SBI Arogya Supreme Policy
The COVID-19 pandemic has made people realise the importance of leading a healthy
What is Arogya Supreme Policy?
Arogya Supreme Policy is a comprehensive health insurance plan launched by SBI General Insurance Company Limited on 8th July 2021. It is a complete health insurance plan that covers the hospitalization expenses of the insured resulting from an accident or illness. It offers 20 basic covers and 8 optional covers with a wide range of sum insured options so that the policyholder does not have to worry about paying enormous medical bills.
SBI Arogya Supreme Policy at a Glance
Rs 1,00,000 - Rs 5,00,00,000
Types of Coverage
Individual/ Individual Family/ Family Floater
Adult - 18- 65 years
Children - 91 days - 25 years
Pro, Plus, Premium
Pre-Policy Medical Check-Up
Required for applicants above 45 years and sum insured of Rs 50,00,000 & above
1 year/ 2 years/ 3 years
Family Discount, Long Term Policy Discount, Loyalty Discount, Online Discount, Co-Pay Discount, Regional Discount
Features & Benefits of SBI Arogya Supreme Policy
Take a look at the various features and benefits of the Arogya Supreme policy offered by SBI Health Insurance:
- It comes with 20 basic covers and 8 optional covers.
- It offers exclusive covers, including domestic air ambulance cover, recovery benefit, e-opinion cover and compassionate benefit.
- It comes with a wide range of sum insured options of up to Rs 5,00,00,000.
- It provides the option to cover the entire family, including self, spouse, dependent children, dependent parents and dependent parent-in-law.
- It does not require pre-policy medical check-up for applicants below 45 years and applying for sum insured of below Rs 50,00,000.
- It comes with multiple policy tenure options of 1 year, 2 years and 3 years.
- It provides a Flexi-benefit option of co-payment to the policyholder.
- It comes with renewal benefits of cumulative bonus and preventive health check-up cover.
- It provides a 100% refill of the sum insured amount.
- It offers multiple premium savings options, including online discount, loyalty discount, family discount and long term policy discount.
Types of SBI Arogya Supreme Policy
The SBI Arogya Supreme policy comes in three types:
- Pro Plan- The Pro plan is available with a maximum sum insured of up to Rs 5,00,000.
- Plus Plan- The Plus plan offers sum insured ranging from Rs 6,00,000 to Rs 20,00,000.
- Premium Plan- The Premium plan comes with a sum insured amount of more than Rs 25,00,000.
Inclusions of SBI Arogya Supreme Policy
The SBI Arogya Supreme policy provides coverage for the following:
- In-Patient Hospitalization- It covers the cost of getting admitted to a hospital for at least 24 hours due to an illness or accidental injury. It covers expenses such as room rent, cost of diagnostic procedures, medicines cost, ICU expenses, consultation fee, etc.
- Road Ambulance- It covers the charges of availing road ambulance services up to a sum insured of Rs 7000 per hospitalization depending on the plan type.
- Pre-Hospitalization Cover- It pays for the medical expenses incurred up to 30 or 60 days before hospitalization depending on the plan type.
- Post-Hospitalization Cover- It pays for the medical expenses incurred up to 60/90/180 days after getting discharged from the hospital depending on the plan type.
- Day Care Treatment- It covers the medical expenses arising out of day care treatment, which requires hospitalization for less than 24 hours. It does not cover the cost of outpatient department (OPD) treatment.
- Domiciliary Hospitalization- It covers the cost of availing medical treatment at home as per the advice of a medical practitioner.
- Organ Donor Expenses- It covers medical expenses incurred due to the hospitalization of the organ donor for harvesting the donated organ.
- Alternative Treatment - It covers the cost of getting admitted to an AYUSH hospital where treatment is provided based on Ayurveda, Siddha, Unani and Homeopathy system of medicines.
- Mental Healthcare- It covers hospitalization expenses resulting from the treatment of a mental illness diagnosed during the policy period.
- HIV/AIDS Cover- It covers the medical expenses arising out of getting admitted to a hospital for the treatment of HIV/AIDS diagnosed during the policy period.
- Bariatric Surgery Cover- It covers the cost of getting admitted to a hospital to undergo bariatric surgery.
- Advance Procedures- It covers the hospitalization or day care treatment cost of 12 advance procedures for up to 25% of the total sum insured amount. The procedures include Balloon Sinupalsty, Oral Chemotherapy, Intra Vitreal Injections, Stereotactic Radio Surgeries, Vaporisation of the Prostate, Stem Cell Therapy, Uterine Artery Emobalization and HIFU, Deep Brain Stimulation, Immunotherapy, Robotic Surgeries, Bronchial Thermoplasty and IONM.
- Cataract Treatment- It pays for the treatment cost of cataract for up Rs 1,00,000 per eye depending on the plan type.
- Genetic Disorder- It covers hospitalization expenses incurred on the treatment of a genetic disorder for up to a maximum of Rs 1,00,000.
