Rising healthcare costs and unexpected medical situations have made health insurance an essential tool for protecting your family’s well-being and financial stability. It provides strong financial protection during medical emergencies, ensuring peace of mind for individuals and families alike. Among India’s most trusted insurers, SBI Health Insurance offers a wide range of policies customized to diverse healthcare needs.
If it’s an unexpected health emergency or a scheduled procedure, health insurance can be a real lifesaver. But to make the most of your policy, it’s important to understand how to file a claim properly. Here’s a quick and easy direction to help you through the process.
What Is a Health Insurance Claim?
A health insurance claim is a request made by the insured to the insurance provider to get coverage of medical expenses as per the policy. You can choose between two ways to make a claim: cashless or reimbursement.
1. Cashless Claim
With a cashless claim, your insurer pays the hospital directly, so you don’t have to pay anything upfront, except for items not covered by your policy. To use this option, you must visit a hospital that is part of the insurer’s network.
2. Reimbursement Claim
A reimbursement claim with SBI involves the policyholder initially covering medical expenses out of pocket, then submitting a claim to SBI for repayment. These claims can be made for treatments received at both network and non-network hospitals.
SBI Health Insurance Cashless Claim Process
- Cashless Facility Process: To use the cashless treatment option, go to the closest hospital in the SBI General network. Show your SBI General policy document and a valid photo ID at the hospital’s insurance help desk to begin the process.
- Pre-Authorization Process: The network hospital will confirm your identity and send a completed pre-authorization form, along with the necessary documents, to SBI General Insurance.
- Cashless Treatment Admission: Once your health insurance claim is approved, you can be admitted to the hospital and receive treatment without making any upfront payment, in line with your policy terms. However, if the claim is pending or not approved, you’ll still receive the required treatment, but you will need to settle the medical expenses in advance.
- Claim Settlement: The hospital will forward all necessary claim documents to SBI General Insurance for processing and settlement of your hospital expenses. After the bill is approved, you can be discharged from the hospital.
SBI Health Insurance Reimbursement Claim Process
- Access Treatment at Any Hospital: You’re free to receive care at any hospital of your choice, even if it’s outside SBI General’s network. Simply settle the hospital bills directly at the time of treatment.
- Gather All Original Documents: Upon discharge, ensure you collect all original medical records, including bills, prescriptions, discharge summaries, and diagnostic reports. These documents are essential for processing your claim.
- Submit Your Claim for Processing: You can download the claim form from the SBI General Insurance website or obtain a copy from your nearest branch. Complete the form and submit it along with the necessary documents, either at the nearest SBI General office or through an authorised agent.
- Claim Review and Settlement: SBI General will assess your claim, and upon successful verification, the approved amount will be reimbursed directly to your registered bank account.
Knowing how to file a health insurance claim is just as important as having a policy. If you opt for a cashless facility or reimbursement, SBI Health Insurance offers a simplified and customer-friendly process to help you in your time of need. By following the correct procedures and submitting accurate documents, you can ensure that your claim is processed without unnecessary delays. For scheduled treatments at network hospitals, enjoy the convenience of cashless claim settlement. In case of emergencies or if treatment is received at a non-network hospital, you can opt for reimbursement claims.
Need Assistance? For support with policy information or other services, please get in touch with My Health Plans, the authorized service provider for SBI Health Insurance. Please don’t hesitate to reach out for assistance.