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SBI Health Insurance

SBI General Insurance Company Ltd. started as a joint business enterprise between the State Bank of India (74% of capital share) and Insurance Australia Group (26% of capital share). The company’s geographical coverage extends to 110 cities pan India and has its presence across 350+ locations via satellite resources. SBI health insurance company offers an extensive range of sum assured options from Rs.  50,000 to Rs. 50 lakhs.

IRDA data reveals that SBI General insurance company ’s incurred claim ratio is 85%, which reflects positively. The company earned a total net premium of Rs. 14.76 billion in the financial year 2017, suggesting a growth of 23% from the previous financial year.

SBI General Health Insurance Company at a Glance

Key Features Highlights
Incurred Claim Ratio 75.01%
Network Hospitals 4400+
Waiting Period 4 years
Renewability Lifelong

Key Features of SBI Medical Insurance Company

  • A wide range of sum assured from Rs. 50,000 to Rs.500,000
  • No mandatory medical check-up required for people below the age of 45 years with no medical history
  • Provision to secure your entire family in a comprehensive under one family floater plan
  • There is flexibility to choose your plan – Metro plan, Semi-metro plan and Rest of India
  • Assured policy renewal option ( for SBI policies and other insurer’s policy as well)
  • 30 days of pre-hospitalization expenses and 60 days of post-hospitalization expenses are covered
  • Free medical check-up facility up to Rs. 2500 ( after completion of 4 non-claim years)
  • Add-on covers also available
  • The annual policy premium provides tax saving benefits under Section 80D of the Income Tax Act, 1961

SBI General Health Insurance Plans Comparison Table

Plan Name Entry Age Criteria Waiting period for pre-existing diseases Pre-medical Test Sum Assured (Rs.)
SBI Group Health Insurance Plan 18 years and above 4 years After 65 years 1 lakh to 5 lakh
SBI Critical illness Insurance Plan 18 to 65 yrs. Not covered Required Up to 50 lakhs
SBI Hospital Daily Cash Insurance Plan 18 to 65 yrs. 90 days After 35 years Rs. 500 to 2000 per day
SBI Arogya Plus Health Insurance Plan 3 months to 65 years 4 years After 55 years 1 to 3 lakhs
SBI Arogya Premier Plan 18 to 65 years. 48 months After 55 years 10 to 30 lakhs
SBI Arogya Top-up Plan 3 months to 65 years After 4 years After 55 years 1 lakh to 50 lakhs ( subjected to deductibles)

Types of SBI Health Insurance Plans

SBI Medical insurance company offers a variety of health insurance plans; you can buy the one that meets most of your health concerns –

  • SBI Group Health Insurance Plan

    This plan offers coverage from Rs. 1 lakh to Rs. 5 lakhs. It covers the expenses incurred on chemotherapy, operation theatre, dialysis etc.

  • SBI Critical illness Insurance Plan

    SBI Critical Illness Insurance policy provides coverage against thirteen most crucial critical illnesses and the sum assured limit is Rs. 50 lakhs.

  • SBI Hospital Daily Cash Insurance Plan

    Anyone between the age group of 18 and 65 years can buy this plan. Covers accidental and ICU hospitalization up to twice the benefit.

  • SBI Arogya Plus Health Insurance Plan

    142 daycare procedures are covered and no medical screening is required till 55 years of age.

  • SBI Arogya Premier Plan

    After 9 months of the waiting period, maternity expenses are covered. Alternative cover for Homeopathy, Ayurveda, Siddha & Unani treatment.

  • Arogya Top-up Plan

    Get a top-up cover from Rs. 1 to 30 lakhs with deductibles of Rs. 1 to 10 lakhs.

SBI Health Insurance Claim Process?

  • Register you claim request by calling the toll-free number of SBI General Health Insurance Company
  • Submit a duly-filled claim form along with a copy of original medical documents to initiate the claim process.
  • On submission of documents, your claim will be settled within 30 days.
  • As per the policy terms and conditions, your health insurance claim will be approved or rejected.
  • To avail cashless treatment, a pre-authorization request has to be approved by the insurance company or the TPA desk at the hospital.
  • For planned hospitalization, you need to inform the SBI health insurance company in advance.
  • In case of emergency hospitalization, you need to intimate within of hospital admission.

