Certain diseases/surgeries like Hernia, Hydrocele etc shall be
covered after a waiting period of 1 year.
Pre-acceptance Health check is not mandatory for people who are
less than 45 years old and without any history of illness. Insureds with
following condition, acceptance of proposal is subject to a satisfactory
medical examination as per SBI Generals requirements:
Certain diseases like Cataract, Hysterectomy shall be covered after
a waiting period of 2 years from commencement of Policy.
Insured with adverse medical history as declared in Proposal Form
or,
Insured aged above 45 years & irrespective of SI.
Pre-acceptance medical tests at the cost of the proposer. However, if
the proposal is accepted the Insurer will reimburse 50% of the cost
incurred towards the medical tests so undertaken at the advice of the
insurer.
Joint replacement surgery shall be covered after a waiting period of
3 years from commencement of Policy except done due to an
accident.
Treatment with alternative medicines like acupuncture,
acupressure, osteopath, naturopathy, chiropractic, reflexology and
aromatherapy
Treatment arising from or traceable to pregnancy (whether uterine
or extra uterine) and childbirth including caesarean section, and/or
any treatment related to prenatal and postnatal care.
Congenital diseases
What is SBI Generals Policy on Renewal?
All expenses related to AIDS and related diseases.
SBI General provides assurance on continuous renewal of your Health
Insurance Policy. Every renewal premium shall be so paid and accepted
upon the distinct understanding that no alteration has taken place in
the facts contained in the proposal or declaration herein before
mentioned and that nothing is known to the Insured that may increase
the risk to the Insurer.
Disclaimer: The above information is only indicative in nature. For full
details of the coverage & exclusions please contact our nearest office
and refer to the policy documents.
No renewal receipt shall be valid unless it is on the printed form of
Insurer and signed by an authorised official of Insurer.
What is Health Insurance Portability? Is SBI Generals Health
Insurance Policy - Retail portable?
In case any disease / illness is contracted during the last 12 months
(whether a claim is made or not with the insurers), the information of
the same needs to be provided to us at the time of renewal. We may
require that an additional premium be paid for the enhanced risk
profile arising out of such diseases contracted and policy would only
be renewed upon collection of premium and such additional
premium. In the event of any failure to either provide or disclose any
change in medical condition by the insured / proposer / beneficiaries
said act would amount to suppression of material fact and company
will not be liable for any claim.
Use/Abuse of intoxicating drugs or alcohol.
Most of the Health Insurance Policies offered by the General
Insurance companies in India have waiting periods during which
certain pre existing diseases are excluded in the coverage. They are
excluded for certain predefined period (number of years) before they
are covered i.e. The Policy holder is expected to have continuous
cover for the predefined period before the pre existing diseases are
covered under the policy.
Portability will ensure that these accrued benefits are transferred
(without any dilution) to the new insurer at the time of renewal and
porting and the consumer do not lose on these accrued benefits while
opting to switch the insurer using Health Insurance Portability.
What are the major Exclusions under this policy?
The Policy holder can port the following accrued credits:
The Company will not be liable under the Policy in respect of
payment towards treatment taken due to:
General waiting period
Any condition, ailment or injury or related condition(s) for which
you have been diagnosed, received medical treatment, had signs
and / or symptoms, prior to inception of your first policy, until 48
consecutive months have elapsed, after the date of inception of
the first policy with us.
Any time bound exclusions
Any disease contracted during the first 30 days of commencement
of the policy.
Waiting periods pertaining to the coverage of pre-existing
diseases/conditions
What are the benefits of the Health Insurance portability for
the Policy holders?
Health Insurance portability will allow the Policy Holder, protection
against discontinuity and loss of coverage against pre-existing
diseases consequent to his/her decision to shift to another insurer at
the time of renewal.
The fast, fair & transparent Claim procedure that will keep
you in control
SBI General's dedicated and experienced claims team aim to deliver
you a differentiated customer service of a fast, fair, convenient and
transparent claims process for the management and settlement of
your claim.
At SBI General, our philosophy is to always look for ways to pay valid
claims in a fair and timely manner. Our claims service will:
Take control of your familys health.
And happiness too.
We also offer the following Policies:
Private Car Insurance Policy - Package
SBI Generals
Health Insurance Policy - Retail
Long Term Home Insurance Policy
Two Wheeler Insurance Policy
Provide assistance in emergency situations
Keep you informed of the progress of your claim
Provide you with the choice of accessing our preferred local
service providers
What's more, our skilled staffs are empowered to act and make
decisions, so that your claim is processed as quickly and efficiently as
possible. This should help you get back in control as quickly as
possible.
For more details, contact:
About SBI General Insurance
SBI General Insurance Company Limited is a joint venture between the
State Bank of India and Insurance Australia Group (IAG). State Bank
of India enjoys the largest banking franchise in India. Along with its 5
Associate Banks, SBI Group has the unrivalled strength of over 19,000
branches across the country, arguably one of the largest in the world.
