SBI Health Insurance Claim Settlement Ratio

Regarding insurers like SBI General, its brand equity extends a certain popularity across the market, irrespective of the quality of products it hosts. Unfortunately, SBI’s health insurance products have failed to stand up to the top-notch policies across the industry. Additionally, SBI’s government-owned status has led to issues across its overall operational efficiency, and its policies are neither comprehensive nor affordable.

However, SBI’s brand equity has earned it a solid client base, and a few brand loyalists still prefer plans from this stable. Considering its extensive insurance track record, the brand surely has a long list of products across the board, which is a great sign considering the rising demand for health insurance policies. However, since multiple insurers and health insurance policies emerged, you are only expected to compare health insurance plans and tally the numerous insurers before you finalise upon a provider.

The first step towards comparing health insurers is analysing their true credibility by considering various parameters. As the first metric (but not the only one) to measure an insurer’s reliability, we will now be discussing the SBI Health Insurance Claim Settlement Ratio 2024.

What is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) of a health insurer is calculated by -

(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100

The optimal CSR for a health insurer stands at 90 and above. Nevertheless, surpassing 100 indicates that the insurer engages in delayed claim settlement practices. Avoiding such delays is crucial, given that health insurance plans aim to protect your savings during health crises. Delayed settlements only add unnecessary inconvenience, contradicting the very purpose of having a health insurance plan. Again, if the CSR of an insurer is below 80, it indicates that the insurer rejects multiple claims, more than what’s common among the top-notch health insurance providers. Steer clear of these insurers, too.

Now, let's examine the track record of SBI Health Insurance Settlement Ratio data.

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What is the SBI Health Insurance Settlement Ratio for 2024?

(To find the SBI Health Insurance Claim Settlement Ratio for 2024, consult SBI Health's 2022-2023 data. However, depending on a single year might not suffice, as it's crucial to thoroughly evaluate the insurer's consistent performance. Hence, we have gathered data from the past three years - 2020 to 2023, computed their average and tallied it with the industry standard.)

Overview of SBI Health Insurance

What is the significance of the SBI Health Insurance Claim Settlement Ratio 2024?

The data for the SBI Health Insurance Claim Settlement Ratio has shown some consistencies that might be considered a good sign for policyholders. However, it's important that you get a deeper analysis of this metric -

1. Consistency: SBI Health Insurance Claim Settlement Ratio has consistently remained above 90 from 2020 to 2023. This consistency is promising and is an encouraging sign for its policyholders.
2. Overall Performance: In terms of overall performance, SBI Health Insurance is as credible as it can get. The numbers are well above 90 and always surpass the industry average (year on year and across the 3 years in total). Going by CSR alone, SBI Health Insurance is an incredible pick.

Why is the Claim Settlement Ratio important?

Checking a health insurance provider's Claim Settlement Ratio (CSR) is a good starting point to gauge its reliability. It offers insights into the insurer's track record and history of settling claims. However, it's important to note that CSR doesn't cover the time taken to settle claims or the amount settled compared to the filed claim amount. So, while CSR is useful, it's just one piece of the puzzle in assessing an insurer's credibility. For a more comprehensive understanding, also consider factors like the brand's complaint volume and Incurred Claim Ratio (ICR) before deciding on a health insurance plan.

What is the Claim Settlement Process for SBI Health Insurance?

1. CASHLESS

STEP 1: Contact SBI Health 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.

STEP 2: Submit the required documents (as mentioned below).

STEP 3: The hospital will request the insurer for their pre-authorisation approval.

STEP 4: The insurer approves the treatment, and you can go ahead with a cashless mode of claim settlement, which will be covered by your insurer when you are discharged.

(Please note that if your cashless request is denied, you can still proceed with the treatment. You will need to pay the bill from your pocket initially and can later file for a reimbursement claim settlement. The process for this is mentioned below.)

2. REIMBURSEMENT

STEP 1: You can register your claim online by visiting the official link.

STEP 2: Complete the claim form and submit it with the required documents (as listed below) online or at the nearest branch.

STEP 3: After cross-verification of your documents and the hospital desk, the insurer will disburse your claim amount to your bank account.

You can also receive guidance on your claim settlement by calling their helpline number - 1800 210 3366 / 1800 210 6366 or mail at sbig.health@sbigeneral.in for assistance.

What are the documents required to settle claims for SBI Health Insurance?

When planning to file a claim to SBI Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy -

1. CASHLESS

• Policy number (health insurance card)
• Copy of ID proof

2. REIMBURSEMENT

• Copy of duly filled Claim form
• Copy of the ID proof of the patient
• Copy of Aadhar and PAN of the proposer
• Copy of Discharge summary
• Copy of investigation reports confirming diagnosis and all doctor consultation papers
• Copy of final bill with detailed breakup
• Copy of payment receipt against the payment made
• A copy of a cancelled cheque bearing the proposer's pre-printed name on it, a copy of the proposer's last three months' bank statement bearing the bank account number and IFSC code, or a copy of the proposer's first page of the bank passbook showing bank account details.

Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.

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Conclusion

SBI Health Insurance is a great pick if you merely consider the brand's Claim Settlement Ratio. However, the health insurance plans from this stable aren’t at all comprehensive or affordable. These policies do not bring out any unique or innovative features or exclusive add-ons. Therefore, despite having great metrics data to measure its credibility (CSR, Incurred Claim Ratio, complaint volume, and number of partner hospitals),

Thus, unless you are a brand loyalist, it doesn’t make much sense to pursue this insurer to purchase a value-worthy health insurance plan from this stable. You should check out the best health insurance plans from some of the top-notch insurers in the country.