Renewal Process of SBI Health Insurance

Before renewing your insurance policy, you can try reading SBI health insurance reviews to see what the other customers have to say about plans. After that, you can renew your policy online on the insurer’s site by sharing your policy details such as-

  • Last name
  • Date of birth
  • Mobile number
  • Email ID
  • Continue to get health insurance quote

SBI Health Insurance Plan Inclusions–

Medical Expenses Covered Insurance Limit (Rs.)
Hospitalization expenses inclusive of room and service charges, boarding and nursing charges etc. Up to 1% of the insured amount on daily basis
Intensive Care Unit (ICU) charges Up to 2% of the insured amount on daily basis
All permissible claims under 1 & 2 during the policy tenure Up to 25% of the insured amount per illness or injury per claim
Fees  charged by consultants & specialists Up to 40% of the insured amount per illness or injury per claim
Charges incurred on anesthesia, surgical appliances, blood, oxygen, operation theatre etc. Up to 40% of the insured amount per illness or injury per claim
Pre-hospitalization expenditure Up to 10% of the allowable hospitalization expenses incurred 30 days before the hospital admission date
Post-hospitalization expenditure Up to 10% of the allowable hospitalization expenses incurred 60 days post-hospital discharge
Ambulance charges 1% of the total sum insured ( maximum limit of Rs. 1500)
Free medical check-up ( after every 4 non-claim years) 1% of total sum insured ( maximum limit of Rs. 2500)
Parental care above the age of 60 years Provision of an attendant or nurse after discharge from the hospital (either Rs. 500 or actual cost, whichever turns out to be lesser, up to a max of 10 days per hospitalization). Maximum limit of reimbursement is 15 days during the policy tenure
Childcare charges below the age of 10 years For each completed day of hospitalization, you can avail escort charges of Rs. 500. Maximum limit of reimbursement is 30 days during the policy tenure
Cataract treatment limit ( per eye basis) After completion of 2 policy years, you can get compensated for an amount equal to 15% of sum insured or up to a maximum limit of Rs. 25000
Accidental hospitalization expenses Increment of sum assured by 25% up to a maximum limit of Rs.1 lakhs (for accidental hospitalization) Reimbursable only once during the policy period
Coverage for alternative treatment per Policy period (Ayurveda treatment in a government registered hospital which is covered under our panel) Reimbursement of Ayurveda treatment, maximum of 15% of sum insured or Rs. 20000. Reimbursement of homeopathy and Unani treatment up to a maximum of 10% or Rs. 15000.
Domiciliary hospitalization expenses Regular domiciliary hospitalization charges as per policy documents. Subjected to 20% of the sum assured or Rs.20,000 whichever is less
Convalescence benefit from 10 years to 60 years Up to a maximum of Rs. 5000, in case of hospitalization due to accidental injuries, illnesses for a period of 10 following days or more. Allowed only once during the policy tenure
Co-payment facilities in non-network hospitals ( up to the claim limit) 10% on all permissible claims
Cashless claim settlement facility Valid across all the empanelled hospitals that are registered with SBI General Health Insurance
Coverage for specified day surgeries, requiring less than 24 hours of hospitalization Reimbursement of specified day care procedures including dental surgeries due to accidents, dialysis procedure, chemotherapy, radiotherapy, eye surgeries, tonsillectomy and similar

Add-on covers in SBI General Health Insurance

  • Elimination of sub-limits on room rent, ICU charges, consultancy and operation expenses
  • This is valid after payment of an additional premium amount
  • Add-on covers can be availed by the primary insured person and other insured family members

SBI Health Insurance Plan Exclusions

Listed below are the circumstances where the insurance company is not liable to fulfill your claim requests –

  • Before completion of 2 years, any claims arising due to any kind of injury, ailments or treatment for any pre-existing medical condition from the date of policy inception
  • Any treatment or hospitalization expenses incurred during the initial 30 days from the commencement of the insurance policy
  • Any claim arising due to specific ailments or treatments required for hernia, before completion of 1 year from the policy inception date
  • Treatment for hysterectomy, cataract etc. before completion of 2 years of waiting period from the policy inception date
  • Claims arising from joint replacement surgeries, before the completion of the waiting period of 3 from the commencement of policy ( unless it is an accidental case)
  • Expenses incurred on alternative treatments like aromatherapy, acupressure, acupuncture, osteopathy, reflexology, naturopathy, and chiropractic.
  • Treatment required for uterine or extra-uterine pregnancy and childbirth including cesarean delivery and any form of prenatal and postnatal treatments.
  • Any form of congenital diseases or disorders are not covered under SBI medical insurance plan
  • Treatment required for AIDS and HIV infection
  • Drug abuse and symptoms related to intoxication or alcohol consumption

