SBI General health insurance

Benefits under SBI General health insurance plans include :

• Cashless facility – SBI General processes all cashless claims across 6000 + quality hospitals in their network across India
• Hospitalisation expenses : Coverage for room rental expenses up to the sum insured for most of their plans. Pre and post hospitalisation expenses are covered up to the sum insured, 30/60 days prior and 60/90 days post hospitalisation depending on the plan opted for
• Inpatient Treatment Covered expenses include: Hospital room rent, Boarding expenses and doctor fees, Operation Theatre and Intensive Care charges, Nursing expenses and Medicines that you consume during the hospital stay
• Health Check up : Policy provides health check-up as per the applicable plan as specified in the Product Benefits Table, once every 4 claim free years.
• Lifelong Renewability : SBI General assures you renewability for life without any extra loadings based on the claims
• 142 Day Care procedures covered
• No medical check-up if proposer doesn’t have any medical history up to 45 years of age
• No Claims Bonus available at 10% increase after every claim free year upto maximum of 50% of Basic Sum insured
• Income Tax Exemption under section 80D if the Income Tax Act.

How can one buy a SBI General health insurance policy?

• Step 1- Visit a product comparison website https://www.eindiainsurance.com/ to review and compare policy benefits, coverage and premium details online
• Step 2 - Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy
• Step 3 - Fill the SBI General online health insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate
• Step 4 – If this is a Straight through proposal, the premium remitted online will be transferred directly to the insurance company, and the policy will be issued, dispatched and will reach you in 7 working days
• Step 5 – For Non Straight through cases, SBI General will process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy tests at designated diagnostic centers or they may just levy a loading based on the health report
• Step 6 - If the proposal is accepted, the same will be issued accordingly.
• Step 7 - The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form in the prescribed Turn around time.

Claim Process

Cashless Claims Process

Reimbursement Claims Process

Information to be kept ready while intimating the claim:

• Policy Number
• Insured/Claimant contact details (phone no. , email id, address, landmark etc.)
• Name of Insured/ claimant person, who is hospitalised
• Relationship of insured with the person who is hospitalised.
• Name of the hospital
• Health Claims - Nature of ailment
• Commencement date of the symptom of ailment
• Accident Claims
  • Nature of accident
  • Date & time of accident
  • Location of accident

Exclusions under the policy

• Treatment outside India
• Epidemics recognized by WHO or/and Indian government. Government screening programs, etc are not covered by this policy
• War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority
• Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons/materials
• Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or, as may be necessitated due to an accident
• Cosmetic or aesthetic treatments of any description, treatment or surgery for change of life/gender, Lasik treatment for refractive error. Any form of plastic surgery (unless necessary for the treatment of Illness or Accidental bodily injury)
• The cost of spectacles, contact lenses, hearing aids, crutches, wheelchairs, artificial limbs, dentures, artificial teeth and all other external appliances. Prosthesis and/or devices
• Expenses incurred on Items for personal comfort like television, telephone, etc. incurred during hospitalization and which have been specifically charged for in the hospitalisation bills issued by the hospital
• External medical equipment of any kind used at home as post Hospitalisation care including cost of instrument used in the treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Ambulatory Peritoneal Dialysis (C.A.P.D) and Oxygen concentrator for Bronchial Asthmatic condition.
• Dental treatment or surgery of any kind unless required as a result of Accidental Bodily Injury to natural teeth requiring hospitalization treatment
• Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) and any violation of law or participation in an event/activity that is against law with a criminal intent
• Any complications arising out of or ailments requiring treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction.
• Any condition directly or indirectly caused by or associated with Human Immunodeficiency Virus or Variant/mutant viruses and or any syndrome or condition of a similar kind commonly referred to as AIDS
• Venereal disease or any sexually transmitted disease or sickness.
• Treatment arising from or traceable to pregnancy childbirth, miscarriage, abortion or complications of any of this, including caesarean section. However, this exclusion will not apply to abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and certification by Gynaecologist that it is life threatening
• Any fertility, sub fertility or assisted conception operation or sterilization procedure and related treatment.
• Vaccination or inoculation except as part of post-bite treatment for animal bite.
• Treatment for any mental illness or psychiatric or psychological ailment / condition.
• Outpatient Diagnostic, Medical and Surgical procedures or treatments, non-prescribed drugs and medical supplies, Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.
• Any treatment required arising from Insured’s participation in any hazardous activity including but not limited to all forms of skiing, scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unless specifically agreed by the Insurer
• Treatments in health hydro, spas, nature care clinics and the like
• Treatment with alternative medicines like acupuncture, acupressure, osteopath, naturopathy, chiropractic, reflexology and aromatherapy
• Expenses incurred primarily for diagnostics, x-ray or laboratory examinations, or other diagnostics studies not consistent with or incidental to diagnosis and treatment of the positive existence or presence of any disease, illness or injury, for which confinement is required at a hospital or at home under domiciliary hospitalization as defined.
• Hospitalization for donation of any body organs by an Insured Person including complications arising from the donation of organs
• Treatment for obesity, weight reduction or weight management.
• Disease / injury illness whilst performing duties as a serving member of a military or police force.
• Any kind of Service charges, Surcharges, Admission fees / Registration charges etc levied by the hospital.