• SBI Health Insurance Claims Procedure

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    SBI General Insurance Company Limited is a joint venture between the State Bank of India and Insurance Australia Group (IAG). This insurance service provider offers a range of health insurance schemes that come with a lump sum amount, to take care of large expenses incurred during hospitalization, be it for accidents or health ailments.

    There are around 3000+ hospitals, tied up with SBI insurance for hassle-free services on health policies. To ensure a fast and smooth claims process, SBI Insurance has set up in-house health claim unit desks at every tie up hospital. Third Party Administrators (TPA), who are licensed by IRDA, have also been set up at hospitals.

    Incurred Claim Ratio for SBI Health Insurance:

    One of the parameters of measuring an organization’s performance is Incurred Claim Ratio (ICR). The ICR helps prospective customers to get a better sense of the company’s reliability. SBI’s Health Insurance’s incurred claim ratio for the financial year 2014-15 and 2015-16 is as follows:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    38893 21161 54.41

    For 2014-15:

    Net Earned Premium (in Lakhs) Net Claims Paid (in Lakhs) Incurred Claims Ratio (%)
    Rs 24,252 Rs 19,492 80.37

    SBI Health Insurance’s ICR indicates the company’s profits, where they are able to clear claims without overburdening their finances.

    Claim Scenarios:

    There are two types of scenarios, where a health policy can be used and reimbursements claimed - cashless treatment and expense reimbursement incurred post treatment.

    In Case of Cashless Treatment:

    When a person insured undergoes medical treatment for a particular illness, with all expenses taken care of by a health insurance company, then it is termed as cashless treatment. Depending on the insurance cover opted by the individual, SBI Health Insurance also offers cashless treatment. In order to avail this policy, the person will have to avail treatment at any of the hospitals in the country, where the health insurance provider has registered.

    1. Procedure to File a Claim (Planned/Emergency Hospitalization):

      • For the planned hospitalization SBI Health Insurance or TPA should be intimated at least two days in advance. Call the helpline number 1800 3009 (Toll Free) This will be provided in the card for intimating the TPA desk at the tie up hospital.
      • Carry the health card when getting admitted in any of the network hospitals. Submit the card, along with a photo ID proof for verification. Fill the “Cashless Request Form”, which is available at the TPA desk in all hospitals.
      • Once the hospital has verified the credentials, a pre-authorization form, duly signed by the doctor in attendance, has to be filled. In case of planned hospitalization, submit the authorization letter along with a photo ID at the time of admission.
      • The pre-authorization form along with other necessary medical details will be sent to the TPA by the hospital. The insurance provider will then coordinate with the bank to check and update the claim status. Depending on the relevance of the claim, the company may either accept or reject it. The person insured may also have to provide additional information, if requested by the provider.
      • The original bills and reports will have to be signed by the claimant. Photocopies of the same should be retained in case of future verification.
      • The medical bills, if covered in the policy taken by claimant, will be settled by SBI Health Insurance. The uncovered expenses will have to be taken care of by the policyholder.
    2. Claims Process:

      The health insurance company will verify the claims request and then approve or reject the same, depending on the policy. In order to claim a reimbursement for the expenses incurred during medical treatment, the following procedure should be followed:

      • Post discharge, the policyholder should file for a claim and notify the insurance provider regarding the same.
      • The claim forms, along with a photocopy of a valid photo ID proof should be submitted.
      • Reports of investigation and relevant medical certificates, signed by the treating doctor, should be sent to the company. Original reports and discharge summary will have to be submitted for verification.

    In Case of Reimbursement of Treatment Expenses:

    In some instances, SBI Health Insurance can reject the person insured’s reimbursement claims for cashless hospital and treatment. In such a case, the concerned person can still claim reimbursements by following the process mentioned below:

    1. Procedure to File a Claim:

      Not every time does an insurance company accept claims for settlement from the life insured admitted or getting treated at a non-registered hospital. However, if this is the case, here’s what the person can do:

      • At the time of emergency hospitalization, the next of kin of the life insured should intimate the insurance provider or TPA through a phone call or email. The number is - Toll-Free: 1800 22 9090.
      • The hospital dues should be promptly settled in full, retaining all the original bills and reports to be submitted while claiming.
      • The claim form should be duly filled with correct details and submitted to RCare for processing the reimbursement. If the claim complies with the regulations set by the insurance company, there will be no issues in getting the reimbursement.
    2. Documents Required:

