Name : Mr.

RAJESH BILOTIA Group Mediclaim Policy

Address
: 56,56- KALAPATHTHAR UJJAIN,56- KALAPATHTHAR (Plan
(Plan
Name-
Name-
Arogya
Arogya
Smart)
UJJAIN,
Ujjain M.L.Nagar,Ujjain,Ujjain, Advanced)
Protect)
Madhya Pradesh-456010,
Policy /Certificate No: POGMC00300520390
Contact No : 9424012293
Policy Issue Date: 31/07/2025T14:58:52
Email ID : K52350915@GMAIL.COM Customer ID:

Dear Mr. RAJESH BILOTIA

Welcome to the SBI General Family. Health is the most precious thing we possess. So we are glad to see that you have made the right
decision to protect your health and secure your mental peace through SBI General's Group Mediclaim Policy (Plan Name- Arogya Advanced).

We are hereby enclosing the following documents pertaining to your policy that outline the details of risk and cover as proposed by you.

• Certificate Of Insurance

• Customer Information Sheet • Policy Term & Condition

• Network Hospital List

https://www.sbigeneral.in/portal/contactus/hospital

We request you to verify and confirm that these documents are in order. Please ensure safety of documents
as they form part of our contract with you. For all your future correspondence with us, kindly quote your Customer ID and policy mentioned
above.

In case of any queries or suggestions, please do not hesitate to get in touch with us. You can contact us at
customer.care@sbigeneral.in or call our customer care number 1800-22-1111(MTNL/BSNL user) and
1800-102-1111(for other users).
We look forward to a continuing and mutually beneficial relationship.

Yours sincerely
Scan the QR Code to enjoy wellness
benefits and value addded services
with Group Mediclaim Policy(Plan
Name- Arogya Advanced)
Smart)
Protect)
Authorized Signatory

SBI General Insurance and SBI are separate legal entities and SBI is working as Corporate Agent of the company for sourcing of insurance products

1
 SBI General Insurance Company Limited
In
A

Certificate of Insurance
Product Name- Group Mediclaim Policy
Plan Name- Arogya Advanced
Master Policy No: AASBI20012025001
Master Policy Holder Name: SBIG
Certificate of Insurance No.: POGMC00300520390 Issue Date: 31/07/2025T14:58:52
Intermediary Name Sbi Patni Bazar Ujjain 30191 Intermediary Code : 0018419
Intermediary Contact details Phone/Mobile/Email Id: null Address:
Servicing Branch Office / GSTIN No:
Policy Period* From: 23/07/2025T14:55:33 hrs To: mid night 22/07/2026T23:59:59
Plan Name: Arogya Advanced Plan Number: NA

Primary Insured Details

Insured
InsuredName*
Name* RAJESH
RAJESH BILOTIA
BILOTIA
56,56- KALAPATHTHAR UJJAIN,56- KALAPATHTHAR UJJAIN,Ujjain
Address
M.L.Nagar,Ujjain,Ujjain, Madhya Pradesh-456010
Mobile Number 9424012293
E-mail ID K52350915@GMAIL.COM
PAN No./Form60/61/ Aadhar/Passport/Driving License/Other ID proof
Nationality Indian
Alternate Mobile Number
Type of Cover Opted Individual / Individual Family
Sum Insured Opted (in Rs.) 500000
Previous Policy No.
Date of 1st inception of Policy 23/07/2025
Number of Applicants 1
Auto Renewals Opted

INSURED PERSON'S DETAILS

Nationality ABHA
(Indian/ Non (Ayushman
Insured Relationship
Insured Gender Indian/ Non- Bharat Health
Member Marital Status Occupation with Primary DOB
Member ID (M/F/O) resident Account)
Name Applicant
Indian/ number (if
Others) available) #
RAJESH Other
Male Married Indian Self 02/05/1976
BILOTIA Occupation

Appointee Name &

Nominee Relationship Nominee Nominee/Appointee
Insured Member Name Nominee Name Relationship (If
with Proposer Age contact no.
Nominee is Minor)
RAJESH BILOTIA RAJESH BILOTIA Self 49

50

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 2
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
 SBI General Insurance Company Limited

50
In
AA
Ins

COVERAGE DETAILS:

Sr
Table of Benefits Table of Benefits
No.
1 Inpatient Care (No room rent capping) Covered Up
, room
to Base
rentSum
limited
Insured
to 1% of Sum Insured per day for Normal
Inpatient Care
and 2% of Sum Insured per day for ICU.
2 OPD (OPD SI will be over and above base SI) 3,000/- per family
2 Pre-Hospitalization Medical expenses 30 Days
3 Pre-Hospitalization Medical expenses 60 Days
AA 3 Post Hospitalization Medical expenses 60 Days
4 Post Hospitalization Medical expenses 90 Days
AASB 4 Emergency Ground Ambulance 1500/- per hospitalization
5 Emergency Ground Ambulance 1500/- per hospitalization
5 Inpatient Care under Alternative treatment Covered Up to Base Sum Insured
6 Inpatient care under Alternative treatment Covered Up to Base Sum Insured
6 Domiciliary hospitalization Covered Up to 20% of Sum Insured
7 Domiciliary hospitalization Covered Up to Base Sum Insured
50 7
8
Day Care Treatment
Day Care Treatment
Covered Up to Base Sum Insured
Covered Up to Base Sum Insured
8 Modern Treatment Covered Up to 50% Base Sum Insured
9 Modern Treatment Covered Up to 50% Sum Insured
10 Organ Donor Expenses Covered Up to 10% Sum Insured
11 Bariatric Surgery Covered Up to 20% Sum Insured
50

Declaration

As part of our Go Green initiative, your policy will be issued digitally to your registered mobile number via WhatsApp, SMS, and email. By issuing
an e-policy, we help conserve the environment by saving a tree. An electronic policy document holds the same legal validity as a physical copy.
The date on which the policy document is delivered will be considered for determining the free look period.

However, if you would prefer to receive a physical copy of your policy document, simply send an SMS with the message "PRINT <Policy
Number>" to 561612 from your registered mobile number.

Applicable Waiting Period -

Sr no Waiting Period
1 For Pre-existing diseases (PED) 24 months
2 Initial Waiting Period 30 days
3 Waiting Period for Disease Specific Exclusions 12 months

Special Conditions (if any):

Insured Person Name Special Condition/Exclusion

RAJESH BILOTIA

Additional Conditions, Exclusions, Warranties:

Coverage subject to the following additional Conditions and Clauses / Endorsements / Warranties with reference to the Section that it Is
applicable to

Insured Person Name Pre-Existing Conditions

RAJESH BILOTIA

Exclusions:
Following is a partial list of the policy exclusions. Please refer to the policy document for the complete list of exclusions:
i. Investigation & Evaluation (Code- Excl04)
ii. Rest Cure, rehabilitation, and respite care (Code- Excl05)

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 3
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

iii. Obesity/ Weight Control (Code- Excl06)

iv. Change of Gender treatments (Code- Excl07)
v. Cosmetic or plastic Surgery (Code- Excl08)
vi. Hazardous or Adventure sports (Code- Excl09)
vii. Breach of law (Code- Excl10)
viii. Excluded Providers (Code- Excl 11)
ix. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof (Code- Excl12)
x. Refractive Error (Code- Excl15)
xi. Unproven Treatments (Code- Excl 16)
xii. Sterility and Infertility (Code- Excl17)
xiii. Maternity (Code Excl18)

Contact Details:

Contact Details: Policy Servicing Claims Servicing

customer.care@sbigeneral.in ;
Email seniorcitizengrievances@sbigeneral.in (for sbig.health@sbigeneral.in
Senior Citizens)
1800 210 3366
Toll Free number 18001021111 (24*7)
1800 210 6366
Website www.sbigeneral.in <http://www.sbigeneral.in/>
Fax No 1800227244, 18001027244 +91 20 49334525

Redressal of Grievance

• Step 1: If you are dissatisfied with the resolution provided above or for lack of response, you may write to head.customercare@sbigeneral.in
We will look into the matter and decide the same expeditiously within 14 days from the date of receipt of your complaint.
For Senior Citizens: Senior Citizens can reach us at seniorcitizengrievances@sbigeneral.in; Toll Free - 1800 102 1111 (24*7)
• Step 2: In case, you are not satisfied with the decision/resolution communicated by the above office, or have not received any response
within 14 days, you may send your Appeal addressed to the Grievance Redressal Officer at: gro@sbigeneral.in. or contact at: 022-45138021

Address: Grievance Redressal Officer, 9th Floor, A & B Wing, Fulcrum Building, Sahar Road, Andheri (East), Mumbai 400 099 .List of
Grievance Redressal Officers at Branch:
https://content.sbigeneral.in/uploads/0449cac1bcd144bbb160d3f6b714fbbd.pdf/
• Step 3: In case, you are not satisfied with the decision/resolution communicated by the above office, or have not received any response
within 14 days, you may Register your complaint with IRDAI on the below given link https://bimabharosa.irdai.gov.in/Home/Home
• Step 4: If your grievance remains unresolved from the date of filing your first complaint or is partially resolved, you may approach the
Insurance Ombudsman falling in your jurisdiction for Redressal of your Grievance. The details of the Insurance Ombudsman can be accessed
at https://www.cioins.co.in/Ombudsman

For any communications with respect to the Insurance Contract you can contact our nearest branch office or write to us at “SBI General Insurance
Company Limited. 9th Floor, Wing A& B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400 099

Premium Details (All Values in INR)

Net Premium 16,948.31

Add: Taxes as applicable 3,050.70
Final Premium (including GST) 19,999.00

Collection Details: Receipt no: Receipt Date: 23/07/2025T00:00:00

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 4
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Signed at (RO/BO/DO – Details) For and on behalf of SBI General Insurance

Digitally signed by DS SBI

GENERAL INSURANCE
COMPANY LTD
Date: 2025.07.31 21:09:22 IST
Date : 23/07/2025T14:55:33 Authorized Signature

P.S. If premium paid through cheque, the policy is void ab initio in case of dishonour of cheque.
Consolidated Stamp Duty paid towards Insurance Policy Stamps vide Order No 363727061 Dated 23/07/2025T00:00:00 of General Stamp Office,
Mumbai
Service Tax Reg. No.

PREMIUM CERTIFICATE
Premium certificate for the purpose of deduction under section 80 - (D) of Income Tax (Amendment) Act, 1986.
Transaction Id:363727061
This is to certify that Mr,RAJESH BILOTIA has paid INR 19999 towards the premium for Health Insurance vide Direct Credit Transaction ID/Cheque
No. for the period from 23/07/2025T14:55:33 To 22/07/2026T23:59:59 Midnight for Policy No. POGMC00300520390

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the purpose of
deductionundersection80D. The benefit shall be as per the provisions of the Income Tax Act, 1961 and any amendments made thereafter.
You may get tax benefits up to Rs. 19999 subject to maximum permissible limits under Income Tax Act 1961 as modified from time to time. For
more details kindly consult your tax advisor. In the event of non-realization of premium, benefits cannot be obtained against this premium receipt.
GSTI No.: 23AAMCS8857L1ZK

Date: 23/07/2025T14:55:33

Place: Ujjain Authorised Signatory

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 5
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Branch Office Address: Reference No: 363727061

SBI General Insurance Company Limited
9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East, Mumbai OF Receipt No:
- 400099. Date: 23/07/2025T14:55:33
Branch Code: 00094
Party/Depositor ID:
RECEIPT
Received with thanks from RAJESH BILOTIA an amount of Rs.19999 by EFT
Dated: 23/07/2025T14:55:33
Drawn on Bank:
Branch: Ratlam
Party ID Quote Quote/Policy/Claim No. Name of Party Amount(Rs.)
POGMC00300520390 RAJESH BILOTIA 19,999.00

Disclaimer
1) Receipt subject to realisation of instrument submitted
2) Kindly refer to the policy document for time of commencement of cover

For and on behalf of SBI General Insurance Co. Ltd

Authorized Signatory

Important Note:
Insurance is a contract of Utmost Good Faith requiring the Insured not only to disclose all information related to his health and which has a bearing
on the acceptance or rejection of the Proposal by the Insurer and also not to suppress any factual information in response to the questions in the
Proposal form.
Please examine this Policy including its attached Schedules/ Annexure if any. In the event of any discrepancy, contact the office of the Insurer
immediately, it being noted that this Policy shall be otherwise considered as being entirely in order.
In case of payment by cheque, in the event of dishonor of cheque for any reason whatsoever, insurance provided under this document
automatically stands cancelled from the inception of the Policy irrespective of whether a separate communication is sent or not.
All terms, conditions and exclusions as per standard Policy wordings attached with this Schedule.

To Verify your Policy details click/visit https://www.sbigeneral.in/policyprint/healthpolicyothers

INSURANCE IS THE SUBJECT MATTER OF SOLICITATION

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 6
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

GST TAX INVOICE

GST Invoice No: GST Invoice Date: 23/07/2025T14:55:33
GSTIN/Unique No:(SBI General) 23AAMCS8857L1ZK SBI General State Madhya Pradesh
SBI General Branch Address: SBI General Insurance Company Limited
9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East, Mumbai - 400099.
Details of Policy Holder:
Name: Mr.RAJESH BILOTIA
Address: 56,56- KALAPATHTHAR UJJAIN,56- KALAPATHTHAR UJJAIN,Ujjain M.L.Nagar,Ujjain,Ujjain,Madhya Pradesh-
456010
Policy Holder State Madhya Pradesh Place of supply Madhya Pradesh
Whether invoice under Reverse No
Charge
GSTIN/Uniqu Policy
23AAMCS8857L1ZK POGMC00300520390
e No: Number:
Insurance Premium CGST SGST / UTGST IGST
Product HSN Code (without
Name Taxes) Rate Amount Rate Amount Rate Amount

Group Medi
16,948.31 % 1525.35 % 1525.35 0.00% 0
Claim

Total
Invoice
19,999.00
Value (In
Figures)
Taxes
3,050.70 Authorised Signator
Applicable

SBI
General Receipt
23/07/2025T00:00:00
Receipt Date:
No:

“I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare e-invoice in view of exemption provided to insurance companies
under Notification no. 13/2020-Central Tax dated March 21, 2020"

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 7
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

CUSTOMER INFORMATION SHEET

This document provides key information about your policy. You are also advised to go through your policy document.

SL DESCRIPTION POLICY CLAUSE

TITLE
No (Please refer to applicable policy clause number in next column) NUMBER
Name of Insurance
1 Group Mediclaim Policy
Product /Policy
2 Policy Number POGMC00300520390
Type of Insurance
3 Indemnity
Product/Policy
4 Sum Insured (Basis) Individual Sum Insured
Sr.No Insured Name Base Sum Insured
1 RAJESH BILOTIA 500000.00

Note: This is the base Sum Insured for policy Please refer the policy Schedule for cover wise
limits.
5 Policy Coverage Covers Expenses in respect of: SECTION NO. 2
(What the Policy Base Covers COVERAGE
Covers)
i. Inpatient
1. Inpatient Care:
Care: Admission
Coverage of in expenses
hospital beyond
incurred24during
hoursHospitalisation for Medically
Necessary treatment beyond 24 hours. Room Rent as specified in the Policy
a. Room Rent: Expenses
Schedule/Certificate incurred on Room Rent will be covered up to the Limits
of Insurance
specified in the
Pre-hospitalisation Policy Schedule.
Expenses - Covered prior to 30 days of hospitalisation.
ii.
b. ICU: Expenses incurred on ICU will be covered up to the Limits specified in the
iii. Post-hospitalisation Expenses - Covered post 60 days of hospitalization.
Policy Schedule.
iv. Day Care Expenses - Day Care expenses procedures requiring less than 24 hours of
2. Organ Donor Expenses: Medical Expenses incurred in respect of donor for any of the organ
hospitalization
transplant surgery conducted on the Insured Person up to the limit specified in Policy
v. Modern
Schedule.
Treatment: Coverage for Medical Expenses incurred up to the limit of 50% of Base
Sum Insured towards Modern Treatment
3. Day Care treatment: MedicalMedical
Expenses incurredincurred
for Day for
Carethe
Treatment/ Procedure will be
vi. Domiciliary
covered up
Hospitalization:
to the Limits specified in
Expenses
the Policy Schedule.
Insured Person’s
Domiciliary Hospitalization during the Policy Period following an Illness or Injury
4. Pre-hospitalization Medical Expenses: Covered prior to 60 days of hospitalization.
vii. Alternative Treatment: Covers Medical Expenses up to the Sum Insured towards Inpatient
5. Post-hospitalization
hospitalization underMedical
AYUSH Expenses:
Hospital. Covered post 90 days of hospitalization.
6. Emergency
Modern Treatment:
Ground Medical Expenses
Ambulance: Coversincurred
expenses onfor
Modern
Groundtreatment
ambulancemethods or in
as specified
viii.
Advanced
Certificateprocedures
of Insuranceup to the limits specified in Policy Schedule.
7. Inpatient care under Alternative Treatment: Medical Expenses incurred by Alternative/
AYUSH treatment methods will be covered up to the Limits specified in the Policy
Schedule.
8. Domiciliary Hospitalization: We will pay the Medical Expenses up to the Sum Insured as
specified in the Policy Schedule.
9. Bariatric Surgery: Medical Expenses incurred towards Surgical Procedure for obesity will be
covered up to the Limits specified in the Policy Schedule.
Optional Cover
1. OPD Cover: Expenses for OPD consultation and treatment up to limit specified in Policy
Schedule on advice of a Medical Practitioner.
2. Emergency Ground Ambulance: Covers expenses up to the limit of Rs. 1500/- per
hospitalization.
6 Exclusions (What Following is a partial list of the policy exclusions. Please refer to the policy document for the SECTION NO. 3. B.
the policy does not complete list of exclusions: WAITING PERIODS
cover) 1. Investigation & Evaluation (Code- Excl04) AND EXCLUSIONS
2. Rest Cure, rehabilitation, and respite care (Code- Excl05)
3. Obesity/ Weight Control (Code- Excl06)
4. Change of Gender treatments (Code- Excl07)
5. Cosmetic or plastic Surgery (Code- Excl08)
6. Hazardous or Adventure sports (Code- Excl09)
7. Breach of law (Code- Excl10)
8. Excluded Providers (Code- Excl 11)
9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and
consequences thereof (Code- Excl12)
10. Refractive Error (Code- Excl15)
11. Unproven Treatments (Code- Excl 16)
12. Sterility and Infertility (Code- Excl17)
13. Maternity (Code Excl18)

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 8
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

7 Waiting period Initial Waiting Period: 30 Days SECTION NO. 3. A.

WAITING PERIODS
Specific Waiting Periods AND EXCLUSIONS
o 12 months for Cataract, Benign Prostatic Hypertrophy, Hysterectomy / myomectomy for
menorrhagia or fibromyoma or prolapse of uterus, Surgery of Genitourinary tract, Calculus
Diseases of any etiology, Gastric/ Duodenal Ulcer, Gout and Rheumatism, Chronic Renal
failure including dialysis etc. (not applicable for claims arising due to accident).
Pre-Existing diseases: 24 months.
8 Financial Limits of The policy will pay only up to the limits specified hereunder for the following
the Coverage diseases/procedures:

Sub-Limit:
• Organ Donor Expenses: Medical Expenses incurred up to the limit of 10% of Base Sum
Insured towards Organ Donor Expenses.
• Modern Treatment: Medical Expenses incurred up to the limit of 50% of Base Sum Insured
towards Modern Treatment.
• Bariatric Surgery: Medical Expenses incurred up to the limit of 20% of Base Sum Insured
towards Bariatric Surgery.
• Emergency Ground Ambulance: Covers expenses up to the limit of Rs. 1500/- per
hospitalization.
i. Room rent limit: 1% of Sum Insured per day for Normal and 2% of Sum Insured per day for ICU.
ii. Modern Treatment: Medical Expenses incurred up to the limit of 50% of Base Sum Insured
iii. Domiciliary Hospitalization: Medical Expenses can be claimed on a Reimbursement basis only and shall be
limited to 20% of Base Sum Insured.
iv. Emergency Ground Ambulance: Covers expenses up to the limit of Rs. 1500/- per hospitalization.
9 Claims /Claims a. For Cashless Service: Insured may refer Pre-Authorization form attached as Annexure-C to III. CONDITIONS
Procedure the Policy Wordings and for updated Hospital Network details refer the link WHEN A CLAIM
https://www.sbigeneral.in/portal/contact-us/hospital ARISES

b. For Reimbursement of Claim: For reimbursement of claims the insured person may submit
the necessary documents to TPA/Company within the prescribed time limit as specified in
the Policy wordings.
Turn Around Time (TAT) for claim settlement
i. TAT for pre-authorization of cashless facility - within 1 hour from receipt of
complete documents.
ii. TAT for cashless final bill settlement - within 3 hours from receipt of complete
documents.
• Hospital Network details can be obtained from link:
https://www.sbigeneral.in/portal/contact-us/hospital

• List of Hospitals which are blacklisted or from where no claims will be accepted by the
insurer is available in below link: https://www.sbigeneral.in/contact-us/hospital

• Toll Free number: 1800 210 3366, 1800 210 6366

• Claim forms can be downloaded from below link: https://www.sbigeneral.in/claim/claims-

form-download
Note: For cover wise claims procedure, please refer to policy wordings.
10 Policy Servicing Email: customer.care@sbigeneral.in
Toll-Free 1800221111
number
(24*7)
Website: www.sbigeneral.in

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 9
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

11 Grievances Stage 1: If you are dissatisfied with the resolution provided above or for lack of response, you SECTION NO. 4.1.16.
/Complaints may write to head.customercare@sbigeneral.in We will look into the matter and decide the REDRESSAL OF
same expeditiously within 14 days from the date of receipt of your complaint. GRIEVANCE

For Senior Citizens: Senior Citizens can reach us at seniorcitizengrievances@sbigeneral.in ; Toll

Free - 1800 102 1111 (24*7)

Stage 2: In case, you are not satisfied with the decision/resolution communicated by the above
office, or have not received any response within 14 days, you may send your Appeal addressed
to the Grievance Redressal Officer at : gro@sbigeneral.in or contact at 022-45138021.

Address: Grievance Redressal Officer, 9th Floor, A & B Wing, Fulcrum Building, Sahar Road,
Andheri (East), Mumbai 400 099. List of Grievance Redressal Officers at Branch:
https://content.sbigeneral.in/uploads/0449cac1bcd144bbb160d3f6b714fbbd.pdf/

Stage 3: In case, you are not satisfied with the decision/resolution communicated by the above
office, or have not received any response within 14 days, you may Register your complaint with
IRDAI on the below given link
https://bimabharosa.irdai.gov.in/Home/Home

Stage 4: If your grievance remains unresolved from the date of filing your first complaint or is
partially resolved, you may approach the Insurance Ombudsman falling in your jurisdiction for
Redressal of your Grievance. The details of the Insurance Ombudsman can be accessed at (
https://www.cioins.co.in/Ombudsman)
12 Things to remember 1. Free Look Cancellation: The insured will be allowed a period of at least 30 days from the SECTION NO. 4-
date of receipt of the policy to review the terms and conditions of the policy and to GENERAL TERMS
return the same if not acceptable. For detailed conditions and refund summary, please AND CLAUSES
refer to policy wordings.

2. Policy renewal: The Policy shall ordinarily be renewable provided the product is not
withdrawn, except on grounds of established fraud or non-disclosure or
misrepresentation by the Insured Person.
3. Portability: The insured person will have the option to port the policy to other insurers by
3. Migration: The insured person will have the option to migrate the Policy to other health
applying to such insurer to port the entire policy along with all the members of the family,
insurance products/ plans offered by the company by applying for migration of the policy
if any, at least 45 days before, but not earlier than 60 days from the policy renewal date
at least 30 days before the policy renewal date as per IRDAI guidelines on Migration. For
as per IRDAI guidelines related to portability. For Detailed Guidelines on portability, kindly
Detailed Guidelines on Migration, kindly refer the link -
refer the link:
https://content.sbigeneral.in//uploads/c6a2844dd65446019b130bae1fa20f.pdf
https://content.sbigeneral.in//uploads/c6a2844dd65446019b130bae1fa20f.pdf
4. Portability: The insured person will have the option to port the policy to other insurers by
4. Change in Sum Insured: Sum Insured can be changed (increase / decrease) only at the
applying to such insurer to port the entire policy along with all the members of the family,
time of Renewal or at any time, subject to underwriting by the Company. For any increase
if any, at least 45 days before, but not earlier than 60 days from the policy renewal date
in Sum Insured, the waiting period shall start afresh only for the enhance portion of the
as per IRDAI guidelines related to portability. For Detailed Guidelines on portability, kindly
Sum Insured.
refer the link:
https://content.sbigeneral.in//uploads/c6a2844dd65446019b130bae1fa20f.pdf
5. Moratorium Period: After completion of sixty continuous months of coverage (including
portability and migration) in health insurance Policy, no Policy and claim shall be
5. Change in Sum Insured: Sum Insured can be changed (increase / decrease) only at the
contestable by the Insurer on grounds of non-disclosure, misrepresentation, except on
time of Renewal or at any time, subject to underwriting by the Company. For any increase
grounds of established fraud. This period of sixty continuous months is called as
in Sum Insured, the waiting period shall start afresh only for the enhance portion of the
moratorium period. The moratorium would be applicable for the Sums Insured of the first
Sum Insured.
Policy. Wherever, the Sum Insured is enhanced, completion of sixty continuous months
would be applicable from the date of enhancement of Sums Insured only on the
6. Moratorium Period: After completion of sixty continuous months of coverage (including
enhanced limits.
portability and migration) in health insurance Policy, no Policy and claim shall be
contestable by the Insurer on grounds of non-disclosure, misrepresentation, except on
grounds of established fraud. This period of sixty continuous months is called as
moratorium period. The moratorium would be applicable for the Sums Insured of the first
Policy. Wherever, the Sum Insured is enhanced, completion of sixty continuous months
would be applicable from the date of enhancement of Sums Insured only on the
enhanced limits.
13 Your Obligations Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure SECTION NO. 4-
may affect the claim settlement. GENERAL TERMS
AND CLAUSES
Disclosure of Information:
The Policy shall be void and all premiums paid thereon shall be forfeited to the Company in the
event of misrepresentation, mis-description, or non-disclosure of any Material Fact by the
Policyholder.

Declaration by the Policy Holder: I have read the above and confirm having noted the details

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 10
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Place:
Date: Signature of the Policyholder:
Note:
a) For product related documents including Customer Information Sheet, kindly refer to the below link: https://www.sbigeneral.in/downloads
b) In case of any conflict, the terms and conditions mentioned in the policy document shall prevail

For more details on the risk factor, terms, and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 11
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

GROUP MEDICLAIM POLICY

POLICY WORDING
PREAMBLE local authorities, wherever applicable and having facilities for carrying
out treatment procedures and medical or surgical / para-surgical
This Policy is a contract of insurance issued by SBI General (hereinafter interventions or both under the supervision of registered AYUSH Medical
called We/Us/‘The Company’) to the proposer Specified in the schedule Practitioner(s) on day care basis without in-patient services and must
(hereinafter called the ‘Insured’) to cover theperson(s) named in the comply with all the following criterion:
schedule (hereinafter called the "InsuredPersons). The policy is based on I. Having qualified registered AYUSH Medical Practitioner in charge
the statements and declaration provided in the Proposal Form by the round the clock;
proposer and is subject to receipt of the requisite premium.
II. Having dedicated AYUSH therapy sections as required and/or has
Note: This Policy Wording provides detailed terms, conditions and equipped operation theatre where surgical procedures are to be
exclusions for all Sections available under this Product. Kindly refer to carried out;
the Policy Schedule / Certificate of Insurance to know exact details of III. Maintaining daily records of the patients and making them
Sections opted by You. Only Wordings related to Sections Specified in accessible to the insurance company’s authorized representative.
your Policy Schedule/Certificate of Insurance are applicable 5. Cashless Facility means a facility extended by the insurer to the
Disclaimer: The Description Specified under this wording throughout the insured where the payments, of the costs of treatment undergone
Insurance Policy is only to aid Your understanding of the by the insured in accordance with the policy terms and conditions,
Coverage/Benefit Offered. In case of dispute, the Terms and Conditions are directly made to the Network Provider by the insurer to the
detailed in the Policy Document and Policy Schedule shall prevail extent pre-authorization is approved.

