SBI General Health Insurance Plan

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SBI Health Insurance Plan has been designed to cater to your specific healthcare needs and to meet all your medical requirements in a customized manner. The idea is to help you lead a happy and healthy life without any financial burden of availing the treatment in some of the best hospitals. It offers financial protection and health security at the same time. The growing cost of medical treatment can drain all your savings. And if you buy the SBI general health insurance plan, you and your family can be sure of the best healthcare treatment in case of a health emergency.  

Key Features of SBI General Health Insurance Plan

Here is a broad list of the General Health Insurance Plans:

  • The sum insured ranged from INR 50,000 to INR 5 lakhs
  • A pre-medical check-up is only required for people above the age of 45 years with a clean medical history
  • Three plan options namely – Metro plan, Semi-metro pan and Rest of India
  • Provision to cover your entire family in a comprehensive manner under a single family floater plan
  • Easy renewal of the policy ( for SBI plans and a health plan from a different insurer)
  • 30 days of pre-hospitalization expenditure and 60 days of post-hospitalization expenditures are covered
  • Up to Rs. 2500 of free medical check-up facility after completion of 4 consecutive claim-free years
  • Add-on benefits to enhance the coverage
  • Tax saving benefits under the purview of the Section 80D of the Income Tax Act, 1961

SBI General Health Insurance Plan Covers the Following -

Medical Expenses Covered Insurance Limit (Rs.)
Hospitalization charges including boarding and nursing charges, room and service charges,  etc. Up to 1 percent of the SI on a daily basis
Intensive Care Unit (ICU) charges Up to 2 percent of the SI on a daily basis
All permissible claims under 1 & 2 during the policy term Up to 25 percent of the SI per injury or illness for every claim
Charges incurred on blood, oxygen, surgical appliances, anesthesia, operation theatre, etc. Up to 40 percent of the SI for each injury or illness for every claim
Fees  charged by the doctors & specialists Up to 40 percent of the SI for each injury or illness for every claim
Ambulance Cover 1 percent of the Total SI ( maximum limit up to Rs. 0)
Post-hospitalization charges ( 60 days after getting discharge) Up to 10 percent of the permissible hospitalization expenses  
Pre-hospitalization Cover (30 days prior to the admission) Up to 10 percent of the permissible hospitalization expenses
Free medical check-up ( after every 4 claim-free years) 1 percent of  the total sum insured ( up to a maximum of Rs. 2500)
Domiciliary Hospitalization Cover Coverage up to 20 percent of the sum insured amount or to a maximum of Rs.20,000
Child Care Cover  This coverage is available for children below the age of 10 years.  For each day of hospitalization, the coverage amount is limited to Rs. 500. And the maximum compensation is subjected to a period of 30 days during a policy term
Parental Care Cover This coverage is available for people above the age of 60 years. It includes expenses incurred on the attendant or nurse after the patient gets discharged from the hospital. The coverage is limited to Rs. 500 or the actual cost or up to a maximum of 10 days of the hospitalization expenses. And Maximum compensation during a policy term is limited to 15days.
Accidental Hospitalization Cover (Once during a policy term) Additional 25 percent of the sum assured and up to a maximum of Rs.1 lakhs (for accidental hospitalization)
Cataract Cover ( for each eye) It is available once you have completed 2 years of the policy term. The compensation is limited to Rs. 25000 or a maximum of 15% of the Sum Insured
Coverage for Specific Day Surgeries ( requiring less than 24 hours of hospitalization) It includes specific dental surgeries involving an accident, eye surgeries, dialysis procedure, radiotherapy, chemotherapy, tonsillectomy, and other similar surgeries
Co-payment facilities in non-network hospitals 10 percent on all permissible claims( up to the claim limit)
Cashless Hospitalization Available in all the SBI General Health Insurance Network Hospitals
Alternative Treatment Cover (Ayurveda treatment in one of the registered government hospitals) The maximum compensation limit is 15 percent of the sum insured or to up to Rs. 20000.In the case of Unani and Homeopathy treatment up to a maximum of 10 percent of the insured amount or Rs. 00.