Benefits of SBI Health Insurance Policy

SBI health insurance provides health care services and a sense of security to its customers. Elucidated below are a few prominent reasons why it is a favorite with customers –

  1. You can cover your entire family including your dependent children, parents, spouse, and self under a single plan with family floater policy.
  2. It provides flexible plans options like Metro health insurance plan, Semi-Metro Plan and Rest of India.
  3. You can easily renew your existing health insurance plan from other insurers with SBI medical insurance.
  4. Free health check-up up to Rs. 2500 for every 4 claim free years.
  5. You can enhance the cover by taking additional cover like removing sub-limits on room charges and consultation fees.
  6. Cashless treatment is also available in over 4000 network hospitals in India.

How to Calculate SBI Insurance Premium?

Usually, the following factors are taken into consideration to calculate the premium

  1. Coverage type
  2. Members covered
  3. Sum assured limit
  4. Age of the members

You can also use SBI health insurance premium calculator online to know your premium.

Documents Required for SBI Health Insurance Claim

  • Claim form duly signed and filled
  • Hospital discharge summary ( in original)
  • Bills/receipts/medical reports
  • Prescription and doctor consultation letter
  • KYC form
  • Copy of SBI medical insurance policy
  • Death certificate/post-mortem report ( attested, in case of accidental death)
  • I.R copy ( accidental cases)
  • PAN Card/Address Proof/Other documents ( as the case may be)

Eligibility Criteria of SBI General Health Insurance

  • People who are above the age of 60 years and are issuing the policy for the first time with SBI health insurance, can purchase a policy up to Rs.2 lakhs only
  • And for a family floater plan ( including self, spouse, dependent parents, and children), the minimum sum assured limit is Rs. 2 lakhs only
  • The requirement of a medical screening depends on factors like your medical history, age, sum insured limit and the number of family members to be insured
  • SBI health insurance renewal for people above 70 years is subjected to policy terms and conditions as per the IRDA guidelines.

SBI Health Insurance for Account Holders

  • In Financial Year 2013-14, SBI General in association with State Bank of India provided personal accident insurance cover to 1.5 cr. savings bank account holders. The company has its presence in somewhere around 14,000 branches. SBI account holders can also buy Individual and group health insurance plans.
  • The age criterion for policy purchase is around 18-65 years for adults and 3 months-18 years for children. For specified disease, there is a compulsory waiting period of 1 year. For SBI group health insurance, there is no requirement for pre-medical tests for people (up to the age of 65 years) who have no medical history. After a waiting period of 4 years, the pre-existing disease can also be covered.

SBI  Health Insurance FAQs

Q1. How many members are covered in SBI General Health Insurance Floater plan?

Ans: In SBI health insurance floater policy all the family members are included in one plan and single sum insured.  For instance it covers 2 Adults, 2 Adults & 1 Child, 2 Adults & 2 Children, 2 Adults, 1 Adult & 2 Children, 1 Adult & 1 Children.

Q2. What does it mean by daycare surgeries in SBI mediclaim policy?

Ans: The policy compensates the expenses incurred on some specified day care surgeries/ treatment where hospitalization is not required for more than 24 hours.

Q3. If I do not make a claim, am I eligible to get a refund?

Ans: If no claims are made during the policy period you do not claim in any policy period then you will not get any refund, and you are eligible to get a cumulative bonus of 5 to 25 percent.

Q4. Does this policy cover expenses incurred on homeopathy treatment?

Ans: For Ayurvedic, Homeopathy and Unani treatment is taken in a government hospital or a government recognized institute is covered under SBI mediclaim policy.

The sum assured limit for Ayurvedic Treatment is Rs. 20,000 and max. up to 15 percent. The sum assured limit for Ayurvedic Treatment is Rs. 15,000 and max. up to 10 percent.

Q5. What are the tax benefits that can be availed on this plan?

Ans: Deductions u/s 80 D of Income Tax Act can be availed on the health insurance premium amount-

  • For dependents, spouse and self the tax exemption limit is INR 25000
  • For dependent parents the limit is INR 25,000
  • In case the parents are senior citizens then the tax limit is INR 30,000

Q6. How is the premium for an SBI Health insurance family floater policy calculated?

Ans: Health insurance premium is determined after considering the age of the oldest family member.

Q7. What do you mean by cashless hospitalization in SBI medical insurance policy?

Ans. You can avail cashless treatment in any of the network hospitals. The insurer will pay off the hospital bill directly. To check the list of panel hospitals you can visit the insurer’s site.