SBI General Insurance is a subsidiary insurance company of the country's most notable public sector bank - State Bank of India. Since the insurer’s brand is a common household name in India, the insurer is well-known. However, this is not equivalent to being a “preferred health insurer option.”
As a health insurance provider, although SBI Health Insurance boasts of a good Claim Settlement Ratio, Incurred Claim Ratio and complaint volume, the insurer is still not a popular pick. Much of this can be attributed to the limited options across its health insurance products and the lack of comprehensiveness (that policies from other top-notch insurers offer conveniently).
| Pros | Cons |
|---|---|
| Decent Claim Settlement Ratio | High Complaint Volume |
| Good Incurred Claim Ratio | Expensive health insurance plans |
Metrics of SBI Health Insurance
SBI General Insurance is a joint venture between the State Bank of India (SBI) and the Insurance Australia Group (IAG) founded in 2009. After IAG sold off its share and a Bancassurance tie-up was announced with Karnataka Gramin Bank, the bank’s popularity grew. Unfortunately, all of this popularity is associated with the reputation associated with the brand name, and not a lot can be attributed to the health insurance products sold by the insurer.
Health insurance plans from this stable are not affordable and lack the long list of features readily available under plans from other insurers. Moreover, the entire process for settling claims and resolving queries with this provider might still be cumbersome and time-consuming, considering that SBI General Insurance is a government-owned enterprise.
However, before discussing some of the health insurance plans offered by this brand, let’s look at a few metrics for the insurer to determine its credibility. (Please note that we have taken the metrics of the last 3 years and averaged them to get a better insight into the consistency of the insurer in terms of its operational proficiency.)
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Claim Settlement Ratio of SBI Health Insurance
A health insurer’s Claim Settlement Ratio or CSR is given by -
(Total number of claims settled by an insurer over a year/ Total number of claims raised to the insurer over the year) * 100
While this metric is the first step towards measuring an insurer’s credibility, it isn’t the only factor. However, please only opt for those health insurance providers whose CSR is between 90 and 100. Any provider with a CSR of less than 80 or more than 100 is best avoided.
| Years | SBI Health Insurance Review | Industry Average |
|---|---|---|
| 2020 - 2021 | 93.31 | 91.484 |
| 2021 - 2022 | 97.31 | 89.967 |
| 2022 - 2023 | 94.2 | 91.460 |
| Average (2020 - 2023) | 94.94 | 90.970 |
Insight: SBI Health Insurance’s CSR falls within the ideally recommended range of 90 to 100, which is a great sign for their existing and potential policyholders.
Incurred Claim Ratio of SBI Health Insurance
For health insurance claims, there are often cases where the insurer settles only part of a claim for no reason at all. This means that despite having a health insurance plan and paying your premiums punctually, you still pay a substantial share of the invoice from your pocket. This defies the purpose of having health insurance in the first place.
To avoid falling for such insurers, looking at a brand’s CSR isn’t enough. You also need to look at the Incurred Claim Ratio or ICR. The ICR is calculated by -
(The total amount of claims settled by an insurer over a year / Total amount of claims raised to the insurer over the year) * 100
A health insurance provider with an ICR of 50 to 70 (or a bit higher) is good to go, while those with an ICR of less than 50 or more than 100 are best avoided. ICRs often give you an insight into the insurer’s long-term sustainability and claim settlement potential, which is essential since health insurance plans are equivalent to long-term financial commitments between the insurer and the insured.
| Years | SBI Health Insurance Review | Industry Average |
|---|---|---|
| 2020 - 2021 | 60.72 | 78.27 |
| 2021 - 2022 | 81.92 | 91.79 |
| 2022 - 2023 | 73.92 | 78.82 |
| Average (2020 - 2023) | 72.19 | 82.96 |
Insight: SBI Health Insurance’s ICR is slightly higher than the recommended range. However, that is a good sign for policyholders since it means that the insurer is willing to prioritise its client’s requirements for claim settlement rather than focusing on its business profits.
Complaint Volume of SBI Health Insurance
Ideally, this is one of the most critical metrics that determine the credibility of a health insurance provider. Complaint volume is a data point that showcases clients' satisfaction regarding claim settlements. The numbers are much lower if the experience and process have been good.
