SBI Health Insurance

SBI Health insurance was formed with the motive to serve the emerging medical needs of growing population. In today’s world, every person desires to live a tension free life and which is why they search for various alternative through which they can get financial stability from eventualities. SBI Health insurance took birth with the help of two major contributors namely, State Bank of India (SBI), leading public sector bank and Insurance Australia Group (IAG), an international general insurance company.

SBI general insurance emerged in 2010 and from there onwards it started introducing insurance plans for small sized and large sized companies, individuals, retailers, families at an affordable rate of premium. SBI general insurance company is not limited to health insurance policies but also offer services motor insurance, travel insurance, home insurance, and personal accident.

SBI General Insurance Company: Facts and Figures

Important Features of SBI Health Insurance

A policyholder can extract plenty of benefits from SBI Health insurance after investing their money.

• A policyholder can extract plenty of benefits from SBI Health insurance after investing their money.
• First, the medical benefits like pre and post hospitalization expenses, cashless treatment on demand for a particular diseases/ injury/ accidents, medical expert opinion, free health checkup, treatment facility at home, ICU and room services, AYUSH treatment, emergency ambulance, etc.
• Second is tax benefits up to Rs 50,000 in favor of the premium paid for health plan chosen.
• Third is the Cumulative bonus which can be earned if no claim has been made during the policy period and the maximum bonus will be equal to 50% of the sum insured.
• Fourth one is reloading of the sum insured if the previous coverage amount has been completely drained up in making claims. SBI Health insurance guarantees all these benefits along with other related advantages specific to each health plan under SBI.
• Anybody i.e. children, senior citizens, adults (65 years), family are eligible to purchase this health insurance plan.
• Family Members can be included under SBI family floater health plan.
• The policy can be renewed online on the SBI website for the customer’s convenience.
• Flexibility in choosing the sum insured between Rs 50,000 to 50 lakhs.
• Cover serious illnesses such as Kidney Failure (End Stage Renal Failure),Cancer, heart attack, paralysis,lung failure, etc.
• Discounts are offered on the premium if family members are included and higher sum insured is opted by the policyholder.

Highlights of SBI Health Insurance

Things To Know Before Buying SBI Health Insurance

• Claim Settlement Ratio: Claim Settlement is key to health insurance company profitability as it creates a sense of trustworthiness among customers who buy their policies. SBI Health with 98% of settlement ratio displays that company entertain the maximum number of claims raised by the policyholders.
• Quick Customer Service: The customer care unit of SBI health insurance extensively look over each claim and strives to address the claim within a specified time limit i.e. 30 days. Also, the customer care team will acknowledge the documents required for the process of making a claim.
• Better communication: SBI Health Insurance provides various methods for claim communication through direct calling, emailing or SMS. The policyholder can simply dial their toll-free number 1800 22 1111 or throw an SMS by writing "CLAIM" to 561612 or email at customer.care@sbigeneral.in. Also, if the insured wants to renew the policy then he can easily process online on the SBI General’s website.
• Brand Power and Value: The company SBI general insurance contains the name of the biggest and oldest nationalized bank of India which is been offering banking services all across the country. SBI has record of millions of customers
• Wide Presence all over India: SBI General Insurance has been operating in every state and city which become highly accessible and convenient for
• Cashless Treatment: SBI General Insurance provides a cashless facility where an insured can receive round the clock treatment at any of the network hospitals registered by the company and located near to your location. The policyholders have to present health card at the time of availing treatment.
• Flexible Policy Terms: All the health insurance policies of SBI General provide flexible policy terms for various plans. A policyholder can select one year/ two years/three-year policy.
• Portability: If a policyholder is not interested and upset with their health policies, then Star Health insurance offers the option of portability. After exercising this option, the policyholder can convert his previous policy into Star Health policy without affecting the profits and benefits earned in the previous policy.
• Tax Benefits: How can one forget about tax benefits or exemption when we are talking about SBI health Insurance. Buying health insurance nor only preserves your wealth from draining into medical cost but also provide a yearly tax deduction. The insured can get maximum of 1.25 lakhs of tax deduction in the annual payment income tax under section 80D of Income Tax Act.
• Coverage for the family: The SBI health plans gives the option to individuals to add their family members to avail the health benefits. The family which can be included are self, spouse, parents, parents-in-law, and 2 dependent children. The company offers this benefit under family floater option and family individual option.
• High Coverage Values: SBI Health insurance comes with a wide range of sum insured under each plan from Rs 1 lakh to Rs 50 lakhs that is formulated to give advance financial protection from medical urgencies.
• Cheaper Rates of Premium: Premium rates under each health insurance plan are deployed after giving proper consideration to the budget and requirement of the insured. Moreover, SBI Health insurance awards a discount on choosing a policy term of 2 or 3 years.