SECTION NO. 1 -DEFINITIONS 6. Break in Policy means the period of gap that occurs at the end of
The terms defined below and at other junctures in the Policy have the the existing policy term/ installment premium due date, when the
meanings ascribed to them wherever they appear in this Policy and, premium due for renewal on a given policy or installment premium
where, the context so requires, references to the singular include due is not paid on or before the premium renewal date or Grace
references to the plural; references to the male includes the female and Period.
other gender and references to any statutory enactment includes .
subsequent changes to the same. 7. Condition Precedent means a policy term or condition upon which
the Insurer’s liability under the policy is conditional upon.
1.1 Standard Definitions
1. Accident means sudden, unforeseen, and involuntary event 8. Complainant means a Policyholder or prospect or Nominee or
caused by external, visible, and violent means. assignee or any beneficiary of an insurance Policy who has filed a
Complaint or Grievance against an Insurer and /or distribution
2. Any one Illness means continuous period of illness and includes
channel.
relapse within 45 days from the date of last consultation with the
Hospital / Nursing Home where treatment was taken.
9. Complaint or Grievance means written expression (includes
3. AYUSH Hospital means an AYUSH Hospital is a healthcare facility communication in the form of electronic mail or voice based
wherein medical / surgical / para-surgical treatment procedures electronic scripts) of dissatisfaction by a complainant with respect
and interventions are carried out by AYUSH Medical to solicitation or sale or purchase of an insurance policy or related
Practitioner(s) comprising of any of the following: services by insurer and /or by distribution channel.
I Central or State Government AYUSH Hospital; or 10. Congenital Anomaly refers to a condition(s) which is present since
birth, and which is abnormal with reference to form, structure, or
II Teaching hospital attached to AYUSH College recognized by position.
the Central Government /Central Council of Indian Medicine/ I. Internal Congenital Anomaly - Congenital Anomaly which is not in
Central Council for Homeopathy; or the visible and accessible parts of the body.
III AYUSH Hospital, standalone or co-located with in-patient II. External Congenital Anomaly - Congenital Anomaly which is in the
healthcare facility of any recognized system of medicine, visible and accessible parts of the body
registered with the local authorities, wherever applicable, .
and is under the supervision of a qualified registered AYUSH 11. Co-payment means a cost sharing requirement under a health
Medical Practitioner and must comply with all the following insurance policy that provides that the policyholder/insured will
criterion: bear a specified percentage of the admissible claims amount. A co-
a) Having at least 5 in-patient beds; payment does not reduce the Sum Insured.
b) Having qualified AYUSH Medical Practitioner in charge 12. Cumulative Bonus means any increase or addition in the Sum
round the clock; Insured granted by the insurer without an associated increase in
premium
c) Having dedicated AYUSH therapy sections as required .
and / or has equipped operation theatre where surgical
13. Day Care Centre means any institution established for day care
procedures are to be carried out;
treatment of illness and/or injuries or a medical setup with a
d) Maintaining daily records of the patients and making hospital and which has been registered with the local authorities,
them accessible to the insurance company’s authorized wherever applicable, and is under supervision of a registered and
representative. qualified medical practitioner and must comply with all minimum
4. AYUSH Day Care Centre means and includes Community Health criterion as under:
Centre (CHC), Primary Health Centre (PHC), Dispensary, Clinic,
Polyclinic or any such health centre which is registered with the

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 12
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

i. has qualified nursing staff under its employment. iii. has qualified Medical Practitioner(s) in charge round the
ii. has qualified medical practitioner/s in charge; clock,
iii. has fully equipped operation theatre of its own where surgical iv. has a fully equipped operation theatre of its own where
procedures are carried out surgical procedures are carried out,
iv. maintains daily records of patients and will make these accessible
v. maintains daily records of patients and will make these
to the insurance company’s authorized personnel.
accessible to the insurance company’s authorized personnel.
.
14. Day Care Treatment means medical treatment, and/or surgical 22. Hospitalization means admission in a Hospital for a minimum
procedure which is period of 24 consecutive ‘In-patient Care’ hours except for
i. Undertaken under General or Local Anesthesia in a hospital/day specified procedures/ treatments, where such admission could be
care center in less than 24 hours because of technological for a period of less than 24 consecutive hours.
advancement, and
23. Injury means accidental physical bodily harm excluding illness or
ii. which would have otherwise required hospitalization of more than
disease solely and directly caused by external, violent, visible, and
24 hours
evident means which is verified and certified by a Medical
15. Deductible means a cost sharing requirement under a health Practitioner.
insurance policy that provides that the Insurer will not be liable
for a specified rupee amount in case of indemnity policies and for 24. Illness means a sickness or a disease or pathological condition
a specified number of days/hours in case of Hospital cash policies, leading to the impairment of normal physiological function and
which will apply before any benefits are payable by the insurer. A requires medical treatment.
Deductible does not reduce the Sum Insured. (a) Acute condition - Acute condition is a disease, Illness that is
16. Dental Treatment means a treatment related to teeth or likely to respond quickly to treatment which aims to return
structures supporting teeth including examinations, fillings (where the person to his or her state of health immediately before
appropriate), crowns, extractions, and surgery. suffering the disease/ Illness which leads to full recovery
17. Disclosure of information norm means the policy shall be void (b) Chronic condition - A chronic condition is defined as a
and all premiums paid hereon shall be forfeited to the Company, disease, Illness that has one or more of the following
in the event of misrepresentation, mis-description or characteristics:
nondisclosure of any material fact. i. it needs ongoing or long-term monitoring through
18. Domiciliary Hospitalization means medical treatment for an consultations, examinations, check-ups, and /or tests
illness/disease/injury which in the normal course would require ii. it needs ongoing or long-term control or relief of
care and treatment at a hospital but is actually taken while symptoms
confined at home under any of the following circumstances: iii. it requires your rehabilitation for the patient or for the
i. the condition of the patient is such that he/she is not in a patient to be specially trained to cope with it
condition to be moved to a hospital, or iv. it continues indefinitely
ii. the patient takes treatment at home on account of v. it recurs or is likely to recur.
nonavailability of room in a hospital.
25. In-patient Care/Hospitalization means treatment for which the
19. Emergency Care means management for an Illness which results Insured Person has to stay in a Hospital for more than 24 hours for
in symptoms which occur suddenly and unexpectedly and requires a covered event.
immediate care by a medical practitioner to prevent death or
serious long-term impairment of the Insured Person’s health. 26. Intensive Care Unit means an identified section, ward or wing of a
Hospital which is under the constant supervision of a dedicated
20. Grace period means the specified period of time, immediately
Medical Practitioner(s), and which is specially equipped for the
following the premium due date during which premium payment
continuous monitoring and treatment of patients who are in a
can be made to renew or continue a policy in force without loss of
critical condition or require life support facilities and where the
continuity benefits pertaining to waiting periods and coverage of
level of care and supervision is considerably more sophisticated
pre-existing diseases. Coverage need not be available during the
and intensive than in the ordinary and other wards.
period for which no premium is received. The grace period for
payment of the premium for all types of insurance policies shall be: 27. ICU Charges means the amount charged by a Hospital towards ICU
fifteen days where premium payment mode is monthly and thirty expenses which shall include the expenses for ICU bed general
days in all other cases. medical support services provided to any ICU patient including
Provided the insurers shall offer coverage during the grace period, monitoring devices, critical care nursing and intensivist charges.
if the premium is paid in instalments during the policy period.
28. Maternity Expenses means
21. Hospital means any institution established for In-patient Care and
Day Care Treatment of diseases, injuries and which has been a) medical treatment expenses traceable to childbirth (including
registered as a Hospital with the local authorities under the complicated deliveries and caesarean sections incurred during
clinical Establishments (Registration and Regulation) Act, 2010 or hospitalization);
under the enactments specified under the Schedule of Section b) expenses towards lawful medical termination of pregnancy
56(1) of the said Act or complies with all minimum criteria as during the policy period.
under:
29. Medical Advice means any consultation or advice from a Medical
i. has qualified nursing staff under its employment round the Practitioner including the issuance of any prescription or follow up
clock, prescription.
ii. has at least 10 in-patient beds, in towns having a population 30. Medical Expenses means those expenses that an Insured Person
of less than 10,00,000 and 15 in-patient beds in all other has necessarily and actually incurred for medical treatment on
places, account of Illness or accident on the advice of a Medical

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 13
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Practitioner, as long as these are no more than would have been 42. Post-Hospitalization Medical Expenses means medical expenses
payable if the Insured Person had not been insured and no more incurred during pre- defined number of days immediately after
than other hospitals or doctors in the same locality would have the Insured Person is discharged from the hospital provided that:
charged for the same medical treatment.
i. Such Medical Expenses are for the same condition for which
31. Medical Necessary Treatment means any treatment, tests, the Insured Person’s hospitalization was required, and
medication, or stay in Hospital or part of stay in Hospital which:
ii. The inpatient hospitalization claim for such hospitalization is
i. is required for the medical management of the illness or admissible by the insurance company.
injury suffered by the Insured Person.
43. Proposal form means a form to be filled in by the prospect in
ii. must not exceed the level of care necessary to provide safe, physical or electronic form, for furnishing the information
adequate, and appropriate medical care in scope, duration, or including material information, if any, as required by the Insurer
intensity. in respect of a risk, in order to enable the insurer to take
iii. must have been prescribed by a medical practitioner. informed decision in the context of underwriting the risk, and in
iv. must conform to the professional standards widely accepted the event of acceptance of the risk, to determine the rates,
in international medical practice or by the medical advantages, terms and conditions of the cover to be granted.
community in India. Explanation:
(i) “Material Information” for the purpose of these regulations
32. Medical Practitioner means a person who holds a valid shall mean all important, essential and relevant information and
registration from the Medical Council of any State or Medical documents explicitly sought by insurer in the proposal form.
Council of India or Council for Indian Medicine or for Period for (ii) The requirements of “disclosure of material information”
treating the Renewal continuous for the purpose of gaining credit regarding a proposal or policy, apply both to the insurer and the
for Pre-Existing Diseases, time-bound exclusions and for all prospect, under these regulations.
waiting periods.
44. Qualified Nurse is a person who holds a valid registration from
33. Migration means a facility provided to policyholders (including all the nursing council of India or the nursing council of any state in
members under family cover and group policies), to transfer the India.
credits gained for pre-existing diseases and specific waiting
periods from one health insurance policy to another with the 45. Renewal means the terms on which the contract of insurance can
same insurer. be renewed on mutual consent with a provision of Grace Period
for treating the Renewal continuous for the purpose of gaining
34. Network Provider means Hospitals or health care providers credit for Pre-Existing Diseases, time-bound exclusions and for all
enlisted by an insurer, TPA or jointly by an Insurer and TPA to waiting periods.
provide medical services to an insured by a Cashless facility.
46. Reasonable and Customary Charges means the charges for
35. Non-Network Provider means any Hospital, Day Care Centre or services or supplies, which are the standard charges for the
other provider that is not part of the Network. specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking into
36. New Borne Baby means baby born during the Policy Period and is
account the nature of the illness / injury involved.
aged up to 90 days.
47. Room Rent means the amount charged by a Hospital towards
37. Notification of Claim means the process of intimating a claim to Room and Boarding expenses and shall include the associated
the insurer or TPA through any of the recognized modes of medical expenses.
communication. 48. Senior citizen means any person, who has attained the Age of sixty
38. OPD Treatment means the one in which the Insured visits a clinic years or above.
/ hospital or associated facility like a consultation room for 49. Specific waiting period means a period up to 36 months from the
diagnosis and treatment based on the advice of a Medical commencement of a health insurance policy during which period
Practitioner. The Insured is not admitted as a day care or specified diseases/treatments (except due to an accident) are not
inpatient. covered. On completion of the period, diseases/treatments shall
be covered provided the policy has been continuously renewed
39. Pre-existing disease (PED) means any condition, ailment, injury or
without any break.
disease:
50. Solicitation means the act of approaching a prospect or a
i. that is/are diagnosed by a physician not more than 36 months Policyholder by an Insurer or by a distribution channel with a view
prior to the date of commencement of the policy issued by the to persuading the prospect or a Policyholder to purchase or to
insurer; or renew an insurance Policy.
ii. for which medical advice or treatment was recommended by, 51. Surgery or Surgical Procedures means manual and / or operative
or received from, a physician, not more than 36 months prior procedure (s) required for treatment of an illness or injury,
to the date of commencement of the policy. correction of deformities and defects, diagnosis and cure of
40. Pre-Hospitalization Medical Expenses means medical expenses diseases, relief from suffering and prolongation of life, performed
incurred during pre- defined number of days preceding the in a hospital or day care centre by a Medical Practitioner.
hospitalization of the Insured Person, provided that: 52. Unproven/Experimental Treatment is a treatment including drug
a) that is/are diagnosed by a physician not more than 36 months experimental therapy, which is based on established medical
prior to the date of commencement of the policy issued by the practice in India, is a treatment experimental or unproven.
insurer; or
1.2 Specific Definitions
b) for which medical advice or treatment was recommended by, or
received from, a physician, not more than 36 months prior to the 1. Adventurous/Hazardous Sports means any sport or activity
date of commencement of the policy. involving physical exertion and skill in which an Insured Person
41. Portability means a facility provided to the health insurance participates or competes for entertainment or as part of his
policyholders (including all members under family cover), to profession whether he / she is trained or not.
transfer the credits gained for, pre-existing diseases and specific 2. Age means completed years on last birthday as on
waiting periods from one insurer to another insurer. Commencement Date.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 14
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

3. Ambulance means a motor vehicle operated by a 16. Franchise means the Insurer is not responsible for the loss which
licensed/authorized service provider and equipped for the does not exceed an agreed amount(as specified in the Policy
transport and paramedical treatment of the person requiring Schedule/Certificate of Insurance), but is responsible for the
medical attention. entire amount of the loss which exceeds the agreed Franchise
amount (as specified in the Policy Schedule/
4. Attendant is a person who performs personal services for those
Certificate of Insurance).
unable to care for themselves. Attendant is not authorized to
provide any medical treatment. 17. HIV means Human Immunodeficiency Virus
5. Associated Medical Expenses means those expenses that an 18. Home means the Insured Person’s place of permanent residence
Insured Person has necessarily and actually incurred for medical as specified in the Policy Schedule/ Certificate of insurance.
treatment on account of Illness or Accident on the advice of a
19. Immediate Family means any one of the relationships with the
Medical Practitioner. In case of copayment associated with room
Insured Person: spouse, father, mother, father-in-law, mother-in-
rent higher than the entitled room rent limit, Associated Medical
law, brother, sister-in-law, sister, brother-in-law,son or daughter
Expenses will not include:
or legal guardian wherever applicable.
a. Cost of pharmacy and consumables;
b. Cost of diagnostics 20. Insured Person/You/Your means persons named in the Policy
c. Cost of implants and medical devices Schedule/Certificate of Insurance who are insured under the
Policy and are resident of India in respect of whom the applicable
6. Alternative /AYUSH Treatment refers to hospitalization
premium has been received.
treatments given under Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy systems. 21. Life-threatening situation shall mean a serious medical condition
or symptom resulting from Injury or Illness which is not Pre-
7. Bank Rate means Bank rate fixed by the Reserve Bank of India
Existing Disease, which arises suddenly and unexpectedly, and
(RBI) which is prevalent as on 1st day of the financial year in
requires immediate care and treatment by a Medical Practitioner,
which the claim has fallen due.
generally received within 24 hours of onset to avoid jeopardy to
8. Base Sum Insured means the pre-defined limit specified in the life or serious long-term impairment of the Insured Person’s
Policy Schedule/Certificate of Insurance. health, until stabilization at which time this medical condition or
symptom is not considered an Emergency anymore.
9. Break in policy means the period of gap that occurs at the end of
the existing policy term/installment premium due date, when the 22. Material Facts means all relevant information sought by the
premium due for renewal on a given policy or installment Company in the Proposal Form and other connected documents
premium due is not paid on or before the premium renewal date to enable it to take informed decision in the context of
or grace period. underwriting the risk.
10. Biological Attack or Weapons means the emission, 23. Mental Illness means a substantial disorder of thinking, mood,
discharge,dispersal, release or escape of any pathogenic (disease perception, orientation or memory that grossly impairs judgment,
producing) micro-organisms and/or biologically produced toxins behaviour, capacity to recognise reality or ability to meet the
(including genetically modified organisms and chemically ordinary demands of life, mental conditions associated with the
synthesized toxins) which are capable of causing any Illness, abuse of alcohol and drugs but does not include mental
incapacitating disablement or death. retardation which is a condition of arrested or incomplete
development of mind of a person, specially characterised by sub
11. Chemical attack or weapons means the emission,
normality of intelligence.
discharge,dispersal, release or escape of any solid, liquid or
gaseous chemical compound which, when suitably distributed, is 24. Medical practitioner for treatment of mental illnesses means a
capable of causing any Illness, incapacitating disablement or medical practitioner possessing a post-graduate degree or
death. diploma in psychiatry awarded by an university recognized by the
University Grants Commission established under the University
12. Commencement Date means the date of commencement of
Grants Commission Act, 1956, or awarded or recognized by the
insurance coverage under the Policy as specified in the Policy
National Board of Examinations and included in the First Schedule
Schedule.
to the Indian Medical Council Act, 1956, or recognized by the
13. Dependents means only the family members listed below: Medical Council of India, constituted under the Indian Medical
i. Legally married spouse as long as continues to be married or Council Act, 1956, and includes, in relation to any State, any
Live-in partner ( For : Live-in partner, HR/Group Manager`s medical officer who having regard to his knowledge and
declaration would be required) experience in psychiatry, has been declared by the Government of
ii. Children (natural or legally adopted), aged from day 1 and that State to be a psychiatrist for the purposes of this Act,
onwards up to the day as specified in the Policy Schedule/
25. Mental Health Establishment means any health establishment,
Certificate
including Ayurveda, Yoga and Naturopathy, Unani, Siddha and
iii.Natural parents or Legal parents.
Homoeopathy establishment, by whatever name called, either
iv. Parent-in-law.
wholly or partly, meant for the care of persons with mental
v. Any other dependent where there is Insurable Interest.
Illness, established, owned, controlled or maintained by the
14. Diagnostic Centre means a place where diagnostic tests and appropriate Government, local authority, trust, whether private
exploratory or therapeutic procedures required for the detection, or public, corporation, co-operative society, organisation or any
identification and treatment of a medical condition are done. other entity or person, where persons with mental Illness are
15. Disability for the purpose of this policy means a person with not admitted and reside at, or kept in, for care, treatment,
less than forty percent of a specified disability as per the Act, convalescence and rehabilitation, either temporarily or otherwise;
where, specified disability has not been defined in measurable and includes any general Hospital or general nursing home
terms and includes an Insured Person with disability where established or maintained by the appropriate Government, local
specified disability has been defined in measurable terms, as authority, trust, whether private or public, corporation, co-
Certified by the Medical Board appointed by the government for operative society, organisation or any other entity or person; but
certifying Disability. does not include a family residential place where a person with
mental Illness resides with his relatives or friends;

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 15
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

26. Policy means these Policy wordings, the Policy Schedule and any 39. We/Our/Us/Company means the SBI General Insurance
applicable endorsements or extensions attaching to or forming Company Limited.
part thereof, as amended from time to time, and shall be read .
together. The Policy contains details of the extent of cover
SECTION NO. 2 - COVERAGE
available to the Insured Person, applicable exclusions and the
terms & conditions applicable under the Policy. SECTION A-BASE COVER
27. Policy Period means the period between the Commencement HOSPITALIZATION COVER
Date and either the Expiry Date specified in the Policy
We will pay under below listed Covers on Medically Necessary
Schedule/Certificate of Insurance or the date of cancellation of
Hospitalization of an Insured Person due to Illness or Injury sustained
this Policy, whichever is earlier.
or contracted during the Policy Period. The payment is subject to Sum
28. Policy holder means the entity or person named as such in the Insured and limits including Loyalty Credit if applicable as specified on
Schedule. the Schedule of Coverage in the Policy Schedule/Certificate of
29. Policy Schedule means the Policy Schedule attached to and Insurance. Subject to otherwise terms and conditions of the Policy.
forming part of this Policy specifying the details of the Insured A.1 Inpatient Care:
Persons, the Sum Insured, the Policy Period and the Sub-limits to
We will indemnify reasonable and customary charges that are incurred
which benefits under the Policy are subject to, including any
during the Hospitalisation of the Insured Person for Medically
annexures and/or endorsements, made to or on it from time to
Necessary treatment required due to an Illness or Injury sustained by
time, and if more than one, then the latest in time.
the Insured Person during the Policy Period for the below listed
30. Policy Year means a period of twelve months beginning from the medical expenses:
Commencement Date and ending on the last day of such twelve-
i. Room Rent as specified in the Policy Schedule/Certificate of
month period. For the purpose of subsequent years, Policy Year
Insurance;
shall mean a period of twelve months commencing from the end
of the previous Policy Year and lapsing on the last day of such ii. Nursing charges for Hospitalization as an Inpatient excluding
twelve-month period, till the Expiry Date, as specified in the private nursing charges;
Policy Schedule. iii. Medical Practitioners' fees, excluding any charges or fees for
31. Post-Natal Medical Expenses means medical expenses incurred Standby Services;
for the insured mother post the delivery for a period of 6 weeks. iv. Physiotherapy, investigation and diagnostics procedures directly
32. Pre-Natal Medical Expenses means medical expenses incurred related to the current admission;
for the insured mother during the maternity period prior to v. Anesthesia, Blood, Oxygen expenses.
delivery.
vi. Medicines and drugs as prescribed by the treating Medical
33. Health Check-up means a package of the medical test(s) Practitioner;
undertaken for a general assessment of health status, excluding
any diagnostic or investigative medical tests for evaluation of vii. Intravenous fluids, blood transfusion, injection administration
Illness or a disease. charges, allowable consumables and / or enteral feedings.

34. Second medical opinion cover means a procedure whereby upon viii. Operation theatre charges;
request of the Insured Person, an independent Medical ix. The cost of prosthetics and other devices or equipment, if
Practitioner reviews and opines on the treating Medical implanted internally during Surgery;
Practitioner’s recommendation as to care and treatment of the
Insured Person by reviewing Insured Person’s medical status and x. ICU Charges.
history. Such an opinion shall not be deemed to substitute the xi. Any other cover as requested by Policy Holder or present in
Insured Person’s physical visit or consultation to an independent expiring policy
Medical Practitioner.
Condition
35. Sub-limit means a cost sharing requirement under a health
i. If the Insured Person is admitted in a Hospital room where the
insurance policy in which an insurer would not be liable to pay
room category opted or Room Rent incurred is higher than the
any amount in excess of the pre-defined limit. The Sub- limit as
eligibility as specified in the Policy Schedule/Certificate of
applicable under the Policy is specified in the Policy Schedule
Insurance, then We shall be liable to pay only a pro-rated
against the relevant Cover in force under the Policy.
portion of the total Associated Medical Expenses (including
36. Sum Insured Means the total of the base sum insured which is surcharge or taxes thereon) as per the following formula:
our maximum, total and cumulative liability for any and all claims
during the Policy Period in respect of all Insured Person(s) which ii. (Eligible Room Rent limit / Room Rent actually incurred)* total
is specified in the Policy Schedule. Associated Medical Expenses shall include Room Rent, nursing
charges, Medical Practitioners' fees and operation theatre
37. Telemedicine means Medical consultation service availed via charges. Proportionate deductions may apply based on the room
telecommunications and digital communication technologies by category.
the Insured Person from a Medical Practitioner while taking
treatment for the health condition that has resulted in an iii. The proportionate deductions and relevant Associated Medical
admissible Claim under a cover in this Policy. Such Telemedicine Expenses Specified above under point (i) and (ii)shall not be
services shall be delivered in compliance with the Medical Council applicable for hospitalization in an ICU.
of India’s ‘Telemedicine Practice Guidelines’ dated March 2020 or iv. Voluntary Co-payment/ Franchise and Super Top up cover if
its subsequent amendments, if any. opted will be applicable to this cover.
38. Waiting Period means a period from the inception of this Policy v. The expenses related to or subsumed into room charges /
during which specified diseases/treatments are not covered.On procedure charges / costs of treatment are Specified in Annexure
completion of the Waiting Period, diseases/ treatments shall be II are not covered, unless otherwise Specified in the Policy
covered provided the Policy has been continuously renewed Schedule/Certificate of Insurance.
without any break

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 16
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

A.2 Organ Donor Expenses Conditions:

We will indemnify Reasonable and Customary charges for the Medical i. We have accepted a claim under Section 2 A.1 (Inpatient Care)
Expenses incurred in respect of donor for any of the organ transplant or A.3 (Day Care Treatments) or A.6 (Modern Treatment) or A.7
surgery conducted on the Insured Person during the Policy Period, (Inpatient Care under Alternative Treatments) or A.8
provided that: (Domiciliary Hospitalization) or A.9 (Bariatric
Surgery),B.33(Home Health Care) in respect of that Insured
Conditions:
Person.
i. The organ donated is for the use of the Insured Person who has
ii. Post-hospitalization Medical Expenses can be claimed under this
been asked to undergo an organ transplant on Medical Advice;
Section on a Reimbursement basis only.
and the undergoing of a transplant has to be confirmed by a
specialist Medical Practitioner. A.6 Modern Treatment
ii. The organ donor is any person whose organ has been made We will indemnify the Reasonable and Customary Charges for Medical
available in accordance and in compliance with The Expenses incurred on the Insured Person's Treatment for any illness/
Transplantation of Human Organs (Amendment) Bill, 2011, injury where treatment undertaken is from below listed Modern
Transplantation of Human Organs and Tissues Rules, 2014 and treatment methods or Advanced procedures up to 50% of Base Sum
other applicable laws and rules and the organ donated is for the Insured or as per the limits specified in Policy Schedule/Certificate of
use of the Insured Person, and Insurance but not limited to the following
iii. We have accepted an inpatient Hospitalization claim for the i.Uterine Artery Embolization and HIFU
Insured Person under Section 2 A.1 (In-Patient Care). ii.Balloon Sinuplasty
iii. Deep Brain stimulation
iv. The Organ Donor’s Pre-Hospitalization and Post-Hospitalization iv. Oral chemotherapy
expenses are excluded under the Policy v. Immunotherapy- Monoclonal Antibody to be given as injection
v. Any donor screening charges or other Medical Expenses or vi. Intra vitreal injections
Hospitalization consequent to the harvesting of organ for the vii. Robotic surgeries
donor is excluded under the Policy. viii. Stereotactic radio Surgeries
ix. Bronchial Thermoplasty
vi. This benefit shall be limited to maximum amount as Specified in
x. Vaporisation of the prostrate (Green laser treatment or holmium
Policy schedule/ Certificate of Insurance.
laser treatment)
A.3 Day Care Treatment: xi. IONM- (lntra Operative Neuro Monitoring)
We will indemnify the reasonable and customary charges for Medical xii. Stem cell therapy: Hematopoietic stem cells for bone marrow
Expenses incurred on the Insured Person's Day Care transplant for haematological conditions
Treatment/Procedure for Medically Necessary Treatment and is Note: Any other advance procedure/ treatment as approved by IMA
carried out on the written advice of a Medical Practitioner during the and specifically Specified in the Policy Schedule/Certificate of
Policy Period. Insurance will be covered.
Conditions: A.7 Inpatient care under Alternative Treatment:
i. The list of admissible Day Care Treatment/ Procedures would be We will indemnify the reasonable and customary charges for Medical
as per the list in Annexure III (The list of day care treatment is an Expenses incurred by Alternative/ AYUSH treatment methods
indicative list and any other treatment which may get included in involving Inpatient Care availed in AYUSH Hospitals up to Base Sum
future shall be covered by the virtue of standard definition of Insured.
“Day Care Treatment”)
A.8 Domiciliary Hospitalization:
ii. We shall not cover any OPD Treatment and Diagnostic Services
under this Benefit. We will indemnify the Reasonable and Customary Charges for
Medical Expenses for the Insured Person's Domiciliary Hospitalization
A.4 Pre-hospitalization Medical expenses: during the Policy Period, provided that the condition for which the
We will indemnify the Reasonable and Customary Charges for Insured medical treatment is required for at least twenty-four hours.
Person's Pre-hospitalization Medical Expenses incurred prior to Conditions:
hospitalization up to 30 days.
i. The Domiciliary Hospitalization is for Medically Necessary
Conditions: Treatment and is carried out on the written advice of a Medical
i. We have accepted a claim under Section 2 A.1 (Inpatient Care) Practitioner.
or A.3 (Day Care Treatment) or A.6 (Modern Treatment) or A.7 ii.
(Inpatient Care under Alternative Treatments) or A.8
(Domiciliary Hospitalization) or A.9 (Bariatric Surgery) or B.33
(Home Health Care) in respect of that Insured Person.
ii. Pre-hospitalization Medical Expenses can be claimed under this Expenses incurred due to following diseases will not be payable-
Section on a Reimbursement basis only.
1. Asthma
A.5 Post-hospitalization Medical expenses: 2. Bronchitis
We will indemnify the Reasonable and Customary Charges for Insured 3. Chronic Nephritis and Nephritic Syndrome
Person's Post-hospitalization Medical Expenses incurred immediately 4. Diarrhea and all type of Dysenteries including Gastro-enteritis
from the day of discharge from the hospital up to 60 days 5. Diabetes Mellitus and Insipidus
6. Epilepsy
7. Hypertension
8. Influenza, Cough and Cold
9. All Psychiatric or Psychosomatic Disorders