Insurance Australia Group Limited (IAG) is an international general
insurance group, with operations in Australia, New Zealand, the
United Kingdom and Asia. IAG's businesses underwrite around
A$9.0 billion of premium per annum.
SBI General's current geographical coverage extends to 52 cities pan
India. We are currently serving 3 key customer segments i.e. Retail
Segment (catering to Individual & Families), Corporate Segment
(catering mid to large size Companies) and SME Segment. Current
Policy offering of SBI General covers Motor, Health, Personal Accident
& Home Insurance for Individuals and Aviation, Fire, Marine, Package,
Construction & Engineering, Liability, Group Health, Group Personal
Accident & Miscellaneous Insurance for Businesses.
Call Now (Toll Free)
1800 22 1111 | 1800 102 1111
www.sbigeneral.in
The above information is indicative in nature, for more details on complete
coverage and terms & conditions, please read the policy document carefully
before concluding a sale.
SBI General Insurance Company Limited
Corporate & Registered Office: 'Natraj', 101, 201 & 301,
Junction of Western Express Highway & Andheri - Kurla Road,
Andheri (East), Mumbai - 400 069.
IRDA Reg. No. 144 dated 15/12/2009 | HRIND01
Insurance is the subject matter of the solicitation
ADBRO/0054/JAN/12-13 | Version 1.4, June' 14
Do I need to undergo Pre-Acceptance Health Check Up
compulsorily?
Wide range of plan options
SBI GENERALS HEALTH INSURANCE POLICY - RETAIL
12 Limit of Cataract
We understand that people are unique and have varying levels of control
over their health. Each of us would like to define a healthy life on our own
terms. At SBI General, its our aim to partner with you and help you
achieve better health and a sense of security along the way.
In times of rising health care costs, a sudden illness or injury can leave
you financially devastated and highly stressed. With SBI Generals Health
Insurance Policy - Retail, you can be in control by making medical
treatment expenses more manageable and ensuring quality health &
happiness for your family.
What are the key benefits of the SBI Generals Health
Insurance Policy - Retail?
13 Accidental
Hospitalisation
Consultants &
Specialists Fees
Anaesthesia, Blood,
Oxygen, OT Charges,
Surgical Appliances
Up to 40% of the SI
per illness/injury per claim.
Pre-hospitalisation
Up to 10% of the eligible
hospitalisation expenses incurred
30 days prior to date of
admission into the hospital.
No medical test up to the age of 45 for people with no medical history
Flexible Plan OptionsMetro Plan, Semi Metro Plan & Rest of India
Add-on Covers available including removal of sub-limits on Room &
ICU rent, Operation and Consultancy charges
Assured renewal
Up to 40% of the SI
per illness/injury per claim.
Wide Coverage From Rs.50,000 up to Rs.500,000
Family Floater benefit giving comprehensive protection to your family
members under one single Policy
Post-hospitalisation
You can now renew your current Health Insurance Policy (any Insurer)
with us
Up to 10% of the eligible
hospitalisation expenses incurred
60 days after the date of
discharge from the hospital.
The premium paid is exempt from Income Tax under Sec 80 D of
Income Tax Act (Tax benefits are subject to change in tax laws)
Ambulance charges
1% of SI up to a max of Rs. 1500.
Coverage of Pre and Post Hospitalisation Expenses - 30 days before
and 60 days after the hospitalisation
Free Medical
Check up
Free medical check-up - 1% of
SI up to a max of Rs. 2500 for
every 4 claim free years.
Free Medical check-up for every 4 claim free years up to a maximum
limit of Rs.2,500
What are the major covers provided by the SBI Generals
Health Insurance Policy - Retail?
This policy covers the following subject to the terms and
conditions:
S.No.
Expense Heads
Expense Limit (Rs.)
Medical Treatment with Room,
Board & Nursing Expenses &
Service Charges etc.
Up to 1% of the
Sum Insured per day
Medical Treatment in
Intensive Care Unit
Up to 2% of the
Sum Insured per day
All admissible claims under
1 & 2 during the policy period
Up to 25% of the SI
per illness/injury per
claim
Comprehensive coverage
Max. age of entry - 65 years
10 Parental Care:
Attendant nursing
charge to take care of
you parents who are
above 60 years of age.
11 Child Care:
Attendant escort
charges to take care
of child below
10 years of age.
Available for persons above
60 years old. Attendant nursing
charges after discharge from the
hospital for Rs 500 or actual
whichever is less per day up to a
max. 10 days per hospitalisation.
The charges can be reimbursed
for a period not exceeding 15 days
during the entire Policy period.
Available for child below 10 years.
Attendant escort charges of
Rs 500 for each completed day of
hospitalisation subject to maximum
of 30 days during the Policy Period.