Types of SBI Health Insurance Plans

1. Health Insurance Policy

The most comprehensive plan of SBI Health which encompasses all the medical benefits along with additional benefits at a reasonable rate of premium. The SBI General Health insurance policy gives a pool of options to grant coverage benefits-

• Plan A Metro Plan: This will include areas of Mumbai & Delhi. If the insured living in this location takes treatment in any part of India, then 100% of the claim amount will be paid.
• Plan B Semi Metro Plan: This will include areas of Chennai, Kolkata, Bangalore, Ahmedabad, Hyderabad. Under this plan, the insured will get 100% of claim amount if treatment is operated at above mentioned cities and rest of India except Delhi and Mumbai.
• Plan C (Rest of India): This will include remaining parts of India that are not covered under the above two plans. On opting this plan, the insured is guaranteed to receive 100% payment for getting treatment at in any part of India except in the cities mentioned in Plan A and B.

What Medical Expenses Are Covered?

• In-Patient Hospitalization: Covers the treatment expenses conducted at any hospital such as room charges, ICU, surgeon, anesthetist, nursing, drugs, blood, etc which are necessary during hospitalization.
• 1. Board,Room & Nursing Expenses & Service Charges covered Up to 1% of the Sum Insured per day.
  2. Intensive Care Unit charges where 2% of the Sum Insured is offered per day
  3. Anaesthetist,Surgeon,Specialists, Consultants Fees covered Up to 40% of the Sum Insured per illness/injury per claim
  4. Anesthesia, Oxygen, OT Charges,Blood,Surgical Appliances covered up to 40% of the Sum Insured per illness/ ailment/ injury per claim.
• Pre-Hospitalization: Consultation fees, surgeon fees, surgical appliances, ICU, etc arise as pre-hospitalization cost. All these costs are covered by the company.
• Post-hospitalization: The expenses that happen following the discharge of the patient from the hospital are also covered till 90 days.
• Daycare procedures: Coverage for treatments which are accomplished within a short span of time i.e. within 24 hours are covered. A total of 142 daycare procedures are covered.
• Free medical Checkups: The insured will get 1% of the sum insured for the health checkups after every four years if the policy is renewed with SBI on the policy anniversary.
• Daycare Surgery: The daycare procedures which do not require long periods of hospitalization and are done within 24 hours or a day are also covered.
• Ambulance charges: The service of an ambulance for immediate hospitalization of insured person to a nearby location.
• Domiciliary Hospitalisation: Facility of treatment at home is also covered where the insured person has been declared as unfit to commute to a hospital as advised by a medical practitioner or due to unavailability of a hospital bed.
• Organ Donor Expenses: The insured will get coverage for any organ transplantation where expenses related to inpatient treatment of donor are covered.
• Alternative Treatment: The treatment availed from Ayurveda, Unani, Siddha, and Homeopathy area also covered where the organization must be listed and approved by the Quality Council of India or the government of India. Up to 10% of the sum insured is given for Homeopathy & Unani Treatment and up to 15% of the sum insured is provided for Ayurvedic Treatment.
• Parental Care: This coverage is available for senior citizen above the age of 60 years where SBI will pay Rs 500 or the actual cost for the attendant nursing charges that may arise after the discharge from the hospital.The insurer will pay for a maximum of 15 days on a reimbursement basis.
• Child Care: The charges incurred on the Attendant escort during the hospitalization period of the child below 10 years of age. The insured will get Rs 500 each day of hospitalization and for 30 days maximum in a policy period.
• Accidental Hospitalisation: If any of the insured people suffer from an accident caused by any means will be included in the coverage and 125% of the hospitalization amount will be provided from the sum insured after the deduction of claim raised in the past.
• Convalescence Benefit: This benefit is applicable to the person aged between 10 years to 60 years. The insured will receive a maximum amount of Rs 5000 as compensation on hospitalization of any bodily injuries/ ailments for more than or equal to 10 continuous days.