However, in the case of SBI General Insurance, the complaint numbers may be misleading since the company offers various insurance products apart from health insurance. Such products include motor insurance, which significantly reduces the average complaint volume.
| Years | SBI Health Insurance Review | Industry Average |
|---|---|---|
| 2020 - 2021 | 3.86 | 13.212 |
| 2021 - 2022 | 12.3 | 35.969 |
| 2022 - 2023 | 23.59 | 19.578 |
| Average (2020 - 2023) | 13.25 | 24.029 |
Insight: The complaint volume for SBI Health Insurance may not be one of the lowest in the industry, but it certainly is lower than that of multiple health insurance providers in the market. However, as stated before, these numbers may be misleading, considering that this is a general insurer and not a standalone health insurance provider.
While SBI General Insurance seems to put up a solid front on the above 3 metrics, they are not a popular pick for potential health insurance policyholders. One big thing holding them back is probably the product. So, let’s check out a few popular health insurance policy options from this stable and see what’s the problem.
Top Health Insurance Plans Offered by SBI Health Insurance
- SBI Health Edge
This is one of the latest launches from SBI Health Insurance, offering coverage of ₹3 lakhs to ₹25 lakhs and some in-built features like - daycare coverage, pre and post-hospitalisation coverage, AYUSH treatment coverage, free annual health checkups (for preventive care tests, up to ₹5,000), and bariatric surgery coverage.
The policy has an extensive list of health insurance add-ons. This includes - Domestic Help/Staff Indemnity, Hospital Daily Cash, Accidental Death Cover, Healing Benefit, Unlimited Refill, Vector Borne Fixed Benefit, Critical Illness Cover, Claims Safeguard, Out Patient (OPD) Cover, Booster Benefit, E-opinion, Maternity Expenses, New Born Baby Cover, Assisted Reproduction Treatment, Co-payment, Global Treatment, and 3 types of wellness benefit add-ons.
While such a diverse list of optional covers may encourage the plan's customisation, the policy isn’t without its caveats.
Drawbacks: The maternity and international coverage, despite being add-ons, still has an extensive waiting period of 4 and 3 years, respectively. While the base premium may seem affordable compared to other plans in its category (from other insurers), the premiums increase substantially once you include the riders. Multiple features offered as riders in this plan are already available as built-in features in some top-notch health insurance policies. Additionally, the coverage cap of ₹25 lakhs may not be adequate in some cases (especially if you are opting for this policy as a family floater plan or are considering going for international treatment)
2. SBI Health Arogya Supreme Policy
This is a decent policy that offers a host of in-built features, such as pre-and post-hospitalisation coverage (30 or 60 days and 60/90/180 days, respectively), daycare and domiciliary treatment coverage, mental healthcare coverage, HIV/AIDS cover, advanced treatment coverage (up to 25% of the base cover), bariatric coverage, recovery benefit, refills (up to 100% of the cover, only once across the year), and more.
Among the list of optional riders are features like - Hospital Cash benefits, major illness benefits (covered up to 30 illnesses, capped at ₹25 lakhs), additional sum insured for accidental hospitalisation (up to 1.5 or 2 times the base sum insured), enhanced cumulative bonus, no claim bonus protector, any room upgrade, deductibles, and more.
Drawbacks: This policy has a 4-year pre-existing waiting period. Mental healthcare treatment coverage has a cap of 10% of the sum insured. Room rent and type caps exist (up to 1% of the base sum insured or up to a single private A/C room). The restrictions across the features in this plan are a significant hurdle.
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Conclusion
Despite having proved its credibility across CSR, ICR, and complaint volume metrics, SBI General Insurance has failed to capture the health insurance market. Unless you are determined to approach a government-owned insurance company for your health policy or have a soft corner from the brand in general, you should compare the best health insurance policies available (via free tools) and approach some of the top-notch health insurance providers in the industry. After all, you want a comprehensive health insurance policy (even as a standalone policy, without its add-ons) that is affordable and offers a wide range of coverage that would cater to the customised requirements of diverse policyholders.