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 17
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

10. Pyrexia of unknown Origin for less than 10 days ii. The maximum liability per pregnancy (delivery/termination)
11. Tonsillitis and Upper Respiratory Tract Infection including will be subject to the specified sub-limit as shown in the Policy
12. Arthritis, Gout and Rheumatism Schedule/ Certificate of Insurance and may be claimed by the
eligible Insure Person(s) under the Policy to cover the
A.9 Bariatric Surgery Maternity Expenses up to three living children including IUD,
We will indemnify the Reasonable and Customary Charges for Medical irrespective of number of deliveries, unless the Maternity Sum
Expenses incurred towards Surgical Procedure for obesity, subject to Insured is enhanced by Multiplier option
below conditions: iii. Multiplier benefit for maternity shall provide enhanced
Eligibility: coverage as Specified in Policy schedule/ Certificate of
For adults aged 18 years or older, presence of severe obesity Insurance for multiple births (Twins, Triplets & etc), if opted.
documented in contemporaneous clinical records, defined as any of the
following: iv. Any treatment related to the complication of pregnancy or
Body Mass Index (BMI); termination will be treated within the maternity limits unless
specifically Specified as over and above the maternity limits up
a. Greater than or equal to 40 or to the limits specified in the Policy Schedule/Certificate of
b. Greater than or equal to 35 in conjunction with any of the Insurance.
following severe co-morbidities following failure of less invasive v. The expenses related to medically recommended lawful
methods of weight loss: termination of pregnancy shall be covered but only in life
1. Obesity-related cardiomyopathy threatening situation under the advice of Medical Practitioner
2. Coronary heart disease
3. Severe Sleep Apnoea vi. We will cover Reasonable and Customary Charges for Pre-
4. Uncontrolled Type 2 Diabetes natal Medical Expenses incurred on Hospitalisation prior to the
date of delivery and Reasonable and Customary Charges for
Conditions Postnatal Medical Expenses incurred on Hospitalisation
1. Bariatric surgery performed for Cosmetic reasons is excluded following the date of delivery provided for duration as
Specified in the Policy Schedule/ Certificate of Insurance.
2. The indication for the procedure should be found appropriate by
two qualified surgeons and the Insured shall obtain prior approval vii. SECTION NO. 3. B.15 (Code-Excl 18) of the Exclusions shall not
for cashless treatment from the Company. apply only to the extent that this Benefit is applicable
3. The expenses incurred for Bariatric surgery shall be limited to 20% viii. The claim admitted under this benefit will fall within the Base
of Base Sum Insured or as per the limits specified in Policy Sum Insured for the Policy Period. We shall not be liable to
schedule/ Certificate of Insurance. make any payment in respect of the following:
i. Expenses incurred in respect of the harvesting and storage
4. Standard Exclusion A. III. (Obesity / Weight Control) shall not be of stem cells when carried out as a preventive measure
applicable to the extent of Sum Insured covered under this against possible future Illnesses;
benefit. ii. Medical Expenses for ectopic pregnancy will be covered
B.4 Modification of Inpatient care under Alternative Treatment: under Section 2 A.1 (Inpatient Care) and shall not fall under
If You avail this option, Alternative Treatment under section 2 A.7 will this Benefit.
stand modified as Specified under the Schedule of Coverage in the iii. Section 2 B.29 Sum Insured Reinstatement shall not be
Policy Schedule/Certificate of Insurance. applicable for claim under this benefit
All other terms and Conditions of the respective Section and Policy shall B.8 New Born Baby Cover:
remain unaltered.
We will indemnify the reasonable and customary charges for
B.5 Modification of Domiciliary Hospitalization: Medical Expenses incurred during the Policy Period, towards the
If You avail this option, Domiciliary Hospitalization under section 2 A.8 Medically Necessary Treatment of the New Born Baby for the
will stand modified as Specified under the Schedule of Coverage in the specified period from the date of delivery up to the Base Sum
Policy Schedule/Certificate of Insurance. Insured as specified in the Policy Schedule/ Certificate of Insurance.
All other terms and Conditions of the respective Section and Policy shall
remain unaltered. Conditions:
B.6 Modification of Bariatric Surgery i. A New Born Baby older than the eligible number of days of
If You avail this option, Bariatric Surgery under section 2 A.9 will stand coverage as Specified in the Policy Schedule/Certificate of
modified as Specified under the Schedule of Coverage in the Policy Insurance can be covered under the Policy as an Insured
Schedule/Certificate of Insurance. Person only by way of an endorsement or at the next Renewal,
All other terms and Conditions of the respective Section and Policy shall whichever is earlier, on payment of the additional premium (if
remain unaltered. applicable).
B.7 Maternity Expenses: ii. If this benefit is opted then claim under Section B.10 (Well
We will indemnify the reasonable and customary charges for Medical Baby Cover for New Born) shall not be payable.
Expenses incurred towards Medically Necessary Treatment of the iii. Any claim admitted under this Section shall reduce the Base
Insured Person in case of normal delivery, routine or elective Caesarean Sum Insured as opted and Specified in Policy Schedule/
or Maternity related Complications including Pre-natal Medical Certificate of Insurance.
Expenses and Post-Natal check-ups and miscarriage during the Policy
Period. B.9 Child Vaccination Cover:

Conditions: We will indemnify the reasonable and customary charges for

This Benefit is available only if expenses incurred during the Policy Period on vaccination of the
child till he/she completes 12 years of age, provided that the new
i. The Insured Person in respect of whom a claim for Maternity born/ child is covered as an insured person under the policy.
Expenses is made must have been covered as an Insured Person
since the inception of the First Policy with Us for at least the Conditions:
period of continuous coverage as specified in the Policy Schedule/
Certificate of Insurance of, with maternity as a Benefit.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 18
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

i. Coverage of the Baby on birth shall be subject to the addition of ‘Certificate of Essentiality/Infertility’ as recommended in THE
the Baby as an Insured Person under the Policy by way of an SURROGACY (REGULATION) ACT, 2021.
endorsement or at the next Renewal whichever is earlier on ii. The medical condition that necessitates this option and should be
payment of the requisite premium. confirmed by a Registered Medical Practitioner
ii. This benefit shall cover the charges for the vaccines of the Insured iii. Insured Person(s) has repeatedly failed to conceive after multiple
child during the Policy Period which are listed by the Ministry of IVF/ICSI attempts (Recurrent implantation failure) or has medical
Health and Family welfare under National Immunization Schedule. conditions as absent uterus or missing uterus/or abnormal uterus
iii. Expenses can be claimed under this Section on a Reimbursement (like hypoplastic uterus/intrauterine adhesions/thin
basis only and could be within or above Base sum insured or as endometrium/small uni-cornuate uterus, Tshaped uterus) or the
opted and specified in the Policy Schedule/Certificate of uterus is surgically removed due to any medical conditions as
Insurance. gynecological cancers or Multiple pregnancy losses resulting from
an unexplained medical reason or any illness that makes it
Section 3 C.11 of Specific Exclusions shall not apply only to the extent
impossible for woman to carry a pregnancy.
that this Benefit is applicable.
iv. The Insured shall be a legally married Indian man and woman,
B.10 Well Baby Cover for New Born:
and shall not have any previous biological, adopted, or surrogate
We will indemnify the Reasonable and Customary charges for the child.
necessary Expenses incurred during the Policy Period, towards the new
v. Claim under Surrogacy for commercial purpose shall be excluded.
born baby’s well-being after birth and before discharge from the
hospital. These expenses include doctor check-up and any other check- vi. Pre and Post natal expenses shall be covered up to the limits as
up / tests performed to ensure that the baby is well at birth. mentioned under maternity benefit
Conditions: vii. Our maximum liability for this cover shall be as per the limit
Specified in Policy Schedule/ Certificate of Insurance.
i. The claim admitted under this benefit will fall within the Base Sum
Insured for the Policy Period. B.13 Accident Multiplier
B.11 Stem Cell Preservation Cover We will enhance the Base Sum Insured under Section 2 A.1 (Inpatient
Care) as per the Multiplier opted and specified in Policy Schedule /
We will indemnify the Reasonable and Customary charges related to
Certificate of Insurance to indemnify Insured Person towards,
Expenses incurred during the Policy Period, in respect to testing,
Reasonable and Customary Medical Expenses incurred for In-patient
processing and storage of the umbilical cord blood for one episode of
Hospitalization Treatment resulting from an Accident.
pregnancy in the Policy Period
The Expenses claimed under this Section could be within the Base Sum B.14 Emergency Ground Ambulance
Insured as per limit specified in Policy schedule /Certificate of Insurance We will indemnify the Insured Person up to the amount specified in the
or within the Maternity Sum Insured as opted. Policy Schedule/Certificate of Insurance, per Hospitalization, for
Conditions: expenses incurred on availing Road Ambulance services offered by a
Hospital or by an Ambulance service provider.
The cover can be opted only if Section B.7 (Maternity expenses) is opted
under the policy or as required by the Insured Person. Conditions:
The claim under this benefit shall be payable only once during the Policy We will reimburse payments under this Benefit provided that
Period.
Our maximum liability for this cover shall be as per the limit specified in i. The medical condition of the Insured Person requires immediate
Policy Schedule/ Certificate of Insurance. ambulance services from the place where the Insured Person is
Injured or is suffering from an illness to a Hospital where
B.12 Infertility Cover and Surrogacy Cover
appropriate medical treatment can be obtained or from the
We will indemnify the Medical Expenses related to any type of existing Hospital to another Hospital as advised by the treating
contraception, sterilization, reversal of sterilization, Gestational Medical Practitioner in writing.
Surrogacy, Assisted Reproduction services including artificial
ii. The ambulance service is offered by a healthcare or Registered
insemination and advanced reproductive technologies such as IVF, ZIFT,
Ambulance Service Provider.
GIFT, ICSI. This cover will be applicable for both Male and Female
Insured Persons covered under the policy. iii. The original Ambulance bills and payment receipt is submitted to
Section 3 B.14 (Code-Excl 17) of the Exclusions shall not apply only to Us.
the extent that this Benefit is applicable. iv. We have accepted a claim under Section 2 A.1 (Inpatient Care)
Specific Conditions applicable to ART above in respect of the same period of Hospitalization or A.3 (Day
Care Treatment) or A.6 (Modern Treatment) or A.7 (Inpatient Care
i. Under Assisted Reproduction technology if advised and under Alternative Treatment) or B.3 (Modification of Modern
necessitated by a registered Medical Practitioner, We will also Treatment) or B.4 (Modification of Inpatient Care under
cover the medical expenses of oocyte donor during the process of Alternative Treatment) or B.7 (Maternity Expenses) or B.8 (New
oocyte retrieval as per the provisions of Assisted Reproductive born Baby Cover) or B.10 (Well Baby Cover for New Born).
Technology (Regulation) Act, 2021.
v. We will not make any payment under this Benefit if the Insured
ii. Our maximum liability for this cover shall be as per the limit Person is transferred to any Hospital or diagnostic center for
Specified in Policy Schedule/ Certificate of Insurance. evaluation purposes only.
iii. The cover can be opted only if Maternity expenses benefit is
B.15 Air Ambulance Cover
opted under the policy.
We will indemnify the Insured Person up to the amount specified in the
Specific Conditions applicable to Surrogacy: Policy Schedule/Certificate of Insurance, per Hospitalization, for
i. To claim under this benefit, the Insured person must provide a expenses incurred on availing Air Ambulance services during the Policy
Period.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 19
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Conditions: v. Any Orthotics, which means devices that are designed to support
i. The medical condition of the Insured Person requires immediate a weakened body part shall not be covered.
ambulance services from the place where the Insured Person is vi. Our maximum liability for this cover shall be as per the limit
Injured or is ill to a Hospital where appropriate medical treatment specified in Policy Schedule/ Certificate of Insurance.
can be obtained or from the existing Hospital to another Hospital
vii. Section 3 C.7 (Specific Exclusions) shall not apply only to the
as advised by the treating Medical Practitioner in writing
extent that this Benefit is applicable.
ii. The ambulance service is offered by a healthcare or Registered
Ambulance Service Provider. B.17 Convalescence Benefit

iii. Our maximum liability for this cover shall be as per the limit We shall pay lump-sum amount per hospitalization, during the Policy
specified in Policy Schedule/ Certificate of Insurance. Period if the Insured Person suffers an Injury due to an Accident, and
that Injury solely and directly results in hospitalization of the Insured
iv. Expenses under this benefit shall be payable on reimbursement Person under Section 2 A.1 (Inpatient Care) for more than 7 consecutive
basis subject to the original Ambulance bills and payment receipt and continuous days in the hospital,
submitted to Us. This benefit will be over and above the Base Sum Insured.
v. The Origin and Destination of Air Ambulance Service are within Our maximum liability for this cover shall be as per the limit specified in
the geographical boundaries of Republic of India Policy Schedule/ Certificate of Insurance.
vi. Such Air Ambulance should have been duly licensed for operation B.18 Funeral and Repatriation Cover
by the Competent Authorities of the Government of India. In the event of death of the Insured Person We will indemnify
vii. We have accepted a claim under Section 2 A.1 (Inpatient Care) or reasonable and customary charges towards funeral and Repatriation
A.3 (Day Care Treatment) . expenses including transportation of mortal remains of the Insured
Person from the place of the incident or the Hospital to his/her
viii. The transportation should be provided by medically equipped residence.
aircraft which can provide medical care in flight and should have
medical equipment vital to monitoring and treating the Insured Conditions:
Person suffering from an Illness/Injury such as but not limited to i. Expenses can be claimed under this Section on a Reimbursement
ventilators, ECGs, monitoring units, CPR equipment and basis only.
stretchers.
ii. We have accepted claim under Section 2 (Hospitalization Cover)
B.16 Prosthetics Cover
iii. Our maximum liability for this cover shall be as per the limit
We will indemnify reasonable and customary charges for expenses specified in Policy Schedule/ Certificate of Insurance.
incurred on installation of an external Prosthetics if required by an
iv. Any claim admitted under this Section shall reduce the Base Sum
Insured Person as a result of Injury/ Illness during the Policy Period that
Insured for the Policy Period.
solely and directly results in physical loss of limb(s) within the Policy
Period. Conditions:
For the purpose of this Benefit,
i. The medical condition of the Insured Person requires immediate
1. Prosthetics means the articles or equipment that replaces all or a ambulance services from the place where the Insured Person is
part of a limb where limb is defined as the arm / the leg of a Injured or is ill to a Hospital where appropriate medical treatment
person, can be obtained or from the existing Hospital to another Hospital
as advised by the treating Medical Practitioner in writing
2. External prosthetics would mean the following external
prosthesis: - ii. The ambulance service is offered by a healthcare or Registered
a) Transradial prosthesis: It is the artificial prosthesis limb Ambulance Service Provider.
which replaces the missing arm from under the elbow with iii. Our maximum liability for this cover shall be as per the limit
an artificial limb. specified in Policy Schedule/ Certificate of Insurance.
b) Transhumeral prosthesis: It is the artificial prosthesis limb iv. Expenses under this benefit shall be payable on reimbursement
that replaces the missing arm above the elbow. basis subject to the original Ambulance bills and payment receipt
c) Transtibial prosthesis: It is the artificial prosthesis limb submitted to Us.
which replaces a missing leg, right below the knees. v. The Origin and Destination of Air Ambulance Service are within
d) Transfemoral prosthesis: It is the artificial prosthesis limb the geographical boundaries of Republic of India
which replaces the missing leg above the knees. vi. Such Air Ambulance should have been duly licensed for operation
Conditions: by the Competent Authorities of the Government of India.

i. We have accepted a claim under Section 2 A.1(Inpatient Care) or vii. We have accepted a claim under Section 2 A.1 (Inpatient Care) or
A.3(Day Care Treatment) above. A.3 (Day Care Treatment) .

ii. Medical Expenses can be claimed under this Section on a viii. The transportation should be provided by medically equipped
Reimbursement basis only. aircraft which can provide medical care in flight and should have
medical equipment vital to monitoring and treating the Insured
iii. The permanence of total and irreversible loss of limb shall be Person suffering from an Illness/Injury such as but not limited to
proved with a disability certificate issued by a Medical ventilators, ECGs, monitoring units, CPR equipment and
Practitioner stretchers.
iv. Any repairs or replacement of the Prosthetic which is implanted
B.19 Compassionate visit
during the Policy Period or which was an already existing
prosthetic previous to purchase of policy will not be covered We will indemnify the reasonable and customary charges for expenses

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 20
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

incurred in respect of travel of one Immediate Family member of the B.8(New born Baby Cover) or B.10(Well Baby Cover for New Born) or
Insured Person to the place of Hospitalization of the Insured Person, if B.32. (Home Health Care) due to any illness/ injury, there will be zero
an Insured Person suffers an Injury or an Illness during the Policy Period deductions applicable for such hospitalization expenses
that solely and directly results in the Insured Person's Hospitalization for
i. The eligibility of the Insured Person under this Benefit and the
more than seven (7) continuous and consecutive days.
specified limit / frequency of health check-ups will be as
Conditions: specified in the Policy Schedule/Certificate of Insurance.
i. Expenses can be claimed under this Section on a Reimbursement ii. This benefit is available once per Insured Person during the
basis only, provided we have accepted a claim under Section 2 Policy Period
A.1(Inpatient Care)
B.23 Sub-limit on Specified Illness/Conditions:
ii. We will reimburse two-way airfare/road transport in a licensed
If an Insured Person is Hospitalized during the Policy Period for any of
carrier or two-way railway tickets for the travel of the companion
the Specified Illnesses or Conditions then it is agreed that Our
to the place of Hospitalization of the Insured Person.
maximum liability in respect of any claim made under the Policy for the
iii. Our maximum liability for this cover shall be as per the limit entire Policy Period will be subject to the list of illnesses/ sublimits/
specified in Policy Schedule/ Certificate of Insurance. waiting periods as specified in Policy Schedule/Certificate of Insurance.
B.20 Accompanying Person Cover: Conditions:
If an Insured Person suffers an Injury or an Illness during the Policy Any claim admitted under this shall reduce the Base Sum Insured for
Period that solely and directly results in the Insured Person's the Policy Period.
Hospitalization, We will pay per day amount as specified in Policy
B.24 Loyalty Credit
Schedule/ Certificate of insurance towards the accompanying person.
If the Insured Person's renews his Policy with us without any break,
Conditions
then for each successive renewal, We will increase the Base Sum
i. We have accepted a claim under Section 2 A.1 (Inpatient Care) Insured under the renewed Policy/Certificate of Insurance by an opted
percentage of Base Sum Insured. The Sum Insured increase will be
ii. Our maximum liability for this cover shall be as per the limit
limited to 100% of Base Sum Insured.
chosen subject to completion of 1/2/3 days of continuous and
consecutive hospitalization as opted and specified in the Policy Conditions:
Schedule/Certificate of Insurance. i. If the Base Sum Insured has been reduced at the time of renewal,
iii. The claim pay-out under the benefit shall be limited to maximum the applicable Loyalty Credit shall be reduced in the same
20 days of hospitalization. proportion to the Base Sum Insured.
iv. For the purpose of this Benefit Immediate Family means any one ii. If the Base Sum Insured under the policy has been increased at
of the relationships with the Insured Person: spouse, father, the time of renewal, the Loyalty Credit shall be calculated on the
mother, legal guardian, father-in-law, mother-in-law, brother, Base Sum Insured of the last completed Policy Period.
sister-in-law, sister, brother-in-law, son or daughter. iii. The sub-limits applicable to various benefits shall remain the
B.21 Health Check-up: same and shall not increase proportionately.
The Insured Person can avail preventive Health check-up anytime B.25 Weekly Benefit:
during the Policy Period .
If the Primary Insured Person suffers from any illness or injury which
Conditions: occurs during the Policy Period resulting in hospitalisation extending
i. The eligibility of the Insured Person under this Benefit and the beyond 15 continuous and consecutive days and which solely and
specified limit / frequency of health check-ups will be as specified directly results in the Insured Person's temporary inability to go to
in the Policy Schedule/Certificate of Insurance. work, then we will pay up to the limits as specified in the Policy
Schedule/Certificate of Insurance.
ii. This benefit is available once per Insured Person during the Policy
Period Conditions:
i. We have accepted a claim under Section 2 A.1 (Inpatient Care)
iii. Irrespective of individual or floater policy this benefit shall be
available on individual basis. ii. We will make payment under Section B.25 (Weekly Benefit) for
only a part of the week if the Insured Person has suffered
iv. Any unutilized test or amount under this cover in a Policy Period
Temporary inability for that part of the week.
cannot be carried forward to the next Policy Period.
iii. The Medical Practitioner has certified in writing that the Insured
v. Health checkup will be provided at Our wellness partner or
Personal is temporarily unfit to work with specified period of
empaneled Diagnostic Centers on Cashless basis.
recovery.
vi. The claim admitted under this benefit will fall within the Base
iv. Our maximum liability to pay the claim under this benefit shall
Sum Insured for the Policy Period.
be limited to the limits specified in Policy Schedule/Certificate of
B.22 Zero deductions in claim in case of death of Insured Insurance, provided in any case the payment for weekly benefit
In the event of death of Insured Person during hospitalization period shall not exceed 100 continuous and consecutive weeks and
where claim is admissible under Section 2 A.1 (Inpatient care) or A.3 opted Sum Insured under this benefit.
(Day Care) or or A.6 (Modern Treatment) or A.7 (Inpatient care under v. The payment under this benefit shall be payable only after the
Alternative Treatment) or A.8(Domiciliary Hospitalization) or B.3 exhaustion of official leaves of that particular Insured Person or
(Modification of Modern Treatment) B.4 (Modification of Inpatient as specified in the policy schedule, provided the confirmation
Care under Alternative Treatment) or B.7(Maternity Expenses) or from the Employer of Primary Insured Person is mandatory.
B.8(New born Baby Cover) or B.10(Well Baby Cover for New Born) or
vi. This claim payment under this benefit is over and above the base
B.32. (Home Health Care) due to any illness/ injury, there will be zero
Sum Insured.
deductions applicable for such hospitalization expenses

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 21
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

vii. For the purpose of this benefit, Primary Insured Person shall mean B.29 Sum Insured Reinstatement
the person covered as Self under the policy.
In the event of complete exhaustion of the Base Sum Insured due to
For the purpose of this benefit “Week” is a period of seven
any claim admitted during the Policy Period, We shall restore the Sum
consecutive days
Insured up to the limit of Base Sum Insured. (as applicable under the
Note: In the event of a dispute arising as to when Temporary current Policy Period)
enablement ceased, a Physician commissioned by the Us shall finally
Conditions:
determine the date.
i. For a claim to be admissible under this benefit it should be
B.26 Voluntary Co-payment admissible under the Benefit- 2A.1 Inpatient Care.
Under this benefit, the Insured Person will pay the pre-determined ii. The Reinstated Sum Insured will be applicable only after the Base
percentage as specified in the Policy Schedule/ Certificate of Insurance Sum Insured have been completely exhausted in that Policy
as Voluntary Co-Payment on each and every claim. Period;
Conditions: iii. The Reinstatement of Sum Insured shall be applicable only on
i. If opted, Voluntary Co-payment will be applicable on the covers as subsequent claim.
specified in the Policy Schedule/Certificate of Insurance unless For Reinstatement of Sum Insured, the amount reinstated shall be
agreed otherwise. equivalent/ limited to the Base Sum Insured or multiples of Base
iv.
ii. Voluntary Co-payment will be applied in addition to the existing Sum Insured as specified in Policy Schedule/ Certificate of
co-payment if any. Insurance.
B.27 E-Opinion v. The Reinstatement of Sum Insured will be applied only once
during the Policy Period.
Under this benefit, the Insured Person may avail E-Opinion on his/her
medical condition occurring during the Policy Period from a Medical vi. The unutilized Reinstated Sum Insured it shall not be carried
Practitioner from our empanelled network. forward to any subsequent Policy Period.
Condition: vii. The reinstatement of Sum Insured shall be provided on both
related or unrelated illness/injury on subsequent claim.
It is agreed and understood that the E- Opinion will be based only on the
information and documentation provided to Us, which will be shared viii. The sequence of utilization of Reinstated Sum Insured will be as
with the Medical Practitioner and is subject to the conditions specified below:
below:
a. Base Sum Insured followed by;
i. The Insured Person may have an option to choose E-Opinion from b. Loyalty Credit (if any) followed by;
the list of Specialist as provided by Us on Our Website/App from
our empaneled network. c. Accident Multiplier (if opted and in case of accident/injury)
followed by
ii. It is agreed and understood that Insured Person is free to choose
whether or not to obtain the expert opinion, and if obtained then d. Sum Insured Reinstatement
whether or not to act on it.
B.30 Claim settlement in network only
iii. Appointments to avail this benefit shall be requested through Our
Website/App or by calling Our call center on the toll-free number Under this benefit the coverage provided to the Insured Person shall be
s applicable if an Insured Person is Hospitalized in a Network Hospital
only. The coverage would be as per the terms and conditions specified
iv. Under this benefit, We are only providing You with access to an E- in Policy Schedule/ Certificate of insurance.
opinion and We shall not be deemed to substitute Your visit or
consultation to an independent Medical Practitioner Conditions:
v. The E-Opinion provided under this benefit is not for emergency Any hospitalisation treatment taken at Non-Network Provider shall not
care and shall not be valid for any medico legal purposes. be covered under this Policy
vi. We do not assume any liability towards any loss or damage arising B.31 Claim settlement on Reimbursement only
out of or in relation to any opinion, advice, prescription, actual or Under this benefit, if the Insured Person is hospitalised the claim
alleged errors, omissions and representations made by the settlement shall be carried out on Reimbursement basis only, subject
Medical Practitioner. to Terms and Conditions as specified in the Policy Schedule/Certificate
B.28 Corporate Floater of Insurance.

