SBI Health Insurance Plans

Introduction of SBI Health Insurance Plans

SBI offers a wide range of health insurance plans to suit the needs of various types of customers. SBI General Insurance Company Limited is a joint venture between the State Bank of India and Insurance Australia Group (IAG), in which SBI owns 74% of the total capital and IAG the remaining 26%.

State Bank Of India in association with State Bank of India covered over 1.5 Crores Savings Bank Account holders of SBI with a Personal Accident Insurance cover. In Financial Year 2016-17, SBI General Insurance Company Limited had a gross written premium of Rs. 2,604.5 Crores leading to a growth of 28%. As of 2017, the insurer’s presence extends to 110 cities pan India with more than 2600 employees.

The plans cover hospitalization, critical illness, daily cash benefit, personal accident insurance, and top-up plans. In today’s post, we will discuss everything you need to know about coverage, eligibility, policy term, add-on covers, cashless treatment, hospital networks, and several offers and benefits.

SBI Health Insurance at a glance

I. Network hospitals – 6000+.
II. Waiting period of pre-existing diseases – 3-4 years(depending on plan coverage).
III. Incurred claims ratio – 52%.
IV. Number of policies issued – 4,17,400.
V. Grievances solved – 96.01%.
VI. Renewability – lifetime.
VII. SBI network branches – 24000+.

Reasons for choosing SBI Health Insurance Plans

1. SBI General Health Insurance offers health insurance policies having a wide coverage ranging from Rs.50,000-5 lakh.
2. No pre-policy medical test is required for individuals up to the age of 45 years with have no medical history.
3. The plans offer family floater plans that cover self, spouse, children, and dependent parents under a single policy.
4. You can choose from flexible plan options like Metro Plan, Semi-Metro Plan, or the Rest of India.
5. You get a lifelong renewability option with SBI General Health Insurance plans.
6. Any insurer’s health insurance policy can be renewed with SBI General Health Insurance.

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7. The premium paid towards an SBI General Health Insurance policy is eligible for tax deductions under Section 80D of the Income Tax Act, 1961.
8. The policies do offer pre and post-hospitalization expenses.
9. Get a free health checkup of up to Rs. 2,500 for every 4 claim-free years.
10. Insurance coverage can be enhanced by the add-on covers like the removal of sub-limits on room rent and consultation charges.
11. You can get cashless treatment at over 3,000+ network hospitals across the country.

SBI Health Insurance Plan types

SBI Retail Health Insurance Policy

  1. Age limit – Between 18-65 years.
  2. Pre policy screening – Not mandatory for persons ageing 45 years or below.
  3. Basis – Individual and family floater plans(Metro plan, Semi metro plan and rest of India).
  4. Pre and post hospitalization expenses – Covers all medical incurred from 30 days before and 60 days after hospitalization.
  5. Income Tax Benefits – As per Section 80D of the Income Tax Act, 1961.
  6. Free health check-up – At the end of 4 continuous claim-free years(max limit is Rs. 2,500).
  7. Add on covers – Available for zero sub-limits on room, ICU rent, doctor’s fees etc.
  8. Other benefits – Renewal facility of current policy from any other insurer.
  9. Exclusions –
    A. In the case of pre-existing diseases, a waiting period of 4 years will apply.
    B. Illness, injury or diseases contracted within 30 days from the commencement of the policy won’t be covered.
    C. Treatments consisting non-allopathic medicine will not be covered.
    D. Certain diseases including hernia, hydrocele, piles etc require a waiting period of 1 year before coverage. Whereas, Cataract and Hysterectomy treatments need a waiting period of 2 years.
    E. Treatments related to pregnancy, childbirth, caesarean section, prenatal and postnatal care.
    F. Coverage of treatments due to the use of intoxicating and/or addictive substances like alcohol, drugs etc.
    G. Joint replacement surgery that is not caused by an accident, requires a waiting period of 3 years.

SBI Critical Illness Insurance Policy

  1. Age limit – Between 18-65 years.
  2. Policy period – 1 year or 3 years.
  3. Insured sum amount – Minimum Rs. 2 Lakh and Maximum Rs. 50 Lakh.
  4. Free look period – Return in 15 days for full refund if, you are not satisfied with the policy.
  5. Income tax benefits – Under Section 80D of the Income Tax Act, 1961.
  6. Exclusions –
    A. Pre-existing diseases for related conditions.
    B. All claims require 90 days of waiting period from the policy inception date.
    C. Self inflicted injuries or attempted suicide that requires treatment, are not covered.
    D. Acquired Immune Deficiency Syndrome(AIDS) and similar sexually transmitted diseases.
    E. Illness, injury sustained while under the influence of drugs, alcohol, or other intoxicants.