Other Unique Feature of Health Insurance Policy

• No Pre-policy Medical Examination: Under this plan of SBI Health, the policyholder doesn’t have to appear for the medical test to purchase the policy. Insured under the age of 55 years are exempted from this requirement.
• No Claim Bonus: A bonus equal to 50% of the sum insured is awarded to the insured person for not claiming throughout a policy year. A minimum of 10% of the bonus is given every year whereas the maximum should not cross 50% of the sum insured.
• Tax Benefits: Tax benefits always comes in the first place when health insurance plan is purchased. The maximum limit of benefit can be earned is analogous to Rs 1,25 lakhs per year under section 80 D of the Income Tax Act.
• Optional Coverage: This benefit can be chosen to make the base policy more powerful and effective. These add-on covers are available at a reasonable premium ranging between 3% to 15% of basic premium. The add-on cover that can be purchased-

1. Removal of Room & ICU rent sub-limits
2. Removal of sub-limits on operation and consultancy charges

2. Arogya Premier Policy

A health insurance plan introduced by SBI to meet the medical cost that is touching the sky. This rising cost makes an individual financially weaker as he spends most of his regular income in paying medical expenses and he is left with nothing to feed his family.

However, this situation can be avoided through SBI General Arogya Premier policy where all the medical expenses generated through hospitalization/ consultation/ transplantation are borne by the insurer/ company.

What Medical Expenses Are Covered?

• Pre-Hospitalization: Cost that forms before the hospitalization of the insured are also covered which include diagnostic reports, doctor consultation, medications, etc.
• In-Patient Hospitalization: The total expenses formed out of the treatment of diagnosed illness/ ailment/ accident will be provided coverage from the sum insured chosen on purchase. The cost that consist in-patient hospitalization is-
• 1. Room rent, boarding expenses
  2. Nursing expenses
  3. Intensive care unit
  4. Medical practitioners fees
  5. Anesthesia, blood,oxygen,operation theatre expenses, surgical appliances, diagnostic charges,medicines & consumables, and x-ray, dialysis, radiotherapy,chemotherapy, Physiotherapy, prosthesis/internal implants that are must for successful operation.
  6. Drugs, ordinary splints, medicines, dressing and plaster casts availed during the hospitalization period
  7. OPD expenses arising from OPD consultation and treatment.
• Post-hospitalization: The expenses occurring after the actual hospitalization are covered for a maximum period of 90 days. The payment is realized after the claim is accepted by SBI Health on a reimbursement basis.
• Daycare procedures: The medical processes that are accomplished within a day are also covered. The company has listed 142 daycare procedures such as cataract, piles, tonsils, ulcers etc.
• Maternity Expenses: The expenses emerging out of the delivery of a child are covered such as OPD expenses for the treatment of mother till the discharge date.
• Emergency Ambulance: For quick and easy transportation of the insured person who is not medically fit to travel to a hospital by self and need immediate evacuation through the service of ambulance. The coverage provided will be either equal to the actual amount or the Rs 5000 per hospitalization whichever is less. The total coverage throughout the policy term is Rs 1 lakh.
• Organ Donor Expenses: This cover will function only when the insured is recommended and necessitated by a medical professional for organ transplantation. The in-patient treatment of the person who is donating a particular organ will be covered.
• Reloading of sum insured: Even if you have exhausted your total sum insured, your cover will still continue and your consumed sum insured will automatically get restored/ reloaded.
• Alternative Treatment: Treatment at any center of Ayurveda, Unani, Homeopathy and Siddha are also covered where the organization must be recognized and registered with the central government or Quality Council of India.
• Cumulative Bonus: SBI General Arogya Premier plan rewards you for completing one or more years without making any claim during a particular year. A maximum discount equal to 50% of the sum insured will be given in a whole policy term.

