SBI Health Insurance

SBI Health Insurance
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About SBI Health Insurance

SBI Health insurance plans were formed with the motive to serve the emerging healthcare needs of the growing population. The products offered by SBI will protect against medical contingencies in the future. It offers comprehensive cover in addition to OPD coverage for critical ailments as well.

Highlights of SBI General Insurance Company

The SBI General Insurance company 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. The company emerged in 2010 and from then onwards, it started introducing insurance plans for small-sized and large-sized companies, individuals, retailers and families at an affordable rate of premium.

Number of Network Hospitals6000+
Incurred Claims Ratio52.01%
PortabilityYes
Renewability of the PolicyLifetime
Pre-Policy Medical CheckupNot Required

Table Data updated on 20-03-2020

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What Are the Types of SBI Health Insurance Plans?

  • SBI Arogya Premier Policy
  • SBI Arogya Plus Policy
  • SBI Arogya Top Up Policy
  • SBI Retail Health Insurance Policy
  • SBI Critical Illness Insurance Policy
  • SBI Hospital Daily Cash Insurance Policy
  • SBI Loan Insurance Policy

1. SBI Arogya Premier Policy

SBI Arogya Premier policy, a health insurance plan introduced by SBI where all the medical expenses generated through hospitalization/consultation/transplantation are borne by the insurer/company.

Features & Benefits

  • Pre and post-hospitalization costs of the insured are covered which include diagnostic reports, doctor consultation, medications, etc.
  • The company offers 142 daycare procedures such as cataract, piles, tonsils, ulcers etc.
  • Maternity expenses are covered such as OPD expenses for the treatment of the mother till the discharge date.
  • Organ donor expenses along with organ transplantation will be covered.
  • Reloading of the sum insured on exhaustion of 100% sum assured.
Minimum age of entry18 years for Adults
3 months for children
Maximum age of entry65 years
Sum InsuredRs 10 lakhs to Rs 30 lakhs
Number members can be includedUnder Individual policy: 1 member
Under Family Floater: 4 members
Family Individual Policy: 5 members
Policy TermOne Year
Premium Paying ModesAnnually/Monthly

Table Data updated on 20-03-2020

2. SBI Arogya Plus Policy

SBI Arogya Plus policy is made to support the insured to meet the rising medical cost for the treatment of serious illness and other routine medical expenses.

Features & Benefits

  • In-Patient Hospitalization.
  • Maternity coverage will allow the female insured person to get financial support during the delivery of the child and up to a maximum of two deliveries for the whole policy term.
  • For hospitalization, the company will provide a proper transportation facility for emergency cases. A maximum of Rs.1500 can be claimed during a policy period.
  • Alternative treatment for practices like Ayurveda, Unani, Siddha, and Homeopathy for some ailments.
Minimum Age of entry18 years for Adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 1 lakhs/ 2 lakhs/ 3 lakhs
Number of membersUnder Individual policy: 1 member
Under Family Floater: 4 members
Family Individual Policy: 6 members
Policy TermOne Year
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

3. SBI Arogya Top Up Policy

SBI Arogya Top Up policy has been made to meet pre-decided hospitalization costs as well as emergency hospitalization where the insured is guaranteed a payment of the sum insured in the event of hospitalization.

Features & Benefits

  • The insured will receive due coverage for the treatment taken at network hospitals where insured have to meet various hospitalization charges provided below-
    • Room rent and boarding expenses
    • Nursing expenses
  • The policy covers 142+ medical day care procedures.
  • It covers Maternity Expenses related to the delivery of a child such as OPD expenses.
  • Ambulance facility will be provided in case of emergency hospitalization due to illness/ injury/ accident/ ailment.
Minimum Age of entry18 years for Adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 1 lakhs to Rs 50 lakhs
Number members can be includedUnder Individual policy: 1 member
Under Family Floater: 6 members
Family Individual Policy: 10 members
Premium Paying TermOne Year
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