Under this benefit, in case the Base Sum Insured under the policy gets Conditions:
exhausted, then additional Sum Insured would be available to the i. Any delay in notification or submission may be condoned on
Insured Persons during the Policy Period, subject to Terms and merit where delay is proved to be for reasons beyond the control
Conditions as specified in the Policy Schedule/Certificate of Insurance. of the Insured Person.
The individual or floater Base Sum Insured would be first exhausted
Any claim initiated for a cashless payment or claims that are
followed by the corporate floater amount which would be availed as
beyond the reimbursement timelines specified in the Policy
per the eligibility criteria and up to the limits as specified in the Policy ii.
Wordings shall not be covered unless the delay is proved for the
Schedule/Certificate of Insurance.
reason beyond the Insured Person(s) control.
Conditions:
B.32 Physiotherapy and Rehabilitation cover
i. Any unutilized Sum Insured accrued under this cover shall not be
carried forward to the subsequent Policy Period. We will indemnify the reasonable and customary charges for Medical
Expenses incurred during the Policy Period for physiotherapy and
ii. All other terms, exclusions and conditions contained in the Policy rehabilitation of the Insured Person for physical therapies aimed at
or endorsed thereon remains unchanged.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 22
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

restoring Insured Person's normal physical function as prescribed by the Care) and/or A.3 (Day Care) hospitalization due to Cancer of the
treating Medical Practitioner(s) in writing. Insured Person during the Policy Period.
Our maximum liability for this cover shall be as per the limit as specified
i. The Physiotherapy and Rehabilitation is Medically Necessary
in Policy Schedule/ Certificate of Insurance subject to exhaustion of
Treatment.
Waiting Period as opted for this cover.
ii. This benefit is over and above the base Sum Insured.
B.37 Attendant Charges Cover
iii. Our maximum liability for this cover shall be as per the limit/
If this cover is opted, We will pay a fixed weekly benefit amount for
number of days as specified in Policy Schedule/ Certificate of
actual number of weeks if an Attendant/ Registered Nurse is engaged
Insurance.
to take care of the Insured Person following hospitalisation subject to
For the purpose of this cover Rehabilitation means a treatment or maximum number of weeks and Sum Insured limit per week.
treatments designed to facilitate the process of recovery from injury,
Conditions:
illness, or disease to as normal a condition as possible. Only the
rehabilitation services provided by a certified medical practitioner will Cover under this benefit can be availed only if recommended by
be considered. Medical Practitioner stating reason for providing Attendant Care/
B.33 Home Health Care Nursing Care at Home.
We will cover the reasonable and customary charges towards Medical i. The benefit will be paid for maximum up to 25 weeks per Policy
Expenses incurred for Home Health Care Services during the Policy Period.
Period availed through empanelled Service Provider on Cashless Facility ii. The claim is triggered due to a prior Hospitalization within
basis, only if the following conditions are fulfilled: preceding 30 days
Conditions: iii. Claim under this benefit shall be paid only if we have accepted a
i. The treatment in normal course would require In-patient Care at a Claim for Section 2 A.1 (In-patient Care) .
Hospital, and be admissible under Section 2 A.1 (Inpatient Care) iv. SECTION NO.3.B.2(Code- Excl 05) of the Exclusions shall not apply
but is actually taken while confined at home. only to the extent that this Benefit is applicable.
ii. The benefit shall not be available for any emergency treatment v. The Insured Person is unable to perform 3 out of below 6
/care. activities due to illness / injury resulting from preceding
iii. The Treatment is availed from the Company’s empanelled service Hospitalization.
provider as per procedure given under “Section 4-B, III - a) Washing: the ability to wash in the bath or shower (including
Conditions when a claim arises” getting into and out of the shower) or wash satisfactorily by
iv. Records of the treatment administered, duly signed by the other means and maintain an adequate level of cleanliness
treating Medical Practitioner, are maintained for each day of the and personal hygiene.
Home treatment. b) Dressing: the ability to put on, take off, secure and unfasten
all garments and, as appropriate, any braces, artificial limbs
v. This Cover is not available on reimbursement basis,
or other Surgical Appliances.
B.34 Non-medical/Consumables Expenses c) Transferring: the ability to move from a lying position in a
If We have accepted a claim under hospitalization cover, then the items bed to a sitting position in an upright chair or wheel chair
which are not payable as per List I- ‘Expenses not covered’ under and vice versa.
Annexure II related to that particular claim will become payable. d) Toileting: the ability to use the lavatory or otherwise
Conditions: manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene.
i. Such Non-Medical/Consumables items are prescribed by the
treating Medical Practitioner and are medically necessary for the e) Feeding: the ability to feed oneself, food from a plate or
treatment of the same condition for which Insured Person has bowl to the mouth once food has been prepared and made
taken In-Patient Care (2.A.1) or Day Care Treatment (2.A.3) and available.
ii. We have accepted a claim under Section 2.A.1 to 2.A.9 f) Mobility: the ability to move indoors from room to room on
level surfaces at the normal place of residence.
B.35 External Congenital Anomalies
vi. Our maximum liability for this cover shall be as per the limit
We will indemnify the Reasonable and Customary Charges for medical specified in Policy Schedule/ Certificate of Insurance and any
expenses incurred for “Inpatient Care” up to the Base Sum Insured claim admitted under this section shall fall within the Base Sum
unless restricted by "Sub-limit on specified illness / conditions” towards Insured.
treatment for External Congenital Anomalies causing functional
disability. B.38 De-addiction Expenses Cover
Conditions: We will indemnify Reasonable and Customary In-patient expenses
related to De-addiction treatment for Alcohol, Drug and Substance
iii. If the treatment is taken only for aesthetic / cosmetic appearance
Abuse, provided, the Insured Person(s) treatment is carried out by a
without any positive effect or restoration of physiological
registered and specialised Medical Practitioner in a Government
function, such claims shall not be payable.
Registered Rehabilitation Hospital.
iv. Any claim admitted under this section shall fall within the Base
Conditions:
Sum Insured.
i. To claim under this benefit Pre-authorization from Us is
B.36 Cancer Care
mandatory.
We will enhance the Base Sum Insured as per the percentage specified
ii. SECTION 3 B.9(Code- Excl 12) of the Exclusions shall not apply
in Policy Schedule/Certificate of Insurance to cover the Reasonable and
only to the extent of this Benefit.
Customary Medical Expenses incurred for the Section 2.A.1 (In-Patient

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 23
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

iii. Any claim admitted under this section shall fall within the Base Conditions:
Sum Insured.
i. If opted, Franchise will be applicable on the covers as specified in
iv. Our maximum liability for this cover shall be as per the limit the Policy Schedule/Certificate of Insurance unless agreed
specified in Policy Schedule/ Certificate of Insurance subject to otherwise.
exhaustion of waiting period as opted for this cover
B.45 Vision Correction
v.
We will indemnify for Reasonable and Customary Medical Expenses
B.39 Modification of Home/Vehicle incurred by the Insured Person for Laser-Assisted In Situ Keratomileusis
(LASIK) Surgery, including refractive keratotomy (RK) and
Under this benefit, We will indemnify the reasonable expenses incurred
photorefractive keratectomy (PRK) or any other advanced Surgical
to modify the Insured Person’s residence and/or vehicle on the written
Procedures conducted to correct the refractive errors beyond +/- 4.5
advice of the treating Medical Practitioner, provided such modification
dioptre to rectify the refraction of one or both eyes.
is necessitated as a result of disability to the Insured Person, arising out
of Accident during the Policy Period. Conditions:
Conditions: i. Our maximum liability for this cover shall be as per the limit
i. We have accepted a claim under section A.1 (Inpatient Care) or specified in Policy Schedule/ Certificate of Insurance.
A.3 (Day Care) ii. We will not be liable to make any payment in respect of any
ii. The modifications have been carried out in India and certified by a other non-Surgical Procedures.
Medical Practitioner iii. SECTION 3.B.12 (Code-Excl 15) of the Exclusions shall not apply
iii. Any claim admitted under this section shall fall within the Base to the extent that this Benefit is applicable
Sum Insured. B.46 Per claim deductible
B.40 Expenses for External Aids and Medical Equipment For any admissible claim amount, the Insured Person shall bear an
We will reimburse the reasonable and customary expenses incurred by amount equal to the Per Claim Deductible amount as opted and
the Insured Person for medical equipment/ external aids that may be specified in the Policy Schedule/ Certificate of Insurance.
required for normal day to day activities to be carried out in a Per Claim deductible shall be applicable on each and every claim made
convenient and safe manner post hospitalization resulting from an by the Insured Person under Section No.2 (Hospitalization Cover).
accident/ illness subject to acceptance of claim under Section A.1 The Per Claim deductible shall be applicable only on indemnity based
(Inpatient Care) or A.3 (Day care) benefits.
Voluntary Co-payment/Franchise (if any) shall be applicable on this
Conditions: benefit.
i. The condition and use of medical equipment or external Aids shall B.47 Gender Reassignment Cover
be certified by a treating Medical Practitioner, to be necessary
and directly required as a result of the Accident/illness. We will indemnify for Reasonable and Customary Medical Expenses
incurred for Gender Reassignment Treatment taken by Insured Person
ii. Our maximum liability for this cover shall be as per the limit during the Policy Period, up to the Sum Insured specified in the Policy
specified in Policy Schedule/ Certificate of Insurance Schedule/Certificate of Insurance.
iii. Any claim admitted under this section shall fall within the Base The following Treatment/Procedures shall be covered
Sum Insured i. Hormone Therapy: The treatment involves hormone therapy
B.41 Modification of Waiting period for Pre- Existing Diseases (PED) (administered either on an In-patient or outpatient basis) like
Testosterone (masculinizing hormones) for Trans Man (Female to
If you avail this option the pre -existing waiting period stands modified Male) and estrogen (feminizing hormones) for Trans Woman
as specified in the Policy Schedule/Certificate of insurance. All other (Male to Female).
terms and condition of respective policy section shall remain unaltered.
ii. Surgical Intervention including but not limited to below listed
B.42 Modification of Initial Waiting Period procedures
If you avail this option the waiting period stands modified as specified • Genital surgery for Male-to-Female transsexuals
in the Policy Schedule/Certificate of insurance. • Genital surgery for Female-to-Male transsexuals
All other terms and condition of respective policy section shall remain Condition applicable to Gender Re-assignment Treatment.
unaltered.
Conditions:
B.43 Modification of Waiting Period for Diseases Specific Exclusions
i. Coverage in the policy would be as per the WPATH(World
If you avail this option the waiting period for Specific Diseases stands Professional Association for Transgender Health) protocol
modified as specified in the Policy Schedule/Certificate of insurance. subject to applicable Indian Laws.
All other terms and condition of respective policy section shall remain
unaltered. ii. This include (but not restricted to) primary care, gynecologic and
urologic care, reproductive surgery options, voice related
B.44 Franchise surgeries and communication therapy, mental health support
For any admissible claim, the Insured Person shall bear an amount services (e.g., assessment, counselling, psychotherapy), and
equal to the Franchise amount as opted/specified in the Policy hormonal and surgical treatments.
Schedule or Certificate of Insurance, and in case the admissible claim iii. Active Line of Treatment would not be applicable for this
amount exceeds the opted/specified Franchise amount then We will treatment.
indemnify the admissible claim amount (without deducting Franchise
amount, specified in the Policy Schedule/Certificate of Insurance). iv. SECTION 3.B.4(Code- Excl07) of the Exclusions shall not apply only
to the extent that this Benefit is applicable

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 24
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

B.48- Wellness Care ii. It is agreed and understood that You are free to choose whether
or not to obtain the expert opinion, and if obtained then whether
Under this benefit, The Insured Person may avail wellness services as
or not to act on it.
opted. The services may include any or all programs/services intended
to maintain, improve, promote health and fitness of the Insured Person. iii. Appointments to avail this benefit shall be requested through Our
The wellness services offered shall be in compliance to the guidelines Website/App or through calling Our call center on the tollfree
issued from IRDAI from time to time. number specified in the Policy Schedule/Certificate of insurance.
The Wellness care program includes but not limited to Health Assistance iv. Under this benefit, We are only providing You with access to a
(A.I. Personal Fitness coaching), Dietician and Nutrition Econsultation, Second Medical Opinion and We shall not be deemed to
weight loss management programs etc as provided by our Network substitute Your visit or consultation to an independent Medical
Providers. Practitioner
The Insured can avail the wellness care benefits as specified in the Policy
Schedule/Certificate of Insurance, v. The Second Medical Opinion provided under this benefit is not for
emergency care and shall not be valid for any medico legal
Conditions: purposes.
i. The services will be provided through an empanelled Service vi. We do not assume any liability towards any loss or damage arising
Provider. It is entirely for the Insured Person to decide whether to out of or in relation to any opinion, advice, prescription, actual or
obtain these services. alleged errors, omissions and representations made by the
ii. We shall not be responsible for any disputes arising between the Medical Practitioner.
Insured Person and the Service Provider. SECTION D- COMMON DISEASE COVER
iii. The services provided under this benefit, does not constitute We will indemnity Reasonable and Customary charges for Medical
medical advice of any kind and it is not intended to be, and should Expenses incurred if Insured Person is Hospitalized on the advice of a
not be, used to diagnose or identify treatment for a medical or Doctor/ Medical Practitioner for non-surgical treatment due to Disease /
mental health condition. Illness / Infection(s) (listed as below) contracted during the Policy
SECTION C- OUT PATIENT EXPENSES Period.
This benefit will be over and above the Base Sum Insured.
C.1 OPD Cover
Disease List
Conditions:
i. Dengue fever ii. Malaria
i. The Insured Person may purchase Pharmacies prescribed by a
Registered Medical Practitioner, as mentioned in the Policy iii. Lymphatic Filariasis iv. Kala azar
Schedule/Certificate of Insurance
v. Chikungunya fever vi. Japanese Encephalitis
ii. Our maximum liability for this cover shall be as per the limit/
vii. Zika virus viii. Avian influenza
terms and conditions as specified in Policy Schedule/ Certificate of
Insurance ix. HPV x. Mycobacterium Tuberculosis
iii. SECTION 3.C.14 (Specific Exclusions) of the Exclusions shall not xi. Enteric fever/ Typhoid fever
apply only to the extent that this Benefit is applicable.
For the purpose of this benefit, Common Diseases shall cover:
What is not covered under OPD Treatments
1.Dengue fever
Conditions:
a. Replacing any dental appliance which is lost or stolen. We will cover the medical expenses incurred for the Insured Person’s, in
case of being diagnosed with Dengue confirmed by a Medical
b. Plastic surgery or cosmetic surgery unless necessary as a part of Practitioner and hospitalization being absolutely necessary for more
Medically Necessary Treatment and certified in writing by the than 24 hours in addition to below specific conditions.
attending Medical Practitioner.
c. Cost of frames for the prescribed lenses. Specific conditions for this cover:
d. Sunglasses, unless medically prescribed by the treating Medical i. The laboratory examination result countersigned by a
Practitioner. pathologist/microbiologist must confirm Immunoglobulins/ PCR
Any lenses including contact lenses. test showing positive result for Dengue.

Under Out-Patient Expenses the below optional cover is available at ii. Indoor case papers should be obtained and the diagnosis of
an additional premium. admission should be Dengue in addition to the above.
C.2 Second Medical Opinion Cover 2. Malaria
Under this benefit the Insured Person may avail Second Medical
Opinion on his/her medical condition occurring during the Policy Period We will cover the medical expenses incurred for the Insured Person’s
as per the limits specified in the Policy Schedule/Certificate of hospitalization for more than 24 hours, in case of being diagnosed of
Insurance. Malaria, which should be confirmed by a Medical Practitioner with
confirmatory tests indicating presence of Plasmodium Falciparum/
It is agreed and understood that the Second Medical Opinion will be
Vivax/Malariae in the patient's blood by laboratory examination
based only on the information and documentation provided to Us,
countersigned by a pathologist/microbiologist in peripheral blood smear
which will be shared with the Medical Practitioner and is subject to the
or positive rapid diagnostic test (antigen detection test).
conditions specified below:
Specific conditions for this cover
Conditions:
i. A continuous Hospitalization of 24 hours should be absolutely
i. The Insured Person may have an option to choose Second necessary along with high fever and shaking chills.
Medical Opinion from the list of Specialist as provided by Us on
ii. Indoor case papers should be obtained and the diagnosis of
Our Website/App.
admission should be malaria and its complications, if any.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 25
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

3. Lymphatic Filariasis (Commonly known as Elephantiasis) 7. Zika Virus

We will cover the medical expenses incurred for the Insured Person’s
We will cover the medical expenses incurred for the Insured Person’s
hospitalization, in case of being diagnosed by a Medical Practitioner
hospitalization for more than 24 hours, in case of being diagnosed of
and the laboratory examination countersigned by a pathologist must
Zika virus disease characterised by mild fever, skin rash, conjunctivitis,
be documented with presence of microfilariae in a blood smear by
muscle and joint pain, malaise or headache.
microscopic examination and along with any two of the following
criteria:
Specific conditions for this cover:
• Lymphoedema,
i. A diagnosis of Zika virus infection should be confirmed by a
• Elephantiasis,
Medical Practitioner and by plaque-reduction neutralization
• Scrotal swelling
testing (PRNT).
Indoor case papers should be obtained and the diagnosis of admission
ii. PRNT is performed by CDC (Centers for Disease Control and
should be Filariasis in addition to the two of the above conditions.
Prevention) or a CDC-designated confirmatory testing
4. Kala-azar (also known as Visceral leishmaniasis) inconclusive IgM results.
We will cover the medical expenses incurred for the Insured Person’s iii. Indoor case papers should be obtained and the diagnosis of
hospitalization for more than 24 hours, in case of being diagnosed of admission should be Zika virus.
Visceral leishmaniasis, characterized by irregular bouts of fever,
substantial weight loss, swelling of the spleen and liver, and anaemia. 8. Avian Influenza
for more than 24 hours We will cover the medical expenses incurred for the Insured Person’s
Specific Conditions for this cover: hospitalization for more than 24 hours, in case of being diagnosed of
i. The diagnosis must be confirmed by a Medical Practitioner and Avian Influenza, characterised by flu, fever, body ache and confirmed
by parasite demonstration in bone marrow/spleen/lymph node by a Medical Practitioner and by the Specified Diagnostic test as below:
aspiration or in culture medium as the confirmatory diagnosis or Most common affecting variants: A(H5N1) and A(H7N9)
positive serological tests for Kala-azar should clearly indicate the Hospitalization must be necessary, Indoor case papers should be
presence of this disease. obtained and the diagnosis of admission should be Avian Influenza.
Exclusion:
ii. Indoor case papers should be obtained and the diagnosis of Patient affected by other than the Specified variant will not be
admission should be Kala-azar. payable.
5. Chikungunya Diagnostic Tests:
• Viral RNA detection by reverse transcriptase polymerase chain
We will cover the medical expenses incurred for the Insured Person’s reaction (RT-PCR) and real time RT- PCR assay- which confirms
hospitalization for more than 24 hours, in case of being diagnosed of the presence of listed affecting variants.
Chikungunya characterized by an abrupt onset of fever with Joint pain.
Other common signs and symptoms may include muscle pain, • Serological identification of antibodies against avian influenza A
headache, nausea, fatigue and rash. viruses- including the hemagglutination inhibition test (HI),
enzyme immunoassay (EIA), and virus neutralization tests (VN).
Specific conditions for this cover: 9. HPV
i. The diagnosis must be documented by a Medical Practitioner and
confirmed by Serological tests, such as enzyme-linked We will cover the medical expenses incurred for the Insured Person’s
immunosorbent assays (ELISA), confirming the presence of IgM hospitalization for more than 24 hours, in case of being diagnosed of
and IgG anti-chikungunya antibodies. Human Papilloma Virus infection characterised by warts in genital and
surrounding skin. A diagnosis of HPV infection should be confirmed by
ii. Indoor case papers should be obtained and the diagnosis of a Medical Practitioner and by the below Specified diagnostic tests.
admission should be Chikungunya. Hospitalization must be necessary, Indoor case papers should be
6. Japanese Encephalitis obtained and the diagnosis of admission should be Human Papilloma
Virus Infection.
We will cover the medical expenses incurred for the Insured Person’s Diagnostic Test:
hospitalization for more than 24 hours, in case of being diagnosed of • Pap test also known as Pap Smear test involving collection of a
Japanese encephalitis characterized by rapid onset of high fever, sample of cells from the cervix or vagina to send for laboratory
headache, neck stiffness, disorientation, coma, seizures, spastic analysis which would confirm the presence of Human Papilloma
paralysis. To confirm Japanese Encephalitis (JE) infection and to rule Virus.
out other causes of encephalitis requires a laboratory testing of serum
• DNA test conducted on the cells from insured`s cervix, should
or preferably cerebrospinal fluid.
confirm presence of the DNA of the high-risk varieties of HPV
that have been linked to genital cancers.
Specific conditions for this cover:
i. The diagnosis must be confirmed by a Medical Practitioner and 10. Mycobacterium Tuberculosis:
positive serological test for JE by immunoglobulin M (IgM)
antibody capture ELISA (MAC ELISA) for serum and cerebrospinal We will cover the medical expenses incurred for the Insured Person’s
fluid (CSF). hospitalization for more than 24 hours, in case of being diagnosed of
Mycobacterium Tuberculosis characterised by cough for 3 or more
ii. Indoor case papers should be obtained and the diagnosis of weeks and or symptoms like coughing up blood and mucus, chest pain,
admission should be Japanese Encephalitis. unintentional weight loss, fatigue, fever, nigh sweets and chills.

Specific conditions for this cover:

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
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i. Hospitalization must be necessary, Indoor case papers should be ii. The deductible under this benefit shall be applicable on no. of
obtained and the diagnosis of admission should be days of hospitalization, if opted and as specified in the Policy
Mycobacterium Tuberculosis. Schedule/Certificate of Insurance.
ii. A diagnosis of Mycobacterium tuberculosis should be confirmed iii. The benefit shall become payable only after the completion
by medical practitioner and by the below Specified diagnostic number of days of deductible, as opted and specified in the
tests. Policy Schedule/Certificate of Insurance.
Diagnostic Test: iv. Benefits under this Section shall be available on an individual
• The Mantoux tuberculin skin test (TST) basis up to the limits specified in the Policy Schedule/Certificate
• TB blood test i.e. Interferon Gamma Release Assay (IGRA) of Insurance.
• Chest radiography
• Sputum Microbiology examination: A positive culture for M. v. This cover is available on reimbursement basis only.
tuberculosis in microbiology report. Note:
Exclusion:
i. It is condition precedent if Section 2 is opted under the Policy,
Any TB other than pulmonary TB will not be covered.
then Claim under this benefit shall be payable if we have
11. Enteric fever / Typhoid Fever accepted the claim under Section 2.A.1 (In-patient Care)

We will cover the medical expenses incurred for the Insured Person’s ii. This benefit is over and above Sum Insured for Base Cover.
hospitalization for more than 24 hours, in case of being diagnosed of SECTION G- CRITICAL ILLNESS COVER
Typhoid fever/ Enteric Fever characterised by pain in abdomen and high
fever, persistent headache, abdominal discomfort, constipation, If an Insured Person is diagnosed with any of the below listed Critical
diarrhoea, weakness, dizziness, nausea and cough. Illness, during the Policy Period, then We will pay the Critical Illness
A diagnosis of Enteric fever / Typhoid Fever should be confirmed by a Sum Insured specified in the Policy Schedule/Certificate of Insurance
Medical Practitioner and by the below Specified diagnostic tests. provided that:
Diagnostic tests: i. The Critical Illness must have occurred or has manifested for the
• Widal test - Positive for presence of Salmonella Typhi first time for that particular Insured Person during the Policy
• ELISA test confirming S. Paratyphi, S. Typhi. Period, as a first incidence; and
• Blood culture confirming growth of Salmonella Typhi. ii. The Insured Person survives a default Survival Period of at least
Note: The Insured person shall be indemnified for the medical expenses 28 days or as opted and Specified under Policy Schedule/
under Section 2 A & B (Hospitalization Cover) and/or under Section 2 E Certificate of Insurance, from the date of Diagnosis of such
(Common Disease Cover) if both covers are opted. Critical Illness; and
iii. Upon Our admission of the first claim under this Section, in
SECTION E- SUPER TOP UP COVER (Annual Aggregate Deductible)
respect of an Insured Person in any Policy Period, the cover
During the Policy Period, We will indemnify hospitalization expenses up under this benefit shall automatically terminate in respect of that
to limits and in excess of aggregate deductible as specified in the Policy Insured Person;
Schedule/Certificate of Insurance.
iv. Irrespective of Individual or Floater Policy, this cover will be
Conditions: available on individual basis
i. The deductible under this benefit shall be applicable on annual v. Our total liability for an Insured Person under this Benefit will be
aggregate basis i.e will apply once in a Policy Period for all claims limited to the Critical Illness Sum Insured as specified in the
added together. Policy Schedule/Certificate of Insurance
ii. In case of family floater Policy, the annual aggregate Deductible vi. For the purpose of this Policy, Critical Illness means an illness,
shall be applicable on floater basis. sickness or a disease or a corrective measure as specifically
iii. Annual Aggregate Deductible under this benefit shall not apply to defined below, that first commence at least 90 days after the
any claim made under Section 2 B.14 (Emergency Ground commencement of the Policy Period, or as opted and as
Ambulance), or B.15 (Air Ambulance cover & Medical Evacuation) Specified in the Policy Schedule/Certificate of Insurance
or B.16 (Prosthetic cover) or B.19(Funeral and Repatriation Cover), STANDARD DEFINITION
or B.20(Compassionate visit) or B.23(Sublimit on specified illness / 1. Cancer of specified severity:
conditions), if applicable.
A malignant tumor characterized by the uncontrolled growth and
iv. Annual Aggregate Deductible shall not reduce the Sum Insured. spread of malignant cells with invasion and destruction of normal
For the purpose of this benefit Deductible applicable under this Benefit tissues. This diagnosis must be supported by histological evidence of
is Annual Aggregate Deductible. For a claim to become payable, the sum malignancy. The term cancer includes leukemia, lymphoma and
of all admissible claims under the Policy, subject to Policy terms and sarcoma.
conditions, in a given Policy Period has to exceed the Aggregate The following are excluded -
Deductible as mentioned in the Policy Schedule/Certificate of Insurance i. All tumors which are histologically described as carcinoma in situ,
SECTION F-HOSPITAL DAILY CASH benign, premalignant, borderline malignant, low malignant
During the Hospitalisation of the Insured Person for Medically Necessary potential, neoplasm of unknown behavior or non-invasive,
treatment required due to an Illness or Injury, We will pay the per day including but not limited to: Carcinoma in situ of breasts, Cervical
amount / benefit up to maximum number of days as opted and dysplasia CIN-1, CIN 2 and CIN-3.
specified in the Policy Schedule/ Certificate of Insurance, ii. Any non-melanoma skin carcinoma unless there is evidence of
Conditions: metastases to lymph nodes or beyond;

i. Our maximum liability to pay the claim under this benefit shall be iii. Malignant melanoma that has not caused invasion beyond the
limited to the limits specified in Policy Schedule/Certificate of epidermis;
Insurance. iv. All tumors of the prostate unless histologically classified as

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
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SBI General Insurance Company Limited

having a Gleason score greater than 6 or having progressed to at 6. Kidney failure requiring regular dialysis Kidney failure requiring
least clinical TNM classification T2N0M0 regular dialysis
v. All Thyroid cancers histologically classified as T1N0M0 (TNM End stage renal disease presenting as chronic irreversible failure of
Classification) or below; both kidneys to function, as a result of which either regular renal
dialysis (haemodialysis or peritoneal dialysis) is instituted or renal
vi. Chronic lymphocytic leukaemia less than RAI stage 3
transplantation is carried out. Diagnosis has to be confirmed by a
vii. Non-invasive papillary cancer of the bladder histologically specialist medical practitioner.
described as TaN0M0 or of a lesser classification.
7. Stroke Resulting In Permanent Symptoms
viii. All Gastro-Intestinal Stromal Tumors histologically classified as
Any cerebrovascular incident producing permanent neurological
T1N0M0 (TNM Classification) or below and with mitotic count of
sequelae. This includes infarction of brain tissue, thrombosis in an
less than or equal to 5/50 HPFs;
intracranial vessel, haemorrhage and embolisation from an
2. Myocardial Infarction (First Heart Attack of specific severity) extracranial source. Diagnosis has to be confirmed by a specialist
medical practitioner and evidenced by typical clinical symptoms as
The first occurrence of heart attack or myocardial infarction, which
well as typical findings in CT Scan or MRI of the brain. Evidence of
means the death of a portion of the heart muscle as a result of
permanent neurological deficit lasting for at least 3 months has to be
inadequate blood supply to the relevant area. The diagnosis for
produced.
Myocardial Infarction should be evidenced by all of the following
The following are excluded:
criteria:
i. Transient ischemic attacks (TIA)
i. A history of typical clinical symptoms consistent with the
diagnosis of acute myocardial infarction (For e.g. typical chest ii. Traumatic injury of the brain
pain) iii. Vascular disease affecting only the eye or optic nerve or
ii. New characteristic electrocardiogram changes vestibular functions.
iii. Elevation of infarction specific enzymes, Troponins, or other 8. Major Organ / Bone Marrow Transplant
specific biochemical markers
The actual undergoing of a transplant of:
The following are excluded:
i. One of the following human organs: heart, lung, liver, kidney,
i. Other acute Coronary Syndromes pancreas, that resulted from irreversible end-stage failure of the
ii. Any type of angina pectoris relevant organ, or

iii. A rise in cardiac biomarkers or Troponin T or I in absence of ii. Human bone marrow using haematopoietic stem cells. The
overt ischemic heart disease OR following an intra-arterial undergoing of a transplant has to be confirmed by a specialist
cardiac procedure. medical practitioner.
The following are excluded:
3. Open Chest CABG
i. Other stem-cell transplants
The actual undergoing of heart surgery to correct blockage or
narrowing in one or more coronary artery(s), by coronary artery ii. Where only islets of langerhans are transplanted
bypass grafting done via a sternotomy (cutting through the 9. Permanent Paralysis of Limbs
breastbone) or minimally invasive keyhole coronary artery bypass
procedures. The diagnosis must be supported by a coronary Total and irreversible loss of use of two or more limbs as a result of
angiography and the realization of surgery has to be confirmed by a injury or disease of the brain or spinal cord. A specialist medical
cardiologist. practitioner must be of the opinion that the paralysis will be
The following are excluded: permanent with no hope of recovery and must be present for more
than 3 months.
i. Angioplasty and/or any other intra-arterial procedures
10. Motor Neuron Disease with Permanent Symptoms
4. Open Heart Replacement Or Repair of Heart Valves
Motor neuron disease diagnosed by a specialist medical practitioner
The actual undergoing of open-heart valve surgery is to replace or as spinal muscular atrophy, progressive bulbar palsy, amyotrophic
repair one or more heart valves, as a consequence of defects in, lateral sclerosis or primary lateral sclerosis. There must be progressive
abnormalities of, or disease affected cardiac valve(s). The diagnosis of degeneration of corticospinal tracts and anterior horn cells or bulbar
the valve abnormality must be supported by an echocardiography and efferent neurons. There must be current significant and permanent
the realization of surgery has to be confirmed by a specialist medical functional neurological impairment with objective evidence of motor
practitioner. Catheter based techniques including but not limited to, dysfunction that has persisted for a continuous period of at least 3
balloon valvotomy/valvuloplasty are excluded. months.
5. Coma of Specified Severity
11. Multiple Sclerosis with Persisting Symptoms
A state of unconsciousness with no reaction or response to external
The unequivocal diagnosis of Definite Multiple Sclerosis confirmed
stimuli or internal needs. This diagnosis must be supported by
and evidenced by all of the following:
evidence of all of the following:
i. investigations including typical MRI findings which unequivocally
i. no response to external stimuli continuously for at least 96
confirm the diagnosis to be multiple sclerosis and
hours;
ii. there must be current clinical impairment of motor or sensory
ii. life support measures are necessary to sustain life; and
function, which must have persisted for a continuous period of
iii. permanent neurological deficit which must be assessed at least at least 6 months.
30 days after the onset of the coma.
Other causes of neurological damage such as SLE are excluded.
The condition has to be confirmed by a specialist medical practitioner.
Coma resulting directly from alcohol or drug abuse is excluded.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
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SBI General Insurance Company Limited

