SBI Health Insurance Claim Settlement

When it comes to SBI General Insurance’s claim settlement options, a policyholder has the choice of a refund or cashless claim settlement. SBI General health insurance products include a hassle-free claim settlement process. The entire procedure is really simple to comprehend and shields policyholders from any sort of hassle. The insurer is highly renowned for having satisfied claims of many clients through its quick and easy claim system, a high SBI health insurance settlement ratio and multiple healthcare facilities. 

The Claim Process for Cashless Treatment for  SBI Health Insurance Claim Settlement

Policyholders have the option to select cashless claims settlement at the closest hospital in the network. The most crucial and benefitting factor about cashless claims is that during an emergency, as long as you access a network hospital under the company for the SBI health insurance claim settlement, your medical care will be covered according to your coverage. More than 6,000 hospitals around the nation are part of the SBI General health insurance network for the payment of claims without the use of cash, with the reassurance of a high SBI health claim ratio. The process of the SBI health insurance claim settlement can be accessed in two ways, Planned or Emergency. The only difference in the process is regarding the timeline of notifying the company. The process doesn’t differ much after that is done.  The processes of a cashless SBI health insurance claim settlement are as follows:

1. Policyholders must initially contact SBI General or the TPA (third-party administrator) by phone or email if an accident or sickness necessitates hospitalisation or child care.
2. To obtain their claim number or reference number, policyholders should contact SBI General at their toll-free number, 1800 210 6366/1800 3366, via SMS to 561612, or by email at customer.care@sbigeneral.in.
3. By providing the necessary information on the firm's official website, they may also notify the company about the claim.
4. Within the 24-hour mark, the customer representative will reach out to the insured with the details of the needed documents and next actions.
5. When the cashless claims are at network hospitals of the company, the SBI health insurance claim settlement process becomes easier. The company will get in touch with the hospital immediately and settle the accounts.
6. In other instances, the policyholder will need to submit all the necessary paperwork, including a completed claim form, a valid photo ID card, an original discharge card or certificate, a summary of the death, copies of prescriptions for diagnostic tests, advice on how to proceed with treatment, and medical references, original investigation reports, itemised original hospital bills and receipts, original hospital and related medical expense receipts, original pharmacy bills with prescriptions, etc.
7. Within 30 days of the release of the final survey report, the business will begin the procedure after receiving the necessary paperwork and resolve any pertinent claims.

The Cashless Claim Procedure After Admission

1. After the initial admission, your authorized claim and any important medical details will be forwarded to the company for the SBI health insurance claim settlement by the hospital TPA.
2. Your medical care may begin once your claim request has been reviewed and approved.
3. While the individual is still admitted to the hospital, all required documentation has to be provided to the hospital TPA, so they can evaluate and decide if they have to ask the SBI health insurance for approval if a change to the registered cashless sum is needed.
4. The hospital TPA will email your invoice and discharge certificate to the company for the SBI health insurance claim settlement on the day of your discharge.
5. Following the final amount of your SBI health insurance claim, the company or its TPA grants a big authorization for the full invoice amount.
6. After the final verification, the hospital will charge you for the few expenditures that are prohibited by the law to be paid by the SBI health insurance.

List of Documents Required for SBI Health Cashless Claim

The following documents are required  to finish the cashless claim on the day of admission:

1. The health card provided by SBI health insurance
2. Proof of age, identity
3. Doctor’s prescription to admit to the hospital
4. All medical tests are required to be completed before the admission

Any last piece of documentation needed to complete the cashless claim will be added by the facility in charge.

How to Check SBI Health Insurance Policy Claim Status?

You can either call the SBI general insurance customer service, and the agents will look into your claim process or you can settle for the hassle-free online service provided to you on the SBI health insurance official webpage. Although the claim settlement ratio of SBI health insurance is fairly high, there are other factors to keep in mind while checking the status of your claim. 

The procedures for keeping track of your SBI health insurance claim settlement offline and online are the following:

The Online Process for  SBI Health Insurance Claim Settlement

1. Go to the SBI General Insurance webpage through your browser, and click on the health icon from the home page.
2. Hover over the headphone icon for the ‘contact us’ at the top right corner of the home page, and the drop-down menu will appear, choose ‘Claim status’, which will forward you to a different window.
3. Fill in the required information, like product name, policy number or claim number. Finish the captcha to check your SBI health insurance settlement ratio.
4. You can additionally call 1800 210 3366 toll-free number to check the status of your  SBI Health claim ratio.

The Offline Process for  SBI Health Insurance Claim Settlement

The offline process for SBI health insurance claim settlement will require you to visit the nearest branch. If you are not familiar with its location, you can always use the customer service toll-free number 1800 210 3366. You’ll have to provide the documents required like, insurance intimation number, insurance id card number etc., to the executive in charge of handling your SBI health claim ratio. 

The Claim Process for Reimbursement Treatment for  SBI Health Insurance Claim Settlement

If you get admitted to a non-network hospital, you need to file a reimbursement claim for your health insurance. The process of reimbursement is simple; however, you would be required to pay the entire amount out of your own pocket first and then claim the same. This can be done from a network hospital also. Even for pre and post-hospitalisation claims, you need to pay for the same and then file a reimbursement claim for the same.

The only thing you need to be concerned about in a reimbursement claim is to inform the insurer on time and file with accurate documents. In order to file for reimbursement of SBI health insurance claim settlement, you need to inform the insurer as soon as you are hospitalised. You can inform them at 1800 210 3366 or simply send an SMS called “CLAIM” to their toll-free number 561612. Alternatively, you could also send an email to customer.care@sbigeneral.in. However, remember to mention your claim number along with the policy details for your own records. 

List of Documents Required for SBI Health Reimbursement Claim

The following details must be provided at the time a claim is made for the SBI health claim settlement ratio:

1. The claim form as well as the medical certification
2. Reports from diagnostic procedures like an ECG or an x-ray
3. Discharge details
4. Prescriptions for medicines and costs
5. Final statements

SBI must receive the following paperwork to resolve the claim efficiently:

1. Pharmacy charges
2. Reports of investigations
3. First hospital invoices
4. A reliable ID with a photo
5. Treating the physician's report
6. Post-mortem report, or FIR
7. Hospital receipts and a discharge summary
8. Type of surgery carried out
9. Medical bills and receipts
10. Indoor case documents and a properly completed claim form

The company may request additional documents during the registration process.

Incurred Claim Ratio (ICR) of  SBI Health Insurance

The gross claims settled by health insurance in comparison to the net premiums generated are shown by the Incurred Claims Ratio or ICR. ICR is an effective method for evaluating a health insurer's suitability and dependability. ICR displays the speed at which claims are processed as well as the insurance company's productivity in terms of income. SBI General health insurance's incurred claim ratio for FY 2020–21 is 60.72 per cent, demonstrating that it has a sufficient quantity of assets on hand and is handling the claim process efficiently.

SBI Health Insurance Claim Settlement Ratio (CSR)

The SBI health claim settlement ratio is the ratio of claims resolved by the insurer to all claims submitted in a given fiscal year, known as the claim settlement ratio or CSR. It is computed by dividing the total number of claims submitted by the total number of claims that were successfully settled. The claim settlement ratio varies periodically. A solid CSR shows that the business resolves the majority of its claims, therefore raising the trust of new consumers. For the fiscal year 2020–2021, the claim settlement ratio of SBI was 97.84 per cent for claims resolved in less than three months and 1.34 per cent for claims resolved in more than three months.