3. Arogya Plus Policy

Sometimes critical illnesses becomes your partner for whole life if it is not paid due attention at its initial stage. SBI General Arogya Plus policy is a plan made to support the insured to meet the rising medical cost for the treatment of serious illness and other routine medical expenses. This plan will include coverage for a handful of medical cost may happen to an individual.

What Medical Expenses Are Covered?

• In-Patient Hospitalization: The expense occurred over the treatment of a specific illness/ accident at any network hospital/ Non-network hospital will be covered. The medical costs come under the umbrella of in-patient hospitalization are listed below-
• 1. Intensive care unit
  2. Medical practitioners fees
  3. Nursing expenses
  4. Room rent, boarding expenses
  5. Anesthesia, blood,oxygen, surgical appliances,operation theatre expenses, medicines & consumables,chemotherapy,diagnostic charges and x-ray, dialysis, physiotherapy,radiotherapy, prosthesis/internal implants that are must for successful operation.
  6. Ordinary splints,Drugs,dressing,medicines, and plaster casts availed during the hospitalization period
  7. OPD expenses arising from OPD consultation and treatment.
• Pre-Hospitalization: Before stepping into the hospital for availing a treatment, the insured has to meet with necessary expenses like diagnostic procedures, doctor consultations, medications, etc that become obligatory. These pre-hospitalization expenses are covered under this plan.
• Post-hospitalization: Once the insured patient is freed from the supervision of a medical expert/ attending hospital after the inpatient treatment has been carried out, the expenses related to the recovery of a treated illness may arise. This may involve pharmaceuticals, Vaccinations, medical consultations, etc and are covered for 90 days starting from discharge date.
• Daycare procedures: The illness/ ailments/ injuries that are rectified within 24 hours or a day due to development in technology are termed as day care procedures. The insured will receive proper compensation for the expense incurred over 142 daycare processes.
• Maternity Expense: Maternity coverage will allow the female insured person to get financial support during the delivery of child and up to a maximum of two deliveries for the whole policy term.
• Ambulance charges: For hospitalization to the hospital, the company will provide proper transportation facility for emergency cases. A maximum of Rs 1500 can be claimed during a policy period.
• Alternative treatment: Some people rest their trust more on the treatment and traditional practices of Ayurveda, Unani, Siddha, and Homeopathy for some ailments.
  Through this plan, SBI Health gives you the freedom to get treated at any government recognized AYUSH centers where the insured can get compensation on a reimbursement basis.

4. Arogya Top Up

The plan grooms you for the future medical emergencies by giving basic with extra coverage for increasing rates of medical facilities due to medical advancements. This SBI health plan has been made to meet pre-decided hospitalization cost as well emergency hospitalization where insured is guaranteed a payment of the sum insured on event of hospitalization.

What Medical Expenses Are Covered?

• Pre-Hospitalization: The hospitalization occurring before the actual admission of insured to the hospital for the treatment of a specific illness.
• In-Patient Hospitalization: The insured will receive due coverage for the treatment taken at network hospitals where insured have to meet various hospitalization charges provided below-
• 1. Room rent, boarding expenses
  2. Nursing expenses
  3. Intensive care unit
  4. Medical practitioners fees
  5. Anesthesia,blood, oxygen, surgical appliances, medicines & consumables, operation theatre expenses, diagnostic charges and x-ray, chemotherapy,dialysis, physiotherapy, prosthesis/internal,radiotherapy, implants that are must for successful operation.
  6. Drugs, dressing, medicines, ordinary splints, and plaster casts availed during the hospitalization period
  7. OPD expenses arising from OPD consultation and treatment.
• Post-hospitalization: After getting treated for an illness/ injury, the insured may have to incur certain post-hospitalization cost for the fast recovery of the treated illness. The expenses will include pharmacy bills, doctor consultation, etc covered for 90 days only after the discharge has been issued.
• Daycare procedures: The medical process that does not require much time to get treated and are corrected within a time limit of 24 hours.
• Maternity Expense: This will include all the necessary charges related to the delivery of a child such as OPD expenses.
• Ambulance charges: Ambulance facility will be provided if an emergency arises in which insured need timely transportation to the nearby hospital for the cure of illness/ injury/ accident/ ailment.
• Organ Donor Expenses: The organ donor expenses which took place during in-patient hospitalization of the organ donor for transplantation are covered. The insured person must be the recipient of the organ donated and the whole process is under the consultation of a medical professional.
• Alternative Treatment: The insured is given an alternative treatment facility where services of Ayurveda, Unani, and Homeopathy can be utilized for soundness of health. The organization in which these medical services availed must be registered with the government of India or Quality Council of India and must qualify the required eligibility imposed by the insurer.