12. Benign Brain Tumor ankle level limbs as a result of injury or disease. This will include
medically necessary amputation necessitated by injury or disease.
Benign brain tumor is defined as a life threatening, non-cancerous
The separation has to be permanent without any chance of surgical
tumor in the brain, cranial nerves or meninges within the skull. The
correction. Loss of Limbs resulting directly or indirectly from
presence of the underlying tumor must be confirmed by imaging
selfinflicted injury, alcohol or drug abuse is excluded
studies such as CT scan or MRI.
This brain tumor must result in at least one of the following and must 19. Major head Trauma
be confirmed by the relevant medical specialist.
Accidental head injury resulting in permanent Neurological deficit to
i. Permanent Neurological deficit with persisting clinical symptoms be assessed no sooner than 3 months from the date of the accident.
for a continuous period of at least 90 consecutive days or This diagnosis must be supported by unequivocal findings on
Magnetic Resonance Imaging, Computerized Tomography, or other
ii. Undergone surgical resection or radiation therapy to treat the
reliable imaging techniques. The accident must be caused solely and
brain tumor.
directly by accidental, violent, external and visible means and
iii. The following conditions are excluded: independently of all other causes.
Cysts, Granulomas, malformations in the arteries or veins of the brain, The Accidental Head injury must result in an inability to perform at
hematomas, abscesses, pituitary tumors, tumors of skull bones and least three (3) of the following Activities of Daily Living either with or
tumors of the spinal cord. without the use of mechanical equipment, special devices or other
aids and adaptations in use for disabled persons. For the purpose of
13. Blindness this benefit, the word “permanent” shall mean beyond the scope of
Total, permanent and irreversible loss of all vision in both eyes as a recovery with current medical knowledge and technology.
result of illness or accident. The Activities of Daily Living are:
The Blindness is evidenced by:
i. Washing: the ability to wash in the bath or shower (including
i. corrected visual acuity being 3/60 or less in both eyes or;
getting into and out of the bath or shower) or wash
ii. the field of vision being less than 10 degrees in both eyes. satisfactorily by other means;
The diagnosis of blindness must be confirmed and must not be ii. Dressing: the ability to put on, take off, secure and unfasten all
correctable by aids or surgical procedure. garments and, as appropriate, any braces, artificial limbs or
other surgical appliances;
14. Deafness
iii. Transferring: the ability to move from a bed to an upright chair
Total and irreversible loss of hearing in both ears as a result of illness
or wheelchair and vice versa;
or accident. This diagnosis must be supported by pure tone
audiogram test and certified by an Ear, Nose and Throat (ENT) iv. Mobility: the ability to move indoors from room to room on
specialist. Total means “the loss of hearing to the extent that the loss level surfaces;
is greater than 90decibels across all frequencies of hearing” in both v. Toileting: the ability to use the lavatory or otherwise manage
ears. bowel and bladder functions so as to maintain a satisfactory
15. End Stage Lung Failure level of personal hygiene;
End stage lung disease, causing chronic respiratory failure, as vi. Feeding: the ability to feed oneself once food has been
confirmed, and evidenced by all the following: prepared and made available.
i. FEV1 test results consistently less than 1 liter measured on 3 The following is excluded:
occasions 3 months apart; and
Spinal cord injury
ii. Requiring continuous permanent supplementary oxygen
therapy for hypoxemia; and 20. Primary (Idiopathic) Pulmonary Hypertension
I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary
iii. Arterial blood gas analysis with partial oxygen pressure of
Hypertension by a Cardiologist or specialist in respiratory
55mmHg or less (PaO2 < 55mmHg); and
medicine with evidence of right ventricular enlargement and the
iv. Dyspnea at rest pulmonary artery pressure above 30 mm of Hg on Cardiac
16. End Stage Liver Failure Cauterization. There must be permanent irreversible physical
impairment to the degree of at least Class IV of the New York
Permanent and irreversible failure of liver function that has resulted Heart Association Classification of cardiac impairment.
in all three of the following:
II. The NYHA Classification of Cardiac Impairment are as follows:
i. Permanent jaundice; and
i. Class III: Marked limitation of physical activity.
ii. Ascites; and
Comfortable at rest, but less than ordinary activity causes
iii. Hepatic encephalopathy.
symptoms.
Liver failure secondary to drug or alcohol abuse is excluded.
ii. Class IV: Unable to engage in any physical activity without
17. Loss of Speech discomfort. Symptoms may be present even at rest.
Total and irrecoverable loss of the ability to speak as a result of injury III. Pulmonary hypertension associated with lung disease, chronic
or disease to the vocal cords. The inability to speak must be hypoventilation, pulmonary thromboembolic disease, drugs and
established for a continuous period of 12 months. This diagnosis must toxins, diseases of the left side of the heart, congenital heart
be supported by medical evidence furnished by an Ear, Nose, Throat disease and any secondary cause are specifically excluded.
(ENT) specialist.
18. Loss of Limbs
The physical separation of two or more limbs, at or above the wrist or

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 29
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

21. Third Degree Burns i. Washing: the ability to wash in the bath or shower (including
getting into and out of the shower) or wash satisfactorily by
There must be third-degree burns with scarring that cover at least
other means;
20% of the body’s surface area. The diagnosis must confirm the total
area involved using standardized, clinically accepted, body surface ii. Dressing: the ability to put on, take off, secure and unfasten all
area charts covering 20% of the body surface area. garments and, as appropriate, any braces, artificial limbs or
other surgical appliances;
22. Alzheimer's Disease
iii. Transferring: The ability to move from bed to a upright chair or
Alzheimer’s (presenile dementia) disease is a progressive
wheelchair and vice versa;
degenerative disease of the brain, characterized by diffuse atrophy
throughout the cerebral cortex with distinctive histopathological iv. Toileting: the ability to use the lavatory or otherwise manage
changes. It affects the brain, causing symptoms like memory loss, bowel and bladder functions so as to maintain a satisfactory
confusion, communication problems, and general impairment of level of personal hygiene;
mental function, which gradually worsens leading to changes in
v. Feeding: The ability to feed oneself once the food has
personality.
prepared and made available;
Deterioration or loss of intellectual capacity, as confirmed by clinical
evaluation and imaging tests, arising from Alzheimer’s disease, vi. Mobility: The ability to move indoors from room to room on
resulting in progressive significant reduction in mental and social level surfaces.
functioning, requiring the continuous supervision of the Insured The following is excluded:
Person. The diagnosis must be supported by the clinical confirmation
of a Neurologist and supported by Our appointed Medical Parkinson’s disease secondary to drug and/or alcohol abuse is
Practitioner. excluded.

The disease must result in a permanent inability to perform three or 24. Aorta Graft Surgery
more Activities of daily living with Loss of Independent Living” or The actual undergoing of major Surgery to repair or correct
must require the need of supervision and permanent presence of aneurysm, narrowing, obstruction or dissection of the Aorta through
care staff due to the disease. This must be medically documented for surgical opening of the chest or abdomen. For the purpose of this
a period of at least 90 days cover the definition of “Aorta” shall mean the thoracic and
The following conditions are however not covered: abdominal aorta but not its branches.
i. neurosis or neuropsychiatric symptoms without imaging The insured person understands and agrees that we will not cover:
evidence of Alzheimer’s Disease; i. Surgery performed using only minimally invasive or intra-
ii. alcohol related brain damage; and arterial techniques.

iii. any other type of irreversible organic disorder/dementia ii. Angioplasty and all other intra-arterial, catheter based
not associated with Alzheimer’s Disease. techniques, "keyhole" or laser procedures.

The Activities of Daily Living are: Aorta graft surgery benefit covers Surgery to the aorta wherein part
of it is removed and replaced with a graft.
a. Washing: the ability to wash in the bath or shower
(including getting into and out of the bath or shower) or 25.Amputation of Feet due to Complications from Diabetes
wash satisfactorily by other means; Diabetic neuropathy and vasculitis resulting in the amputation of
b. Dressing: the ability to put on, take off, secure and both feet at or above ankle as advised by a Registered Doctor who is
unfasten all garments and, as appropriate, any braces, a specialist as the only means to maintain life. Amputation of toe or
artificial limbs or other surgical appliances; toes, or any other causes for amputation shall not be covered.

c. Transferring: the ability to move from a bed to an upright 26. Myasthenia Gravis
chair or wheelchair and vice versa; An acquired autoimmune disorder of neuromuscular transmission
d. Mobility: the ability to move indoors from room to room leading to fluctuating muscle weakness and fatigability, where all of
on level surfaces; the following criteria are met:
Presence of permanent muscle weakness categorized as Class IV or V
e. Toileting: the ability to use the lavatory or otherwise according to the Myasthenia Gravis Foundation of America Clinical
manage bowel and bladder functions so as to maintain a Classification given below; and
satisfactory level of personal hygiene; The Diagnosis of Myasthenia Gravis and categorization are
f. Feeding: the ability to feed oneself once food has been confirmed by a Registered Doctor who is a neurologist.
prepared and made available. Myasthenia Gravis Foundation of America Clinical Classification:

23. Parkinson's Disease Class I: Any eye muscle weakness, possible ptosis, no other
evidence of muscle weakness elsewhere.
The unequivocal diagnosis of progressive degenerative primary
idiopathic Parkinson’s disease by Neurologist acceptable to us. The Class II: Eye muscle weakness of any severity, mild weakness of
diagnosis must be supported by all the following conditions: other muscles.
i. The disease cannot be controlled with medication; and Class III: Eye muscle weakness of any severity, moderate weakness
of other muscles.
ii. Signs of progressive impairment; and
Class IV: Eye muscle weakness of any severity, severe weakness of
Inability of the Insured Person to perform at least 3 of the 6 activities
other muscles.
of daily as listed below (either with or without the use of mechanical
equipment, special devices or other aids and adaptations in use for Class V: Intubation needed to maintain airway.
disabled persons) for a continuous period of at least 6 months:
The Activities of Daily Living are:

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
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SBI General Insurance Company Limited

27. Elephantiasis 30. Dissecting Aortic Aneurysm

Massive swelling in the tissues of the body as a result of destroyed A condition where the inner lining of the aorta (intima layer) is
regional lymphatic circulation by chronic filariasis infection. The interrupted so that blood enters the wall of the aorta and separates
unequivocal diagnosis of elephantiasis must be confirmed by a its layers. For the purpose of this definition, aorta shall mean the
Registered Doctor who is a specialist physician. There must be clinical thoracic and abdominal aorta but not its branches. The diagnosis
evidence of permanent massive swelling of legs, arms, scrotum, must be made by a Registered Doctor who is a specialist with
vulva, or breasts. There must also be laboratory confirmation of computed tomography (CT) scan, magnetic resonance imaging
microfilariae infection. (MRI), magnetic resonance angiograph (MRA) or angiogram.
Myasthenia Gravis Foundation of America Clinical Classification: Emergency surgical repair is required.
Swelling or lymphedema caused by infection with a sexually 31. Progressive Scleroderma
transmitted disease, trauma, post-operative scarring, congestive
heart failure, or congenital lymphatic system abnormalities is A systemic collagen-vascular disease causing progressive diffuse
excluded. fibrosis in the skin, blood vessels and visceral organs. This diagnosis
must be unequivocally supported by biopsy and serological evidence
28. Aplastic Anaemia and the disorder must have reached systemic proportions to involve
Chronic persistent bone marrow failure which results in anaemia, the heart, lungs or kidneys.
neutropenia and thrombocytopenia requiring treatment with at least The following are excluded:
one of the following: I.
Localized scleroderma (linear scleroderma or morphea)
I. Blood product transfusion; Eosinophilic fasciitis; and
II. Marrow stimulating agents; II.
Crest Syndrome
III. Immunosuppressive agents; or III.
IV. Bone marrow transplantation. 32. Chronic Adrenal Insufficiency (Addison's Disease)
The diagnosis must be confirmed by a haematologist using relevant An autoimmune disorder causing a gradual destruction of the
laboratory investigations including Bone Marrow Biopsy resulting in adrenal gland resulting in the need for life long glucocorticoid and
bone marrow cellularity of less than 25% which is evidenced by any mineral corticoid replacement therapy. The disorder must be
two of the following: confirmed by a Registered Doctor who is a specialist in
i. Absolute neutrophil count of less than 500/mm³ or less endocrinology through one of the following:

ii. Platelets count less than 20,000/mm³ or less I. ACTH simulation tests;
II. insulin-induced hypoglycemia test;
iii. Reticulocyte count of less than 20,000/mm³ or less III. plasma ACTH level measurement;
Temporary or reversible Aplastic Anaemia is excluded. Iv. Plasma Renin Activity (PRA) level measurement

29. Loss of Independent Existence Only autoimmune cause of primary adrenal insufficiency is included.
All other causes of adrenal insufficiency are excluded
The insured person is physically incapable of performing at least
33. Other Serious Coronary Artery Disease
three (3) of the “Activities of Daily Living” as defined below (either
with or without the use of mechanical equipment, special devices or The narrowing of the lumen of at least one coronary artery by a
other aids or adaptations in use for disabled persons) for a minimum of 75% and of two others by a minimum of 60%, as proven
continuous period of at least six (6) months signifying a permanent by coronary angiography, regardless of whether or not any form of
and irreversible inability to perform the same. coronary artery intervention or surgery has been performed.
For the purpose of this definition, the word “permanent” shall mean Coronary arteries herein refer to left main stem, left anterior
beyond the hope of recovery with current medical knowledge and descending, circumflex and right coronary artery (but not including
technology. The Diagnosis of Loss of Independent Existence must be their branches).
confirmed by a Registered Doctor.
34. Severe Rheumatoid Arthritis
Insured Person Age between 18 and 74 on first diagnosis is eligible to
receive a benefit under this illness. Unequivocal Diagnosis of systemic immune disorder of rheumatoid
IV. Bone marrow transplantation. arthritis where all of the following criteria are met:
Activities of daily living:
I. Diagnostic criteria of the American College of Rheumatology
i. Washing: the ability to wash in the bath or shower (including for Rheumatoid Arthritis;
getting into and out of the shower) or wash satisfactorily by
II. Permanent inability to perform at least two (2) “Activities of
other means;
Daily Living”;
ii. Dressing: the ability to put on, take off, secure and unfasten all
III. Widespread joint destruction and major clinical deformity of
garments and, as appropriate, any braces, artificial limbs or
three (3) or more of the following joint areas: hands, wrists,
other surgical appliances; Transferring: the ability to move from
elbows, knees, hips, ankle, cervical spine or feet; and
a bed to an upright chair or wheelchair and vice versa;
V. The foregoing conditions have been present for at least six (6)
iii. Toileting: the ability to use the lavatory or otherwise manage
months.
bowel and bladder functions so as to maintain a satisfactory
level of personal hygiene; The Activities of Daily Living are:
iv. Feeding: the ability to feed oneself once food has been i. Washing: the ability to wash in the bath or shower (including
prepared and made available; getting into and out of the bath or shower) or wash
v. Mobility: The ability to move indoors from room to room on satisfactorily by other means;
level surfaces.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 31
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

ii. Dressing: the ability to put on, take off, secure and unfasten all 39. Creutzfeldt-Jacob Disease (CJD)
garments and, as appropriate, any braces, artificial limbs or Creutzfeldt-Jacob disease is an incurable brain infection that causes
other surgical appliances; rapidly progressive deterioration of mental function and
iii. Transferring: the ability to move from a bed to an upright chair movement. A Registered Doctor who is a neurologist must make a
or wheelchair and vice versa; definite diagnosis of Creutzfeldt-Jacob disease based on clinical
assessment, EEG and imaging. There must be objective neurological
iv. Mobility: the ability to move indoors from room to room on
abnormalities on exam along with severe progressive dementia
level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage 40. Ebola
bowel and bladder functions so as to maintain a satisfactory Infection with the Ebola virus where the following conditions are
level of personal hygiene; met:
vi. Feeding: the ability to feed oneself once food has been i. Presence of the Ebola virus has been confirmed by laboratory
prepared and made available. testing;
35. Cardiomyopathy ii. there are ongoing complications of the infection persisting
beyond thirty (30) days from the onset of symptoms; and
An impaired function of the heart muscle, unequivocally diagnosed
as Cardiomyopathy by a Registered Doctor who is a cardiologist, and iii. the infection does not result in death.
which results in permanent physical impairment to the degree of
41. Pneumonectomy
New York Heart Association classification Class IV, or its equivalent,
for at least six (6) months based on the following classification The undergoing of surgery on the advice of an appropriate Medical
criteria: Specialist to remove an entire lung for disease or traumatic injury
NYHA Class IV - Inability to carry out any activity without discomfort. suffered by the life insured.
Symptoms of congestive cardiac failure are present even at rest. The following conditions are excluded:
With any increase in physical activity, discomfort will be a. Removal of a lobe of lungs (lobectomy)
experienced. b. Lung resection or incision
The Diagnosis of Cardiomyopathy has to be supported by
echocardiographic findings of compromised ventricular 42. Brain Surgery
performance. The actual undergoing of surgery to the brain under general
Irrespective of the above, Cardiomyopathy directly related to anesthesia during which a craniotomy is performed. Keyhole
alcohol or drug abuse is excluded. surgery is included however, minimally invasive treatment where
36. Infective Endocarditis no surgical incision is performed to expose the target, such as
irradiation by gamma knife or endovascular neuroradiological
Inflammation of the inner lining of the heart caused by infectious interventions such as embolizations, thrombolysis and stereotactic
organisms, where all of the following criteria are met: biopsy are all excluded. Brain surgery as a result of an Accident is
i. Positive result of the blood culture proving presence of the also excluded. The procedure must be considered medically
infectious organism(s); necessary by a Registered Doctor who is a qualified specialist.
ii. Presence of at least moderate heart valve incompetence 43. Severe Ulcerative Colitis
(meaning regurgitant fraction of 20% or above) or moderate
Acute fulminant ulcerative colitis with life threatening electrolyte
heart valve stenosis (resulting in heart valve area of 30% or
disturbances. All of the following criteria must be met:
less of normal value) attributable to Infective Endocarditis; and
i. the entire colon is affected, with severe bloody diarrhoea and
iii. The Diagnosis of Infective Endocarditis and the severity of
valvular impairment are confirmed by a Registered Doctor who ii. the necessary treatment is total colectomy and ileostomy; and
is a cardiologist. iii. the diagnosis must be based on histopathological features and
37. Medullary Cystic Disease confirmed by a Registered Doctor who is a specialist in
Medullary Cystic Disease where the following criteria are met: gastroenterology.
i. the presence in the kidney of multiple cysts in the renal 44. Chronic Relapsing Pancreatitis
medulla accompanied by the presence of tubular atrophy and
An unequivocal diagnosis of Chronic Relapsing Pancreatitis, made
interstitial fibrosis;
by a Registered Doctor who is a specialist in gastroenterology and
ii. clinical manifestations of anaemia, polyuria, and progressive confirmed as a continuing inflammatory disease of the pancreas
deterioration in kidney function; and characterized by irreversible morphological change and typically
causing pain and/or permanent impairment of function. The
iii. the Diagnosis of Medullary Cystic Disease is confirmed by renal
condition must be confirmed by pancreatic function tests and
biopsy.
radiographic and imaging evidence.
Isolated or benign kidney cysts are specifically excluded from this Relapsing Pancreatitis caused directly or indirectly, wholly or partly,
benefit. by alcohol is excluded.
38. Apallic Syndrome 45. Progressive Supranuclear Palsy
Apallic Syndrome or Persistent vegetative state (PVS) or Confirmed by a Registered Doctor who is a specialist in neurology
unresponsive wakefulness syndrome (UWS) is a Universal necrosis of a definite diagnosis of progressive supranuclear palsy. There
of the brain cortex with the brainstem remaining intact. The must be permanent clinical impairment of motor function, eye
diagnosis must be confirmed by a Neurologist acceptable to us and movement disorder and postural instability.
the patient should be documented to be in a vegetative state for a
minimum of at least one month in order to be classified as UWS,
PVS, Apallic Syndrome.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
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SBI General Insurance Company Limited

46. Terminal illness 52. Muscular Dystrophy

The conclusive diagnosis of an illness, which in the opinion of a A group of hereditary degenerative diseases of muscle characterized
Registered Doctor who is an attending Consultant and agreed by our by weakness and atrophy of muscle. The diagnosis of muscular
appointed Registered Doctor, life expectancy is no greater than twelve dystrophy must be unequivocal and made by a Registered Doctor who
(12) months from the date of notification of claim, regardless of any is a consultant neurologist. The condition must result in the inability
treatment that might be undertaken. of the Life Insured to perform (whether aided or unaided) at least 3 of
the 6 “Activities of Daily Living” for a continuous period of at least 6
47. Fulminant Hepatitis months.
A sub-massive to massive necrosis of the liver by the Hepatitis virus, The Activities of Daily Living are:
leading precipitously to liver failure. This diagnosis must be supported i. Washing: the ability to wash in the bath or shower (including
by all of the following: getting into and out of the bath or shower) or wash satisfactorily
Conditions: by other means;
i. Rapid decreasing of liver size; ii. Dressing: the ability to put on, take off, secure and unfasten all
garments and, as appropriate, any braces, artificial limbs or
ii. Necrosis involving entire lobules, leaving only a collapsed
other surgical appliances;
reticular framework;
iii. Transferring: the ability to move from a bed to an upright chair
iii. Rapid deterioration of liver function tests;
or wheelchair and vice versa;
iv. Deepening jaundice; and
iv. Mobility: the ability to move indoors from room to room on
v. Hepatic encephalopathy. level surfaces;
Acute Hepatitis infection or carrier status alone does not meet the v. Toileting: the ability to use the lavatory or otherwise manage
diagnostic criteria. bowel and bladder functions so as to maintain a satisfactory
level of personal hygiene;
i. The presence of bacterial infection in cerebrospinal fluid by
lumbar puncture; and vi. Feeding: the ability to feed oneself once food has been
prepared and made available.
ii. A consultant neurologist.
The Activities of Daily Living are: 53. Hemiplegia
The total and permanent loss of the use of one side of the body
i. Washing: the ability to wash in the bath or shower (including
through paralysis persisting for a period of at least 6 weeks and with
getting into and out of the bath or shower) or wash satisfactorily
no foreseeable possibility of recovery caused by illness or injury,
by other means;
except when such injury is self-inflicted.
ii. Dressing: the ability to put on, take off, secure and unfasten all
54. Poliomyelitis
garments and, as appropriate, any braces, artificial limbs or other
surgical appliances; The occurrence of Poliomyelitis where the following conditions are
met:
iii. Transferring: the ability to move from a bed to an upright chair
or wheelchair and vice versa; i. Poliovirus is identified as the cause,
ii. Paralysis of the limb muscles or respiratory muscles must be
iv. Mobility: the ability to move indoors from room to room on level
present and persist for at least 3 months
surfaces;
55. Tuberculosis Meningitis
v. Toileting: the ability to use the lavatory or otherwise manage
bowel and bladder functions so as to maintain a satisfactory level Meningitis caused by tubercle bacilli, resulting in permanent
of personal hygiene; neurological deficit persisting for at least 180 consecutive days. Such
a diagnosis must be confirmed by a Registered Doctor who is a
vi. Feeding: the ability to feed oneself once food has been prepared
specialist in neurology. Permanent neurological deficit with persisting
and made available
clinical symptoms means symptoms of dysfunction in the nervous
50. Loss of One Limb and One Eye system that are not present on clinical examination and expected to
Total, permanent and irrecoverable loss of sight of one eye and loss by last throughout the lifetime of life insured.
severance of one limb at or above the elbow or knee. A loss of sight of 56. Encephalitis
one eye must be clinically confirmed by a Registered Doctor who is an
Severe inflammation of brain substance (cerebral hemisphere,
eye specialist, and must not be correctable by aides or surgical
brainstem or cerebellum) caused by viral infection and resulting in
procedures
permanent neurological deficit. This diagnosis must be certified by a
51. Necrotising Fasciitis Registered Doctor who is a consultant neurologist and the permanent
Necrotizing fasciitis is a progressive, rapidly spreading, infection neurological deficit must be documented for at least 6 weeks. The
located in the deep fascia causing necrosis of the subcutaneous permanent deficit should result in permanent inability to perform
tissues. An unequivocal diagnosis of necrotizing fasciitis must be made three or more Activities for Daily Living (listed below).
by a Registered Doctor who is a specialist and the diagnosis must be The Activities of Daily Living are:
supported with laboratory evidence of the presence of bacteria that is i. Washing: the ability to wash in the bath or shower (including
a known cause of necrotizing fasciitis. There must also be widespread getting into and out of the bath or shower) or wash
destruction of muscle and other soft tissues that results in a total and satisfactorily by other means;
permanent loss or function of the affected body part.
ii. Dressing: the ability to put on, take off, secure and unfasten all
garments and, as appropriate, any braces, artificial limbs or
other surgical appliances;

