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SBI HEALTH INSURANCE

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SBI Health Insurance

Overview
SBI General Insurance Company Limited was formed as a joint venture between State Bank of India and Insurance Australia Group in 2010. The company offers motor, health, personal accident, travel and home insurance products. The company has a distribution network of 19,000 IRDAI certified employees and 8000 agents. The company has exposure through 100+ cities across India.

SBI Health Insurance at a Glance
  • Cashless access to over 4400+ network hospitals
  • 27330 policies issues till date
  • Offers lifetime renewability
  • Approximately 95.80% grievances resolved.
  • The brand has an incurred claims ratio of 54.41%%.
  • Claim settlement ratio of 55.94% for FY 2016-17.
Awards & Recognitions
  • Recognised with Bancassurance Leader in 2017 by Fintelekt
  • Recognised as Rising Star Insurer of the year by Fintelekt in 2012
Documents needed to apply for SBI Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph
Why SBI Health Insurance?
Here are some reasons why SBI is the right insurance provider for you:

Sum Insured Sum insured ranging from Rs. 1 Lac to Rs. 50 Lacs available.
Cashless hospitalisation SBI provides access to over 3000 network hospitals across India where you can avail cashless facility.
Claim process Cashless access to over 3000network hospitals.
In-patient hospitalization/treatment Expenses incurred during hospitalisation for 24hours or more is covered by all SBI Health Insurance plans.
Pre-hospitalisation expenses Expenses incurred during 30 days prior to hospitalisation are also covered.
Post-hospitalization Expenses Expenses incurred during 60 days post hospitalisation are covered.
No Pre-Policy Medical For those below the age of 55 years (65 years in case of Group Health Insurance) with no medical history, do not require any pre-policy medical test.

Types of SBI Health Insurance Plans
SBI offers insurance coverage in three variations: Individual Plans, Family Health Insurance Plans and Group Health Insurance Plans.

1: SBI Arogya Premier Policy–This is SBI’s flagship product which is geared towards High Net-Worth individuals who prefer comprehensive coverage and premium facilities for the beneficiaries.

2: SBI Arogya Plus Policy– This policy helps the policyholder get financial protection against treatment in Out-Patient Department (OPD) and In-Patient Hospitalisations.

3: SBI Group Health Insurance Policy –This group health insurance policy is for individuals and families who want financial coverage against rising medical costs.

4: SBI Critical Illness Insurance Policy - This plan offers coverage against 13 major critical illnesses and offers fixed sum in case of diagnosis.

5: SBI Hospital Daily Cash–Since hospitalisations can affect the income of a person, this policy provides financial coverage against the policy holder by offer daily cash for each day of hospitalisation.

6: SBI Arogya Top up Policy- A Top Up Plan that provides extra protection at a low premium for any unexpected medical treatment.

7. SBI Retail Health Insurance Policy – This policy lets the holder pay premium as per the treatment cost range at his/her city of residence. Depending on whether it’s a Plan A (Mumbai, Delhi), Plan B (Chennai, Kolkata, Bangalore, Hyderabad, Ahmedabad) or Plan C (rest of India) location, the premium amount will vary.

SBI Health Insurance Plans

1: SBI Arogya Premier Policy
Entry age 18 to 65 years
Type of Plan Individual / Floater
Sum Insured 10-30 lacs
Coverage for Spouse, dependent children (upto 23 years), parents and parents-in-law
Policy term 1-3 years

Inclusions, Benefits and Features
  • Ambulance expenses – Ambulance charges for emergency hospitalisation, including air ambulance expenses will be covered upto Rs. 100,000.
  • In-Patient Hospitalisation – Covers room rent, boarding, medical practitioner’s fees, Intensive Care Unit, Nursing expenses, etc.
  • Pre-Hospitalisation – Expenses for pre hospitalisation covered upto 60 days
  • Post-Hospitalisation – Expenses for post hospitalisation covered upto 90 days
  • Day-Care Procedures– Up to 142 day care procedures will be covered.
  • Domiciliary Treatment–Treatment of illness done at home, which would normally need hospitalisation will also be covered in the policy.
  • Organ Donor–Covers treatment expenses for organ donor.
  • Maternity Expenses – Costs incurred for labour and pregnancy related treatment will also be covered.
  • Health Check up–Expenses towards health check-up will be reimbursed upto Rs. 5,000 after 4 consecutive claim free years.
  • Reinstatement of Sum Insured–This policy enables the basic sum assured to be reinstated once it has been exhausted during the year.
  • AYUSH treatment– Alternative treatment taken in a government hospital or in any institute recognized by government and/or accredited by quality council of India/national accreditation board on health.
  • Cumulative Bonus - A bonus of 10% of the sum insured is available after a claim free year, capped at 50%.
Basic Sum insured per insured person per policy year(Rs. in Lacs) 10-30 Lacs
Inpatient treatment Covered
Pre-hospitalisation 60 days
Post hospitalisation 90 days
Day Care procedures Covered
Domiciliary treatment Covered
Organ donor Covered
Emergency Ambulance Upto certain limit
Automatic restoration Available
Cumulative Bonus Up to 50%
Health Checkup Available after 4 consecutive claim free years