Sum Insured Amount (in Rs)  

The minimum coverage amount for you and your family is Rs.50, 000. And the maximum coverage limit is Rs. 5 lakhs.

 Here’s is a quick rundown of the terms and conditions of the SBI General Health Insurance Plan:

  • First time buyers or people above the age of 60 years are permissible to opt for maximum coverage of Rs.2 lakhs only
  • The minimum coverage limit for a family floater plan ( including you, your spouse, children and parents) is Rs. 2 lakhs only
  • Pre-medical screening depends on a number of factors such as your age, medical history, sum insured limit and the number of insured family members
  • The renewal of policy for people above the age of 70 years is subjected to the policy terms and conditions as per the IRDA guidelines.

Add-on Benefits in SBI General Health Insurance Plan  

  • Add-on benefits are available after payment of an extra premium amount
  • Add-on benefits can be availed by the policyholder and other insured family members
  • Removal of sub-limits on ICU charges, room rent, consultancy and operation expenses

SBI General Health Insurance Plan Variants

There are three plan options to choose from and they are listed in the table below. You can buy one as per your medical needs and financial capabilities -

SBI General Health Insurance Plan Option Location wise Admissible Claim Amount in Location A (Delhi & Mumbai ) Admissible Claim Amount in Location B (Chennai, Ahmadabad Kolkata, Hyderabad Bangalore) Admissible Claim Amount in Location C (Other cities in India)
Plan A (Delhi & Mumbai ) 100 percent 100 percent 100 percent
Plan B (Chennai, Ahmadabad, Kolkata, Hyderabad, Bangalore) 80 percent 100 percent 100 percent
Plan C (Other cities in India) 70 percent 80 percent 100 percent

 

  • Plan A provides 100 percent of reimbursement on the permissible claim amount in Delhi and Mumbai.
  • Plan B provides 80 percent of reimbursement on the permissible claim amount in Delhi and Mumbai. And 100 percent in Chennai, Ahmadabad Kolkata, Hyderabad, Bangalore, and other Indian cities.
  • Plan C provides 70 percent of reimbursement on the permissible claim amount in Delhi and Mumbai. And 80 percent in Chennai, Ahmadabad Kolkata, Hyderabad Bangalore and 100 percent in other Indian cities.
  • All the payments are subjected to the satisfaction of the insurance company along with all the required documents and bills.

*Provisions are subjected to policy terms and conditions and the admissible claim amount in the health insurance plan

SBI General Health Insurance Plan Exclusions

Listed below are the circumstances where the insurance company can invalidate your claim requests -

  • Claims arising before the completion of 48 months for any kind of illness, injury, or any pre-existing disease from the date of policy inception
  • Expenses incurred on treatment or hospitalization within 30 days of the policy commencement
  • Treatment for cataract, hysterectomy, etc. before completion of 2 years of the waiting period
  • Expenses incurred on specific illnesses like hernia, etc. within a year of the policy inception date
  • Expenses incurred on joint replacement surgeries before the completion of 3 years of the waiting period from the policy commencement date ( except for accidental cases)
  • Expenses incurred on alternative treatments such as acupressure, aromatherapy, acupuncture, reflexology, osteopathy, naturopathy, and chiropractic
  • Treatment required for congenital diseases and disorders
  • Expenses incurred on the treatment of AIDS and HIV infection
  • Hospitalization for childbirth including caesarean delivery, uterine or extra-uterine pregnancy and even prenatal and postnatal treatments.
  • Drug abuse and symptoms related to alcohol consumption or intoxication

SBI Health Insurance Claim Settlement Process

  • Register your claim request at their toll-free number
  • To start the claim process, you need to submit the duly filled insurance claim form and all the original medical documents
  • The insurer will initiate the claim settlement process within 30 days of submission of all the documents
  • The acceptance of claim request is subjected to the policy terms and conditions
  • Cashless hospitalization is available in more than 3000 network hospitals
  • A pre-authorization request needs to be accepted by the SBI General health insurance company or the TPA department to initiate the cashless hospitalization procedure
  • If the hospitalization was planned in advance then the insured needs to inform the insurer before the hospitalization or within 24 hours in case of an emergency