      In order to claim the money spent in hospital bills and treatment, the person insured will have to submit original copies of the following documents:

      • Hospital details – When the person insured is undergoing treatment in an unregistered or non-network hospital, the details of the hospital should be provided. Details may include duration of treatment, number of doctors, nurses, and available beds.
      • Hospital bills – All the original bills, duly stamped and signed by a person of authority in the hospital should be submitted.
      • Discharge report – The person will also have to submit the original discharge report.
      • Other reports – Original reports regarding treatment, such as lab reports, other investigation reports, and medicine bills have to be submitted.
      • Follow-up details – The life insured will also have to send details regarding follow-up and future line of treatment, along with bills, if any, in original.
      • Claim form The claim form, correctly filled and signed should be submitted along with the other original documents mentioned above.
    3. Claims Process:

      • The insurer or TPA should be notified about the policyholder’s hospitalization within a week of discharge.
      • In relevant scenarios, pre-authorization from the company should be availed.
      • Original bills, documents and any other relevant reports, should be submitted within 10 days post discharge, based on the company’s request. The documents should be sent to the following address:

        SBI Life Insurance Co. Ltd.,

        "Natraj",

        M.V. Road & Western Express Highway Junction,

        Andheri (East), Mumbai - 400 069

      This was the SBI Health Insurance claims process. In order to avail complete benefit of the policy, make sure you follow the procedure correctly.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    SBI Health Insurance Claims Procedure Reviews