2: SBI Arogya Plus Policy
Entry age 18 to 65 years.
Type of Plan Individual / Floater
Sum Insured 1,2,3 Lacs
Coverage for Spouse, dependent children (upto 23 years), parents and parents-in-law
Policy term 1 year

Inclusions, Benefits and Features
  • Hospitalization Cover: Room, Boarding and Nursing expenses
  • Upto 142 Day care procedures
  • Pre-hospitalisation – up to 60 days
  • Post-hospitalisation – up to 90 days
  • Ambulance expenses up to Rs. 1500
  • Domiciliary hospitalisation
  • Maternity expenses covered up to OPD only
  • Alternative treatment at Government hospitals
3: SBIGroup Health Insurance Policy
Entry age 18 to 65 years.
Type of Plan Individual / Floater
Sum Insured 1-5 lacs
Coverage for Spouse, dependent children (upto 23 years), parents and parents-in-law
Policy term 1 year

Inclusions, Benefits and Features
  • In-patient hospitalisation - 1%/day for Non ICU and 2%/day for ICU
  • Pre Hospitalization - Medical expenses up to 30 days prior to the date of admission
  • Post Hospitaliztion - Medical expenses up to a period of 60 days after the discharge
  • Pre-existing Diseases - 1 year for specified diseases and 4 years for pre-existing
  • Day Care Procedures
  • Domiciliary hospitalisation – Up to 1%/day for Non ICU and 2%/day for ICU
  • Ambulance charges – 1% of sum insured, up to max Rs.1500
4: SBI Critical Illness Insurance Policy
Entry age 18 to 65 years.
Type of Plan Individual
Sum Insured 2-50 Lacs
Coverage for Individual
Policy term 1, 3 years

13 Critical Illnesses covered:
Sr. No. Critical Illness Survival Period Minimum Assessment Period
1 Cancer 28 days 28 days
2 Kidney Failure (End Stage Renal Failure) 28 days 28 days
3 Primary Pulmonary Arterial Hypertension 28 days 28 days
4 Multiple Sclerosis 28 days 28 days
5 Major Organ Transplant 28 days 180 days
6 Coronary artery by-pass grafts (with surgery to divide the breastbone) 28 days 28 days
7 Aorta Graft Surgery 28 days 28 days
8 Heart Valve Surgery 28 days 28 days
9 Stroke 28 days 28 days
10 Myocardial Infarction (First Heart Attack) 28 days 28 days
11 Coma 28 days 30 days
12 Total Blindness 28 days 28 days
13 Paralysis 28 days 90 days

5: SBI Hospital Daily Cash
Two coverage options – 30days and 60 days

Entry age 18-65 years
Type of Plan Individual
Sum Insured 4 options of daily cash benefit – Rs.500, Rs.1000, Rs.1500 & Rs.2,000
Coverage for Hospitalisation
Policy term 1 year

Inclusions, Benefits and Features
Benefits A (INR) B(INR) C(INR) D(INR)
Daily Hospitalization benefits due to sickness 500 1000 1500 2000
Daily Hospitalization benefits due to sickness 1000 2000 3000 4000
Accident hospital confinement 1000 2000 3000 4000
Convalescence benefit for hospitalization exceeding consecutive 10 days Fixed lumpsum amt payable - 3 times benefits payable max 5000, if hospitalization exceeds 10 consecutive days

6: SBI Arogya Top up Policy
Entry age 3 months to 65 years.
Type of Plan Individual / Floater
Sum Insured 1-50 lacs
Coverage for Spouse, dependent children (upto 23 years), parents and parents-in-law
Policy term 1 year

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation – 60days
  • Post-Hospitalisation – 90days
  • Surgeon’s fees, Consultant’s fees, Anesthetist’s and Specialist’s fees.
  • Ambulance expenses up to Rs. 5000 per hospitalisation.
  • Day care procedures – up to 142 procedures covered
  • Alternative treatment covered
  • Domiciliary hospitalisation
  • Maternity Expenses: Covers maternity expenses after first 9months.
  • Organ donor expenses
7: SBI Retail Health Insurance Policy
Entry age 18 to 65 years
Type of Plan Individual / Floater
Sum Insured 50,000-5 lacs
Coverage for Spouse, dependent children (upto 23 years), parents and parents-in-law
Policy term 2 years


Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation – 30days
  • Post-Hospitalisation – 60days
  • Health check-up – Up to Rs. 5000 after 4 consecutive claim free years
  • Ambulance expenses up to Rs. 5000 per hospitalisation.
  • Day care procedures
  • Alternative treatment covered
  • Domiciliary hospitalisation
  • Parental care – Available for persons above 60 years. Attendant nursing charges above Rs. 500 after discharge is also available.
SBI Exclusions:
  • Pre-Existing Diseases / Illness: coverage offered after 48 months
  • Any condition, ailment or injury or related condition(s) for which you have been diagnosed, received medical treatment, had signs and / or symptoms, prior to inception of your first policy, until 48 consecutive months have elapsed, after the date of inception of the first policy with us.
  • Any disease contracted during the first 30 days of commencement of the policy.
  • Certain diseases/surgeries like Hernia, Hydrocele etc shall be covered after a waiting period of 1 year.
  • Certain diseases like Cataract, Hysterectomy shall be covered after a waiting period of 2 years from commencement of Policy.
  • Joint replacement surgery shall be covered after a waiting period of 3 years from commencement of Policy except done due to an accident.
  • Treatment with alternative medicines like acupuncture, acupressure, osteopath, naturopathy, chiropractic, reflexology and aromatherapy
  • Treatment arising from or traceable to pregnancy (whether uterine or extra uterine) and childbirth including caesarean section, and/or any treatment related to prenatal and postnatal care.
  • Congenital diseases.
  • All expenses related to AIDS and related diseases.
  • Use/Abuse of intoxicating drugs or alcohol.
  • 30 days waiting period from first entry into policy.
  • Treatment taken outside India.
  • Injury/disease directly or indirectly caused or contributed due to nuclear weapons/materials.
  • War, invasion, acts of foreign enemy, hostilities, etc.
SBI Login:
  • For Individuals: Log into the SBI Health Insurance website with your User ID and password.
  • You can generate user id and password by registering on the website with your name, phone, email, and password. You can login with your registered email ID and password.
SBI Health Insurance Renewal:
  • Visit the SBI Health Insurance website renewals page and provide policy number and date of birth of the insured.
  • After such you will be provide the option to take a look at your policy and pay for renewal via online payment.
  • Claim your eligible bonus while renewing
  • If you are opting for any additional features or enhancing sum insured, additional premium to be paid.
SBI Health Insurance Claim Settlement:
Contact 800 22 1111 or SMS "CLAIM" to 561612 and get your claim number / reference number. If the cashless claim is denied, the insured member can get treated and file for a reimbursement claim after discharge.
Customer care executive will provide the details of the documents required Submit the claim form along with the medical documents within 15 days of your discharge from the hospital.
Claims manager will contact within 24 hours of registering claims Claims can be registered at the insurer's customer service centre or any of the branch offices through an application, call, email or in person.
Submit all requested documents  
SBI will initiate process and all claims will be settled within 30 days  

SBI Health Insurance FAQs:
1. Where can I download SBI Health Insurance claims form from?
You can download SBI Health Insurance Claims Form from this link - http://www.sbigeneral.in/SBIG/downloads

2. What are the modes of payment available?
Available modes of payment are cash payment at SBI branch, credit card, debit card and net banking.

3. Are my existing diseases covered in SBI Health Insurance?
Existing diseases covered after 48 months of continuous coverage with SBI.

4. Is it necessary to get a pre-medical check up?
SBI requires no pre-medical check-up for persons up to 55 years (in some cases 65 years) with no medical history.

5. Is there a portability option for SBI Health Insurance?
Customers can change from existing health insurance providers to SBI using their portability option to any preferred policy.

6. What is the maximum number of claims allowed for SBI Heath Insurance during the year?
Unlimited number of claims is allowed during the year up to the maximum exhaustion of sum insured.

7. Does any health policy cover expenses on outpatient treatment also?
Usually policies cover only in-patient treatment but the SBI Arogya Plus policy covers out-patient treatments.

8. Can foreigners avail policy or is it restricted to Indian nationals?
Foreigners living in India can avail policy but the coverage will be limited to India.

9. Does the list of hospitals remain the same?
The list of hospitals may or may not change and SBI Health Insurance reserves the right to modify, add or restrict any network hospital for cashless services available under the policy.

10. Do SBI Health Insurance covers all alternative treatments?
Selected plans of SBI Health Insurance cover certain Ayurvedic and Unani treatments, but treatment with alternative medicines like acupuncture, acupressure, osteopath, naturopathy, chiropractic, reflexology and aromatherapy are exclusions.