Understanding SBI Health Insurance Claims

There are two types of claims you can make:

1. Cashless Claim – You get treated at a network hospital and don’t pay the hospital bill (SBI pays directly).

2. Reimbursement Claim – You get treated at any hospital, pay first, and SBI refunds the amount later.

We will break down both step-by-step.

1. SBI Cashless Health Insurance Claim Process (Easiest Method)

If you are going to a network hospital, always choose cashless — it saves money, time, and paperwork.

Step-by-Step Simple Cashless Process

Step 1: Find an SBI Network Hospital

Search “SBI Health Insurance network hospital + your city” or call the helpline.
Carry your SBI Health Insurance card or policy number.

Step 2: Show Your Health Card at Hospital TPA Desk

At the admission desk, submit:

• Policy number / e-card

• Aadhaar or any ID

• Your mobile number

The hospital will send a pre-authorization request to SBI.

Step 3: Wait for Approval (Usually 30–90 minutes)

SBI checks your policy and confirms whether the treatment is covered.
You will get an SMS about the approval.

Step 4: Take Treatment Without Paying the Bill

Once approved, your treatment continues under cashless facility.

You only pay:

• Non-medical expenses (gloves, registration etc.)

• Excess amount (if treatment goes above your sum insured)

Step 5: Sign at Discharge & Leave Without Billing Hassle

The hospital sends the final bill to SBI.
You only sign the documents and leave.

2. SBI Reimbursement Claim Process (When Cashless Is Not Available)

This is needed when:

• You visit a non-network hospital

• Cashless request gets rejected

• Emergency admission without time for paperwork

Don’t worry — reimbursement is still straightforward.

Tip:

Keep all original bills and reports safely.
Missing documents = delayed or rejected claim.

Step-by-Step Reimbursement Process

Step 1: Inform SBI About Hospitalization

You have:

• 24 hours for emergency admission

• 48–72 hours before planned admission

Inform via:

• Customer care

• Email (from policy document)

• SBI portal/app

You will get a claim reference number.

Step 2: Collect All Required Documents from the Hospital

You MUST collect these:

• Hospital discharge summary

• Original bills + payment receipts

• Consultation papers

• Diagnostic test reports

• Medicine bills

• Hospital registration number + doctor’s stamp

• FIR/Accident report (if accidental claim)

Step 3: Fill SBI Claim Form (Part A & Part B)

Part A – You fill
Part B – Hospital fills

Most hospitals fill Part B for you on request.

Step 4: Submit Documents to SBI

You can submit through:

• TPA office

• Courier to claim office

• Online upload (if available)

Step 5: Claim Review & Approval

SBI verifies everything.
You may receive calls for clarification.

Normal approval time: 7–15 working days

Step 6: Get Refund in Your Bank Account

Once approved, the amount is credited directly to your bank.

Common Reasons SBI Claims Get Delayed or Rejected

Avoid these mistakes:

• Missing original bills
• Claiming for uncovered treatments
• Not informing the insurer on time
• Submitting handwritten bills without stamp
• Claiming during waiting period
• Wrong or incomplete claim form

Tips to Ensure Fast SBI Claim Approval

• Always choose a network hospital for cashless
• Keep photocopies of all medical documents
• Inform SBI as early as possible
• Double-check claim form before submitting
• Keep SMS, mails, policy card handy
• Check if treatment is covered before admission
• Don’t hide pre-existing conditions

Human Examples (Easy to Relate)

Example 1 – Cashless Claim

Rajat rushed his father to a network hospital in Delhi.
He showed the SBI health card → hospital sent approval → treatment started.
At discharge, they only paid ₹2,000 for non-medical items.

Example 2 – Reimbursement Claim

Neha delivered her baby in a non-network hospital.
She submitted bills worth ₹85,000; SBI reimbursed ₹72,000 after deduction as per policy terms.

Frequently Asked Questions (FAQ)

1. How do I know if my hospital is SBI network?

Search online “SBI health insurance network hospitals” + city name or call customer care.

2. How long does reimbursement take?

Usually 7–15 days, depending on documents.

3. Can SBI reject my claim?

Yes — if documents are missing, treatment is not covered, or the waiting period is not over.

4. Is pre-authorization mandatory for cashless claims?

Yes, the hospital must send the request for approval.

5. What if the cashless claim is denied?

You can still apply for reimbursement by paying the bill and keeping all documents.

Conclusion

The SBI health insurance claim process is not complicated — you only need to know:

• Which hospital to choose
• When to inform SBI
• What documents to collect

With the right steps, both cashless and reimbursement claims become smooth and stress-free.