  • Page 1 of 1
    • SBI General Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      I have a Health insurance policy from SBI MEdiclaim. My final premium amount I paid is around Rs. 5400 per year and sum assured to me is around Rs. 3,00,000. I have not taken any claim yet. But the policy scheme and coverage is satisfactory. I would recommend others too.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 07, 2018
    • SBI General Health Insurance
      "Average"
      0.5 3.5/5 "Pretty good"
      I am having the health insurance policy with the SBI general insurance company. I would like to say that the coverage value is fine one for me, also I have not faced any claims with them till now. Plan benefits are also good one for me with the SBI general insurance company.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jan 05, 2018
    • SBI General Health Insurance
      "Good coverage"
      0.5 3.0/5 "Satisfactory"
      I have been paying Rs.26000 yearly for this Health Insurance and been getting a health coverage of Rs.2 Lakhs with them. The number of hospitals in this network are pretty high and the payment are all done through online. I heard claim experience with them is quite good too.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 25, 2017
    • SBI General Health Insurance
      "Better policy to use"
      0.5 3.0/5 "Satisfactory"
      I bought a health insurance policy along with the SBI credit card. This policy has the accidental and the fever policy. This is policy covers 1member . I can claim up to 3 lakhs with this policy. The customer is not giving proper response because they never gave me the health card yet.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 22, 2017
    • SBI General Health Insurance
      "Excellent"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the SBI general insurance company, also the coverage , premium is very comfort for me. There are no hassle while making claims, also am an employee with them, so I have not faced much hiccups with them.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 16, 2017
    • SBI General Health Insurance
      "Not satisfactory"
      0.5 2.0/5 "Expected more"
      State Bank of India is not good in the health insurance benefits. Though I do not have a claim, I am still not happy with the policy. The premium is paid on a yearly basis. This time I am not going to renew the policy. The medical coverage is also not to my satisfaction.
      Was this review helpful? 0
      , lucknow
      Reviewed on Nov 09, 2017
    • SBI General Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I have the health insurance policy with SBI general insurance company. I got this policy for past 8years. This policy covers whole family around 5members. I can claim the medical coverage up to 10lakhs. I pay Rs,5000 to renew the policy every year. The plan benefits and the policy coverage is good with this policy. The cashless treatment option is not available with this policy.
      Was this review helpful? 0
      , pondicherry
      Reviewed on Nov 08, 2017
    • SBI General Health Insurance
      "Low premium with good benefits"
      0.5 5.0/5 "Blown Away!"
      In SBI there are good medical benefits for Younger ladies during the pregnancy of 9 months. They could claim for hospitalization. Premium would be 3500 per annum but coverage upto 15 Lakhs it is more benefits of family. I always prefer this SBI Health insurance.
      Was this review helpful? 0
      , vadodara
      Reviewed on Nov 12, 2016
    • SBI General Health Insurance
      "Fake policy .Please be aware , you will be harassed ."
      0.5 0.5/5 "Unacceptable"
      Please be aware customers as when you buy their policy no medical tests are done . Later when you will go and claim medical insurance they will simply reject your claim on the basis of previous medical history. If no medical tests are done then how can they reject by looking at previous medical history and why these things are not intimated to the customers when they are buying the policy. I will suggest to the general customers not to take this policy at all, as I am suffering in my case even after paying my full premium and buying their insurance . They are cheaters.
      Was this review helpful? 1
      , durgapur
      Reviewed on Sep 18, 2016
    • SBI General Health Insurance
      "Convenient and reliable"
      0.5 5.0/5 "Blown Away!"
      I do have health insurance policy with SBI general insurance company and am with them from the last two years of time. Medical coverage value is around five lakh Rupees for my immediate family. I have faced the claim with them and I got 100% of cost of treatment as reimbursement.
      Was this review helpful? 2
      , bangalore
      Reviewed on Jul 01, 2016
    • SBI General Health Insurance
      "Not bad "
      0.5 4.0/5 "Great!"
      The service provided was good with SBI health based on the health coverage.I dont have any claim experience with them.They have more than 400 hospitals covered under the Insurance.They are not providing 100% coverage on health they give 50% coverage.
      Was this review helpful? 0
      , cuttack
      Reviewed on Feb 17, 2016
    • SBI General Health Insurance
      "Excellent Services"
      0.5 5.0/5 "Blown Away!"
      The services has been excellent from SBI General Insurance. The services are very good. I had a claim experience when my mum was admitted. From the admission till the end of the discharge. Everything went smooth. The coverage is for five lakhs. It is for my family and me.
      Was this review helpful? 3
      , chennai
      Reviewed on Nov 11, 2015
    • SBI General Health Insurance
      "Above Average"
      0.5 3.5/5 "Pretty good"
      It is a corporate health insurance with SBI General Insurance. It is provided by my company. The premiums taken care by them. The coverage is only for myself. It is of 1.5 lakh. I have not had any claim yet to know the actual process.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Oct 06, 2015
    • SBI General Health Insurance
      "Very good.."
      0.5 3.0/5 "Satisfactory"
      Corporate offer it is and I believe we can get the benefits of health insurance only if customers hospitalized more than 24hours. Per annum the coverage is of 2lakhs and SBI general insurance is not offering no claim benefits to customer but satisfied with services.
      Was this review helpful? 0
      , bangalore
      Reviewed on Aug 29, 2015
    • SBI General Health Insurance
      "Good coverage"
      0.5 4.0/5 "Great!"
      I do have a General Insurance with SBI which I have taken for health.A special plan for child as well.They do provide a coverage amount around 3Lakh in this Insurance and I pay around 9000Rs every year.I havenâ??t got any claim experience with them and I will recommend them once I got experience.
      Was this review helpful? 2
      , hyderabad
      Reviewed on Aug 25, 2015
    • SBI General Health Insurance
      "Good "
      0.5 3.0/5 "Satisfactory"
      I have the health insurance policy with the SBI General insurance company. It has been provided by my company. I don't have any claim experience with them but I heard good comments from my friends. It will cover the full family. Overall experience is okay for me.
      Was this review helpful? 2
      , coimbatore
      Reviewed on Aug 21, 2015
    • SBI General Health Insurance
      "Its ok "
      0.5 3.0/5 "Satisfactory"
      SBI Medi claim policy is good, we pay about rs 700 a month for the medical insurance. The policy coverage is 5 lakhs every month. The money is debited from my account every month. Its a health cum death policy . For death policy I will get a cover for 5 lakhs and for medical it is 2 lakhs.
      Was this review helpful? 9
      , hyderabad
      Reviewed on Mar 12, 2015
    • SBI General Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I took one year health insurance plan from State bank of India . If there was any accident occurred they are providing the cash less treatment immediately. I havent got any claim experience so far. Through online I am paying my premium amount.
      Was this review helpful? 6
      , lucknow
      Reviewed on Nov 15, 2014
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