5. Hospital Daily Cash Insurance

The policyholder buying this SBI Health plan will receive daily cash for the hospitalization happened due to an illness or accident for a fixed period of time.

The coverage is provided in two different ways from which the insured has to choose one-

• 30 days coverage: Under this coverage, there are four plans respectively-
• 1. Rs 500 Plan
  2. Rs 1000 Plan
  3. Rs 1500 Plan
  4. Rs 2000 Plan
• 60 days coverage: Just as 30 days coverage, it also includes four types of plan-
• 1. Rs 500 Plan
  2. Rs 1000 Plan
  3. Rs 1500 Plan
  4. Rs 2000 Plan

What Medical Expenses Are Covered?

• Daily Cash Benefit: The insured getting treatment for any kind of illness or accident is promised to receive daily cash depending upon the kind of hospitalization-
• 1. Hospitalization due to sickness: A guaranteed daily cash amount between Rs 500 to Rs 2000 is given based on the coverage opted.
  2. ICU Hospitalization: Daily cash will be supplied for a maximum period of 7 days if the ICU facility has been availed for treatment.
  3. Accidental Hospital Confinement: A sum which is twice the hospital cash per day will be given for accidental injuries up to 5 days maximum per hospitalization and 10 days per policy period.
• Convalescence Expenses: The insured under this option will receive 3 times of daily cash limit if the hospitalization exceeds a continues for 10 consecutive days.
• Coverage of various illnesses: Tonsillectomy, Hernia, piles,internal or external tumor /cyst/nodule, fistula, Benign Prostatic Hypertrophy, cataract, Hypertension, Diabetes, Sinusitis,Heart Disease, nasal disorders, Renal failure, Non-infective Arthritis,etc. are covered but after a waiting period of 1 or 2 years.

Other Unique Features:

There are some features that distinguish the plan from other SBI health insurance Plans-

• Lower rates of Premium: The premium rates are highly cheaper starting from Rs 335 per year for 30 days coverage and Rs 408 for 60 days coverage.
• No Pre-Policy Health Checkup: The Insured below the age of 45 years do not have to undergo medical check-ups. Anybody above may have to appear for the same where the SBI Health will reimbdisxtinnguishurse 50% of sum insured.

6. Group Health insurance

Whether it is the needs of a family or an individual, this plan covers all the medical expenses specific to a particular person and liberates you from the tension of paying huge costs for medical facilities. Moreover, the insured person is not required to appear for any medical test before the policy purchase if they are below 65 years.

What Medical Expenses Are Covered?

• In-patient hospitalization Cost: Expenses that prevails at time of treatment of an illness/ injury in a local hospital. The cost that is covered is illustrated below along with the amount of sum insured given for each expense-
• 1. Room boarding and Nursing charges will receive 1% every day for Non-ICU and 2% per day for availing ICU facility.
  2. Medical practitioners/ specialists fees and other incidental Expenses will be fully compensated.
  3. Anesthesia, Oxygen, Blood,Operation Theatre Charges, Surgical Appliances, Physiotherapy, Diagnostic Materials,Medicines & Drugs, and X‐ray, Dialysis, Radiotherapy, Cost of Pacemaker,Chemotherapy, prosthesis/internal implants and other cost will be accepted by the SBI General for payment.
• Pre-hospitalization: The hospitalization that occurs 30 days preceding the date of admission into the hospital.
• Post-hospitalization: The hospitalization pops up after the in-patient treatment and discharge has been allotted are covered.
• Daycare Procedures: Illnesses/ ailments which are repaired in a shorter time period i.e. within 24 hours are fully covered. Illnesses covered are Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery (Due to accident), Tonsillectomy, etc.
• Ambulance Charges: A monetary value equivalent to Rs 1500 or 1% of the sum insured will be paid for using the service of the ambulance for cases requiring immediate medical attention.
• Domiciliary Hospitalisation: Treatment which has been operated at home will also covered and an amount equal to Rs 2000 or 20% of the sum insured will be paid on the condition that the process has been reported to the company. Treatment can be availed only if the insured health condition is highly feeble and cannot be transferred to hospital OR hospital bed is not available.

