SBI Health Insurance Claim Settlement Ratio (CSR) & Claim Process

SBI Claim Settlement Ratio

97.05%

SBI

94.21%

Industry Average

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. SBI has a claim settlement ratio of 97.05%, as compared to the industry average of 94.21%.

SBI Claim Process

SBI supports both cashless claims and reimbursement claims. This section covers the information on how to check SBI health insurance claim status, fill SBI health insurance claim form, and the claim settlement process.

Cashless health insurance claim process If you take admission at a network hospital of SBI General Insurance Company, the following is the process to be followed for the cashless claim

The cashless request needs to be submitted to TPA (Third party administrator) of SBI General Insurance Company Limited. In case of planned admission, the request needs to be submitted 48 hours in advance to the admission. In case of emergency admission at the hospital,the request needs to be submitted to TPA within 24 hours of admission at the hospital
TPA of SBI General Insurance Company will review all the initial documents submitted by the hospital authorities along with cashless claim request
Once the cashless claim request is approved by the insurance company, further documents are to be produced by the hospital to process the claim
Once all the documents are verified, the claim amount will be directly settled with the network hospital

Reimbursement health insurance claim processIn the case of the medical treatment availed at a hospital which is not included in-network hospital of SBI General Insurance Company, medical expenses can be claimed via the reimbursement process. Following process needs to be followed for claim reimbursement

Take admission at the non-network hospital of the insurance company and settle the bill out of your pocket
Collect all the original documents from the hospital
Register the claim with SBI General Insurance Company by submitting original documents received from the hospital along with duly filled and signed claim form and other relevant documents, if any
TPA of SBI General Insurance Company will scrutinise all the documents and update the insured on status of a claim
Once the claim is approved, the payment of claim will be made within a specified time period by SBI General Insurance Company Limited

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FAQs

Following are the major and important 13 critical illnesses covered under SBI General’s critical illness insurance plan

Open Chest CABG
Cancer of specified severity
Open heart replacement and repair of heart valves
Aorta graft surgery
Stroke resulting in permanent symptoms
Kidney failure requiring regular dialysis
First heart attack of specified severity
Major organ/bone marrow transplant
Primary pulmonary arterial hypertension
Coma of specified severity
Multiple sclerosis with persisting symptoms
Permanent paralysis of limbs
Total blindness

Health insurance portability refers to the shifting of health insurance plans from one insurance provider to another insurance provider with all the existing benefits carried along. Portability gives the benefit of selecting the suitable plan of your choice with the existing benefits like no claim bonus accumulated and waiting period etc continued

SBI health insurance plans come with a free look period of 15 days during which the policyholder can decide whether to continue with the policy or not. In case, insured is not satisfied with the terms and conditions of the policy, he/she can cancel it without any charges within this free look period of 15 days. However, it’s important and mandatory to state the reason for the cancellation of the policy

Premiums for SBI health insurance plans can be paid online or also through offline mode. Following are the modes through which online payments can be made

Net banking
Credit card
Debit card

However, payment can also be done offline through the below ways

Cash/cheque at nearby SBI bank branches
Electronic Clearing System (ECS)
Drop boxes

Co-payment is a system of cost-sharing in health insurance plans wherein the insured is required to bear a fixed out-of-pocket cost for covered services. This can also be in a fixed percentage. A fixed percentage of the claim amount needs to be paid by the insured and the remaining will be paid to the insurance company

Yes. SBI health insurance plans come with a 30 days grace period. In case you fail to make a premium payment within the due date for premium payment, you can still make the payment within 30 days from the due date. The benefits will continue during the grace period

Below are the treatments and illnesses that are excluded from domiciliary treatment cover

Asthma
Diarrhoea and all types of Dysenteries and Gastroenteritis
Insipidus and Diabetes Mellitus
Influenza, Cough and cold
Bronchitis
Nephritic Syndrome and Chronic Nephritis
Epilepsy
Hypertension
Arthritis, Rheumatism and Gout
All Psychiatric and Psychosomatic disorders
Pyrexia of unknown origin for less than 10 days
Tonsillitis and Upper Respiratory Tract infection including Laryngitis and pharyngitis

SBI health insurance is quite beneficial as the plans offered by the company offer a range of comprehensive coverage benefits which ensure that most medical costs get covered. Moreover, the company offers a range of health insurance plans so that you can choose a plan as per your coverage needs. The claim process of SBI health insurance plans is simple ensuring that you get cashless assistance in emergencies for a smoother experience

You can make a claim under your SBI health insurance policy in a cashless manner or through reimbursement. Cashless claims are available if you get admitted to a networked hospital. In case of a non-networked hospital or if your cashless claim is not approved, you can opt for reimbursement claims wherein you bear the medical expenses initially and then get them reimbursed by the company. The claim process for each of these types of claims has been explained earlier above

SBI believes in a quick and easy claim settlement process and allows you to get your claims settled in the easiest possible manner. In case of claims, you can contact the toll-free number of the company 1800 102 1111 and register your claim. You can also send a SMS to 561612 by writing ‘CLAIMS’ in the message text. You can send an email to customer.care@sbigeneral.in to intimate the company about your claim or simply intimate it online at the link https://www.sbigeneral.in/portal/claim/claims-intimation. Once your claim is intimated, the company would get in touch with you and guide you with the claim settlement process.