SBI Health Insurance Policy

SBI Health Insurance Policy

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SBI Health Insurance Policy – SBI General Insurance, a subsidiary of the State Bank of India, is one of the country’s top private general insurance providers. Launched in 2009 in partnership with Insurance Australia Group (IAG), it has built a solid reputation in the health insurance space. With access to a wide network of over 17,000 hospitals and a claim settlement ratio of 66.08% in FY22, SBI Health Insurance offers a variety of plans tailored for individuals, families, and senior citizens. In this article, we’ll cover the main features, benefits, who’s eligible, how the claims process works, and answer some common questions to help you choose the right health insurance plan.

What is SBI Health Insurance?

SBI Health Insurance, from SBI General Insurance, helps you stay financially protected against medical costs like hospital stays, outpatient treatments, critical illnesses, and more. With a range of plans such as Arogya Plus, Arogya Supreme, Super Health, and Critical Illness Insurance, SBI offers coverage that suits different needs—including COVID-19 treatment, maternity care, and advanced medical procedures. You can choose between individual and family floater plans, with coverage amounts ranging from ₹50,000 up to ₹2 crore, giving you plenty of flexibility to find a policy that fits your budget and lifestyle.

Key Features of SBI Health Insurance

SBI Health Insurance plans are designed to address a wide range of medical needs with the following features:

  1. Wide Coverage Options: Sum insured ranges from ₹50,000 to ₹2 crore, covering in-patient hospitalization, pre- and post-hospitalization expenses (60–90 days), daycare procedures, and ambulance charges.

  2. Cashless Hospitalization: Access to over 17,000 network hospitals across India for cashless treatment, reducing out-of-pocket expenses.

  3. No Pre-Medical Tests: Individuals up to 55 years without medical history can enroll without mandatory health check-ups.

  4. Comprehensive Add-Ons: Optional covers include critical illness, global treatment, maternity, OPD, and no-claim bonus protectors, customizable to your needs.

  5. Maternity and Newborn Coverage: Plans like Arogya Plus cover maternity expenses after a 9-month waiting period and include internal congenital diseases.

  6. Critical Illness Coverage: Lump-sum payments for 13 critical diseases, with sum insured up to ₹50 lakh, no pre-medical screening for those under 45.

  7. Tax Benefits: Premiums qualify for deductions under Section 80D of the Income Tax Act.

  8. Lifelong Renewability: Plans like Arogya Sanjeevani offer lifelong renewal with no maximum exit age.

  9. OPD and Alternative Treatments: Coverage for outpatient care, AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, Homeopathy), and advanced procedures like robotic surgeries.

  10. Digital Accessibility: Manage policies, download health cards, and track claims via the SBI General Insurance app or website (www.sbigeneral.in).

Key SBI Health Insurance Plans

SBI General offers a variety of plans to suit different needs:

  • SBI Arogya Plus: Covers OPD and hospitalization with sum insured options of ₹1 lakh, ₹2 lakh, or ₹3 lakh. No pre-medical tests for those 55 or below. Includes maternity, HIV/AIDS, and mental illness coverage.

  • SBI Arogya Supreme: Comprehensive plan with 20 base covers and 8 optional covers, including daycare, organ donor expenses, and sum insured refill benefits.

  • SBI Super Health: Offers 27 base covers and 7 optional covers, with sum insured up to ₹2 crore. Features wellness benefits like unlimited gym membership and health multiplier for serious illnesses.

  • SBI Arogya Top-Up: Enhances existing coverage with sum insured from ₹1 lakh to ₹50 lakh and deductibles from ₹1 lakh to ₹10 lakh. No pre-medical tests up to age 55.

  • SBI Critical Illness Insurance: Provides lump-sum payments for 13 critical diseases, with sum insured up to ₹50 lakh and a 90-day waiting period.

  • SBI Hospital Daily Cash: Offers daily cash benefits (₹500–₹2,000) for hospitalization, doubling for ICU stays and tripling for convalescence after 10 days.

  • SBI Arogya Sanjeevani: Affordable plan with coverage up to ₹10 lakh, lifelong renewability, and coverage for COVID-19 treatment.

Benefits of SBI Health Insurance

  1. Comprehensive Coverage: Includes in-patient care, daycare procedures, maternity, mental health, and advanced treatments, ensuring holistic protection.

  2. Affordable Premiums: Plans like Arogya Plus start at low premiums (e.g., ~₹3,377 for ages 18–35), with discounts like 5% for early purchase of the Super Top-Up policy.

  3. Cashless Claims: Hassle-free claims at 17,000+ network hospitals, with pre-authorization processed swiftly.

  4. Trusted Brand: Backed by SBI’s legacy, serving over 68 million customers with a high claim-paying ability (iAAA rating).

  5. Flexible Payment Options: Premiums can be paid monthly, quarterly, half-yearly, or annually for plans like Super Health.

  6. Wellness Benefits: Access to gym memberships, dietician consultations, and health check-ups after four claim-free years.