- Internal Congenital Anomaly- It pays for the cost of getting admitted to a hospital for the treatment of an internal congenital anomaly for up to 25% of the total sum insured amount.
- Domestic Emergency Assistance Services- It provides emergency medical assistance services if the insured needs to be medically evacuated or repatriated at least 150 Km away from his/her residence.
- Compassionate Visit- It covers the transportation cost of an immediate family member of the insured to a hospital in another city where he/she has been hospitalized for more than five days.
- E-Opinion- It covers the cost of availing e-opinion for a medical condition from the SBI Health Insurance‘s panel of doctors.
- Recovery Benefit- It pays a lump sum amount of up to Rs 15,000 per hospitalization as a recovery benefit depending on the plan type in case the insured has been hospitalized for more than 10 consecutive days.
- Sum Insured Refill- It ensures that the sum insured is refilled up to 100% despite partial or complete utilization, including cumulative bonus and enhanced cumulative bonus.
The following optional or add-on covers are available under the SBI Arogya Supreme policy:
- Hospital Cash Benefit
- Major Illness Benefit
- Additional Sum Insured for Accidental Hospitalization
- Enhanced Cumulative Bonus
- No Claim Bonus Protector
- Any Room Upgrade
The terms and conditions of these covers are mentioned in the policy wordings of SBI Arogya Supreme policy. People are advised to go through the policy wordings carefully before buying the plan.
Exclusions of SBI Arogya Supreme Policy
The SBI Arogya Supreme policy does not cover the following:
- Maternity expenses
- Obesity-related surgeries
- Plastic surgery or cosmetic surgery
- Sterility and infertility treatments
- Treatment of addiction of alcohol or other substances
- Overseas treatment
- Claims due to participation in hazardous or adventure sports activities
- Hospitalization due to breach of law
- Medical expenses due to refractive error
- Cost of OTC dietary supplements & substances
- Gender change treatments
- Unproven treatments
- Rest cure, respite care and rehabilitation expenses
- Hospitalization for investigative & evaluative purposes
- Claims arising out of war or war-like situations
- Injuries due to nuclear materials or weapons
The Arogya Supreme policy by SBI Health Insurance comes with the following renewal benefits:
It offers an additional 15% of the sum insured up to a maximum of 100% on every renewal provided no claims were raised in the previous policy year.
Preventive Health Check-Up
It offers a preventive health check-up facility every year irrespective of any claims raised during the previous policy period.
How to Claim SBI Arogya Supreme Policy?
There are two ways to raise a claim under the SBI Arogya Supreme policy - Cashless Claims and Reimbursement Claims. Follow the steps given below to raise a claim for Arogya Supreme policy:
- Intimate SBI General Insurance Company about your hospitalization within 24 hours (emergency cashless hospitalization), 48 hours of hospital discharge (reimbursement claims) and 72 hours prior (planned cashless hospitalization)
- Send a pre-authorization form to the insurer in case of cashless treatment
- Once pre-authorization has been granted, receive the treatment and get discharged
- In case of reimbursement claim, pay full hospital bill during discharge and collect all the documents
- Submit the required documents to the insurer within 30 days of getting discharged
- The insurer will settle the claim within 30 days
Documents Required for Reimbursement Claims:
The following documents should be submitted in case of reimbursement claims:
- Duly filled claim Arogya Supreme claim form
- Original investigation reports
- Certified copy of hospital discharge summary
- Certified copy of hospital bills, investigation bills, medicine bills
- Self-attested copy of Aadhaar Card, PAN Card, address proof and photo ID
- Bank account/ NEFT details
- KYC details
- Certified copy of death certificate (in case of insured’s death)
Ans: Yes. SBI Arogya Supreme policy provides coverage for the hospitalization expenses incurred towards the treatment of COVID-19.
Ans: The following waiting periods apply to SBI Arogya Supreme policy:
- Initial waiting period - 30 days
- Specific diseases & procedures - 2 years
- Pre-existing diseases - 4 years
- COVID-19 - 15 days
- Major illness benefit - 90 days
- Hypertension, cardiac condition and diabetes - 90 days
Ans: The Arogya Supreme policy by SBI Health Insurance covers 30 critical diseases under the Major Illness add-on benefit cover. It includes cancer, stroke, open chest CABG, end-stage liver failure, open heart replacement, kidney failure, end-stage lung failure, third degree burns, brain surgery, major organ transplant and coma amongst others.
Ans: Yes. The Arogya Supreme policy comes with a grace period of 30 days after the expiry of the existing policy. In the case of monthly premium payments, a grace period of 15 days is offered. If the policy is not renewed within the grace period, it will get lapsed.
Ans: Yes. The SBI Arogya Supreme policy can be cancelled within the free-look period or the first 15 days of buying the policy without any cancellation charges. However, cancellation charges will be applicable if the policy is cancelled after the free-look period.