SBI General Group Health Insurance Policy

  1. Age – 18 years and above.
  2. Sum assured – Rs. 1-5 Lakhs.
  3. Basis – Individual and Floater.
  4. Screening – Medical screening required for applicants above the age of 65 years.
  5. Cashless treatment – Avail at 3000+ network hospitals.
  6. Pre policy medical test – Not mandatory for persons under the age of 65 years.
  7. Waiting period – 1 year(pre-existing diseases are covered after 4 years).
  8. Pre and post hospitalization expenses – Covers all medical expenses incurred 30 days before and 60 days after hospitalization.
  9. Other benefits – Renew facility of current health insurance policy from any other insurer.
  10. Add on covers – Available including zero sub-limits on room, ICU rent, doctor’s fees etc.
  11. Income tax benefits – As per Section 80D of the Income Tax Act, 1961.
  12. Exclusions –
    A. In the case of pre-existing diseases, a waiting period of 4 years is applicable.
    B. Illness, injury or diseases contracted within 30 days from the inception date of the policy won’t be covered.
    C. Treatments consisting of non-allopathic medicine will not be covered.
    D. Certain diseases require a waiting period of 1 year before coverage, including hernia, hydrocele, piles etc. Whereas, Cataract and Hysterectomy need a waiting period of 2 years.
    E. Treatments related to pregnancy, childbirth, caesarean, prenatal and postnatal care.
    F. Coverage of treatments due to the use of intoxicating and/or addictive substances like alcohol, drugs etc.
    G. Joint replacement surgery that is not caused by an accident, requires a waiting period of 3 years.

SBI Hospital Daily Cash Insurance Policy

  1. Age limit – 18-65 years for adults. Children ageing as below as 3 months are covered.
  2. Daily cash benefit – Rs. 2,000/day of hospitalization.
  3. ICU hospitalization expenses – Rs. 4,000/day of Daily cash benefit.
  4. Accidental hospitalisation expenses – Rs.4,000/day Daily cash benefit.
  5. Fixed sum – Rs. 5,000 of Fixed sum for expenses incurred during convalescence.
  6. Free look period – Return in 15 days for full refund if you are not satisfied with the policy.
  7. Income tax benefits – As per Section 80D of the Income Tax Act, 1961.
  8. Exclusions –
    A. Pre-existing diseases or illness.
    B. Illness, injury or diseases contracted within 30 days from the inception date of the policy won’t be covered.
    C. Treatments consisting non-allopathic medicine will not be covered.
    D. Certain diseases including hernia, hydrocele, piles etc require a waiting period of 1 year. Whereas, Cataract and Hysterectomy need a waiting period of 2 years.
    E. Treatments related to pregnancy, childbirth, caesarean, prenatal and postnatal care.
    F. Coverage of treatments due to the use of intoxicating and/or addictive substances like alcohol, drugs etc.
    G. Joint replacement surgery that is not caused by an accident, requires a waiting period of 3 years.

SBI Health Insurance Plans

SBI Arogya Premier Policy

This policy is designed to cover individuals as well as their family members in medical emergencies.

Features

  1. Wide coverage in policies starting from Rs. 10 Lakhs – 30 Lakhs.
  2. Comes in individual/family floater options. The family includes the insured, his/her spouse, children, parents/parents-in-law.
  3. Entry age limit is minimum 3 months and maximum 65 years.
  4. No medical tests required for people ageing 55 years or below.
  5. Tenure is 1,2 or 3 years.
  6. Pre and post hospitalization expenses are covered for 60 days and 90 days respectively.
  7. Maternity expenses are covered after 9 months after taking the policy.
  8. Ambulance coverage is upto Rs. 1 Lakh.
  9. Covers 142 day care expenses even organ donor expenses.
  10. Additional coverage for AYUSH treatments if, taken in recognized government hospitals.
  11. Reimbursement of health check-up for upto Rs. 5,000 if no claims are made for 4 years.
  12. Tax benefit in form of tax deduction under Section 80D of the Income Tax Act, 1961.

