Advancement in medical science has helped increase the longevity of human beings. However, it has also made health care expensive. Any sudden hospitalisation or illness can drain your savings. To avoid such a situation, you can opt for a health insurance. SBI General Arogya Premier Policy is a high-value health plan to cover hospitalisation and treatment expenses.
What is SBI General Arogya Premier Policy?
This insurance plan is designed to the meet the health care requirements of those individuals who do not like any compromise in this aspect. With vast medical coverage options to choose from, the policy helps high-net-worth individuals get the finest medical care from the top-rated hospitals. Thus, the plan helps provide financial security to policyholders.
Eligibility Criteria
Any individual can take SBI General Arogya Premier Policy for himself and for his family. Below are the eligibility criteria which the policy seeker should note before buying the policy:
| Particulars | Min-Max |
| Age Of Entry | Child: 3 Months
Adult: 18-65 yrs
|
| Policy Tenure | 1-3 Yrs |
| Sum Insured | Rs 10 lakh-Rs 30 lakh |
SBI General Arogya Premier Policy Features
• There is no need of undergoing pre-policy medical tests for the customers up to the age of 55 years provided they have no medical history
• A bonus equal to the 10% of sum insured on every renewal will be paid by the insurer for each claim free year
• This health insurance plan offers tax benefits under section 80D of the Income Tax Act
• In case the policyholder doesn’t make any claim for four consecutive years, health check-up up to Rs 5,000 will be reimbursed by the insurance company
• 100% Sum insured will be automatically reinstated in case the sum insured gets reduced due to the claim made in a policy year at no additional premium
What SBI General Arogya Premier Policy covers?
• This insurance policy covers ambulance as well as air ambulance charges which ensures the customer avail best possible treatment in a different city or state if the need arises
• It covers customary maternity expenses which most of the health insurance plans usually don’t cover. However, it can only be covered after 9 months of waiting
• This health plan covers all the medical expenses including pre and post hospitalization for an organ donor’s treatment for the harvesting of the donated organ
• This policy reimburses the expenses of alternate treatment options available like Ayurveda, Unani, and Homeopathy. However, the institution or the hospital should be government approved or accredited by the National Accreditation Board on Health (NABH) or Quality Council of India
Also Know: SBI General Arogya Top Up Policy
Documents Required For Claim Process
Following are the documents which the insured have to submit to the insurance company to process claim:
• Duly filled claim form
• Valid Identity card proof with 2 recent photos of insured
• Original Discharge card/certificate/death summary
• Copies of prescription for diagnostic test
• Original hospital bill
The insured needs to intimate the administrator within 48 hrs from the date of hospitalization and within 15 days of discharge; he needs to provide the company with claim form along with the original bills, and other documents. In case of post hospitalization claims, the administrator must be informed within 15 days from the completion of post hospitalization treatment.
Cases where you can’t claim this Plan (Exclusions)
SBI General Arogya Premier Policy covers a wide range of medical conditions and situations. However, these are the major exclusions in this policy which this policy doesn’t cover:
• Pre-existing disease which is not declared in the proposal form
• Treatment taken outside of India
• Injury directly or indirectly caused by Nuclear weapons
• Cost of spectacles, contact lens, artificial teeth are not included in this plan
• Epidemic disease recognized by an Indian government or WHO
• Insured admitted in the hospital primary for the diagnostic purpose
How long does it take to pay out a claim?
The insurance company will assess the claim document upon receiving. Upon satisfactory assessment of the claim, the insurer will make the payment of claim. In case, it is repudiated, the same will be communicated to the policyholder with reason.
Renewal Process of this plan
SBI General Arogya Premier Policy can be renewed every year by paying the required premium to the insurance company. In case, the policyholder is not able to pay the premium, S/he can pay it under 30 days from the premium due date under the grace period.
Advantages of buying SBI General Arogya Premier Policy
• This insurance plan gives financial security to the policyholder even if they have made a claim due to the auto reinstatement of sum insured
• It covers a wide range of medical conditions and situations which further gives peace of mind to the policyholder
• This policy helps you save tax under section 80D
Important Aspects
• The basic premium will be loaded by 5% for a habit of smoking, alcohol, and tobacco
• Change in sum insured is allowed only on renewals, not in between
• To claim cashless treatment, the insured has to take pre-authorization by way of the written form which administrator will provide
|
Features |
|
| Claim Type (In-House or TPA) | TPA |
| Pre-Hospitalization | Expenses incurred 60 days prior to hospitalization |
| Network Hospital Count | 5500+ |
| Post-Hospitalization | Expenses incurred after 90 days from the date of discharge |
| Room Eligibility | Room rent and boarding expenses covered |
| Share Claim Payments | No Co-pay under this policy |
| Restoration of Cover | Covered |
| No Claim Bonus | 10%-50% |
| Ambulance Charges | Yes, it covers Actual Ambulance charges including air ambulance up to Rs 1 lakh |
| Worldwide Coverage | NA |
| Maternity Cover | Covered after nine months of waiting |
| Hospitalization at Home | Yes |
| Day Care Treatment | Yes, covers 142 day care surgeries which require less than 24 hrs of hospitalization up to the sum insured |
| Non-Allopathic Treatment Coverage | Yes, Ayurvedic, Homeopathy, and Unani treatments are covered |
| Emergency Ambulance | No |
| Health Check-up
|
Cover these expenses up to Rs 5,000 after 4 consecutive claim free years |
FAQs
Q1. Is portability allowed under SBI General Arogya Premier plan?
Yes, an individual can port their existing health indemnity plan into this policy. However, they must fulfill the criteria described by the insurer before opting this policy.
Q2. Does SBI General Arogya Premier plan cover Ayurvedic treatment?
Yes, this health plan covers the expenses occurred due to alternate treatment such as Ayurvedic, Homeopathic and Unani.
Q3. What are the income tax benefits that an individual can avail on this policy?
The tax benefits are provided under section 80D of the Income Tax Act. The following benefits are available under this plan:
• For self, partner (spouse) and dependent children: Up to Rs. 25,000
• For parents: Up to Rs. 25,000
• For parents who are senior citizen: Up to Rs. 30,000
Q4. Is there any kind of pre-medical health check-up required for this plan?
A pre-acceptance medical check-up is not mandatory for this plan for the customers who are below 55 years of age and have no medical history. The policy owner with the following conditions will need the pre-medical health check-up:
- Customers with the age of 55 years and above Customers with an unfavorable medical history as listed in the proposal form
- The cost of pre-acceptance medical exam has to be borne by the customers. However, the expenses can be reimbursed up to 50% of the total cost incurred if the proposal is accepted by SBI General.
Q5. Does this plan provide any long-term discount?
Yes, the health plan provides its customers with a discount of 5% and 7.5% for the 2 years and 3 years policy term respectively.
Q6. What is the basic difference between individual and floater plans?
Individual plans are designed for one person and cover that individual only. On the other hand, the floater plan covers the entire family (maximum 2 adults and 2 children). Floater plans provide the benefit of one sum insured to all the members.