7. Loan insurance Policy

This insurance cover will help you in the payment of loan amount taken for the purchase of home by offering financial protection from Critical Illness, Personal Accident, Loss of employment which is uncertain and can happen at any point of time.

What Medical Expenses Are Covered?

• Critical Illness Cover: The insured will get coverage from 13 critical illnesses whose treatment can involve a whole lot of money. The illnesses listed are-
• 1. Coma
  2. Paralysis
  3. Aorta Graft Surgery
  4. Kidney Failure (End Stage Renal Failure)
  5. Primary Pulmonary
  6. Major Organ Transplant
  7. Coronary Artery Bypass Graft
  8. Heart Valve Surgery
  9. Stroke
  10. Myocardial Infarction (First Heart Attack)
  11. Cancer
  12. Total blindness
  13. Multiple Sclerosis Arterial Hypertension
• Personal Accident: The insured will receive 100% of the total expense arrived on the event of accidental death or permanent total disability. The coverage will be provided as reflected in the table given below-
• 1. For Loss of Sight (both eyes): 100% of the compensation on actual expense amount.
  2. For Loss of one hand or one foot/ both hands/ both feet where the organ is separated from body: 100% of the compensation on actual expense amount
  3. For paralysis of one hand or one feet or both hands or feet where the organ is not separated from the body but has stopped function: 100% of the compensation on actual expense amount.

Other Unique Benefits:

• Coverage during loss of Employment/ Job: If a person becomes temporarily or permanently unemployed during the policy term, then a maximum of 3 EMIs will be paid in favor of the loan amount taken.
• 3 years maximum coverage: As it is loan insurance and loan will not sustain for whole life. So, this cover gives maximum coverage for 3 years to give freedom and flexibility.
• No pre-policy medical screening: The insured below the age of 45 years are exempted from presenting any
• Two Sum Insured Options: This plan offers two sum insured options i.e. Fixed and Reducing.

8. Critical Illness Insurance Policy

This plan saves your family untimely death due to critical illness investigated for the first time by a medical professional. A coverage amount will be paid if the insured who is fighting with the diagnosed disease survives for more than 28 days starting from the date of primary diagnosis.

What Medical Expenses Are Covered?

The sum insured will be provided to the insured person, if he/ she is detected with any of the following diseases as pointed below-

• Total Blindness
• Permanent Paralysis of Limbs
• Open Chest Bag
• Aorta Graft Surgery
• Stroke Resulting in Permanent Symptoms
• First Heart Attack of Specified Severity
• Kidney Failure Requiring Regular Dialysis
• Cancer of Specified Severity
• Primary Pulmonary Arterial Hypertension
• Major Organ/ Bone Marrow Transplant
• Multiple Sclerosis with Persisting Symptoms
• Coma of Specified Severity
• Open Heart Replacement or Repair of Heart Valves

Exclusions

• Cosmetic or aesthetic treatments of any description, surgery for change of life/gender, Lasik treatment for refractive error.
• wheelchairs,Cost of spectacles, hearing aids, crutches,contact lenses, artificial limbs, dentures, artificial teeth and all other external appliances.
• Suicides or involving self-destruction activities.
• Illness arising due to consumption of hallucinogenic stuff /sedatives, alcohol, tobacco etc.
• Injuries caused due to participation in war, foreign attack, insurrection, military, radioactivity etc.
• Treatment of sterility, infertility, subfertility or any other condition.
• Weight management treatments or obesity