  7. Global Treatment: Select plans like Health Edge cover in-patient treatment abroad for serious illnesses.

Eligibility Criteria

  • Age: Minimum entry age is 18 years; children from 3 months can be covered if parents are insured. Maximum entry age is 65 for most plans, with no exit age limit.

  • Residency: Indian residents and NRIs (for specific plans).

  • Medical History: No pre-medical tests for those under 45 (or 55 for some plans) without adverse medical history. Above 45 or with medical history, tests are required, with 50% cost reimbursement if the policy is accepted.

  • Family Floater: Covers up to 2 adults and 2 children, with premiums based on the oldest member’s age.

Documents Required

  • Identity Proof: Aadhaar Card, PAN Card, Passport, Voter ID, or Driving License.

  • Address Proof: Aadhaar Card, Passport, electricity bill, telephone bill, or rental agreement.

  • Photograph: Recent passport-size photograph.

  • Medical Reports: If required, based on age or medical history.

  • For NRIs: Passport, visa, and overseas address proof.

How to Purchase SBI Health Insurance Online

  1. Visit the SBI General Website or App: Go to www.sbigeneral.in or download the SBI General Insurance app from Google Play Store or App Store.

  2. Select a Plan: Choose from Arogya Plus, Supreme, Super Health, or other plans based on your needs.

  3. Enter Details: Provide personal information (name, age, contact details) and select sum insured and policy tenure.

  4. Calculate Premium: Use the SBIG Insurakhsak calculator to get an instant quote.

  5. Upload Documents: Submit KYC documents via DigiLocker or direct upload.

  6. Complete Video KYC: Schedule a video call for real-time verification, if required.

  7. Make Payment: Pay premiums via credit/debit card, NEFT/RTGS, or cheque.

  8. Policy Issuance: Receive policy documents via email or app, with health cards downloadable for cashless claims.

Claims Process

Cashless Claims

  1. Visit a Network Hospital: Choose from 17,000+ network hospitals listed on www.sbigeneral.in.

  2. Inform SBI General: Notify within 24 hours for emergencies or 2 days before planned hospitalization.

  3. Present Health Card: Show your digital health card at the hospital’s insurance desk.

  4. Pre-Authorization: The hospital submits a pre-authorization form to SBI General for approval.

  5. Treatment and Discharge: Receive cashless treatment; the hospital settles bills directly with SBI General.

Reimbursement Claims

  1. Collect Documents: Gather original bills, prescriptions, discharge summary, and diagnostic reports.

  2. Download Claim Form: Access the form from www.sbigeneral.in or the app.

  3. Submit Claim: Send the filled form and documents to the Health Vertical Office or via email (customer.care@sbigeneral.in) within 15 days of discharge.

  4. Processing: Claims are settled within 30 days of receiving all documents.

Charges and Exclusions

  • Co-Payment: 10–30% co-pay may apply for non-network hospitals or based on plan and location.

  • Waiting Periods: Pre-existing diseases covered after 2–4 years; maternity after 9 months; critical illnesses after 90 days.,

  • Permanent Exclusions: Treatments outside India, injuries from hazardous sports, infertility, and self-inflicted injuries.

  • Premiums: Vary by plan, age, and sum insured (e.g., Arogya Plus starts at ~₹3,377 for young adults).

Frequently Asked Questions (FAQs)

  1. What is the minimum and maximum sum insured for SBI Health Insurance?
    The minimum sum insured is ₹50,000, and the maximum is ₹2 crore, depending on the plan (e.g., Super Health).,

  2. Do I need a medical check-up to buy SBI Health Insurance?
    No pre-medical tests are required for individuals up to 55 years (or 45 for some plans) without adverse medical history. Above this age or with medical history, tests are needed, with 50% cost reimbursed if the policy is accepted.

  3. Does SBI Health Insurance cover pre-existing diseases?
    Yes, after a waiting period of 2–4 years, depending on the plan.

  4. Can I avail cashless treatment at any hospital?
    Cashless treatment is available at over 17,000 network hospitals. For non-network hospitals, a 10% co-pay may apply, and you can file for reimbursement.,

  5. What is the claim settlement time for SBI Health Insurance?
    Claims are settled within 30 days of receiving all required documents.

  6. Does SBI Health Insurance cover maternity expenses?
    Yes, plans like Arogya Plus cover maternity expenses after a 9-month waiting period, including newborn coverage.

  7. Can NRIs purchase SBI Health Insurance?
    Yes, NRIs can purchase plans with appropriate documentation (passport, visa, overseas address proof) and Video KYC.

  8. What is the free-look period for SBI Health Insurance?
    You can cancel the policy within 30 days of issuance (for policies with a term of one year or more) without a cancellation fee. After this, a fee may apply.

  9. Are AYUSH treatments covered under SBI Health Insurance?
    Yes, plans like Arogya Supreme and Arogya Plus cover AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, Homeopathy).

  10. How can I contact SBI General Insurance for support?
    Call the toll-free number 1800 102 1111, email customer.care@sbigeneral.in, or use the PNB One app’s chatbot.