SBI Arogya Plus Policy

It is a mediclaim policy specifically to cover the rising costs of OPD, hospitalization expenses and minimize the pocket expenses of the policyholder.

Features

  1. The policy covers 2 coverage options, individual or floater basis.
  2. Minimum and maximum age limit is 3 months and 65 years respectively.
  3. There is no exit age.
  4. Offered insured sum options are Rs. 1, 2 and 3 Lakhs, while the premiums are flat Rs. 8,900, Rs. 13,350 and Rs. 17,800 respectively.
  5. Policy tenure is also for 1,2 or 3 years.
  6. The policy covers pre and post hospitalization expenses of 60 days and 90 days respectively.
  7. The policy provides coverage of 142 day care procedures.
  8. Domiciliary hospitalisation and ambulance expenses are also covered in this scheme.
  9. Insured person can claim tax benefits under Section 80D of the Income Tax Act, 1961.

SBI Arogya Top Up Policy

This mediclaim policy is best suited for the expenses due to unexpected critical events like accidents. With a large top-up cover, the policy helps individuals to meet the huge expenses of hospitalization.

Features

  1. No medical tests required for persons ageing 55 years or below.
  2. Offered coverage ranges from Rs. 1- 50 Lakhs with deductible options of Rs. 1- 10 Lakhs. The deductible option comes with the multiple of Rs. 1 Lkah.
  3. The policy term is 1,2 or 3 years with having a discount of 5% on 2 year policy and 7.5% on 3 year policy.
  4. Reimbursement of Rs. 5,000 for ambulance charge is covered.
  5. AYUSH and Homeopathy treatments are covered under this scheme.
  6. Tax benefits can be claimed as it offers tax deduction under Section 80D of the Income Tax Act, 1961.
  7. The policy has a grace period facility of 30 days from the last day of the tenure for renewal purpose.

SBI Hospital Daily Cash Insurance Policy

This policy offers daily benefits on hospitalization and additional cover for travel costs, food, etc which are not covered in basic plans. The scheme provides fixed benefits for everyday expenses which makes it unique among other plans.

Features

  1. The entry age is 18-65 years for adults and 3 months or above for children.
  2. Offered daily cash benefit is Rs. 2,000-4,000.
  3. ICU hospitalization expense coverage is 2times than daily cover.
  4. Daily cash benefit for accidental hospitalisation is also covered under this scheme.
  5. Convalescence benefits are paid in fixed lump sum.
  6. Easy refund within 15 days of free look period in case you are not satisfied with the plan.
  7. Tax benefits under Section 80D of the Income Tax Act, 1961 is also available in this policy.

SBI Critical Illness Insurance Policy

This plan specifically provides cover against 13 of the most life-threatening diseases. The enlisted diseases are all-sufficient to drain anyone’s savings, so this plan is made to take care of these situations.

Features

  1. The minimum and maximum age limit is 18 years and 65 years respectively.
  2. Policy tenure is 1,2 or 3 years.
  3. The maximum sum insured is upto Rs. 50 Lakhs.
  4. Pre medical screening is not required for person ageing 45 years or below.
  5. 15 days of free look period is available for easy refund.
  6. The enlisted critical illnesses are,
    A. Cancer,
    B. Kidney failure,
    C. Paralysis,
    D. Coma,
    E. Total blindness,
    F. Stroke,
    G. Primary pulmonary arterial hypertension,
    H. Coronary artery by pass grafts,
    I. Multiple sclerosis,
    J. Heart attack,
    K. Heart surgery,
    L. Aorta graft surgery,
    M. Organ transplant.

SBI Group Health Insurance Policy

This group health insurance policy helps to cover you and your family from various medical emergencies, which makes the process stress-free and quality health care available.

Features

  1. Entry age limit is 18-65 years for adults and 3 months to 30 years for children.
  2. Sum Insured limit is Rs. 1-5 Lakhs.
  3. Fees practitioner and specialist fees are covered.
  4. Pre and post hospitalization expenses are covered for 30 days and 60 days respectively.
  5. The plan comes with both individual and family floater options.
  6. Ambulance charge is also covered under this scheme.
  7. Eye care, day care, dialysis, chemotherapy, radiotherapy etc expenses are recompensed.
  8. In case of specified disease, 1 year of waiting period is applicable.
  9. Pre-existing disease coverages can be availed after 4 years.
  10. Domiciliary hospitalisation expenses are covered in this plan.
  11. Tax benefits are also available under the section 80D of the Income Tax Act, 1961.

