Health Insurance Policy

Sum Insured is the maximum amount that an insurance company will pay to the insured, according to the insurance contract, in the event of a claim.

Any condition, aliment or injury or relation condition(s), for which the insured had signs or symptoms and/or diagnosed and/or received medical advice/treatment within 48 months prior to the first policy with the insurance company.

The duration only after which a claim can be made is called the waiting period.

Yes, waiting periods will be applicable afresh in relation to the amount by which the Sum Insured has been enhanced. For example, if the waiting period for pre- existing disease is 4 years, any expenses under this cover can be claimed only after 4 years from the date of policy inception.

Sub-limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.

In a floater option, single policy under one Sum Insured covers all in the family for e.g. 2Adults, 2 A 1C, 2A 2C, 2A, 1A2C, 1A 1C. The Sum Insured can be used by anyone in the family or all covered in the policy for multiple number of times till the time the Sum Insured limit is exhausted.

The minimum age of entry for SBI General’s Health Insurance Policy - Retail is 18 years However, children from the age of 3 months can be covered subject to both parents concurrently covered with SBI General’s Health Insurance Policy - Retail. The Maximum age of entry for the policy is 65 years

There is No maximum exit age for this policy.

The bill of hospitalisation at any of our network providers/ hospitals would be paid directly by us. A list of these hospitals/ providers is available on the website or you can reconfirm the same from our Call Centre or nearest branch office.

Currently SBI General’s Health Insurance Policy - Retail is available for a one year period only.

Individual plan has to be separate for every individual. Floater covers all in family (max. 2 Adults and 2 Children) and provides one sum insured to all, hence there is saving of premium.

Premium for Family Floater Policy is calculated basis the age of the oldest member of the family to be insured.

The disease under Permanent Exclusions will not be covered in the Health Insurance plan.

The medical tests can be conducted at any designated centers identified by SBI General.

Pre-acceptance Health check is not mandatory for people who are less than 45 years old and without any history of illness. Insured’s with following condition, acceptance of proposal is subject to a satisfactory medical examination as per SBI General’s requirements:

• Insured with adverse medical history as declared in Proposal Form or,
• Insured aged above 45 years & irrespective of SI.

The cost of Pre-acceptance medical tests has to be borne by the proposer. However, if the proposal is accepted by Us, we will reimburse 50% of the cost incurred towards the medical tests so undertaken at our advice.

Deduction u/s 80 D of income tax act is available from taxable income for premium paid towards health insurance

• For self, spouse and dependent children - Maximum ₹25000/-
• For Parent(s)- Maximum ₹25,000/-
• In case Parent(s) are resident senior citizen- Maximum ₹30,000/-

However, please note that tax benefits are subject to change in tax laws.

It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.

It refers to payment of the Medical Expenses incurred by the insured, immediately 30 days before and 60 days after Hospitalisation.

Every renewal premium shall be so paid and accepted upon the distinct understanding that no alteration has taken place in the facts contained in the proposal or declaration herein before mentioned and that nothing is known to the Insured that may increase the risk to the Insurer. No renewal receipt shall be valid unless it is on the printed form of Insurer and signed by an authorized official of Insurer. In case any disease/ illness is contracted during the last 12 months (whether a claim is made or not with the insurers), the information of the same needs to be provided to us at the time of renewal. We may require that an additional premium be paid for the enhanced risk profile arising out of such diseases contracted and policy would only be renewed upon collection of premium and such additional premium. In the event of any failure to either provide or disclose any change in medical condition by the insured/ proposer/ beneficiaries said act would amount to suppression of material fact and company will not be liable for any claim.

Most of the Health Insurance Policies offered by the General Insurance companies in India have waiting periods during which certain pre-existing diseases are excluded in the coverage. They are excluded for certain predefined period (number of years) before they are covered i.e. The Policy holder is expected to have continuous cover for the predefined period before the pre-existing diseases are covered under the policy. Portability will ensure that these accrued benefits are transferred (without any dilution) to the new insurer at the time of renewal and porting and the consumer do not lose on these accrued benefits while opting to switch the insurer using Health Insurance Portability.

 The Policy holder can port the following accrued credits:

• General waiting period
• Waiting periods pertaining to the coverage of pre-existing diseases/conditions
• Any time bound exclusions

Health Insurance portability will allow the Policy Holder, protection against discontinuity and loss of coverage against pre-existing diseases consequent to his/ her decision to shift to another insurer at the time of renewal.

If you do not claim in any policy period then you will not get any refund, however you are eligible for a “Cumulative Bonus” of 5% which can be accumulated up to 25%.

In case of hospitalisation due to accident, your remaining Sum insured will become 125%, subject to maximum of INR  1,00,000/-

Alternative Treatment, like Ayurvedic, Homeopathy or Unani, taken in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/ National Accreditation Board on Health) is covered under the policy. Ayurvedic Treatment is covered maximum up to 15% of Sum Insured per Policy period up to a maximum of INR 20000 & Homeopathy and Unani Treatment is covered up to maximum 10% of Sum Insured per Policy period up to a maximum of INR 15000.

You can change your sum Insured at the time of renewal, however please note that maximum Sum Insured would be restricted to INR 200,000/- for insured persons aged 60 and above and taking a policy with us for the first time.

Co-payment refers to the amount expected to be paid by the insured for a medical service covered by the plan. This policy has a Plan based co-pay (between 20-30%), based on the geographical location of the hospitalisation. Also, this policy attracts co- pay of 10% in case of hospitalisation in non- network hospital.