Key Features of SBI Group Health Insurance Plan
The major benefits of buying SBI Group Health Insurance policy are listed below:
- Entry age for health insurance cover is 18 to 65 years
- Entry age for a child ranges from 3 months to 30 years
- Sum assured limit from Rs.1 lakhs to Rs.5 lakhs
- Pre and post hospitalization expenses 60 days after and 30 days before hospitalization
- Get cashless treatment in network hospitals
- Coverage of pre-existing diseases after 4 years
- One year of the waiting period in case of specified diseases
- Multiple Coverage Options - Individual & Family Floater options for Sum Insured
- Lifelong renewability
- Tax saving under sec 80/D
Inclusions of SBI Group Health Insurance Plan
The insurer shall offer compensation for the following medical expenses:
- Medical practitioner and specialists fees
- Ambulance charges up to Rs. 1500 or 1 percent of the Sum Insured
- 10% Co-payment up to admissible claim limit
- Daycare surgery covers for Eye treatment, Dialysis, Tonsillectomy, Chemotherapy, Radiotherapy, etc.
- Domiciliary hospitalization up to 20% of the sum assured and Rs. 20,000 whichever is less
- Co-Payment on claims in non-network hospitals 10% on all eligible admissible claims.
- Cashless hospitalization in the Network Hospitals
- Selective day care surgical procedures where less than 24 hours hospitalization is required. It includes certain specified procedures such as Tonsillectomy, Dialysis, Radiotherapy; Chemotherapy, Dental Surgery (accidental cases), Eye Surgery, etc. are covered.
- Room boarding and nursing charges including ICU Charges to be covered at 2 percent per day and 1 percent per day for Non ICU. All incremental expenses related to room rent, doctor’s fees and other incidental expenses shall be borne by the policyholder.
- Pre-hospitalization expenses are limited to 30 days before the date of hospital admission
- Post-hospitalization expenses are limited to 60 days after getting discharged from the hospital
- The cost incurred towards anesthesia, oxygen, blood, Operation Theatre charges, Medicines and Drugs, Surgical Appliances, Diagnostic Materials, Physiotherapy, Dialysis, and X-ray are covered. It also covers charges incurred on Radiotherapy, Chemotherapy, Cost of Pacemaker, Internal Implants/Prosthesis and any integral expenses incurred on the operation.
All the coverage benefits are subjected to sub-limits as mentioned in the SBI Group Health Insurance policy contract.
Exclusions of SBI Group Health Insurance Plan
In any case, the insurer shall not compensate claims arising due to the following reasons:
- Any disease that is diagnosed during the first 30 days of the policy purchase date
- One year of the mandatory waiting period or certain specified diseases like hernia else treatment expenses will not be compensated
- Pregnancy treatment or complications like abortion, miscarriage, childbirth, or any prenatal and postnatal treatment
- Any alternative treatment like naturopathy, aromatherapy, acupuncture, homeopathic, Ayurveda, reflexology, and
- Any type of congenital diseases that are diagnosed during or before the policy period
- AIDS/HIV and other sexually transmitted diseases.
- Self-inflicted injuries and conditions of depression and mental disorders
- Health treatment for drug intoxication and an overdose of alcohol consumption
SBI Group Health Insurance Claim Procedure
The procedure to lodge a claim with SBI Health Insurance Company is quite simple. You can file both cashless and reimbursement claims. The process is listed below:
SBI Group Health Insurance Reimbursement Claims
- The policyholder shall follow the treatment recommended by the doctor without any delays.
- In the case of post-hospitalization claims, the claim should be filed within 15 days of completion of the post-hospitalization treatment. This is subjected to a maximum of 75 days of getting discharged from the non-network hospital.
- The policyholder needs to undergo a medical examination as required by the SBI Health Insurance Company. The insurance provider shall bear the cost of the medical tests (subjected to terms and conditions).
- The policyholder shall submit all the medical receipts, bills, pieces of evidence, certificates, and information from the attending hospital/medical practitioner / diagnostic laboratory as required by the SBI health insurance company.
- On receipt of intimation from the policyholder regarding a claim under the policy, the insurance provider is allowed to examine and gather information about a disease or injury requiring hospitalization of the policyholder.
SBI Group Health Insurance Cashless Claims
The administrator will provide you with the identity card and the user guide. You can find the following details in the user guide:
- SBI Group Health Insurance Claim submission guidelines
- Contact details of all the offices of the administrator
- Website details of the Administrator
- Detailed list of the SBI network hospitals with their contact details
- And the process to avail cashless benefits at the network hospitals is also mentioned in the SBI Group Health Insurance user guide