SBI Loan Insurance Policy

The loan insurance is a unique mediclaim policy, which helps to relieve the stress of paying a home loan in case of unfortunate medical situations like, critical illness, personal accident, or even loss of employment.
Features,

  1. The policy can be availed for upto 3 years.
  2. Sum assured upto Rs. 1 Crore.
  3. Pre medical check up is not required, and medical check-ups for the age upto 55 years is also not required.
  4. The minimum and maximum age limit is 18 years and 60 years respectively.
  5. Permanent disability coverage is provided under the scheme.
  6. Maximum of 3 EMIs will be compensated in case of job loss.
  7. Covered critical illnesses are,
    A. Cancer,
    B. Kidney failure,
    C. Paralysis,
    D. Coma,
    E. Total blindness,
    F. Stroke,
    G. Primary pulmonary arterial hypertension,
    H. Aorta graft surgery,
    I. Coronary artery bypass graft,
    J. Multiple sclerosis,
    K. Heart attack,
    L. Heart surgery,
    M. Organ transplant.
  8. In case of eyes loss or permanent disability, a compensation of 100% is offered.
  9. Coverage of accidental death is also provided.

SBI Retail Health Insurance Policy

This health insurance plan provides coverage to you and all of your family members for the best medical treatment available.

Features

  1. The policy doesn’t require pre medical screening for people ageing upto 45 years(if they don’t have any medical history).
  2. The special feature of this plan is the offered choices from flexible plans like Metro plan, Semi Metro plan and rest of India plan.
  3. The policy provides coverage like room rent, medicine cost, ICU charge, OT charge and doctor’s charge etc.
  4. Pre and post hospitalization expenses covered upto 30 days and 60 days respectively.
  5. Sum Insured option ranges from Rs. 50,000-5 Lakhs.

What SBI Health Insurance Plans cover

  1. Hospitalization expenses like room and service charges, boarding and nursing charges etc.
  2. Consultant and specialist charges.
  3. Charges incurred for anesthesia, surgical appliance, blood, oxygen, operation theatre etc.
  4. Pre and post hospitalization expenses, ambulance charges are also covered.
  5. Free medical check-up is available after every 4 claim free years.
  6. Coverage for specified day surgeries, requiring less than 24 hours of hospitalization.

What is not covered under SBI Health Insurance Plans

  1. Any claim arising due to injury or pre existing diseases are not covered before completion of 2 years from the date of policy inception.
  2. Any treatment or hospitalisation expenses incurred during the initial 30 days from the commencement of the policy.
  3. From the date of inception upto 1 year, treatment of Hernia is not covered.
  4. Hysterectomy, cataract treatments are not covered before completion of 2 years of waiting period from the inception date.
  5. Treatments like aromatherapy, acupuncture, osteopathy, naturopathy etc are not covered.
  6. Uterine or extra Uterine pregnancy, childbirth including cesarean delivery are not covered.
  7. Any form of congenital disease are not covered.
  8. AIDS and HIV treatments are not covered.
  9. Treatment of drug abuse due to intoxication and alcohol consumption are not covered.

Claim process of SBI Health Insurance Plans

  1. Inform SBI General Insurance Company over a call or email.
  2. Submit a duly signed and filled claim form along with copies of original medical documents.
  3. After submission, the insurer will verify and the request will either get approved or rejected.
  4. If approved, then the claim will be settled within 30 days. If gets rejected, the insurer will inform the reasons.
  5. For cashless hospitalization, a pre authorisation request needs to get approved by the insurer or the TPA desk at the hospital.
  6. In case of planned hospitalization, the insurer needs to be informed in advance.
  7. In case of emergency, the insurer needs to be informed within 24 hours of hospital admission.

Required documents for Insurance Claim

  1. Duly signed and filled claim form.
  2. KYC form.
  3. Copy of SBI health insurance policy.
  4. Original copies of hospital discharge summery.
  5. Prescriptions and doctor consultation letters.
  6. Original medical bills/reports.
  7. Death certificate/Post mortem report(if needed).
  8. PAN Card/address proof and other asked documents.
  9. IR copy(in accidental cases).

Contact

Call(Monday to Saturday) – 1800-22-1111 / 1800-102-1111 (toll free).
Fax – 1800-22-7244 / 1800-102-7244.
E-mail – [email protected]

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