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 33
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

iii. Transferring: the ability to move from a bed to an upright chair excluded until the expiry of number of months (as
or wheelchair and vice versa; Specified in Policy Schedule/Certificate of Insurance) of
continuous coverage after the date of inception of the
iv. Mobility: the ability to move indoors from room to room on
first policy with insurer.
level surfaces;
b) In case of enhancement of sum insured the exclusion shall
v. Toileting: the ability to use the lavatory or otherwise manage apply afresh to the extent of sum insured increase.
bowel and bladder functions so as to maintain a satisfactory
c) If the Insured Person is continuously covered without any
level of personal hygiene;
break as defined under the portability norms of the extant
vi. Feeding: the ability to feed oneself once food has been IRDAI (Health Insurance) Regulations, then waiting period
prepared and made available. for the same would be reduced to the extent of prior
coverage.
57. Myelofibrosis
d) Coverage under the policy after the expiry of number of
A disorder which can cause fibrous tissue to replace the normal bone
months (as Specified in Policy Schedule/Certificate of
marrow and results in anaemia, low levels of white blood cells and
Insurance) for any pre-existing disease is subject to the
platelets and enlargement of the spleen. The condition must have
same being declared at the time of application and
progressed to the point that it is permanent and the severity is such
accepted by Us.
that the Life Insured requires a blood transfusion at least monthly.
The diagnosis of myelofibrosis must be supported by bone marrow 2. Specified disease/procedure waiting period- Code- Excl02
biopsy and confirmed by a Registered Doctor who is a specialist. a) Expenses related to the treatment of the listed
58. Pheochromocytoma Conditions,surgeries/treatments shall be excluded until
the expiry of number of months (as Specified in Policy
Presence of a neuroendocrine tumour of the adrenal or
Schedule/Certificate of Insurance) of continuous coverage
extrachromaffin tissue that secretes excess catecholamines requiring
after the date of inception of the first policy with us. This
the actual undergoing of surgery to remove the tumour.
exclusion shall not be applicable for claims arising due to
The WHO Classification of Lupus Nephritis:
an accident
The Diagnosis of Pheochromocytoma must be confirmed by a
Registered Doctor who is an endocrinologist. b) In case of enhancement of sum insured the exclusion shall
apply afresh to the extent of sum insured increase.
59. Systemic Lupus Erythematosus with Lupus Nephritis
c) If any of the specified disease/procedure falls under the
A multi-system autoimmune disorder characterized by the waiting period specified for pre-Existing diseases, then the
development of autoantibodies directed against various selfantigens. longer of the two waiting periods shall apply.
In respect of this Policy, systemic lupus erythematosus will be
d) The waiting period for listed conditions shall apply even if
restricted to those forms of systemic lupus erythematosus which
contracted after the policy or declared and accepted
involve the kidneys (Class III to Class V Lupus Nephritis, established by
without a specific exclusion.
renal biopsy, and in accordance with the WHO Classification). The
final diagnosis must be confirmed by a Registered Doctor specializing e) If the Insured Person is continuously covered without any
in Rheumatology and Immunology. break as defined under the applicable norms on
The WHO Classification of Lupus Nephritis: portability stipulated by IRDAI, then waiting period for
the same would be reduced to the extent of prior
Class I Minimal Change Lupus Glomerulonephritis
coverage.
Class II Mesangial Lupus Glomerulonephritis
Class III Focal Segmental Proliferative Lupus Glomerulonephritis f) List of specific diseases/procedures
Class IV Diffuse Proliferative Lupus Glomerulonephritis
• Cataract
Class V Membranous Lupus Glomerulonephritis
• Benign Prostatic Hypertrophy
60. Eisenmenger's Syndrome • Hysterectomy / myomectomy for menorrhagia or
Development of severe pulmonary hypertension and shunt reversal fibromyoma or prolapse of uterus
resulting from heart condition. The diagnosis must be made by a • Non-infective Arthritis, Treatment of Spondylosis /
Registered Doctor who is a specialist with echocardiography and Spondylitis, Gout & Rheumatism
cardiac catheterization and supported by the following criteria: • Surgery of Genitourinary tract
• Calculus Diseases of any etiology
i. Mean pulmonary artery pressure > 40 mm Hg; • Sinusitis and related disorders
ii. Pulmonary vascular resistance > 3mm/L/min (Wood units); and • Surgery for prolapsed intervertebral disc unless arising
from accident
iii. Normal pulmonary wedge pressure < 15 mm Hg. • Surgery of varicose veins and varicose ulcer
SECTION NO. 3 -WAITING PERIOD AND EXCLUSIONS • Chronic Renal failure including dialysis
• Gastric/ Duodenal Ulcer
The Company is not liable to make any payment under the Policy in • Gout and Rheumatism
connection with or in respect of the following expenses till the expiry • Treatment for joint replacement unless arising from
of the waiting period and any claim in respect of any Insured Person accident
directly or indirectly for, caused by, arising from or any way • Age-related Osteoarthritis & Osteoporosis
attributable to any of the following unless expressly stated to the
contrary in this Policy; 3. Initial waiting period- Code- Excl03
A. Waiting Periods a) Expenses related to the treatment of any illness within 30
1. Pre-Existing Diseases (Code- Excl01) days from the first policy commencement date shall be
a) Expenses related to the treatment of a pre-existing excluded except claims arising due to an accident,
Disease (PED) and its direct complications shall be provided the same are covered.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 34
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

b) This exclusion shall not, however, apply if the Insured Insured Person committing or attempting to commit a breach of law
Person has Continuous Coverage for more than twelve with criminal intent.
months.
8. Excluded Providers: Code- Excl11
c) The within referred waiting period is made applicable to Expenses incurred towards treatment in any hospital or by any
the enhanced sum insured in the event of granting higher Medical Practitioner or any other provider specifically excluded by the
sum insured subsequently. Insurer and disclosed in its website / notified to the policyholders are
B. Standard Exclusions not admissible. However, in case of life threatening situations or
following an accident, expenses up to the stage of stabilization are
1. Investigation & Evaluation- Code- Excl04 payable but not the complete claim.
a) Expenses related to any admission primarily for diagnostics and 9.Substance Abuse and Alcohol: Code Excl12
evaluation purposes only are excluded. Treatment for, Alcoholism, drug or substance abuse or any addictive
b) Any diagnostic expenses which are not related or not incidental condition and consequences thereof.
to the current diagnosis and treatment are excluded. 10. Wellness and Rejuvenation : Code:Excl13
Treatments received in heath hydros, nature cure clinics, spas or
2. Specified disease/procedure waiting period- Code- Excl02
similar establishments or private beds registered as a nursing home 3)
a) Expenses related to the treatment of the listed Conditions, attached to such establishments or where admission is arranged
dressing, moving around either by skilled nurses or assistant or wholly or partly for domestic reasons.
non-skilled persons.
11. Dietary supplements and substances : Code- Excl14
i. Custodial care either at home or in a nursing facility for Dietary supplements and substances that can be purchased without
personal care such as help with activities of daily living prescription, including but not limited to Vitamins, minerals and
such as bathing, dressing, moving around either by skilled organic substances unless prescribed by a medical practitioner as part
nurses or assistant or non-skilled persons. of hospitalization claim or day care procedure.
ii. Any services for people who are terminally ill to address 12. Refractive Error: Code- Excl15
physical, social, emotional and spiritual needs. Expenses related to the treatment for correction of eye sight due to
3. Obesity/ Weight Control: Code- Excl06 refractive error less than 7.5 dioptres.
Expenses related to the surgical treatment of obesity that does not 13. Unproven Treatments: Code- Excl16
fulfil all the below conditions: Expenses related to any unproven treatment, services and supplies for
1) Surgery to be conducted is upon the advice of the Doctor or in connection with any treatment. Unproven treatments are
treatments, procedures or supplies that lack significant medical
2) The surgery/Procedure conducted should be supported by documentation to support their effectiveness.
clinical protocols
14. Sterility and Infertility: Code- Excl17
3) The member has to be 18 years of age or older and
Expenses related to sterility and infertility. This includes:
4) Body Mass Index (BMI);
(i) Any type of contraception, sterilization
a) greater than or equal to 40 or
(ii) Assisted Reproduction services including artificial insemination
b) greater than or equal to 35 in conjunction with any of the and advanced reproductive technologies such as IVF, ZIFT, GIFT,
following severe co-morbidities following failure of less ICSI
invasive methods of weight loss:
(iii) Gestational Surrogacy
i. Obesity-related cardiomyopathy
ii. Coronary heart disease (iv) Reversal of sterilization
iii. Severe Sleep Apnea 15. Maternity: Code Excl18
iv. Uncontrolled Type2 Diabetes
i. Medical treatment expenses traceable to childbirth (including
4. Change-of-Gender treatments: Code- Excl07 complicated deliveries and caesarean sections incurred during
Expenses related to any treatment, including surgical management, to hospitalization) except ectopic pregnancy;
change characteristics of the body to those of the opposite sex.
ii. Expenses towards miscarriage (unless due to an accident) and
However, such exclusion shall not be applicable to respective Insured
lawful medical termination of pregnancy during the policy
Person to comply with Transgender Persons (Protection of Rights) Act,
period.
2019.
5. Cosmetic or plastic Surgery: Code- Excl08 C. Specific Exclusions
Expenses for cosmetic or plastic surgery or any treatment to change 1. Any medical treatment taken outside India, unless otherwise
appearance unless for reconstruction following an Accident, Burn(s) agreed by Us as Specified in the Policy Schedule/Certificate of
or Cancer or as part of medically necessary treatment to remove a Insurance.
direct and immediate health risk to the insured. For this to be
2. Hospitalization for donation of any body organs by an Insured
considered a medical necessity, it must be certified by the attending
including complications arising from the donation of organs.
Medical Practitioner.
3. Nuclear damage caused by, contributed to, by or arising from
6. Hazardous or Adventure sports: Code- Excl09
ionising radiation or contamination by radioactivity from:
Expenses related to any treatment necessitated due to participation
as a professional in hazardous or adventure sports, including but not a. any nuclear fuel or from any nuclear waste; or
limited to, para-jumping, rock climbing, mountaineering, rafting, b. from the combustion of nuclear fuel (including any selfsustaining
motor racing, horse racing or scuba diving, hand gliding, sky diving, process of nuclear fission);
deep-sea diving.
c. nuclear weapons material;
7. Breach of law: Code- Excl10
Expenses for treatment directly arising from or consequent upon any d. nuclear equipment or any part of that equipment;

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 35
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

a. any nuclear fuel or from any nuclear waste; or 1. Disclosure of Information

The Policy shall be void and all premiums paid thereon shall be
b. from the combustion of nuclear fuel (including any
forfeited to the Company in the event of misrepresentation,
selfsustaining process of nuclear fission);
misdescription, or non-disclosure of any Material Fact by the Policy
c. nuclear weapons material; holder.
d. nuclear equipment or any part of that equipment; 2. Condition Precedent to Admission of Liability
4. War, invasion, acts of foreign enemies, hostilities (whether war The terms and conditions of the policy must be fulfilled by the insured
be declared or not), civil war, commotion, unrest, rebellion, person for the Company to make any payment for claim(s) arising
revolution, insurrection, military or usurped power or under the policy
confiscation or nationalisation or requisition of or damage by or 3. Claim Settlement (provision for Penal lnterest)
under the order of any government or public local authority.
i. The Company shall settle or reject a claim as the case may be,
5. Injury or Disease caused by or contributed to by nuclear 30 days from the date of receipt of last necessary document.
weapons/materials.
ii. ln the case of delay in the payment of a claim, the Company
6. Circumcision unless necessary for treatment of a disease, illness shall be liable to pay interest to the policyholder from the date
or injury not excluded hereunder, or, as may be necessitated of receipt of last necessary document to the date of payment of
due to an accident. claim at a rate 2% above the bank rate
7. Prostheses, corrective devices, medical appliances, external iii. However, where the circumstances of a claim warrant an
medical equipment of any kind used at home as post investigation in the opinion of the Company, it shall initiate and
hospitalization care including cost of instrument used in the complete such investigation at the earliest, in any case not later
treatment of Sleep Apnoea Syndrome (C.P.A.P), Continuous than 30 days from the date of receipt of last necessary
Peritoneal Ambulatory Dialysis (C.P.A.D) and Oxygen document- ln such cases, the Company shall settle or reject the
concentrator for Bronchial Asthmatic condition, unless agree by claim within 45 days from the date of receipt of last necessary
Us and as Specified in the Policy Schedule/Certificate of document.
Insurance.
iv. ln case of delay beyond stipulated 45 days, the Company shall
9. Treatment with alternative medicines like acupuncture, be liable to pay interest to the policyholder at a rate 2% above
acupressure, osteopath, naturopathy, chiropractic, reflexology the bank rate from the date of receipt of last necessary
and aromatherapy. document to the date of payment of claim.
10. Intentional self-injury (including but not limited to the use or
misuse of any intoxicating drugs or alcohol) and any violation of Bank Rate means Bank rate fixed by the Reserve Bank of India
law or participation in an event/activity that is against law with (RBI) which is prevalent as on 1st day of the financial year in
a criminal intent. which the claim has fallen due.

11. Vaccination or inoculation except as post bite treatment for 4. Complete Discharge
animal bite. Any payment to the Insured Person or his/her nominees or his/her
12. Convalescence, general debility, “Run-down” condition, rest legal representative or assignee or to the Hospital, as the case may
cure, Congenital external illness/disease/defect, unless agreed be, for any benefit under the Policy shall be valid discharge towards
by Us and as Specified in the Policy Schedule/ Certificate of payment of claim by the Company to the extent of that amount for
Insurance. the particular claim

14. Outpatient diagnostic, medical and surgical procedures or 5. Multiple Policies

treatments, non-prescribed drugs and medical supplies, a. Indemnity Policies:
hormone replacement therapy, unless agreed by Us and as A Policyholder can file for Claim settlement as per his/her choice
Specified in the Policy Schedule/Certificate of Insurance under any Policy. The Insurer of that chosen Policy shall be
15. Dental treatment or Surgery of any kind unless requiring treated as the primary Insurer.
Hospitalisation as a result of accidental Bodily Injury, unless In case the available coverage under the said Policy is less than
agreed by Us and as Specified in the Policy Schedule/ Certificate the admissible Claim amount, the primary Insurer shall seek the
of Insurance details of other available policies of the Policyholder and shall
coordinate with other Insurers to ensure settlement of the
16. Venereal/ Sexually Transmitted disease other than HIV/AIDS.
balance amount as per the Policy conditions, without causing
17. Stem cell storage/preservation unless agreed by Us and as any hassles to the Policyholder.
Specified in the Policy Schedule/Certificate of Insurance.
b. Benefit based Policies:
18. Any kind of service charge, surcharge levied by the hospital. On occurrence of the Insured event, the Policyholders can Claim
19. Personal comfort and convenience items or services such as from all Insurers under all policies.
television, telephone, barber or guest service and similar 6. Fraud
incidental services and supplies.
If any claim made by the Insured Person, is any respect of fraudulent,
20. Standard list of excluded items as Specified in the Annexure II, or if any false statement, or declaration is made or used in support
unless agreed by Us and as Specified in the Policy Schedule/ thereof, or if any fraudulent means or devices are used by the insured
Certificate of Insurance person or anyone acting on his/her behalf to obtain any benefit under
21. Any medical procedure or treatment, which is not medically this policy, all benefits under this policy and the premium paid shall be
necessary or not performed by a Doctor/Treating Medical forfeited.
Practitioner. Any amount already paid against claims made under this policy but
SECTION NO. 4-GENERAL TERMS AND CLAUSES which are found fraudulent later shall be repaid by all
recipient(s)/policyholder(s), who has made that particular claim, who
1.1 Standard terms & Conditions shall be jointly and severally liable for such repayment to the insurer.
I. Condition Precedent to the contract

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 36
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

For the purpose of this clause, the expression "fraud" means any of 8. Migration
the following acts committed by the Insured person or by his agent or
The Insured Person will have the option to migrate the Policy to
the hospital/doctor/any other party acting on behalf of the Insured
other health insurance products/plans offered by the Company by
Person, with intent to deceive the Insurer or to induce the Insurer to
applying for Migration of the Policy at least 30 days before the Policy
issue an insurance policy:
Renewal date as per lRDAl guidelines on Migration. If such person is
a) the suggestion, as a fact of that which is not true and which the presently covered and has been continuously covered without any
Insured person does not believe to be true; lapses under any health insurance product/plan offered by the
Company, the Insured Person is entitled to transfer the credits
b) the active concealment of a fact by the Insured person having
gained to the extent of the Sum Insured, No Claim Bonus, Specific
knowledge or belief of the fact;
Waiting Periods, Waiting Period for Pre-existing Diseases,
c) any other act fitted to deceive; and Moratorium Period etc. in the previous Policy to the Migrated Policy.
d) any such act or omission as the law specially declares to be For Detailed Guidelines on Migration, kindly refer the link-
fraudulent https://content.sbigeneral.in//uploads/c6a2844dd65446019b130ffb
ae1fa20f.pdf
The Company shall not repudiate the claim and / or forfeit the policy
benefits on the ground of Fraud, if the Insured Person / beneficiary 9. Portability
can prove that the misstatement was true to the best of his The Insured Person will have the option to port the Policy to other
knowledge and there was no deliberate intention to suppress the fact Insurers by applying to such Insurer to port the entire Policy along
or that such misstatement of or suppression of material fact are with all the members of the Family, if any, at least 45 days before,
within the knowledge of the insurer. but not earlier than 60 days from the Policy Renewal date as per
7. Cancellation: lRDAl guidelines related to Portability. If such person is presently
a. Cancellation by you: covered and has been continuously covered without any lapses under
any health insurance Policy with an Indian General/Health Insurer,
The Policyholder may cancel his/her Policy at any time during the the proposed Insured Person is entitled to transfer the credits gained
term, by giving 7 days’ notice in writing. The Insurer shall to the extent of the Sum Insured, No Claim Bonus, Specific Waiting
i. refund proportionate premium for unexpired Policy Period, if the Periods, Waiting Period for Pre-existing Diseases, Moratorium
term of Policy upto one year and there is no Claim (s) made during Period, etc. from the existing Insurer to the acquiring Insurer in the
the Policy Period. previous Policy.
ii. refund premium for the unexpired Policy Period, in respect of
policies with term more than 1 year and risk coverage for such Policy For Detailed Guidelines on Portability, kindly refer the link-
years has not commenced. https://content.sbigeneral.in//uploads/c6a2844dd65446019b130ffba
e1fa20f.pdf
b. Cancellation by Us:
10. Renewal of Policy:
The Company may cancel the policy at any time on grounds of
misrepresentation non-disclosure of material facts, fraud by the i. The Policy shall ordinarily be renewable provided the product is
Insured Person by giving 15 days' written notice. There would be no not withdrawn, except on grounds of established fraud or non-
refund of premium on cancellation on grounds of misrepresentation, disclosure or misrepresentation by the Insured Person.
non-disclosure of material facts or fraud. ii. The Company shall endeavor to give notice for Renewal.
However, the Company is not under obligation to give any
notice for Renewal.
iii. Renewal shall not be denied on the ground that the Insured
Person had made a Claim or Claims in the preceding Policy
years.
iv. Request for Renewal along with the requisite premium shall be
received by the Company before the end of the Policy Period.
v. At the end of the Policy Period, the Policy shall terminate and
can be renewed within the Grace Period of 30 days to maintain
continuity of benefits without Break in Policy. Coverage is not
available during the Grace Period.
vi. No loading shall apply on Renewals based on individual Claims
experience.
11. Withdrawal of the Policy-
ln the likelihood of this product being withdrawn in future, the
Company will intimate the Insured Person about the same 90 days
prior to expiry of the policy. The lnsured Person will have the option
to migrate to similar health insurance product available with the
Company at the time of renewal with all the accrued continuity
benefits such as cumulative bonus, waiver of waiting period as per
IRDAI guidelines, provided the policy has been maintained without a
break.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 37
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

12. Moratorium Period iv. No interest will be charged If the instalment premium is not
paid on due date.
After completion of sixty continuous months of coverage (including
portability and migration) in health insurance Policy, no Policy and v. In case of instalment premium due not received within the
claim shall be contestable by the Insurer on grounds of non- Grace Period, the Policy will get cancelled.
disclosure, misrepresentation, except on grounds of established
vi. In the event of a Claim, all subsequent premium instalments
fraud. This period of sixty continuous months is called as
shall immediately become due and payable.
moratorium period. The moratorium would be applicable for the
Sums Insured of the first Policy. Wherever, the Sum Insured is vii. The Company has the right to recover and deduct all the
enhanced, completion of sixty continuous months would be pending instalments from the Claim amount due under the
applicable from the date of enhancement of Sums Insured only on Policy.
the enhanced limits. 16. Redressal of Grievance In case of any grievance the Insured
13. Possibility of Revision of terms of the Policy including the Person may contact the company through:
Premium Rates Website: https://www.sbigeneral.in/
The Company, with prior approval of IRDAI, may revise or modify the .
terms of the policy including the premium rates. The Insured Person Stage 1: If you are dissatisfied with the resolution provided above or
shall be notified three (3) months before the changes are affected. for lack of response, you may write to
head.customercare@sbigeneral.in We will look into the matter and
14. Free Look Period decide the same expeditiously within 14 days from the date of
The Free Look Period shall be applicable on new individual health receipt of your complaint.
insurance policies and not on renewals of the Policy. The Insured
Person shall be allowed free look period of thirty days from date of For Senior Citizens: Senior Citizens can reach us at
receipt of the policy document to review the terms and conditions of seniorcitizengrievances@sbigeneral.in; Toll Free - 1800 22 1111 /
the policy, and to return the same if not acceptable. 1800 102 1111 (24*7)
Stage 2: In case, you are not satisfied with the decision/resolution
lf the insured has not made any claim during the Free Look Period,
communicated by the above office, or have not received any
the Insured shall be entitled to
response within 14 days, you may send your Appeal addressed to
(1) Every Policyholder of new individual health insurance policies the Grievance Redressal Officer at : gro@sbigeneral.in or contact at
except those with tenure of less than a year, shall be provided a 022-45138021.
free look period of 30 days beginning from the date of receipt
of policy document, whether received electronically or Address: Grievance Redressal Officer, 9th Floor, A & B Wing,
otherwise, to review the terms and conditions of such Policy. Fulcrum Building, Sahar Road, Andheri (East), Mumbai 400 099. List
of Grievance Redressal Officers at Branch:
(2) In the event a Policyholder disagrees to any of the Policy terms https://content.sbigeneral.in/uploads/0449cac1bcd144bbb160d3f6
or conditions, or otherwise and has not made any claim, he b714fbbd.pdf/
shall have the option to return the Policy to the insurer for
cancellation, stating the reasons for the same. Stage 3: In case, you are not satisfied with the decision/resolution
communicated by the above office, or have not received any
(3) Irrespective of the reasons mentioned, the Policyholder shall be response within 14 days, you may Register your complaint with
entitled to a refund of the premium paid subject only to a IRDAI on the below given link
deduction of a proportionate risk premium for the period of https://bimabharosa.irdai.gov.in/Home/Home
cover and the expenses, if any, incurred by the insurer on
medical examination of the proposer and stamp duty charges. Stage 4: If your grievance remains unresolved from the date of filing
your first complaint or is partially resolved, you may approach the
(4) A request received by insurer for cancellation of the Policy Insurance Ombudsman falling in your jurisdiction for Redressal of
during free look period shall be processed and premium shall your Grievance. The details of the Insurance Ombudsman can be
be refunded within 7 days of receipt of such request, as stated accessed at ( https://www.cioins.co.in/Ombudsman)
at sub regulation (3) above.
17. Nomination
15. Premium payment in instalments (wherever applicable): The policy holder is required at the inception of the policy to make a
If the Insured Person has opted for Payment of Premium on an nomination for the purpose of payment of claims under the policy in
instalment basis i.e. Single, Half Yearly, Quarterly or Monthly, as the event of death of the policy holder. Any change of nomination
mentioned in the Policy Schedule/Certificate of Insurance, the shall be communicated to the Company in writing and such change
following Conditions shall apply (notwithstanding any terms contrary shall be effective only when an endorsement on the policy is made.
elsewhere in the Policy) ln the event of death of the Insured Person, the Company will pay
i. Grace Period would be given to pay the instalment premium the nominee (as named in the Policy Schedule/ /endorsement (if
due for the Policy. In case of monthly instalment option, a any)) and in case there is no subsisting nominee, to the legal heirs or
Grace Period of 15 days is applicable. Whereas, in case of legal representatives of the Insured Person whose discharge shall be
Single, Half Yearly, Quarterly instalment options, a Grace treated as full and final discharge of its liability under the Policy.
Period of 30 days is applicable. 1.2 Specific Conditions
ii. During such Grace Period, coverage will be available from the I. Renewal Conditions
due date of instalment premium till the date of receipt of We will offer other benefits besides those Specified in Section
premium by Company. A,B,C,D,E, F, and G as given below:

iii. The Insured Person will get the accrued continuity benefit in • Any Cover / benefit available in expiring policy as specifically
respect of the Sum Insured, No Claim Bonus, Specific Waiting agreed by us to be covered and Specified in the Policy
Periods, Waiting Periods for Pre-existing Diseases, Schedule/Certificate of Insurance.
Moratorium period etc in the event of payment of premium • Cover beyond Indian Geographical jurisdiction available in
within the stipulated Grace Period expiring policy, if specifically agreed by us to be covered and
Specified in the Policy Schedule/Certificate of Insurance.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 38
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

a. Arbitration clause e. Premium

The premium payable under this Policy shall be paid in accordance
i. If any dispute or difference shall arise as to the quantum to be
with the schedule of payments in the Policy Schedule/ Certificate of
paid under this Policy (liability being otherwise admitted) such
Insurance agreed between the Policyholder and Us in writing. No
difference shall independent of all other questions be referred
receipt for premium shall be valid except on Our official form signed
to the decision of a sole arbitrator to be appointed in writing
by Our duly authorized official. The due payment of premium and
by the parties thereto, or if they cannot agree upon a single
realization thereof by Us and the observance and fulfilment of the
arbitrator within 30 days of any party invoking arbitration, the
terms, provisions, conditions and endorsements of this Policy by the
same shall be referred to a panel of three arbitrators,
Insured Person in so far as they relate to anything to be done or
comprising of two arbitrators, one to be appointed by each of
complied with by the Insured Person shall be a condition precedent
the parties to the dispute/difference and the third arbitrator
to Our liability to make any payment under this Policy.
to be appointed by such two Arbitrators who shall act as the
presiding arbitrator and Arbitration shall be conducted under f. Records to be Maintained
and in accordance with the provisions of the Arbitration and The Insured Person shall keep an accurate record containing all
Conciliation Act, 1996) as amended by Arbitration and relevant medical records and shall allow the Company or its
Conciliation (Amendment) Act, 2015 (No. 3 of 2016).
representatives to inspect such records. The Insured Person shall
ii. It is clearly agreed and understood that no difference or furnish such information as the Company may require for
dispute shall be referable to arbitration, as hereinbefore settlement of any claim under the Policy, within reasonable time
provided, if the Company has disputed or not accepted liability limit and within the time limit specified in the Policy
under or in respect of this Policy.
g. Territorial Jurisdiction
iii. It is hereby expressly stipulated and declared that it shall be a All disputes or differences under or in relation to the interpretation
condition precedent to any right of action or suit upon this of the terms, conditions, validity, construct, limitations and/or
Policy that the award by such arbitrator/ arbitrators of the exclusions contained in the Policy shall be determined by the Indian
amount of expenses shall be first obtained. court and according to Indian law.
b. Change of Sum Insured h. Terms and conditions of the Policy
Sum Insured can be changed (increase / decrease) only at the time The terms and conditions contained herein and in the Policy
of Renewal or at any time, subject to underwriting by the Company. Schedule/Certificate of Insurance shall be deemed to form part of
For any increase in Sum Insured, the waiting period shall start afresh the Policy and shall be read together as one document.
only for the enhance portion of the Sum Insured. II. Conditions applicable during the contract
c. Material Change a. Alterations in the Policy
The Insured Person shall notify the Company in writing of any The Proposal Form, Policy Schedule/Certificate of Insurance
material change in the risk in relation to the declaration made in the constitute the complete contract of insurance. This Policy
Proposal form or medical examination report at each Renewal and constitutes the complete contract of insurance between the
the Company may, adjust the scope of cover and / or premium, if Policyholder and Us. No change or alteration will be effective or
necessary, accordingly. valid unless approved in writing which will be evidenced by a written
d. Notice and Communication endorsement, signed, and stamped by Us. All endorsement requests
will be made by the Policy Holder and/or the Insured Person only.
i. Any notice, direction, instruction, or any other communication This Policy cannot be changed by anyone (including an insurance
related to the Policy should be made in writing. agent or broker) except Us.
ii. Such communication shall be sent to the address of the b. Revision and Modification of the Policy Product
Company or through any other electronic modes specified in
the Policy Schedule/Certificate of Insurance. i. Any revision or modification will be done with the approval of
the Authority. We shall notify You about revision /modification
iii. The Company shall communicate to the Insured at the address in the Policy including premium payable thereunder. Such
or through any other electronic mode Specified in the information shall be given to You at least ninety (90) days prior
schedule/certificate of insurance. to the effective date of modification or revision coming into
effect.
III. Conditions when a claim arises
Compliance with Policy Provisions Failure by You or the Insured
Person to comply with any of the provisions in this Policy shall
invalidate all claims hereunder.
Claims procedure:
If Insured meet with any accidental Bodily Injury or suffer an Illness
that may result in a claim, then as a Condition Precedent to Our
liability, Insured must comply with the following:
Procedures Cashless Hospitalization Reimbursement Claims
You shall intimate the Claims to us through any available mode of communication as specified in the Policy,
Claim Intimation
Health Card or our Website.
Within 24 hours of the Emergency Hospitalization Within 48 hours of admission or
Claim Intimation timelines before discharge from the
At least 72 hours prior to the planned Hospitalization Hospital, whichever is earlier

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 39
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

1. Policy Number
2. Name of the Insured Person(s) named in the Policy schedule / Certificate of Insurance availing treatment,
Particulars to be provided to us for 3. Nature of disease/illness/injury,
Claim notification 4. Name and address of the attending Medical Practitioner Hospital
5. Date and time of event if applicable
6. Date of admission
1. Policy Number
2. Name of the Insured person(s) named in the Policy schedule availing
treatment
3. Nature of disease/Illness/Injury
4. Name and address of the attending
Particulars to be provided for 5. Medical Practitioner/ Hospital
Not Applicable
preauthorization 6. Date of admission & probable date of discharge
7. Approximate Claim Expenses
8. Treatment Details
9. Claim Form / Pre-Authorization Request form
10. Any other relevant information as required
11. cKYC Form and KYC Documents
I. If the particulars are not provided in full or are insufficient for us to
consider the request in Predefined Claim Form, We will request
additional information or documentation
II. On receipt of duly filled pre authorization form from the Network
Process for obtaining Pre- Provider along with other sufficient details to assess the request, We
Not Applicable
Authorization may;·
• Issue the authorization letter specifying the sanctioned amount any
specific limitation on the claim and non-payable items, if applicable or
• Reject the request for preauthorization specifying reasons for the
rejection.
On receipt of duly filled pre-authorization form with other sufficient
details to assess a cashless request, the Company will inform the Home
Healthcare service provider or Network Provider, who will share the
care plan and treatment cost estimation with the Company. On receipt
Procedure for Cashless Claims in
of the complete documents the Company may: Not Applicable
case of Home Health Care
a. issue the authorization letter specifying the sanctioned amount, any
specific limitation on the claim and non-payable items, if applicable, or
b. reject the request for pre-authorization specifying reasons for the
rejection.

