{"id":1101,"title":"SBI GENERAL HEALTH ALPHA Claim Form","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/Health_Alpha_Claim_Form_1401_649df2e79d.pdf","sha256":"1f4da9cb39be8885108d88478867447a71f37f4271055ce71ee820e3ccb84aa4","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder or claimant to file a health insurance claim under the SBI General Health Alpha policy.","notes":["Use DD/MM/YYYY format for all dates.","All fields marked as mandatory (*) must be filled.","Attach a cancelled cheque for the payee bank account; photocopies are not accepted.","Photocopies of cancelled cheque are not considered.","Original bills only should be attached.","The company may seek additional documents including KYC documents as necessary.","Issuance of this form does not amount to admission of liability or waiver of policy terms.","Dishonest or fraudulent claims will void benefits under the policy."],"title":"SBI GENERAL HEALTH ALPHA Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured/Claimant","fields":[{"help":"","type":"text","label":"Name of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender         Male           Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Employee No.","options":[],"required":false,"pdf_field":""},{"help":"Include Plot No/Door No., Building Name, Road, Area, City, District, State, Pincode","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Include Phone No., Mobile, E-mail Id","type":"text","label":"Contact Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format for both From and To dates","type":"date","label":"Period of Insurance   From                                                       To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant or insured"},{"title":"Details of Other Insurance","fields":[{"help":"","type":"yes-no","label":"Is the Accident/Incidence covered under any other Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach copy of other insurance policy","type":"text","label":"If 'Yes', specify details and attach a copy of the policy","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy Issuance Office Location","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format for both From and To dates","type":"date","label":"Period of insurance From To","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Payee Details","fields":[{"help":"Mandatory field","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Mandatory field","type":"text","label":"Bank Branch","options":[],"required":true,"pdf_field":""},{"help":"Mandatory field","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Mandatory field","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Mandatory field","type":"text","label":"MICR No.","options":[],"required":true,"pdf_field":""},{"help":"Mandatory field","type":"text","label":"PAN No.","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration by the Insured","fields":[{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Bills Enclosed","fields":[{"help":"Fill columns: SI. No, Issued by, Bill No, Date (DD/MM/YYYY), Towards, Amount (Rs). Also specify number of Pre-hospitalization and Post-hospitalization bills","type":"table","label":"Details of Bills Enclosed","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Annexure II: Personal Accident Cover - Information to Police Authority","fields":[{"help":"","type":"yes-no","label":"Has the loss been reported to Police Authority?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If 'No', reason for not reporting","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"First Information Report No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Medico Legal Case (MLC) No.","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Report Date","options":[],"required":false,"pdf_field":""},{"help":"Include City, District, State, Pincode","type":"text","label":"Address of Police Station","options":[],"required":false,"pdf_field":""},{"help":"Include Phone No., Mobile, E-mail Id","type":"text","label":"Contact Details","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Annexure II: Personal Accident Cover - Details of Accident and Incidence","fields":[{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Specify A.M. or P.M.","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Include Plot No/Door No., Building Name, Road, Area, City, District, State, Pincode","type":"text","label":"Accident/Incidence Location Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were there any witness to the Accident/Incidence?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If ‘Yes’, provide details, Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Include Plot No/Door No., Building Name, Road, Area, City, District, State, Pincode","type":"text","label":"Address of Witness","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Witness relative of Claimant?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Annexure II: Personal Accident Cover - Hospital Details","fields":[{"help":"","type":"yes-no","label":"Was the person moved to hospital immediately after the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Include Plot No/Door No., Building Name, Road, Area, City, District, State, Pincode","type":"text","label":"Address of Hospital","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Admission","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Discharge","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Annexure II: Personal Accident Cover - Nominee Details","fields":[{"help":"","type":"text","label":"Name of Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Sex      M       F","options":["M","F"],"required":null,"pdf_field":""},{"help":"Include Plot No/Door No., Building Name, Road, Area, City, District, State, Pincode","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Include Phone No., Mobile, E-mail Id","type":"text","label":"Contact Details","options":[],"required":null,"pdf_field":""},{"help":"Include Name, Relationship