4. SBI Retail 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.

This policy gives a pool of options to grant coverage benefits-

  • Plan A Metro Plan: If the insured lives in Mumbai and Delhi and is taking treatment in any part of India, then 100% of the claim will be paid.
  • Plan B Semi Metro Plan: The insured will get 100% of claim amount if the insured is residing in Chennai, Kolkata, Bangalore, Ahmedabad, Hyderabad and taking the treatment in any part of India.
  • Plan C (Rest of India): On opting this plan, the insured is guaranteed to receive 100% payment for getting treatment in any part of India and residing in cities mentioned in Plan A and B.
Minimum Age of entry18 years for Adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 50,000 to Rs 5 lakhs
Number members can be includedUnder Individual policy: 1 member
Under Family Floater: 4 members
Family Individual Policy: 5 members
Policy TermOne Year
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

5. SBI Critical Illness Insurance Policy

This plan protects the family on the unfortunate death of the policyholder due to a diagnosed critical illness. 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.

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

Features & Benefits

  • The policy covers up to 13 critical illnesses like kidney failure, permanent paralysis of limbs, aorta graft surgery, etc.
  • No pre-policy medical checkup required up to 45 years.
  • Availability of multiple plan options for 1 and 3 years of the policy tenure.
  • Policyholders can choose a sum assured up to Rs. 50 lakhs.
Minimum Age of entry18 years for Adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 2 lakhs to Rs 50 lakhs
Number members can be included3 family members (self, spouse, and one child)
Premium Paying TermOne Year/ Three Years
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

6. SBI Hospital Daily Cash Insurance Policy

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

Features & Benefits

  • 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.
    • Hospitalization due to sickness: A guaranteed daily cash amount between Rs. 500 to Rs. 2000 is given based on the coverage opted.
    • ICU Hospitalization: Daily cash will be supplied for a maximum period of 7 days if the ICU facility has been availed for treatment.
    • 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.
  • The insured under this option will receive 3 times of daily cash limit if the hospitalization exceeds a continuous limit for 10 consecutive days.
  • Coverage of various illnesses such as tonsillectomy, piles, internal or external tumour/cyst/nodule, fistula, etc. are covered but after a waiting period of 1 or 2 years.
Minimum Age of entry18 years for Adults
3 months for children
Maximum Age of entry65 years
Sum InsuredRs 500 per day to Rs 2,000
Number members can be includedUnder Individual policy: 1 member
Under Family Floater: 6 members
Premium Paying TermOne Year
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

7. SBI Loan Insurance Policy

In case you are a victim of a critical illness/accident/unemployment and you have a home loan to pay, this policy will cover its expenses on your behalf.

Features & Benefits

  • Critical Illness Cover for 13 critical illnesses such as paralysis, aorta graft surgery, kidney failure (end-stage renal failure), etc.
  • The insured will receive 100% of the total expense arrived in the event of accidental death or permanent total disability.
  • If a person becomes temporarily or permanently unemployed during the policy term, then a maximum of 3 EMIs will be paid in favour of the loan amount taken.
  • 3 years maximum coverage, as it is loan insurance and the loan will not sustain for the whole life.
  • This plan offers two sum insured options i.e. Fixed and Reducing.
Minimum Age of entry18 years for Adults
Maximum Age of entry70 years
Daily Cash LimitRs 1 Lakh
Number members can be includedApplicable for one individual
Premium Paying TermOne Year
Premium Paying ModesAnnually/ Monthly

Table Data updated on 20-03-2020

How To Purchase SBI Health Insurance Plans?

Offline Method:

  1. Select a health plan as per your requirements and visit the nearest SBI general insurance branch.
  2. The insurance officer at the helpdesk will give you an application form.
  3. Provide the required details and submit the form to the concerned department.
  4. The insurer will forward the form for further process and you will receive progress updates of the plan on your registered email id.
  5. The verification team shall contact you to verify the details and after a successful verification process, the insurer will forward your policy document to the registered email id.
  6. You are allowed to call and take further assistance from the customer service anytime after the purchase.