Claim Process for SBI Health Insurance

Claims Procedure for Reimbursement

• The SBI General will accept the claim on reimbursement if they are informed about the event under a regulated time limit as provided in the policy wording.
• The insured must inform the company beforehand about the hospitalization for any illness or any medical problem whether it is planned or unplanned.
• The claim must be communicated to the customer care team within 48 hours after the event took place.
• After getting treatment or availing the medical services of a doctor, the insured must gather mandatory documents as required during the claim process. Documents are key to acceptance and approval of the claim.
• The required documents must be submitted with the insurer along with duly completed claim form. The insured must evaluate each and every document before passing it to the insurer. The submission of the same must be done in 15 days after the hospitalization has been done.
• If the insured procrastinate in the process of submitting mandatory documents, the delay will be forgiven on providing a valid reason for late submission. The insurer has the right to reject the proposal if the valid is not furnished.
• The insurer/ administrator assigned for the claim will examine all the information provided. After the whole process of assessment is completed, the claim will be approved by the insurer, if all the proofs are truly represented. The decision of claim acceptance will be communicated to the claimant in written.
• The payment will be made directly into the account of the policyholder in a given time frame of 7 days starting from the date of acceptance of the claim.

Claims Procedure for Cashless Treatment

• Cashless claim should be reported immediately after the hospitalization occurs. The insured for availing cashless facility should first apply for pre-authorization with the insurer/ administrator.
• The insurer/ administrator after analyzing Insured’s request and after obtaining any further information or documentation administrator has sought, administrator may if satisfied send Insured or the network hospital, an authorization letter. The authorization letter, the ID card issued to Insured along with this policy and any other information or documentation that administrator has specified must be produced to the network hospital identified in the pre-authorisation letter at the time of Insured’s admission to the same
• After getting authorization, the Insured will get free from paying any medical expenses in the network hospital in which treatment is carried out. All liability of all the expenses will be compensated by the Insurer.
• The original bills and evidence of treatment in respect of the same shall be left with the network hospital.

Please Note: Pre-authorisation does not guarantee that all costs and expenses will be covered. SBI General insurance company reserves the right to review each claim for medical expenses and accordingly coverage will be determined according to the terms and conditions of this Policy.

Documents Required for Sbi Health Insurance

• Completely filled Claim Intimation Form declaring the required information for acceptance of the claim.
• Valid photo identity card issued by the government, residence proof and 2 recent photos of Insured and/or his nominee.
• Original Discharge certificate/ death summary
• Copies of diagnostic test reports, consultation notes, medical references, prescriptions paper, pharmacy bills, and other hospital bills.
• Original set of investigation report Investigation Reports like laboratory tests, X-rays and indoor case papers significant to prove the presence of injury.
• Copy of First Information Report/ Punchnama/ Post Mortem report for accident cases.
• Disability certificate from concerned Doctor or hospital declaring the extent and nature of the disability, if applicable.
• Death certificate, if applicable
• Other documents as asked by the SBI General under a health insurance plan.

Renewal Process Of SBI Health Insurance

SBI General’s Guidelines before Renewal

• The renewal will only be accepted and approved if the insured person has submitted due amount of premium on the policy anniversary.
• The renewal receipt on the payment of premium should bear the signature of an authorized person of the insurance provider and the receipt must be on the printed form with the insurer.
• If the insured has been infected by any illnesses/ diseases in any month before the renewal date, should be conveyed to SBI General at the time of applying for renewal. As concealing this fact can hinder the claim process that may highlight in the future.

Online Renewal Process

• First, the insured have to visit the website of SBI General Insurance.
• Then, click on the SBI health insurance plan page you want to renew in the health section. You will see a renewal button, by clicking a form will flash on your screen.
• Fill the asked details like last name and age of policyholder, mobile number, email ID and at last the policy number.
• After providing all relevant details about yourself and policy, they will process your request.

SBI Health Insurance Premium Calculation

While purchasing the SBI health insurance plan, you have to highlight or mention some personal details at the hour of purchase. By using SBI premium calculator, insured can determine the correct value they have to submit every policy year.

• Age of the policyholder: The age is the foremost factor that affect a large portion of the premium. The rule is higher the age greater will be the premium and lower the age smaller will be the premium.
• Type of Plan: The type of SBI Health plan also defines the premium value of the policy. For instance premium for Arogya Premier plan is Rs 8,938 for sum insured of Rs 10 lakhs for a 35 year old individual. Whereas for Arogya Top-Up policy, the premium rate under the same sum insured of Rs 10 lakhs is Rs 3,009 (exclusive of tax). This gap in prices is because of the quantity of benefits and coverage offered in each plan.
• Type of Policy (individual/ family floater): Also, the premium is calculated on the type of policy chosen by the main policyholder. SBI health insurance plans give three option - Individual policy, Family Floater policy, and Family Individual policy. As under family floater, any family members can be included under the same sum insured which increases the total amount of premium.
• Sum Insured: Another significant contributor to the premium calculation process is sum insured value. If the sum insured opted is of higher i.e. Rs 30 lakhs to 50 lakhs then the premium is definitely going to be fancy whereas lower sum insured have cheaper rate of premiums.
• Number of Members included: Family is priority for every individual which why SBI Health insurance provides the option to include the family member in the coverage. This gradually pinches the rate of premium and may fluctuate the price.

