,000+10,000+Well above our recommended benchmark, providing extensive access to cashless treatment across India. 

Source: This information is sourced from the IRDAI annual reports, Ditto Data Lab, and Universal Sompo public disclosure.

Note: The figures above represent Universal Sompo's average performance over FY 2024-26, except the Incurred Claim Ratio, which is averaged over FY 2023-25.

Important Note:

Universal Sompo's Claim Settlement Ratio (CSR) has fluctuated considerably over the years, from 86.66% in FY 2020-21 to 76.12% in FY 2021-22, before improving to 93.39% in FY 2023-24. This inconsistency makes it important to look at the insurer's long-term claims performance rather than relying on a single year's CSR. 

1) Complete Healthcare

Complete Healthcare is one of Universal Sompo’s flagship retail health insurance plans, available in several variants to cater to different coverage needs.

Key Benefits

    • Available in seven variants like Basic, Essential, Privilege, Plus, Premier, Executive, and Digi-Pro, with sum insured options going up to ₹50 lakh. 
    • Covers key benefits such as day care procedures, organ donor expenses, and AYUSH.
    • Certain variants also include maternity, wellness, and Outpatient Department (OPD) treatment benefits.

Key Drawbacks

    • Modern treatments and domiciliary treatments are subject to limits.
    • Benefits vary considerably across variants, making careful comparison important before purchase.

2) A Plus Health Insurance

A Plus Health Insurance is a modular policy available in four variants, which include Basic, Silver, Gold, and Diamond, allowing buyers to choose coverage based on their budget and requirements.

Key Benefits

    • Multiple variants with different room eligibility, restoration, and OPD benefits.
    • Optional add-ons allow buyers to reduce Pre-Existing-Disease (PED) waiting periods and add maternity and consumables cover.
    • The Diamond variant offers additional features, such as OPD and global treatment benefits under specified conditions.

Key Drawbacks

    • Modern treatment and psychiatric treatment are subject to sub-limits.
    • Room rent is restricted to a single private air-conditioned room under the basic variant.
    • A deductible of 10% on sum insured applies to expenses under all respective covers separately for each claim for Global Cover under the Diamond variant. 

3) Super Healthcare

Super Healthcare is available as both a top-up and super top-up plan and is designed to supplement an existing health insurance policy.

Key Benefits

    • The top-up option comes in three plan variants with a sum insured of up to ₹20 lakh, while the super top-up option is available in Gold, Diamond, and Platinum variants with a sum insured of up to ₹1 crore. 
    • Deductibles range from ₹50,000 to ₹10 lakh under the top-up option and from ₹1 lakh to ₹40 lakh under the super top-up option. 
    • Cost-effective way to increase coverage against large hospitalization expenses.
    • Offers additional benefits such as bariatric surgery cover, automatic restoration of 100% once a year for an unrelated illness, maternity and newborn cover, and wellness benefits, all subject to terms and conditions. 

Key Drawbacks

    • Coverage begins only after the deductible is met.
    • It cannot replace a comprehensive base health insurance policy.
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Universal Sompo Health Insurance Network Hospitals and Renewal

Before purchasing a policy or planning a hospitalization, check whether your preferred hospital is included in Universal Sompo's network hospitals. You can refer to the Universal Sompo health insurance hospital list through the insurer's hospital locator or confirm directly with the hospital's insurance desk, as network availability may change over time. 

Universal Sompo Health Insurance renewal can be completed online through the insurer's renewal portal using your policy details. Simply enter your policy number (and any required verification details), review the renewal premium and policy information, make the payment, and download the renewed policy document. To ensure uninterrupted coverage, review your policy 30 to 45 days before renewal and check the following:

    • Revised premium, including any age-band increase.
    • Whether your existing add-ons will continue.
    • Cumulative bonus accumulated under the policy.
    • Insured member and nominee details.
    • Whether your preferred hospitals are still part of the cashless network.
    • Any changes to the policy terms or exclusions.

As mandated by IRDAI, Universal Sompo offers a 15-day grace period for monthly premium modes and a 30-day grace period for all other payment modes. However, it is advisable to complete your Universal Sompo health insurance renewal before the policy expiry date to avoid any interruption in coverage.

Universal Sompo Health Insurance Customer Care and Policy Download

For policy-related queries, claims assistance, or renewals, policyholders can contact the insurer through the Universal Sompo health insurance customer care number, email support, or the insurer’s official contact page. 

Customer Care Details

PurposeContact
Customer Care 1800-22-4030 / 1800-200-4030 
Customer Support contactus@universalsompo.com 
Claims Supportcontactclaims@universalsompo.com
Senior Citizen Number1800-267-4030 

Note: For unresolved complaints, policyholders can escalate the matter through IRDAI’s Bima Bharosa portal or approach the Insurance Ombudsman. 

