Retail health insurance policy

Eligibilty of SBI General Retail health insurance policy

• Adults: Minimum entry age is 18 years and maximum entry age is 65 years.
• Children can be covered from 3 months and maximum upto 23 years subject to parents concurrently covered with us.
• There is no exit age. However, beyond 70 years the renewal will be allowed subject to Insured accepting to pay the premiumand additional loading as applicable for the age band in which the Insured falls at the time of renewal and as approved by IRDA.

Coverages of SBI General Retail health insurance policy

• Room, Board & Nursing Expenses & Service Charges Etc - Up to 1% of the SI per day.
• Intensive Care Unit - Up to 2% of the SI per day.
• All admissible claims under 1 & 2 during the policy period - Up to 25% of the SI per illness/injury per claim.
• Surgeon, Anaesthetist, Consultants, Specialists Fees - Up to 40% of the SI per illness/injury per claim.
• Anaesthesia, Blood, Oxygen, OT Charges, Surgical Appliances - Up to 40% of the SI per illness/injury per claim.
• Pre-hospitalisation - Up to 10% of the eligible hospitalisation expenses incurred in 30 days prior to date of admission into thehospital.
• Post-hospitalisation - Up to 10% of the eligible hospitalisation expenses incurred in 60 days after the date of discharge from thehospital.
• Ambulance charges - 1% of SI up to a max of INR 1500.
• Free Medical Check up - 1% of SI up to a max of INR 2500 For every 4 claim free years.
• Organ Donor: The Medical Expenses incurred for extraction of the required organ from the organ donor are covered under thepolicy subject to Insurer accepting the inpatient Hospitalisation claim made by the Insured
• Parental Care: Available for persons above 60 years old Insurer shall pay for the attendant nursing charges after discharge fromthe hospital for INR 500 or actual whichever is less per day up to a maximum 10 days per hospitalisation subject to the treatingMedical Practitioner at the hospital where the hospitalisation took place, recommending the duration of such nursing carerequirement. The charges can be reimbursed for a period not exceeding 15 days during the entire Policy period.
• Child Care: Insurer shall pay for the attendant escort charges of INR 500 for each completed day of hospitalisation in case of achild below 10 years of age, subject to maximum of 30 days during the Policy Period. Escort person includes mother, father,grandfather, grandmother and any immediate family member.
• Limit of Cataract - 15% of sum insured subject to maximum of INR 25000 per eye subject to first two years exclusion forcataract as provided under the policy.
• Accidental Hospitalisation – In case of hospitalization following an Accident, Sum Insured limit available for the Insured
• Person will be 125% of the amount arrived after deducting the claims paid and/or outstanding from sum insured for theInsured Person under the policy excluding cumulative bonus component and subject to a maximum of INR 1,00,000/-
• Alternative Treatment (Subject to Treatment taken in a government hospital or in any institute recognised by governmentand/or accredited by Quality Council of India/National Accreditation Board on Health) - Ayurvedic Treatment Coveredmaximum 15% of Sum Insured per Policy period up to a maximum of INR 20000 & Homeopathy and Unani Treatment covered maximum 10% of Sum Insured per Policy period up to a maximum of INR 15000.
• Domiciliary Hospitalisation - Reasonable and Customary Charges towards Domiciliary Hospitalisation exceeding 3 days asdefined in Policy definition subject to 20% of the Sum Insured maximum up to INR 20000 whichever is less. Howeverdomiciliary hospitalisation benefits shall not cover:-
  • Expenses incurred for pre and post Domiciliary Hospitalisation treatment or
  • Expenses incurred for treatment for any of the following Diseases
    • Asthma
    • Bronchitis
    • Chronic Nephritis and Nephritic Syndrome
    • Diarrhoea and all type of Dysenteries including Gastro-enteritis
    • Diabetes Mellitus and Insipidus
    • Epilepsy
    • Hypertension
    • Influenza, Cough and Cold
    • All Psychiatric or Psychosomatic Disorders
    • Pyrexia of unknown Origin for less than 10 days
    • Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharingitis
    • Arthritis, Gout and Rheumatism
• Convalescence Benefit –Benefit available for Insured above 10 years & below 60 years. We shall compensate the Insured, upto an amount not exceeding INR 5,000/- per Insured, if the Insured is hospitalised for any bodily injury or illness as coveredunder the Policy, for a period of 10 consecutive days or more. This benefit is payable only once per Insured during the Periodof Insurance.
• 10% Co-Pay after deductible will apply on all eligible admissible claims in non-network hospitals.
• Day Surgery where less than 24 hours hospitalization undertaken for specified procedures like Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery (Due to accident) , Tonsillectomy, etc is covered.