• List of necessary claim documents/information to be Accident & Health claims team

submitted for reimbursement claims SBI General Insurance Company Limited
9th Floor, Westport, Pan Card Club Road, Baner
• Duly filled and signed claim form Pune, Maharashtra - 411 045
• Certified copy of Hospital discharge Summary .
• Certified copy of final hospital bill, pharmacy bills, Investigation i. Cashless Facility can be availed only at Our Network Providers.
labs bills The complete list of Network Providers and empaneled Service
providers are available on Our Website.
• All original reports of Investigations done
ii. We reserve the right to modify, add or restrict any Network
• Self-attested Copy of PAN card & masked Aadhar card, photo Provider for Cashless Facilities at Our sole discretion. The same
id & address Proof of the nominee / beneficiary (Driving license shall be duly updated on Our website. You shall check the
/ Passport / Election Card, etc) for address Specified in claim updated list of Network Providers before applying for Cashless
form Claim.
• Beneficiary bank account / NEFT details: Cancelled cheque or iii. Pre-authorization is valid for 15 days from date of issuance and
copy of first page of bank passbook showing account holder’s if all the details of the Hospitalization/treatment, including
name, Account number, IFSC code, Branch name etc. dates, Hospital and locations match with the details as per
• Certified copy of Death certificate issued by municipal Cashless authorized.
authority (in case of death of insured)
iv. We will make payment for the Cashless authorized amount
Any additional documents may be called as required based on the directly to the Network Provider.
circumstances of the claim. v. If the claim is not notified to Us within the specified time
• Claim documents submission address limits, then We shall be provided the reasons for the delay in
writing. We will condone such delay on merits where the delay
All claim related documents need to be sent to below address within has been proved to be for reasons beyond the claimant’s
30 days of date of discharge from hospital. control.
Please do mention appropriate claim number on claim documents
dispatched.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 40
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

• Claim documents submission:

In case of any Claim, the list of documents as Specified above shall
be provided by the Policy Holder/ Insured Person to Company within
30 days of date of discharge from hospital.
• Scrutiny and Investigation of Claim
We will scrutinize the claim based on submission of above claim
documents by you and if any deficiency in document we will
intimate You in writing within 7 days from the date of submission of
claim documents. We will initiate and complete such investigation
at the earliest, in any case not later than 30 days from the date of
receipt of last necessary document.
• Claim Assessment
We will pay fixed amounts as specified in the applicable Sections in
accordance with the terms of this Policy. We are not liable to make
any payments that are not specified in the Policy.
• Condonation of delay
If the claim is not notified/ or submitted to Us within the specified
time limits, then We shall be provided the reasons for the delay in
writing. We will condone such delay on merits where the delay has
been proved to be for reasons beyond the claimant’s control.
• Payment of Claim
All claims under the Policy shall be payable in Indian currency only.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 41
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

ANNEXURE I - LIST OF OMBUDSMEN OFFICES JAIPUR - Shri Rajiv Dutt Sharma Rajasthan.
Office of the Insurance Ombudsman,
Jurisdiction of Jeevan Nidhi - II Bldg., Gr. Floor, Bhawani
Office Details
Office Singh Marg, Jaipur - 302 005.
AHMEDABAD - Shri Kuldip Singh Gujarat, Tel.: 0141 - 2740363
Office of the InsuranceOmbudsman, Dadra & Nagar Email: Bimalokpal.jaiur@ecoi.co.in
Jeevan Prakash Building, 6th floor, Haveli, ERNAKULAM - Shri G. Radhakrishnan Office Kerala,
Tilak Marg, Relief Road, Daman and Diu. of the Insurance Ombudsman, 2nd Floor, Lakshadweep,
Ahmedabad - 380 001. Pulinat Bldg.,Opp. Cochin Shipyard, M. G. Mahe-a part of
Tel.: 079 - 25501201/02/05/06 Road, Ernakulam - 682 015. Pondicherry.
Email: bimalokpal.ahmedabad@ecoi.co.in Tel.: 0484 - 2358759 / 2359338
BENGALURU - Mr Vipin Anand Office of Karnataka, Email: bimalokpal.ernakulam@ecoi.co.in
the Insurance Ombudsman, Jeevan Sudha KOLKATA - Shri P.K. Rath West Bengal,
Building, PID No. 57-27-N-19 Ground Floor, 1 Office of the Insurance Ombudsman, Sikkim, Andaman &
9/19, 24th Main Road, JP Nagar, 1st Phase, Hindustan Bldg. Annexe, 4th Floor, 4, C.R. Nicobar Islands.
Bengaluru - 560 078. Avenue, KOLKATA - 700 072.
Tel.: 080 - 26652048 / 26652049 Tel.: 033 - 22124339 / 22124340
Email: bimalokpal.bengaluru@ecoi.co.in Email: bimalokpal.kolkata@ecoi.co.in
BHOPAL - Shri R. M. Singh Madhya Pradesh, LUCKNOW- Districts of Uttar
Office of the Insurance Ombudsman, Chhattisgarh. Office of the Insurance Ombudsman, 6th Pradesh: Laitpur,
JanakVihar Complex, 2nd Floor, 6, Malviya Floor, Jeevan Bhawan, Phase-II, Nawal Jhansi, Mahoba,
Nagar, Opp. AirtelOffice, Near New Market, Kishore Road, Hazratganj, Hamirpur, Banda,
Bhopal - 462 003. Lucknow - 226 001. Chitrakoot,
Tel.: 0755 - 2769201 / 2769202 Tel.: 0522 - 2231330 / 2231331 Allahabad,
Email: bimalokpal.bhopal@ecoi.co.in Email: bimalokpal.lucknow@ecoi.co.in Mirzapur,
BHUBANESHWAR - Shri Suresh Chandra Orissa. Sonbhabdra,
Panda Office of the Insurance Ombudsman, Fatehpur,
62, Forest park, Bhubneshwar - 751 009. Pratapgarh,
Tel.: 0674 - 2596461 /2596455 Jaunpur,Varanasi,
Email: bimalokpal.bhubaneswar@ecoi.co.in Gazipur, Jalaun,
Kanpur, Lucknow,
CHANDIGARH - Mr Atul Jerath Punjab, Haryana, Unnao, Sitapur,
Office of the Insurance Ombudsman, Himachal Pradesh, Lakhimpur,
S.C.O. No. 101, 102 & 103, 2nd Floor, Jammu & Kashmir, Bahraich,
Batra Building, Sector 17-D, Chandigarh-160 Chandigarh. Barabanki,
017. Raebareli,
Tel.: 0172 - 2706196 / 2706468 Sravasti, Gonda,
Email: bimalokpal.chandigarh@ecoi.co.in Faizabad, Amethi,
CHENNAI - Shri Segar Sampathkumar Tamil Nadu, Kaushambi,
Office of the Insurance Ombudsman, Fatima Pondicherry Town Balrampur,
Akhtar Court, 4th Floor, 453, Anna Salai, and Karaikal (which Basti,
Teynampet, CHENNAI - 600 018. are part of Ambedkarnagar,
Tel.: 044 - 24333668 / 24335284 Pondicherry). Sultanpur,
Email: bimalokpal.chennai@ecoi.co.in Maharajgang,
Santkabirnagar,
DELHI - Shri Sudhir Krishna Delhi.
Azamgarh,
Office of the Insurance Ombudsman, 2/2 A,
Kushinagar,
Universal Insurance Building, Asaf Ali Road,
Gorkhpur,
New Delhi - 110 002.
Deoria, Mau,
Tel.: 011 - 23232481/23213504
Ghazipur,
Email: bimalokpal.delhi@ecoi.co.in
Chandauli,
GUWAHATI - Shri Somnath Ghosh Office Assam, Meghalaya, Ballia,
of the Insurance Ombudsman, Jeevan Manipur, Mizoram, Sidharathnagar
Nivesh, 5th Floor, Nr. Panbazar over bridge, Arunachal Pradesh,
MUMBAI - Ms Susmita Mukherjee Goa, Mumbai
S.S.Road, Guwahati - 781001(ASSAM). Nagaland and
Office of the Insurance Ombudsman, 3rd Metropolitan
Tel.: 0361 - 2632204 / 2602205 Tripura
Floor, Jeevan Seva Annexe, S. V. Road, Region
Email: bimalokpal.guwahati@ecoi.co.in
Santacruz (W), Mumbai - 400 054. excluding Navi
HYDERABAD - Shri N. Sankaran Office of Andhra Pradesh, Tel.: 022 - 69038821/23/24/25/26/27/28/ Mumbai & Thane.
the Insurance Ombudsman, 6-2-46, 1st Telangana, Yanam 28/29/30/31
floor, "Moin Court", Lane Opp. Saleem and part of Email: bimalokpal.mumbai@ecoi.co.in
Function Palace, A. C. Guards, Lakdi-Ka- Territory
Pool, Hyderabad - 500 004. of Pondicherry.
Tel.: 040 - 67504123 / 23312122
Email: bimalokpal.hyderabad@ecoi.co.in

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 42
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

NOIDA - Shri Chandra Shekhar Prasad State of 14 TELEPHONE CHARGES

Office of the InsuranceOmbudsman, Uttaranchal
Bhagwan Sahai Palace 4th Floor, Main Road, and the following 15 GUEST SERVICES
Naya Bans, Sector 15, Distt: Gautam Buddh Districts of Uttar 16 CREPE BANDAGE
Nagar, Pradesh: Agra,
U.P 201301. Aligarh, Bagpat, 17 DIAPER OF ANY TYPE
Tel.: 0120-2514250 / 2514252 / 2514253 Bareilly, Bijnor, 18 EYELET COLLAR
Email: bimalokpal.noida@ecoi.co.in Budaun,
19 SLINGS
Bulandshehar,
Etah, Kanooj, BLOOD GROUPING AND CROSS MATCHING OF DONORS
20
Mainpuri, SAMPLES
Mathura,
21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED
Meerut,
Moradabad, 22 TELEVISION CHARES
Muzaffarnagar,
23 SURCHARGES
Oraiyya,
Pilibhit, Etawah, 24 ATTENDANT CHARGES
Farrukhabad,
EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS
Firozbad, 25
PART OF BED CHARGE
Gautambodhanaga
r, Ghaziabad, 26 BIRTH CERTIFICATE
Hardoi, 27 CERTIFICATE CHARGES
Shahjahanpur,
Hapur, Shamli, 28 COURIER CHARGES
Rampur, Kashganj, 29 CONVEYANCE CHARGES
Sambhal, Amroha,
Hathras, 30 MEDICAL CERTIFICATE
Kanshiramnagar, 31 MEDICAL RECORDS
Saharanpur.
32 PHOTOCOPIES CHARGES
PATNA - Shri N. K. Singh Bihar, Jharkhand.
Office of the Insurance Ombudsman, 1st 33 MORTUARY CHARGES
Floor, Kalpana Arcade Building, Bazar 34 WALKING AIDS CHARGES
Samiti Road, Bahadurpur, Patna 800 006.
Tel.: 0612-2680952 35 OXYGEN CYLINDER FOR USAGE OUTSIDE THE HOSPITAL
Email: bimalokpal.patna@ecoi.co.in 36 SPACER
PUNE - Shri Vinay Sah Maharashtra, Area 37 SPIROMETRE
Office of the Insurance Ombudsman, of
Jeevan Darshan Bldg., 3rd Floor, Navi Mumbai and 38 NEBULIZER KIT
C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Thane excluding 39 STEAM INHALER
Narayan Peth, Pune -411 030. Mumbai
40 ARMSLING
Tel.: 020-41312555 Metropolitan
Email: bimalokpal.pune@ecoi.co.in Region. 41 THERMOMETER

ANNEXURE II - NON MEDICAL EXPENSES 42 CERVICAL COLLAR

43 SPLINT
List I - Items for which coverage is not available in the policy 44 DIABETIC FOOTWEAR
1 BABY FOOD 45 KNEE BRACES LONG/ SHORT/ HINGED
2 BABY UTILITIES CHARGES 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
3 BEAUTY SERVICES 47 LUMBO SACRAL BELT
4 BELTS/ BRACES 48 NIMBUS BED OR WATER OR AIR BED CHARGES
5 BUDS 49 AMBULANCE COLLAR
6 COLD PACK/HOT PACK 50 AMBULANCE EQUIPMENT
7 CARRY BAGS 51 ABDOMINAL BINDER
8 EMAIL / INTERNET CHARGES 52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
FOOD CHARGES OTHER THAN PATIENT's DIET PROVIDED BY 53 SUGAR FREE Tablets
9
HOSPITAL
CREAMS POWDERS LOTIONS (Toiletries are not payable, only
10 LEGGINGS 54 prescribed medical pharmaceuticals payable ECG
11 LAUNDRY CHARGES ELECTRODES
12 MINERAL WATER 55 ECG ELECTRODES
13 SANITARY PAD 56 GLOVES

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 43
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

57 NEBULISATION KIT 31 DAILY CHART CHARGES

ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, 32 ENTRANCE PASS / VISITORS PASS CHARGES
58
ORTHOKIT, RECOVERY KIT, ETC
33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
59 KIDNEY TRAY
34 FILE OPENING CHARGES
60 MASK
35 INCIDENTAL EXPENSES / MISC. CHARGES NOT EXPLAINED
61 OUNCE GLASS
36 PATIENT IDENTIFICATION BAND / NAME TAG
62 OXYGEN MASK
37 PULSEOXYMETER CHARGES
63 PELVIC TRACTION BELT List III - Items that are to be subsumed into Procedure Charges
64 PAN CAN No. Item
65 TROLLY COVER 1 HAIR REMOVAL CREAM
66 UROMETER, URINE JUG 2 DISPOSABLES RAZORS CHARGES (for site preparations)
67 AMBULANCE 3 EYE PAD
68 VASOFIX SAFETY 4 EYE SHEILD
List II - Items that are to be subsumed into Room charges
5 CAMERA COVER
No. Item
6 DVD, CD CHARGES
1 BABY CHARGES UNLESS SPECIFIED/INDICATED
7 CAUSE SOFT
2 HAND WASH
8 GAUZE
3 SHOE COVER
9 WARD AND THEATRE BOOKING CHARGES
4 CAPS
10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS
5 CRADLE CHARGES
11 MICROSCOPE COVER
6 COMB
12 SURGICAL BLADES, HARMONICSCALPEL, SHAVER
7 EAU-DE-COLOGNE / ROOM FRESHNERS
13 SURGICAL DRILL
8 FOOT COVER
14 EYE KIT
9 GOWN
15 EYE DRAPE
10 SLIPPERS
16 X-RAY FILM
11 TISSUE PAPER
17 BOYLES APPARATUS CHARGES
12 TOOTH-PASTE
18 COTTON
13 TOOTH-BRUSH
19 COTTON BANDAGE
14 BED PAN
20 SURGICAL TAPE
15 FACE MASK
21 APRON
16 FLEXI MASK
22 TORNIQUET
17 HAND HOLDER
23 ORTHOBUNDLE, GYNAEC BUNDLE
18 SPUTUM CUP List IV - Items that are to be subsumed into costs of treatment
19 DISINFECTANT LOTIONS No. Item
20 LUXURY TAX 1 ADMISSION/REGISTRATION CHARGES
21 HVAC 2 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE
22 HOUSE KEEPING CHARGES 3 URINE CONTAINER
23 AIR CONDITIONER CHARGES BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING
4
24 1M IV INJECTION CHARGES CHARGES
25 CLEAN SHEET 5 BIPAP MACHINE
26 BLANKET/VVARMER BLANKET 6 CPAP/ CAPD EQUIPMENTS
27 ADMISSION KIT 7 INFUSION PUMP- COST
28 DIABETIC CHART CHARGES 8 HYDROGEN PEROXIDE/SPIRIT/DISINFECTANTS ETC
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES 9 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES -
9
DIET CHARGES
30 DISCHARGE PROCEDURE CHARGES
10 HIV KIT

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 44
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

11 ANTISEPTIC MOUTHWASH 33 Adenoidectomy 60 Cholecystectomy

12 LOZENGES 34 Labyrinthectomy For Severe 61 Choledocho-jejunostomy
13 MOUTH PAINT Vertigo

14 VACCINATION CHARGES 35 Stapedectomy Under Ga 62 Duodenostomy

15 ALCOHOL SWABES 36 Stapedectomy Under La 63 Gastrostomy

16 SCRUB SOLUTION/STERILLIUM 37 Tympanoplasty (Type IV) 64 Exploration Common Bile

Duct
17 Glucometer & Strips
38 Endolymphatic Sac Surgery 65 Esophagoscopy
18 URINE BAG For Meniere's Disease
ANNEXURE IlI - INDICATIVE LIST OF DAY CARE PROCEDURES 39 Turbinectomy 66 Gastroscopy
40 Endoscopic Stapedectomy 67 Duodenoscopy with
SR Procedure Name SR Procedure Name Polypectomy
1 Coronary Angiography 17 Tonsillectomy Without 41 Incision And Drainage Of 68 Removal of Foreign Body
Adenoidectomy Perichondritis
2 Suturing Oral Mucosa 18 Tonsillectomy With 42 Septoplasty 69 Diathery Of Bleeding
denoidectomy Lesions
3 Myringotomy With 19 Excision And Destruction Of 43 Vestibular Nerve Section 70 Pancreatic PseudocystEus &
Grommet Insertion A Lingual Tonsil Drainage
4 Tymanoplasty (closure of 20 Revision of a 44 Thyroplasty Type I 71 Rf Ablation For Barrett's
An Eardrum Perforation Tympanoplasty Oesophagus
reconstruction of The
Auditory Ossicles) 45 Pseudocyst Of The Pinna 72 Ercp And Papillotomy
Excision
5 Removal Of A Tympanic 21 Other Excisions Of The
Drain Middle And Inner Ear 46 Incision And Drainage 73 Esophagoscope And
Haematoma Auricle Sclerosant Injection
6 Keratosis Removal Under 22 Incision Of The Mastoid
Ga Process And Middle Ear 47 Tympanoplasty (Type II) 74 Eus + Submucosal Resection

7 Operations On The 23 Mastoidectomy 48 Reduction Of Fracture Of 75 Construction Of

Turbinates (nasal Concha) Nasal Bone Gastrostomy Tube

8 Removal of Keratosis 24 Reconstruction Of The 49 Thyroplasty (Type II) 76 Eus + Aspiration Pancreatic
Obturans Middle Ear Cyst

9 Stapedotomy To Treat 25 Other Excisions Of The 50 Tracheostomy 77 Small Bowel Endoscopy

Various Lesions In Middle Middle And Inner Ear (therapeutic)
Ear 51 Excision of Angioma Septum 78 Colonoscopy ,lesion
10 Revision Of A 26 Incision (opening) And Removal - (only for
Stapedectomy Destruction (elimination) investigation purpose is
Of The Inner Ear considered under
investigation purpose)
11 Other Operations On The 27 Other Operations On The
52 Turbinoplasty 79 ERCP
Auditory Ossicles Middle And Inner Ear
12 Myringoplasty (post-aura/ 28 Excision And Destruction Of 53 Vestibular Nerve Section 80 Colonscopy Stenting Of
endaural Approach As Well Diseased Tissue Of The Stricture
As Simple Type - I Nose 54 Thyroplasty Type I 81 Percutaneous Endoscopic
Tympanoplasty) Gastrostomy
13 Fenestration Of The Inner 29 Other Operations On The 55 Pseudocyst Of The Pinna 82 Eus And Pancreatic Pseudo
Ear Nose - ( other operation of Excision Cyst Drainage
the nose is very broad if
56 Incision And Drainage 83 ERCP And Choledochoscopy
any drainage of local pus
Haematoma Auricle
will be considered as OPD)
57 Tympanoplasty (Type II) 84 Proctosigmoidoscopy
14 Revision Of A Fenestration 30 Nasal Sinus Aspiration
Volvulus Detorsion
Of The Inner Ear
58 Reduction Of Fracture Of 85 ERCP And Sphincterotomy
15 Palatoplasty 31 Foreign Body Removal
Nasal Bone
From Nose ( if same is
removed without using any 59 Thyroplasty (Type II) 86 Esophageal Stent Placement
anesthesia at OPD)
16 Transoral Incision And 32 Other Operations On The
Drainage Of A Pharyngeal Tonsils And Adenoids
Abscess

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 45
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

87 ERCP + Placement Of Biliary 111 Appendicectomy With 135 Oesophagoscopy And 161 Circumcision For Trauma
Stents Drainage Biopsy Of Growth
88 Sigmoidoscopy W / Stent 112 Appendicectomy without Oesophagus
Drainage 136 ERCP - Bile Duct Stone 162 Meatoplasty
89 Eus + Coeliac Node Biopsy 113 Infected Keloid Excision Removal

90 UgiScopy And Injection Of 114 Axillary Lymphadenectomy 137 Ileostomy Closure 163 Intersphincteric Abscess
Adrenaline, Sclerosants Incision And Drainage
Bleeding Ulcers 138 Polypectomy Colon 164 Psoas Abscess Incision And
91 91 Incision Of A Pilonidal 115 Wound Debridement And Drainage
Sinus / Abscess Cover 139 Splenic Abscesses 165 Thyroid Abscess Incision
92 Fissure In 116 Abscess-decompression Laparoscopic Drainage And Drainage
AnoSphincterotomy 140 UgiScopy And Polypectomy 166 Tips Procedure For Portal
93 Surgical Treatment Of A 117 Cervical Lymphadenectomy Stomach Hypertension
Varicocele And A Hydrocele 141 Rigid Oesophagoscopy For 167 Esophageal Growth Stent
Of the Spermatic Cord Fb Removal
94 Orchidopexy 118 Infected Sebaceous Cyst 142 Feeding Jejunostomy 168 Pair Procedure Of Hydatid
95 Abdominal Exploration In 119 Inguinal Lymphadenectomy Cyst Liver
Cryptorchidism 143 Colostomy 169 Tru Cut Liver Biopsy
96 Surgical Treatment Of Anal 120 Infected Lipoma Excision 144 Ileostomy 170 Photodynamic Therapy Or
Fistulas Esophageal Tumour And
Division Of The Anal Lung Tumour
Sphincter (sphincterotomy)
Epididymectomy 145 Colostomy Closure 171 Excision Of Cervical Rib

97 Division Of The Anal 121 Maximal Anal Dilatation 146 Submandibular Salivary 172 Laparoscopic Reduction Of
Sphincter (sphincterotomy) Duct Stone Removal Intussusception

98 Epididymectomy 122 Piles 147 Pneumatic Reduction Of 173 Microdochectomy Breast

Intussusception
99 Incision Of The Breast 123 A) Injection Sclerotherapy
Abscess 148 Varicose Veins Legs 174 Surgery For Fracture Penis
Injection Sclerotherapy
100 Operations On The Nipple 124 B) Piles Banding
149 Rigid Oesophagoscopy For 175 Parastomal Hernia
101 Excision Of Single Breast 125 Liver Abscess- Catheter Plummer Vinson Syndrome
Lump Drainage
150 Pancreatic Pseudocysts 176 Revision Colostomy
102 Incision And Excision Of 126 Fissure In Ano- Endoscopic Drainage
Tissue In The Perianal Fissurectomy
Region 151 Zadek's Nail Bed Excision 177 Prolapsed
ColostomyCorrection
103 Surgical Treatment Of 127 Fibroadenoma Breast
Hemorrhoids Excision 152 Subcutaneous Mastectomy 178 Laparoscopic
Cardiomyotomy (Hellers)
104 Other Operations On The 128 OesophagealVaricesSclerot
Anus herapy 153 Excision Of Ranula Under 179 Laparoscopic
Ga Pyloromyotomy (Ramstedt)
105 Ultrasound Guided 129 ERCP - Pancreatic Duct
Aspirations Stone Removal 154 Rigid Oesophagoscopy For 180 Operations On Bartholin’s
Dilation Of Benign Strictures Glands (cyst)
106 Sclerotherapy, Etc 130 Perianal Abscess I&d
155 Eversion Of Sac 181 Incision Of The Ovary
107 Laparotomy For Grading 131 Perianal Hematoma
Lymphoma With Evacuation 156 Unilateral 182 Insufflations Of The
Splenectomy. Fallopian Tubes

108 Laparotomy For Grading 132 UgiScopy And Polypectomy 157 Bilateral 183 Other Operations On The
Lymphoma with Liver Oesophagus Fallopian Tube
Biopsy 158 Lord's Plication 184 Conisation Of The Uterine
109 Laparotomy For Grading 133 Breast Abscess I& D Cervix
Lymphoma with Lymph 186 Therapeutic Curettage
Node Biopsy With Biopsy

110 Therapeutic Laparoscopy 134 Feeding Gastrostomy 159 Jaboulay's Procedure 185 Therapeutic Curettage With
With Laser Colposcopy.
160 Scrotoplasty 186 Therapeutic Curettage With
Biopsy

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 46
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

187 Therapeutic Curettage With 219 Hysteroscopy, Removal Of 251 Tele Gamma Therapy 277 LDR Brachytherapy
Diathermy Myoma
252 FSRT - Fractionated Srt 278 Palliative Radiotherapy
188 Therapeutic Curettage With 220 Turbt
253 VMAT - Volumetric 279 Radical Radiotherapy
Cryosurgery
Modulated Arc Therapy
189 Laser Therapy Of Cervix For 221 Ureterocoele Repair
254 SBRT - Stereotactic Body 280 Palliative Chemotherapy
Various Lesions Of Uterus Congenital Internal
Radiotherapy
190 Other Operations On The 222 Vaginal Mesh For Pop
255 Helical Tomotherapy 281 Template Brachytherapy
Uterine Cervix
256 SRS - Stereotactic 282 Neoadjuvant Chemotherapy
191 Incision Of The Uterus 223 Laparoscopic Myomectomy
Radiosurgery
(hysterectomy)
257 X - Knife Srs 283 Induction Chemotherapy
192 Local Excision And 224 Surgery For Sui
Destruction Of Diseased 258 GammaknifeSrs 284 Consolidation Chemotherapy
Tissue Of The Vagina And
259 TBI - Total Body Radiotherapy 285 Consolidation Chemotherapy
The Pouch Of Douglas
260 Intraluminal Brachytherapy 286 HDR Brachytherapy
193 Incision Of Vagina 225 Repair Recto- Vagina Fistula
261 TSET - Total Electron Skin 287 Incision And Lancing Of A
194 Incision Of Vulva 226 Pelvic Floor Repair
Therapy Salivary Gland And A Salivary
(Excluding Fistula Repair)
Duct
195 Culdotomy 227 URS + LL
262 Extracorporeal Irradiation Of 288 Excision Of Diseased Tissue Of
196 196 Salpingo-oophorectomy 228 Laparoscopic Oophorectomy Blood Products A Salivary Gland And A
Via Laparotom Salivary Duct
197 Endoscopic Polypectomy 229 Percutaneous Cordotomy 263 Telecobalt Therapy 289 Resection Of A Salivary Gland
198 Hysteroscopic Removal Of 230 Intrathecal Baclofen Therapy 264 Telecesium Therapy 290 Reconstruction Of A Salivary
Myoma Gland And A Salivary Duct
199 D&C - 231 Entrapment Neuropathy 265 External Mould 291 Other Operations On The
Release Brachytherapy Salivary Glands And Salivary
Ducts
200 Hysteroscopic Resection Of 232 Diagnostic Cerebral
Septum Angiography 266 Interstitial Brachytherapy 292 Other Incision And Lancing Of
A Salivary Gland And A
201 Thermal Cauterisation Of 233 Vp Shunt
Salivary Duct
Cervix
267 Intracavity Brachytherapy 293 Surgical Wound Toilet (wound
202 HysteroscopicAdhesiolysis 234 Ventriculoatrial Shunt
Debridement) And Removal
203 Polypectomy Endometrium 235 Radiotherapy For Cancer Of Diseased Tissue Of The
204 Hysteroscopic Resection Of 236 Cancer Chemotherapy Skin And
Fibroid SubcutaneousTissues