Policy Download

Policyholders can complete their Universal Sompo health insurance policy download by entering their policy number or registered mobile number on the insurer’s portal. After OTP verification, the policy can be viewed or downloaded. Alternatively, the Universal Sompo Pulz mobile app can also be used to access policy documents and manage basic servicing requests.

Pros and Cons of Universal Sompo Health Insurance

ProsCons
Large cashless hospital network with over 15,000 hospitals across India. Claims performance has shown some inconsistency across financial years.
Strong institutional backing from Indian Bank, Indian Overseas Bank, Karnataka Bank, the Dabur Group, and Japan-based Sompo Insurance. Many value-added benefits, such as consumables cover, maternity, and OPD, are available only as optional add-ons in select plans. 
Offers flexible customization through optional add-ons.Some of the insurer's newer health plans have limited long-term claims experience. 

Who Should Buy Universal Sompo Health Insurance?

Universal Sompo may be suitable for:

    • Young individuals and families with preferred hospitals in the insurer's cashless network.
    • Buyers seeking a high sum insured for comprehensive financial protection.
    • Customers with existing employer or personal health insurance looking for an affordable top-up or super top-up.
    • Buyers who value customization through optional add-ons and flexible plan choices.

Not ideal for:

    • Buyers who want most benefits included in the base plan.
    • Those who prefer simple policies with minimal customization.
    • Customers who prioritize a long and consistent claims track record over newer product offerings.

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Conclusion

Universal Sompo offers health insurance plans across different categories, including comprehensive, customizable, standardized, and top-up options. It also has a large cashless hospital network and a relatively low complaint ratio, which work in its favor. 

However, it's important to look beyond the base premium. Several valuable benefits, such as consumables cover and maternity benefits, are available only as optional add-ons, which can increase the overall cost. Its plans also come with different variants, offerings and limits, which can make selecting the right policy challenging. In addition, its claims performance has varied across financial years, and some of its newer plans have yet to establish a long-term claims track record.

Before making a decision, compare Universal Sompo with other insurers based on policy features, claims experience, hospital network, and premiums. If you're still exploring your options, our guide to the best health insurance plans in India can help you find a plan that best suits your healthcare needs.

Frequently Asked Questions

Is Universal Sompo Health Insurance good, and how reliable is its claim settlement ratio?

Universal Sompo has an average claim settlement ratio (CSR) of 88.91% over the last 3 financial years(FY 2024-26). However, its CSR has fluctuated considerably from 86.66% in FY 2020-21 to 76.12% in FY 2021-22, before improving to 93.39% in FY 2023-24. Because of this variation, it's better to assess the insurer using its long-term claims performance rather than a single year's CSR. 

What are the best Universal Sompo health insurance plans to consider?

Universal Sompo offers plans for different needs, with premiums varying by plan variant, sum insured, age, and coverage requirements. Buyers can refer to the Universal Sompo health insurance premium chart for indicative pricing. A Plus Health Insurance offers customization, Complete Healthcare provides multiple coverage tiers, and Super Healthcare works as a top-up option.

How do you find Universal Sompo network hospitals near you?

You can check the Universal Sompo Health Insurance hospital list using the insurer's online hospital locator by entering your city or PIN code. Since hospital tie-ups can change over time, it's advisable to confirm your preferred hospital's network status before a planned hospitalization. 

How do you renew a Universal Sompo health insurance policy online?

Universal Sompo health insurance renewal can be completed online using your policy number and the required verification details. Before making the payment, review your renewal premium, policy details, covered members, and any changes to your benefits. Once the payment is successful, the renewed policy document is issued digitally.

What is Universal Sompo's customer care number for claims and support?

Universal Sompo's primary customer care helpline is 1800-22-4030. Policyholders can also contact the insurer through its official customer support and claims email IDs for assistance with claims, renewals, policy servicing, and other insurance-related queries. 

How do you download your Universal Sompo health insurance policy document?

You can download your policy from Universal Sompo's online policy download portal by entering your policy number or registered mobile number. After OTP verification, the policy document can be viewed or downloaded. It is also accessible through the Universal Sompo PULZ mobile app. 

Who should buy Universal Sompo Health Insurance over a larger standalone health insurer?

Universal Sompo may suit buyers who prioritize a large cashless hospital network, flexible plan options, and competitive premiums over having the widest product portfolio. It can also be a good choice for customers comfortable customizing their coverage through add-ons, provided they compare the insurer's long-term claims performance with larger standalone health insurers before buying. 

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