with Insured, Date of Birth, Address, Contact Details","type":"text","label":"If nominee is minor, kindly provide the Legal Guardian details","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"nominee"},{"title":"Annexure II: Personal Accident Cover - Benefit Claim","fields":[{"help":"","type":"checkbox","label":"For Which benefit do you claim? [PLEASE TICK (   ) THE APPROPRIATE BOX]","options":["Accidental Death","Permanent Total Disability (PTD)","Home Modification Benefit","Permanent Partial Disability (PPD)","Child Education Benefit","Temporary Total Disability (TTD)","Loan Protector Benefit"],"required":null,"pdf_field":""},{"help":"Specify amount claimed for each selected benefit","type":"amount","label":"Amount claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Annexure II: Personal Accident Cover - To be filled by treating Doctor","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender       Male           Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth / Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of the Accident/Incident and details of injuries sustained","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No for each","type":"checkbox","label":"Nature of Disablement","options":["Permanent Total Disablement","Permanent Partial Disablement","Temporary Total Disablement"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of Disablement","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of treatment given","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the injuries: a) Solely due to Accident/Incident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If 'Yes', give details","type":"yes-no","label":"b) Traceable to any disease","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If 'Yes', give details","type":"yes-no","label":"c) Traceable to any previous injury","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was insured under influence of drugs / alcohol / intoxicants at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If 'Yes', give details","type":"yes-no","label":"Is the injured person suffering from any disease or injury which may have contributed to the accident or likely to aggravate his/her condition or delay improvement?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format for both From and To dates","type":"date","label":"According to you, how long should the injured person be confined to bed/house as the direct and sole consequence of the injury sustained? From To","options":[],"required":null,"pdf_field":""},{"help":"If 'No', please state probable date of his/her being able to attend to normal duties","type":"yes-no","label":"During this period will the injured person be able to attend to his/her normal duties?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of treating Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Qualifications","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registration No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Doctor","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"attachment","label":"Stamp of the Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"Stamp of the Hospital","options":[],"required":null,"pdf_field":""},{"help":"Include Phone No., E-mail Id","type":"text","label":"Contact Details","options":[],"required":false,"pdf_field":""}],"filled_by":"treating doctor"}],"deadlines":[],"applies_to":"health insurance claims under SBI General Health Alpha policy","attachments":["Copy of other insurance policy (if applicable)","Cancelled cheque pertaining to the payee bank account","Bills/receipts for the claim","Documents listed in Annexure III as per benefit claimed (e.g. FIR, Death Certificate, Medical Certificates, Police Copy, Post Mortem Report, Disability Certificate, Photographs, Leave Certificate, Investigation Reports, Treatment Papers, Original Bills and payment receipts)"],"declarations":["The information furnished in this claim form is true and correct to the best of my knowledge and belief.","False or untrue statements or concealment of material facts will forfeit the right to claim reimbursement.","Consent is given to TPA/insurance company to seek necessary medical information/documents from hospitals or medical practitioners.","All bills/receipts for the claim have been included and no supplementary claim will be made except pre/post-hospitalization claims (for indemnity policies).","The claimant accepts the amount as full discharge of the insurer's obligations under the policy.","The claimant will indemnify the insurer against any claim made by other persons under this policy."],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customer.care@sbigeneral.in","label":"Motor Claims Email","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"m\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journeys, always\nDownload SBIG App\nRegister or Tra","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"sbig.health@sbigeneral.in","label":"Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"ailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th Floor, Westport, Pan Card","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"seniorcitizen.health@sbigeneral.in","label":"Senior Citizen Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 102 1111","label":"Motor Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"e Claim\nFAQs\nDownload Claim Form\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journ","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 3366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"e simple click\nCheck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 6366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"heck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"561612","label":"Health Claims SMS 'HEALTHCLAIM'","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"y Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/sbi-general-insurance/1101-sbi-general-health-alpha-claim-form"}