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SBI Health Insurance Claim Settlement

The claim settlement procedure for SBI General health insurance plans is free from hassles. The overall process is extremely easy to understand and prevents a policyholder from facing inconvenience of any kind. With multiple healthcare facilities, the insurer is well-known to have settled claims of countless policyholders through its quick and simple claim procedure. Talking about the claim settlement scenarios in SBI General Health Insurance, a policyholder can either opt for cashless or reimbursement settlement of claims.

  • Claim Process for Cashless Treatment

    SBI General Health Insurance has more than 6,000 network hospitals across the country for cashless settlement of claims. Policyholders have the freedom to choose cashless settlement of claims at their nearest network hospital. The steps of the claim settlement process include- 

    • Find an SBI General Insurance network hospital in the city where you wish to undergo cashless treatment
    • Intimate SBI General immediately, both in case of emergency hospitalisation and planned hospitalisation
    • When visiting the selected network hospital, carry the cashless treatment card/policy number and member ID
    • Show the card/policy number and member ID at the insurance desk of SBI General Network hospital 
    • Fill out the pre-authorization form available at the network hospital
    • Once the insurer has been informed and you have filled out the form, the pre-authorization form will be sent to SBI General Health Insurance
    • After the claim details are examined and reviewed, the SBI General Health Insurance team will inform the policyholder and hospital with regard to approval or rejection of the claim
    • If the claim is approved, the medical expenses will be borne by SBI General Health Insurance directly. However, if the claim is rejected, the policyholder will be required to pay the bills
  • Reimbursement Treatment

    A policyholder can file a reimbursement claim at both, SBI health insurance network hospitals and non-network hospitals. The steps in the reimbursement claim settlement procedure include- 

    • In case of planned hospitalisation, immediate intimation to SBI General
    • In case of emergency hospitalisation, the intimation should be given as soon as hospitalisation occurs 
    • The policyholder is required to submit a claim form with the relevant documents within 30 days of discharge from the hospital 
    • Once the investigation of the documents and claim form details is conducted, the letter of approval is sent to the policyholder by the claim management team of SBI General Health Insurance for confirmation of the approval. After verification, the claim is settled within 15 days
    • If the claim is rejected, the insured is required to respond to the query raised by the insurer or insured to uncover the reason for rejection
  • Documents Needed

    The list of documents required for claim settlement at SBI General Health Insurance include- 

    • Original investigation reports
    • Pharmacy bills with prescription
    • Final hospital discharge summary
    • FIR or post-mortem report, if happened
    • Original bills, receipts & discharge report
    • Indoor case papers with duly-filled claim form
    • Original hospital bills along with a valid photo ID proof
    • Treating doctor's report and original consultation notes
    • Nature of operation performed and surgeon's bill & receipt
    • Test reports along with attending doctor’s or surgeon’s report

     

  • Incurred Claim Ratio (ICR) of SBI Health Insurance

    The Incurred Claims Ratio or ICR indicates the net claims paid by a health insurance company as against the net premiums earned. ICR is a successful approach to finding how suitable and reliable a health insurer is. ICR showcases the pace of claim procedure along with the productivity of the insurance firm, in terms of revenue. The SBI Health Insurance Claim Settlement Ratio for FY 2018-19 is 52%, which showcases that SBI General Health Insurance has an ample amount of assets in hand and executing the claim process in a smooth manner.

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FAQs

  • Can I get a refund of my money if I don’t claim in a policy period?

    No. You will not get any refund if you don’t claim in a policy period. However, you will be eligible for a ‘Cumulative Bonus’ of 5%, which can be accumulated up to 25% at the maximum. 

     

  • When should I inform the company in case of reimbursement or cashless planned period?

    You must inform the company as soon as possible in case of reimbursement or cashless planned period. 

  • What are the documents required for the reimbursement process in SBI General Insurance?

    Following are the documents required for reimbursement process in SBI General Insurance- 

    • Pharmacy bills 
    • Investigation reports  
    • FIR or post-mortem report 
    • Receipts and discharge report from the hospital 
    • Indoor case papers with duly-filled claim form  
    • Original hospital bills 
    • A valid photo ID proof
    • Treating doctor's report 
    • Nature of operation performed 
    • Surgeon's bill and receipt 
  • Whom can I contact for claim intimation and settlement purposes at SBI General Insurance?

    For claim intimation and settlement, you can get in touch with either InsuranceDekho at 7551 196 989 or can initiate contact with SBI General Insurance directly.

  • What is the Claim Settlement Ratio of SBI General Insurance?

    The Claim Settlement Ratio of SBI General Insurance for the Financial Year 2019-20 is 66.08%. 

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    Indeed, InsuranceDekho is the best! I bought the SBI Health Insurance Policy from the company’s official website. The information available on the website made it 100% easier for me to compare the plans myself. After comparing multiple plans listed on their website, I bought the SBI health insurance plan as it provided me with the best coverage. Happy to get the best health plan from the most trustworthy company.

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    When I was buying the SBI Health Insurance Plan from InsuranceDekho, my claim was settled on time. With the help of the supporting team of InsuranceDekho, raising a claim against SBI health insurance was quite easy.

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