Online Method:

Buy SBI health insurance plan from PolicyX.com by following the simple steps:

  1. Visit PolicyX.com and provide the information in the form at the top-right corner of the page.
  2. Click on 'Proceed’.
  3. You will see the quotes section for all the health plans.
  4. Choose the SBI plan of your choice and proceed to buy the plan by clicking on the ‘Buy’ option.
  5. You need to make the payment and after the successful completion of payment, a soft copy of the policy document will be sent on your email id.

What Is the Renewal Process of SBI Health Insurance Plans?

SBI General’s Guidelines Before Renewal:

  • The renewal will only be accepted and approved if the insured person has submitted the due amount of premium on the policy anniversary.
  • The renewal receipt on premium payment 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

You can directly renew your policy by following the below-stated steps:-

Step 1: Go to the official website of SBI General and click on ‘Renew Cover’ tab.

Step 2: Click on the ‘Renew Policy’ tab. Select your category as ‘Health Policy’ and choose your plan.

Step 3: Enter your policy details like policy type and policy number. After this is done, it will show the summary of your policy details. Click on the ‘Renew Now’ option.

Step 4: It will again ask you some details for confirmation; provide the policy number, date of birth and click on the ‘Let’s Renew’ option.

Step 5: After this, make the payment and the renewal process of your policy is done.

What Are the Documents Required for SBI Health Insurance Plans?

  1. Completely filled claim intimation form declaring the required information for acceptance of the claim.
  2. Valid photo identity card issued by the government, residence proof and 2 recent photos of Insured and/or his nominee.
  3. Original Discharge certificate/ death summary.
  4. Copies of diagnostic test reports, consultation notes, medical references, prescriptions, pharmacy bills, and other hospital bills.
  5. An original set of investigation reports like laboratory tests, X-rays and indoor case papers significant to prove the presence of injury.
  6. Copy of First Information Report/ Punchnama/ Post Mortem report for accident cases.
  7. Disability certificate from concerned doctor or hospital, declaring the extent and nature of the disability, if applicable.
  8. Death certificate, if applicable.
  9. Other documents as asked by the company.

What Is the Claim Process for SBI Health Insurance Plans?

Claims Procedure for Reimbursement

  1. The claim must be communicated to the customer care team of the company within 48 hours after the event took place.
  2. 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.
  3. The required documents must be submitted with the insurer along with duly completed claim form.
  4. The insurer/ administrator assigned for the claim settlement will examine all the information provided.
  5. After the whole process of assessment is completed, the claim will be approved by the insurer, if all the proofs are truly represented.
  6. The decision of claim acceptance will be communicated to the claimant in writing.
  7. The payment will be made directly into the account of the policyholder in a given time frame (starting from the date of acceptance of the claim).

Claims Procedure for Cashless Treatment

  1. A cashless claim should be reported immediately after the hospitalization occurs. The insured for availing a cashless facility should first apply for pre-authorization with the insurer/ administrator.
  2. The insurer/ administrator after analyzing the insured’s request and after receiving all the documents should send the insured or the network hospital an authorization letter.
  3. The authorization letter and the ID card issued to Insured along with this policy and any other information or documentation that the administrator has specified must be produced to the network hospital identified in the pre-authorisation letter at the time of the insured's admission.
  4. After getting authorization, the insured will get free from paying any medical expenses in the network hospital in which treatment is carried out. Liability for all the expenses will be compensated by the Insurer.
  5. The original bills and evidence of treatment shall be left with the network hospital.

**Note: Pre-authorisation does not guarantee that all costs and expenses will be covered. The 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.

FAQs

Tax benefits up to Rs. 50,000 in favour of the premiums paid under Section 80D of the Income Tax Act, 1961 are given.

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 fulfil the claim settlement within this time limit, an interest amounting to 2% above the bank rate will be given in addition to the actual amount.

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

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

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

No, SBI health insurance policies do not provide reward points for staying healthy.

50% no claim bonus and 100% reload benefit is paid in case of zero registered claims and on exhaustion of the sum assured respectively.

Page updated on 20-03-2020