Benefits of SBI General Retail health insurance policy

• Minimum SI: ₹ INR 50, 000
• Maximum SI: ₹ INR 500,000
• The Maximum Sum Insured would be restricted to INR 200,000/- for insured persons aged 60 and above and taking a policywith us for the first time.
• Sum Insured of dependents to be less than or equal to Primary Insured’s Sum Insured.
• Plan Options: Plan A (Mumbai& Delhi), Plan B (Chennai, Kolkata, Bangalore, Ahmedabad, and Hyderabad) & Plan C (Rest ofIndia). The plan which Insured is covered for will be shown on the Schedule. The table below sets out the percentage of the admissible claim amount that Insurer will be accountable for where a claim cost is incurred in a Location other than thatprescribed in the Schedule:

  Benefit Plan	Treatment Location A - Mumbai and Delhi	Treatment Location B - Chennai, Kolkata, Bangalore, Ahmedabad, Hyderabad	Treatment Location C - Rest of India
  Plan A(Normal residential location - Mumbai & Delhi)	100%	100%	100%
  Plan B (Normal residential location - Chennai, Kolkata, Bangalore, Ahmedabad, Hyderabad)	80%	100%	100%
  Plan C (Normal residential location - Rest of India )	70%	80%	100%

Exclusions of SBI General Retail health insurance 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 underthe 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 necessitateddue to an accident
• The cost of spectacles, contact lenses, hearing aids, crutches, wheelchairs, artificial limbs, dentures, artificial teeth and all otherexternal appliances. Prosthesis and/or devices.
• Expenses incurred on Items for personal comfort like television, telephone, etc. incurred during hospitalization and which havebeen 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 thetreatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous Ambulatory Peritoneal Dialysis (C.A.P.D) and Oxygen concentratorfor Bronchial Asthmatic condition.
• Dental treatment or surgery of any kind unless required as a result of Accidental Bodily Injury to natural teeth requiringhospitalization treatment.
• Convalescence, general debility, “Run-down” condition, rest cure, Congenital Internal and /or external illness/disease/defect.
• Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol) and any violation oflaw 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 andtreatment for de-addiction.
• Venereal disease or any sexually transmitted disease or sickness.
• 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.
• Vitamins, tonics, nutritional supplements unless forming part of the treatment for injury or disease as certified by theattending Medical Practitioner.
• Surgery to correct deviated septum and hypertrophied turbinate unless necessitated by an accidental bodily injury and provedto our satisfaction that the condition is a result of an accidental injury.
• 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, Hormonereplacement 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 ofskiing, scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unless specifically agreed by the Insurer.
• Genetic disorders and stem cell implantation / surgery/storage.
• Treatments taken at any institution which is primarily a rest home or convalescent facility, a place for custodial care, a facilityfor the aged or alcoholic or drug addicts or for the treatment of psychiatric or mental disorders; even if the institution has beenregistered as a hospital with the Appropriate Authorities
• Expenses incurred primarily for diagnostics, x-ray or laboratory examinations, or other diagnostics studies not consistent withor incidental to diagnosis and treatment of the positive existence or presence of any disease, illness or injury, for whichconfinement is required at a hospital or at home under domiciliary hospitalization as defined.
• Treatment for obesity, weight reduction or weight management.
• Experimental and unproven treatment.