FAQs

1. What kind of daycare procedures are covered under SBI Health insurance policies?

There are 142 processes that are included by the SBI General. Some of the treatments covered are operation of tongue, eye, ear, nose, skin, mouth, face, tonsils, breast, digestive tract, female sexual organs, prostate vesicles, scrotum, urinary system, cancer chemotherapy, radiotherapy, etc.

2. Does the policyholder get any grace period if premiums are not paid on due date?

If the policyholder fails to submit the premium on the due date, then 30 days of grace period is allotted to pay the due premiums.

3. How many days are taken by SBI General to settle a claim?

The company promises to pay the claim amount within 7 days after the claim has been dictated by the insurer and the claim has been accepted by the insurer. If the insurer fails to fulfill the claim settlement within this time limit, then an interest amounting to 2% above the bank rate will be given in addition to the actual amount.

4. In how many days the claim can be intimated for hospitalization?

The claims must be informed within 15 days after the hospitalization period is completed and discharge letter is issued to the insured.

The insured is required to submit all the documents in supplementary to the claim intimation form. The insured must genuinely declare each and every detail asked on the form in order to avoid repudiation/ rejection of a claim.

5. What is the time limit to submit the post-hospitalization claim under SBI health insurance?

The post-hospitalization claims must get verbalized over a call or in written within 15 days after the post-hospitalization terminates. Also, it is the responsibility of the insured to preserve original as well photocopies of all the medical bills, diagnosis reports, consultation notes, pharmacy bills, etc for reimbursement of claims.

6. Do we have the option to cancel the policy if do not like terms and conditions of the health plan?

Yes, the company will provide you 15 days starting just after the purchase of SBI health insurance. In this period, the insured person can examine policy benefits, its terms and conditions, and other associated factors.

The premiums will be returned after the deduction of tax and other medical cost arrived during the 15 days period.

7. Are pre-existing diseases covered in SBI health insurance?

Yes, if you are bearing any kind of diseases during the purchase of the policy, the disease will get covered after a waiting period of 48 months. The insured must comply following conditions to get coverage for the same-

• The pre-existing disease must be disclosed in the proposal form so that it may not hinder claim made in the future.
• The health policy must be renewed with the SBI General on the due dates.

8. What is the condition to get coverage under domiciliary hospitalization?

The treatment taken at home must be more than 3 days and the insured must be accomplished either of the two conditions-

• Hospital bed/ room was not vacant or available in the hospital OR
• Insured health condition is highly feeble making him unable to move out of the bed.
• The treatment must be approved by a medical practitioner.

9. Do we get rewards on not making a claim during the policy period?

Yes, SBI health insurance policies do contain this feature of "No Claim Bonus or Cumulative Bonus" where the insured will get a maximum bonus equal to 50% of the sum insured.

SBI Health Insurance Claim Form

Last updated on 09-07-2019

Health Insurance Companies

• Aditya Birla Health Insurance
• Apollo Munich Health Insurance
• Bajaj Allianz Health Insurance
• Bharti Axa Health Insurance
• Cholamandalam Ms Health Insurance
• ManipalCigna Health Insurance
• Future Generali Health Insurance
• Hdfc Ergo Health Insurance
• Iffco Tokio Health Insurance
• Max Bupa Health Insurance
• National Health Insurance
• New India Health Insurance
• Oriental Health Insurance
• Reliance Health Insurance
• Religare Health Insurance
• Sbi Health Insurance
• Star Health Insurance
• Tata Aig Health Insurance
• United India Health Insurance
• Universal Sompo Health Insurance

Insurance Calculator

• Health Insurance Calculator