SBI General Health Insurance Claim Process: Everything You Need to Know

Health insurance is essential for securing financial stability during medical emergencies. SBI General Health Insurance is one of India’s leading insurance providers, offering comprehensive coverage and a seamless claim process. Understanding the claim process is crucial to ensuring hassle-free reimbursement or cashless hospitalization when needed.

In this detailed guide, we will walk you through the SBI General Health Insurance claim process, including types of claims, required documents, and steps to follow for a smooth settlement.

Types of SBI General Health Insurance Claims

SBI General Health Insurance offers two primary types of claim processes:

Cashless Claim: The insurer directly settles the medical expenses with the hospital.

Reimbursement Claim: The policyholder pays for the treatment and later gets reimbursed by the insurer.

Each claim type has its specific process, which we will explain in detail below.

Cashless Claim Process

A cashless claim means that the insured does not have to pay for the hospitalization expenses out of pocket (except for non-covered expenses). The insurance company settles the bill directly with the network hospital.

Steps to File a Cashless Claim

Step 1: Locate a Network Hospital

Check if the hospital where you plan to get treatment is listed in SBI General Health Insurance’s network hospitals.

You can find the list of network hospitals on the insurer’s official website or contact customer support.

Step 2: Intimate SBI General Health Insurance

For planned hospitalization, inform SBI General Health Insurance at least 48 hours in advance.

For emergency hospitalization, notify the insurer within 24 hours of admission.

You can notify them through their toll-free number, email, or Quickinsure’s assistance.

Step 3: Submit Pre-Authorization Form

The hospital’s insurance helpdesk will provide you with a pre-authorization request form.

Fill in the required details and submit it to the Third-Party Administrator (TPA) for verification.

The hospital will then send the form to SBI General Health Insurance for approval.

Step 4: Approval Process

SBI General Health Insurance will verify the documents and approve the claim.

Once approved, the insurer will directly settle the medical expenses with the hospital.

In case of partial approval or rejection, you may need to pay the remaining amount and file for reimbursement later.

Step 5: Hospitalization & Discharge

Once treatment is complete, the hospital will send final bills to the insurer.

After verification, the insurance company will settle the bill directly.

You may need to pay for non-covered expenses, co-payment, or deductibles as per your policy.

Reimbursement Claim Process

A reimbursement claim is filed when treatment is taken at a non-network hospital or if the cashless claim is not approved. In this case, the insured pays the hospital bill and later claims reimbursement from the insurer.

Steps to File a Reimbursement Claim

Step 1: Inform the Insurance Provider

Notify SBI General Health Insurance about the hospitalization within 24 hours for emergency cases and 48 hours in advance for planned hospitalization.

Step 2: Pay Medical Bills & Collect Documents

Pay for all medical expenses upfront and collect the original bills, receipts, discharge summary, and other required documents.

Ensure that all bills are properly stamped and signed by the hospital authorities.

Step 3: Submit the Claim Form & Documents

Fill out the SBI General Health Insurance claim form accurately.

Attach the required documents (see the list below) and submit them to the insurer via:

Email

Courier

SBI General Health Insurance branch

Step 4: Claim Verification

The insurer will review and verify the submitted documents.

If additional information is required, SBI General Health Insurance may request further details.

Step 5: Claim Approval & Reimbursement

Once approved, the insurance company will transfer the reimbursed amount to the policyholder’s bank account.

If the claim is partially approved or rejected, the insurer will provide reasons for the same.

Documents Required for SBI General Health Insurance Claims

To ensure a smooth claim process, keep the following documents handy:

For Cashless Claims:

✔ Health insurance policy details

✔ Pre-authorization request form (filled and signed by the hospital)

✔ ID proof (Aadhaar, PAN, or any government-issued ID)

✔ Medical reports and prescriptions

✔ Discharge summary (if required by the insurer)

✔ Any other documents requested by the TPA or insurer

For Reimbursement Claims:

✔ Duly filled SBI General Health Insurance claim form

✔ Original hospital bills and receipts

✔ Discharge summary and doctor’s prescription

✔ Diagnostic test reports and prescriptions

✔ Pharmacy bills (with doctor’s prescription)

✔ Canceled cheque for NEFT payment

✔ FIR report (in case of an accident-related claim)

✔ Any additional documents requested by the insurer 

Tips for Hassle-Free Claim Settlement

Always read your policy documents carefully to understand what is covered and excluded.

Ensure all documents are complete before submission to avoid delays.

Use network hospitals whenever possible to benefit from the cashless facility.

Keep a copy of all submitted documents for future reference.

Contact SBI General Health Insurance’s customer support or Quickinsure’s claim assistance if you face any issues.

Conclusion

The SBI General Health Insurance claim process is simple and efficient if followed correctly. Whether opting for a cashless claim at a network hospital or a reimbursement claim, ensuring timely intimation, accurate documentation, and compliance with the claim procedure can help in a hassle-free settlement.