205 Lletz 237 IV Push Chemotherapy 268 3D Brachytherapy 294 Local Excision Of Diseased
Tissue Of The Skin And
206 Conization 238 HBI - Hemibody Subcutaneous Tissues
Radiotherapy
269 Implant Brachytherapy 295 Other Excisions Of The Skin
207 Polypectomy Cervix 239 Infusional Targeted Therapy And Subcutaneous Tissues
208 Hysteroscopic Resection Of 240 SRT - Stereotactic Arc 270 Intravesical Brachytherapy 296 Simple Restoration Of Surface
Endometrial Polyp Therapy Continuity Of The Skin And
209 Vulval Wart Excision 241 Sc Administration Of Growth Subcutaneous Tissues
Factors 271 Adjuvant Radiotherapy 297 Free Skin Transplantation,
210 Laparoscopic Paraovarian 242 Continuous Infusional Donor Site
Cyst Excision Chemotherapy 272 After loading Catheter 298 Free Skin Transplantation,
211 Uterine Artery Embolization 243 Infusional Chemotherapy Brachytherapy Recipient Sit

212 Laparoscopic Cystectomy 244 CCRT - Concurrent Chemo + Conditioning Radiothearpy 299 Revision Of Skin Plasty
273
Rt For Bmt

213 Hymenectomy( Imperforate 245 2D Radiotherapy Extracorporeal Irradiation To 300 Other Restoration And
Hymen) 274 The Homologous Bone Grafts Reconstruction Of The Skin
And Subcutaneous Tissues
214 Endometrial Ablation 246 3D Conformal Radiotherapy
275 Radical Chemotherapy 301 Chemosurgery To The Skin
215 Vaginal Wall Cyst Excision 247 IGRT - Image Guided
Radiotherapy 276 Neoadjuvant Radiotherapy 302 Destruction Of Diseased
Tissue In The Skin And
216 Vulval Cyst Excision 248 IMRT - Step & Shoot Subcutaneous Tissues
217 Laparoscopic Paratubal Cyst 249 IMRT - DMLC
Excision
218 Repair Of Vagina ( Vaginal 250 Rotational Arc Therapy
Atresia )

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 47
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

303 Reconstruction Of 327 Correction Of Eyelid Ptosis 351 Removal Of Metal Wire 381 Partial Removal Of
Deformity /defect In Nail By LevatorPalpebrae Metatarsal
Bed Superioris Resection 352 Closed Reduction On 382 Repair/Graft Of Foot Tendon
(bilateral Fracture, Luxation
304 Excision Of Bursirtis 328 Correction Of Eyelid Ptosis 353 Reduction Of Dislocation 383 Revision/removal Of Knee
By Fascia Lata Graft Under Ga Cap
(bilateral)
354 Epiphyseolysis With 384 Exploration Of Ankle Joint
305 Tennis Elbow Release 329 Diathermy/cryotherapy To Osteosynthesis
Treat Retinal Tear
355 Excision Of Various Lesions 385 Remove/graft Leg Bone
306 Incision, Excision And 330 Anterior Chamber In Coccyx Lesion
Destruction Of Diseased Paracentesi
Tissue Of The Tongue 356 Arthroscopic Repair Of Acl 386 Repair/graft Achilles Tendon
Tear Knee
307 Partial Glossectomy 331 Anterior Chamber
Cyclodiathermy 357 Arthroscopic Repair Of Pcl 387 Remove Of Tissue Expander
Tear Knee
308 Glossectomy 332 Anterior Chamber
Cyclocyrotherapy 358 Tendon Shortening 388 Biopsy Elbow Joint Lining
309 Reconstruction Of The 333 Anterior Chamber 359 Arthroscopic Meniscectomy 389 Removal Of Wrist Prosthesis
Tongue Goniotomy - Knee
310 Other Operations On The 334 Anterior Chamber 360 Treatment Of Clavicle 390 Biopsy Finger Joint Lining
Tongue Trabeculotomy Dislocation
311 Surgery For Cataract 335 Anterior Chamber Filtering 361 Haemarthrosis Knee- Lavage 391 Tendon Lengthening
312 Incision Of Tear Glands 336 Allied Operations to Treat 362 Abscess Knee Joint Drainage 392 Treatment Of Shoulder
Glaucoma Dislocation
313 Other Operations On The 337 Enucleation Of Eye Without 363 Carpal Tunnel Release 393 Lengthening Of Hand
Tear Ducts Implant Tendon
314 Incision Of Diseased Eyelids 338 Dacryocystorhinostomy For 364 Closed Reduction Of Minor 394 Removal Of Elbow Bursa
Various Lesions Of Lacrimal Dislocation
Gland 365 Repair Of Knee Cap Tendon 395 Fixation Of Knee Joint
315 Excision And Destruction Of 339 Laser Photocoagulation To 366 Orif With K Wire Fixation- 396 Treatment Of Foot
Diseased Tissue Of The Treat Retinal Tear Small Bones Dislocation
Eyelid
367 Release Of Midfoot Joint 397 Surgery Of Bunion
316 Operations On The Canthus 340 Biopsy Of Tear Gland
And Epicanthus 368 Orif With Plating- Small Long 398 Tendon Transfer Procedure
Bones
317 Corrective Surgery For 341 Treatment Of Retinal Lesion
Entropion And Ectropion 369 Implant Removal Minor 399 Removal Of Knee Cap Bursa
318 Corrective Surgery For 342 Surgery For Meniscus Tear 370 Closed Reduction And 400 Treatment Of Fracture Of
Blepharoptosis External Fixation Ulna
319 Removal Of A Foreign Body 343 Incision On Bone, Septic 371 Arthrotomy Hip Joint 401 Treatment Of Scapula
From The Conjunctiva And Aseptic Fracture
320 Removal Of A Foreign Body 344 Closed Reduction On 372 Syme's Amputation 402 Removal Of Tumor Of Arm
From The Cornea Fracture, Luxation Or Under GA
Epiphyseolysis With 373 Arthroplasty 403 Removal of Tumor of Arm
Osteosynthesis under RA
321 Incision Of The Cornea 345 Suture And Other 374 Partial Removal Of Rib 404 Removal of Tumor Of Elbow
Operations On Tendons And Under GA
Tendon Sheath
375 Treatment Of Sesamoid 405 Removal of Tumor Of Elbow
322 Operations For Pterygium 346 Reduction Of Dislocation Bone Fracture Under RA
Under Ga
376 Shoulder Arthroscopy / 406 Repair Of Ruptured Tendon
323 Other Operations On The 347 Arthroscopic Knee Surgery
Cornea Aspiration
377 Elbow Arthroscopy 407 Decompress Forearm Space
324 Removal Of A Foreign Body 348 Surgery For Ligament Tear
From The Lens Of The Eye 378 Amputation Of Metacarpal 408 Revision Of Neck Muscle
Bone (torticollis Release )
325 Removal Of A Foreign Body 349 Surgery For Hemoarthrosis/
From The Posterior pyoarthrosis 379 Release Of Thumb 409 Lengthening Of Thigh
Chamber Of The Eye Contracture Tendons
326 Removal Of A Foreign Body 350 Removal Of Fracture Pins/ 380 Incision Of Foot Fascia 410 Treatment Fracture Of
From The Orbit And Eyeball nails Radius & Ulna

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 48
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

411 Repair Of Knee Joint 436 Construction Skin Pedicle 461 Drainage Of Perinephric 486 Amputation Of The Penis
Flap Abscess
412 External Incision And 437 Gluteal Pressure 462 Incision Of The Prostate 487 Other Operations On The
Drainage In The Region Of Ulcerexcision Penis
The Mouth.
463 Transurethral Excision And 488 Cystoscopical Removal of
413 External Incision And 438 Muscle-skin Graft, Leg Destruction of Prostate Stones
Drainage in the Region of Tissue
the Jaw.
464 Transurethral And 489 Lithotripsy
414 External Incision And 439 Removal Of Bone For Graft Percutaneous Destruction of
Drainage in the Region Of Prostate Tissue
the Face.
465 Open Surgical Excision And 490 Biopsy Oftemporal Artery
415 Incision Of The Hard And 440 Muscle-skin Graft Duct Destruction Of Prostate For Various Lesions
Soft Palate Fistula Tissue
416 Excision And Destruction Of 441 Removal Cartilage Graft 466 Radical 491 External Arterio-venous
Diseased Hard Palate Prostatovesiculectomy Shunt
417 Excision And Destruction of 442 Myocutaneous Flap 467 Other Excision And 492 Av Fistula - Wrist
Diseased Soft Palate Destruction of Prostate
Tissue
418 Incision, Excision And 443 Fibro Myocutaneous Flap
Destruction In The Mouth 468 Operations On The Seminal 493 Ursl With Stenting
Vesicles
419 Other Operations In The 444 Breast Reconstruction
Mouth Surgery After Mastectomy 469 Incision And Excision of 494 Ursl With Lithotripsy
Periprostatic Tissue
420 Excision Of Fistula-in-ano 445 Sling Operation For Facial
Palsy 470 Other Operations On The 495 CystoscopicLitholapaxy
Prostate
421 Excision Juvenile Polyps 446 Split Skin Grafting Under Ra
Rectum 471 Incision Of The Scrotum And 496 Eswl
Tunica Vaginalis Testis
422 Vaginoplasty 447 Wolfe Skin Graft
472 Operation On A Testicular 497 Bladder Neck Incision
423 Dilatation Of Accidental 448 Plastic Surgery To The Floor
Hydrocele
Caustic Stricture of The Mouth Under Ga
Oesophageal 473 Excision And Destruction of 498 Cystoscopy & Biopsy
Diseased Scrotal Tissue
424 PresacralTeratomas Excision 449 Thoracoscopy And Lung
Biopsy 474 Other Operations On The 499 Cystoscopy And Removal of
Scrotum AndTunica Polyp
425 Removal Of Vesical Stone 450 Excision Of Cervical
VaginalisTestis
Sympathetic Chain
Thoracoscopic 475 Incision Of The Testes 500 SuprapubicCystostomy
426 Excision Sigmoid Polyp 451 Laser Ablation Of Barrett's 476 Excision And Destruction of 501 Percutaneous Nephrostomy
Oesophagus Diseased Tissue of The
Testes
427 SternomastoidTenotomy 452 Pleurodesis
477 Unilateral Orchidectomy 502 Cystoscopy And "sling"
428 Infantile Hypertrophic 453 Thoracoscopy And Pleural
Procedure
Pyloric Stenosis Biopsy
Pyloromyotomy 478 Bilateral Orchidectomy 503 Tuna- Prostate
429 Excision Of Soft Tissue 454 Ebus + Biopsy 479 Surgical Repositioning of An 504 Excision Of Urethral
Rhabdomyosarcoma Abdominal Testis Diverticulum
430 High Orchidectomy For 455 Thoracoscopy Ligation 480 Reconstruction Of The Testis 505 Removal Of Urethral Stone
Testis Tumours Thoracic Duct
481 Implantation, Exchange And 506 Excision Of Urethral
431 Excision Of Cervical 456 Thoracoscopy Assisted Removal of A Testicular Prolapse
Teratoma Empyaema Drainage Prosthesis
432 Rectal-myomectomy 457 Haemodialysis 482 Other Operations On The 507 Mega-ureter Reconstruction
Testis
433 Rectal Prolapse (delorme's 458 Lithotripsy/nephrolithotom
Procedure) y For Renal Calculus 483 Excision In The Area Of The 508 Kidney Renoscopy And
Epididymis Biopsy
434 Detorsion Of Torsion Testis 459 Excision Of Renal Cyst
484 Operations On The Foreskin 509 Ureter Endoscopy And
435 Eua + Biopsy Multiple 460 Drainage Of Pyonephrosis
Treatment
Fistula In Ano Abscess
485 Local Excision And 510 Vesico Ureteric Reflux
Destruction of Diseased Correction
Tissue Of The Penis

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 49
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

511 Anderson Hynes Operation 520 Surgery For Watering Can 529 Laryngoscopy Direct 534 Treatment of Fracture of
Perineum Operative with Biopsy Wrist
512 External Incision And 521 Repair Of Penile Torsion 530 Treatment of Fracture of 535 Treatment of Fracture of
Drainage In The Region Of Long Bones Ankle
The Mouth.
531 Treatment of Fracture of 536 Treatment of Fracture of
513 Kidney Endoscopy And 522 Drainage Of Prostate Short Bones Clavicle
Biopsy Abscess
532 Treatment of Fracture of Chalazion Surgery
537
514 Paraphimosis Surgery 523 Orchiectomy Foot
515 Injury Prepuce- 524 Cystoscopy And Removal of 533 Treatment of Fracture of
Circumcision Fb Hand

516 Frenular Tear Repair 525 RF Ablation Heart The list of day care treatment is an indicative list and any other
treatment which may get included in future shall be covered by the
517 Meatotomy For Meatal 526 RF Ablation Uterus
virtue of standard definition of “Day Care Treatment”.
Stenosi
518 Surgery For Fournier's 527
RF Ablation Varicose Veins
Gangrene Scrotum
519 Surgery Filarial Scrotum 528 Percutaneous
nephrolithotomy (PCNL)

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 50
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Product Name : Group Mediclaim Policy (Plan Name- Arogya Advanced)

TPA Name: SBI General Insurance
Policy Number : POGMC00300520390
Insured Name: RAJESH BILOTIA
Member ID :
Start Date : 23/07/2025T14:55:33

Relation : Self
Gender : Male
Age: 49

Toll Free Customer Helpline No. of SBI General Health: 1800 210 3366 / 1800 210 6366
Email: sbig.health@sbigeneral.in visit us: www.sbigeneral.in

SBI General Health

9th Floor, Westport, Pan Card Club Road, Baner
Pune, Maharashtra - 411 045
24 Hours Helpline: 1800 210 3366 / 1800 210 6366

This card identifies you as a SBI General beneficiary and valid for cashless hospitalisation at SBI
General Health network hospitals subject to your policy terms and valid authorization letter from SBI
General Health. Presentation of a valid photo identity along with this card is mandatory to avail
cashless access at SBI General Health Network Hospitals.Insured needs to pay for non-medical
hospitalisation bills, amount in excess of limit specified in authorisation letter and conditions not
covered in the policy.
In case of any concerns / clarifications related to policy and service, please do not hesitate to get in
touch with your insurer i.e. SBI General at sbig.health@sbigeneral.in or call Customer Care Toll Free
Numbers 1800 210 3366 / 1800210 6366

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 51
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

ENROLLMENT FORM
GROUP MEDICLAIM POLICY
Information for fields marked with asterisk (*) are mandatory.

FOR OFFICE OFFICE*

Quote No.: QGMC003000000667488 Inward No.:

Receipt No.: 363727061 Receipt Date: 23/07/2025T00:00:00

INTERMEDIARY'S DETAILS (* Mandatory Fields if Sales Channel Type selected is Banca)

Intermediary Name: Sbi Patni Bazar Ujjain 30191
Intermediary Contact: null
Intermediary Code: 0018419
GSTIN/ISDN:

Policy Details*
Policy Start date: 23/07/2025T14:55:33 Policy End date:22/07/2026T23:59:59
Type of Cover: Individual / Individual Family

Details of Proposer (for Primary Insured)

Name of the Proposed *: Mr.RAJESH BILOTIA
Communication Address*: 56,56- KALAPATHTHAR UJJAIN,56- KALAPATHTHAR UJJAIN,Ujjain M.L.Nagar,Ujjain,Ujjain,Madhya Pradesh-
456010
City*: Ujjain
State*:
Landmark:
Pin Code*:
Nationality*: Indian Occupation*: Other Occupation

Date of Birth*: Email ID*:K52350915@GMAIL.COM

Marital Status*: Married Gender*: Male

PAN NO.: Form 60/61:

Contact Details*: Mobile No.: 9424012293 Alternate Contact No.:

Home Loan Account Number*:

Details of The Person Proposed To Be Insured: (* Mandatory Fields)

Name * Date of Birth* Sum Insured* Gender* Marital Status* Occupation*
RAJESH BILOTIA 02/05/1976 500,000.00 Male Married Other Occupation
Nationality* (Indian/Non- Is any insured suffering
Relationship with
Name of the Insured* Indian/Non- Basic Sum Insured* from any Pre-existing
Proposer*
residentIndian/Other) diseases?
RAJESH BILOTIA Indian Self 500,000.0
I/We hereby provide consent to share my/our medical records with the insurer or TPA
If ABHA number is not available, it can be created at www.healthid.ndhm.gov.in
Note: Here Family Includes Self, Spouse, Dependent Children, Dependent Parents & Dependent Parents in law (Maximum up to 6 members
can be covered under one policy)
In case of additional members, please provide details in separate sheet.
I/We hereby provide consent to share my/our medical records with the insurer or TPA
If ABHA number is not available, it can be created at www.healthid.ndhm.gov.in
Note: Here Family Includes Self, Spouse, Dependent Children, Dependent Parents & Dependent Parents in law (Maximum up
to 6 members can be covered under one policy)
Are you or any of the proposed applicant__________________________________________, please tick whichever is applicable:
HNI Jeweller NGO Film Actor/ Producer PEP
If yes, please provide details for all person(s) in a separate sheet.
Politically Exposed Persons (PEPs) are individuals who have been entrusted with prominent public functions by a foreign country,
including the heads of States or Governments, senior politicians, senior government or judicial or military officers, senior executives
of state-owned corporations and important political party officials.

NOMINEE DETAILS*

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 52
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

In the event of death of the insured, any payment due under the policy shall become payable to the nominee in accordance with the policy terms
and conditions. Nominee for self, must be an immediate relative of insured. For all other members, the nominee shall be the proposer only.
Name Contact Details Date of Birth Gender Relationship with Proposer
RAJESH BILOTIA

Where Nominee is a minor, give the details of Appointee

Name of the Appointee Relationship with Nominee Appointee contact details

COVERAGE DETAILS*
Please refer to Annexure-A at the end of this form and choose the covers.

Premium Payment and Bank Account Details*

Premium Amount : Rs.16,948.31 Cheque No.:

Instrument Type:

Bank Name: IFSC Code:

Bank Account Number:

Branch Name: Ratlam

A cheque will be issued in the name of the Proposer only.

In case of cancellation of policy, if premium were paid through credit card the refund amount would be credited to Credit Card
account directly or refund will be paid through cheque. Please provide the following bank details and a copy of Cancelled Cheque if
you opt for direct credit of refund/ claim into your bank account: (Cancelled Cheque should be of the same bank account in which
the refund / claim needs to be credited directly.
Cheque No.: Cheque Date:
Note: The proposer agrees and undertakes to intimate in writing to SBI General Insurance for any change in bank account details.
If ECS is selected, please submit the standing instruction form available at our branches.

SBIGI does not accept Cash for Premium Payments against the Policy.

Policy Renewal Advice Slip

I authorize for automatic debit of renewal premium of this cover from my account as long as the terms and conditions and the premium remain
unchanged, I understand that this authorization can be revoked by me at my will by submitting a written notice to the bank.
Date: 23/07/2025T14:55:33
For internal Purpose only (To be filled by the branch official)
Account No. :-------------------------------------------------- Journal no.--------------------------- Date:

AML GUIDELINES (Premium Payment shall be made by the Policyholder of the Policy)
I/We hereby confirm that all premiums have been/ will be paid from bonafide sources and no premiums have been/will be paid out of proceeds
of crime related to any of the offence listed in Prevention of Money Laundering Act 2002. I understand that the Company has the right to call for
documents to establish source of funds. The Insurance Company has the right to cancel the Insurance Contract in case I am/ have been found
guilty by any competent court of law under any statues, directly or indirectly governing the Prevention of Money Laundering in India.

Nationality:
If Non-Indian please specify the nationality and country address___________________________________________________
If NRI please give details for resident country and address_________________________________________________________
Type of Organisation (Only applicable if policy issued on Group Basis):

I hereby declare that the current address is different from the avalilable in the Central identities Data Repository.
Customer can submit CKYC form for updation.

Insurer Declaration:
Note: The liability of the Company does not commence until the acceptance of the proposal has been formaly intimated by the insured and full
premium has been realized by the Company
We are under no obligation to accept any proposal for Insurance. The Proposer agrees that the receipt of the Proposal Form by SBI General
Insurance Company Limited along with the premium payment does not tantamount to the acceptance of the Proposal for Insurance by SBI
General Insurance Company Limited and does not result in a concluded contract of Insurance. The acceptance of the Proposal for Insurance shall
be at the Company's sole and absolute discretion and upon full realization of the premium payment. In the event of acceptance of the Proposal
for Insurance by SBI General Insurance Company Limited, such acceptance shall be specifically intimated to the Proposal and SBI General
Insurance Company Limited along with the date from which the Insurance cover shall become effective. SBI General Insurance Company Limited
shall not be liable for any claim in respect of an event giving rise to a claim covered under the Policy of Insurance that has occurred prior to
Policyissuance, notcov- ered under this Policy (Your proposal form will be considered after SBl General Insurance Company Limited receives the
premium payment.)

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 53
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

DECLARATION ON BEHALF OF ALL PERSONS PROPOSED TO BE INSURED

1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or
particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorized to propose on behalf
of these other persons.
2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board
approvedunderwriting policy of the insurer and that the policy will come into force only after full payment of the premium chargeable.
3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured / proposer
after the proposal has been submitted but before communication of the risk acceptance by the company.
4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on
the person to be insured/proposer or from any past or present employer concerning anything which aects the physical or mental health
of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to
be insured /proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/ proposer for the
sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.”
6. I/We acknowledge that by opting for digital services (including WhatsApp), I/We provide consent to receive communication/services
from SBI General insurance Company Limited related to my Insurance Policy through my registered mobile number and email.

7. I further declare that the contents of the Policy have been fully explained to me and I shall abide with the Policy terms and conditions.

8. I declare that the premium amount, corresponding to this proposal, is paid out of the legally declared and assessed sources ofmy income
and not out of proceeds of crime related to any offence under the Prevention of Money Laundering Act, 2002 and rules framed
thereunder.
9. I/We hereby provide consent to share my/our medical records with the insurer or TPA. If ABHA number is not available, it can be created
at www.healthid.ndhm.gov.in
10. The details filled in the enrolment form would be used for new as well as for renewal purpose.
Date: 23/07/2025T14:55:33 Signature of Insured:_________

Electronic Insurance Account Details:

Choose your Insurance Repository (For those selecting e-Format)

I have an e-Insurance Account & the No. is :

My CKYC No. (Central Know Your Customer registry number) is (if available):

I, __________, hereby grant explicit consent to SBI General Insurance Company for the retrieval and downloading of my CKYC record from the
Central KYC Records Registry. I understand that this information is essential for the purpose of ensuring accurate and updated records for
insurance services. I acknowledge that SBI General Insurance Company will handle my CKYC information in compliance with all applicable data
protection laws and regulations. This consent is valid until revoked in writing by me. I have read and understood the terms and conditions
regarding the usage of my CKYC information and voluntarily provide my consent.

Customer Name: ____________________________________ Date: 23/07/2025T14:55:33

Kindly visit our website www.sbigeneral.in to view the list of KYC OVD (Officially Valid Documents).
Proposer Declaration:
The contents of the proposal form and connected documents have been fully explained to me and I have fully understood the significance of
proposed Contract.
Date: 23/07/2025T14:55:33

Place: Ujjain

VERNACULAR DECLARATION
Applicable where the Proposer is illiterate or is suffering from a disability due to which writing is restricted or where the Proposer has signed in
vernacular language. (Note: The below must be witnessed by someone other than the Advisor/Employee of the Company).I/We certify that the
product applied for by me/us and the contents of the Proposal Form have been clearly explained to me/us and I/we have fully understood
them. I/We further certify that the replies in the Proposal Form have been recorded as per the information provided by me/us. I, (Full name of
the witness)_______________________(Relation with the Proposer/Primary insured) ______________________adult and inhabitant of
(city)___________________ and residing at____________________________do hereby certify that I have read out and explained the contents
of the Proposal Form and all other documents incidental to availing the insurance policy from SBI General Insurance Company Ltd., to the
Proposer/Primary Insured and he/she/they have understood the same. I/we declare that whatever I/we have stated herein above is true and
correct to the best of knowledge and belief.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 54
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Date: 23/07/2025T14:55:33 Place : Ujjain

Sharing of Information: The information sought from the Insured is for the purpose of Policy issuance and Policy servicing. This information
sought and the details of the Policy are kept confidential and will not be shared with any external party in any circumstances whatsoever
However, in instances when such information details are sought by any governmental bodies, regulatory authorities reinsurer or when the
Company is directed to share such information in accordance with any law/ regulations or directions from any such government bodies /
regulatory authorities, the Company will be bound to abide to such directions.
Fraud Warning: This policy shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure
of any material particulars by the Proposer. Any person who, knowingly and with intent to fraud the insurance company or any other person,
files a proposal for insurance containing any false information, or conceals or the purpose of misleading, Information concerning any fact
material thereto, commits a fraudulent insurance act, which will render the policy voidable at the sole discretion of the insurance company and
result in a denial of insurance benefits.

SECTION 41 OF INSURANCE ACT, 1938

1. No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an
insurance in respect of any kind or risk relating to lives or property in India, any rebate of whole or part of the commission payable or any
rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except
such rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer.
2. Any person making default in complying with the provisions of this section shall be punishable with fine , which may extend to Rupees
Ten Lakhs.
Insurance is subject matter of solicitation.

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 55
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

Annexure - A

Cover Section Cover Name Opted / Not Opted As opted (Sum Insured/Limits)
Inpatient care
Organ Donor
Day Care Treatment
Pre-hospitalization Medical expenses
Post-hospitalization Medical expenses
Modern Treatment
Inpatient care under Alternative
Treatment
Domiciliary Hospitalization
Bariatric Surgery
Modification of Pre-hospitalization
Hospitalization Medical expenses
Cover Modification of Post-hospitalization
Medical expenses
Modification of Modern Treatment
Modification of Inpatient care under
Alternative Treatment
Modification of Domiciliary
Hospitalization
Modification of Bariatric Surgery
Maternity Expenses
New born baby cover
Child Vaccination cover
Well baby cover for New Born
Stem Cell Preservation Cover
Infertility Cover and Surrogacy Cover
Accident Multiplier
Emergency Ground Ambulance
Air Ambulance cover
Prosthetics cover
Convalescence Benefit
Funeral and Repatriation Cover
Compassionate visit
Accompanying person cover
Health check up
Zero Deduction in case of death of
Insured
Sub-limit on specified illness / conditions
Loyalty credit
Weekly benefit
Voluntary Co-payment
E-Opinion
Corporate Floater
Sum Insured Reinstatement
Claim settlement in network only
Claim settlement on Reimbursement only
Physiotherapy and Rehabilitation cover
Home Health Care
Non Medical/Consumables Expenses
External Congenital Anomalies
Cancer Care
Attendant Charges Cover
De-addiction Expenses Cover
Modification of Home/Vehicle

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 56
Group Mediclaim Policy | UIN: SBIHLGP24031V012324
SBI General Insurance Company Limited

External Aids and Medical Equipment

ModiFIcation of Waiting period for Pre-
Existing Diseases (PED)
Modification of Initial Waiting Period
Modification of Waiting Period for
Disease
Specific Exclusions
Franchise
Vision correction
Per claim deductible
Gender Reassignment Cover
OPD Cover
OPD Cover
Second medical opinion cover
Infectious Disease
Common Disease Cover
Cover
Super Top-up Cover (Applicable on
Super Top up cover
cumulative claim basis)
Hospital Daily cash Hospital daily cash
Critical illness cover Critical Illness Cover
Waiting Period Sr no Waiting Period
1 For Pre-existing diseases
(PED)
2 Initial Waiting Period
3 Waiting Period for Disease
Special Exclusions

SBI General Insurance Company Limited

Corporate & Registered Office 9th Floor, Wing A & B, Fulcrum, Sahar Road, Andheri (East), Mumbai - 400099 I CIN: U66000MH2009PLC190546
Tel.: +91 22 42412000 I www.sbigeneral.in I customer.care@sbigeneral.in | | SBI Logo displayed belongs to State Bank of India and used by
SBI General Insurance Company Limited under license | IRDAI Reg No:144| 57
Group Mediclaim Policy | UIN: SBIHLGP24031V012324