SBI Health Insurance Claim Settlement

SBI Health Insurance

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Highlights

6,000+ Network Hospitals

7,56,443 Policies Issued

Lifelong Renewability

59.42% Claim Settlement Ratio

Dedicated Claim Settlement

Coronavirus (COVID-19) Cover

Claim Settlement of SBI Health Insurance

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 3000 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 a SBI General Insurance network hospital in the city where you wish to undergo cashless treatment
    • Intimate SBI General immediately, both in case of an 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 the pre-authorisation form available at the network hospital
    • Once the insurer has been informed and you have filled the form, the pre-authorisation form will be sent to SBI General Health Insurance
    • After the claim details are examined and reviewed, SBI General Health Insurance team will inform the policyholder and hospital with regards 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, network and non-network hospitals. The steps in the reimbursement claim procedure include- 

    • In case of planned hospitalisation, immediate intimation to SBI General
    • In case of an 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

    In case of doubts, feel free to initiate contact at InsuranceDekho at 1800-1205-698. 

  • Incurred Claim Ratio (ICR) of SBI Health Insurance

    The Incurred Claims Ratio or ICR indicates the net claims paid by a health insurer as against the net premiums earned. ICR is a successful approach to find 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 incurred claim ratio of SBI General Health Insurance 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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