14 Alternative Treatment
(Subject to Treatment
taken at a Ayurvedic
hospital confirming
with our definition of
hospital and which is
registered with any of
the local Govt. bodies)
15
Domiciliary
Hospitalisation
16 Convalescence
BenefitBenefit available for
Insured above
10 years & below
60 years.
15% of sum insured subject to
maximum of 25000 per eye
subject to first two years exclusion.
Sum Insured Limit under the policy
shall increase by 25% of the
balance sum insured available
subject to max of Rs.1 Lac. in case
of accidental hospitalisation.
Payable only once under the Policy
per person.
Reimbursement of Ayurvedic
Treatment up to a maximum of15%
of Sum Insured per Policy period
up to a maximum of Rs. 20000 &
Homeopathy and Unani
Treatment upto a maximum 10%
of Sum Insured per Policy period
up to a maximum of Rs. 15000.
Reasonable and Customary
Charges towards Domiciliary
Hospitalisation as defined in
Policy definition subject to 20% of
the Sum Insured maximum up to
Rs. 20000 whichever less is.
Covers the convalescence expense
up to an amount not exceeding
Rs. 5,000/- per Insured, if the
Insured is hospitalised for any bodily
injury or illness as covered under the
Policy, for a period of 10 consecutive
days or more. Admissible only once
during the Period of Insurance.
17 Co-Payment on all
10% on all eligible admissible
eligible admissible claims claims.
in non-network hospitals
18 Cashless facility
Across SBI General's Network
Hospitals
19 Coverage for
select Day Surgery
procedures where
less than 24 hours
hospitalisation is
required.
Covers select Day Surgery where
less than 24 hours hospitalisation
for specified procedures like
Dialysis, Chemotherapy, Radio
therapy, Eye Surgery, Dental
Surgery (Due to accident),
Tonsillectomy, etc are covered.
Tax exemption under Sec. 80D
Fair, transparent & quick claim process
What are the Add-on Covers available with this Policy?
On payment of additional premium the following Add-on Covers are
available with his Policy. Any one or both Add-on Covers can be opted
by the primary insured and which is applicable to all the members in the
family.
- Removal of Room & ICU rent sub-limits
- Removal of sub-limits on Operation and Consultancy charges
What is the minimum and maximum age at which one can
enter and buy this policy?
- For Individual Policy: You, your legal spouse, legal &
dependent children and dependent parents.
- For Family Floater Policy: You, your legal spouse and legal &
dependent children.
Based on the medical history, Sum Insured opted and/or age,
you/your family members may be subject to a Medical Examination.
Renewal for people beyond 70 years will be allowed subject to
Insured accepting to pay the premium and additional loading as
applicable for the age band in which the Insured falls at the time of
renewal and as approved by IRDA.
The minimum age of entry for SBI Generals Health Insurance Policy Retail is 18 years. However Children from the age of 3 months can be
covered subject to both parents concurrently covered with SBI Generals
Health Insurance Policy - Retail.
How is the premium for a Family Floater Policy calculated?
- The Maximum age of entry for the policy is 65 years
Does SBI General provide any differentiated plan option?
Is there any long tenure plan options available under this
Policy?
Currently SBI Generals Health Insurance Policy - Retail is available for a
one year period only.
What is the minimum & maximum coverage possible under
this Policy?
The minimum coverage available for you and your family under this
policy is for a Sum Insured of Rs.50,000. The Maximum coverage
available under this policy is for a Sum Insured of Rs.500,000 subject to
the Terms and Conditions of the Policy.
Premium for Family Floater Policy is calculated basis the age of the
oldest member of the family to be insured.
SBI General firmly believes in providing you with flexible options in terms
of where you would like to get treated should the need arise.
In case you are living in a Metro or in a Semi Metro, and you would like
to get treated there only, the Policy provides you with an option to
choose a Plan. This way it helps you to choose a plan which is more
appropriate to your need and hence priced accordingly. The Policy
firmly puts you in control by giving you the flexibility to select an
appropriate option that is just right on your purse.
The three available plans are:
Benefit
Plan
The following Terms & Conditions apply while Sum Insured is finalised:
Maximum Sum Insured would be restricted to Rs.200,000/for insured persons aged 60 and above and taking a policy with
SBI General Insurance for the first time.
Minimum Sum Insured for Family Floater Policy would be
Rs.200,000/ By Family we mean -
Treatment
Treatment
Treatment
Location A
Location B
Location C
Mumbai
Chennai, Kolkata,
Rest of
& Delhi Bangalore, Ahmedabad
India
& Hyderabad
Plan A
(Mumbai & Delhi)
100%
100%
100%
Plan B (Chennai,
Kolkata, Bangalore,
Ahmedabad,
Hyderabad)
80%
100%
100%
Plan C
(Rest of India)
70%
80%
100%
Plan A - 100% of the admissible claim amount for all Locations
subject to the Policy terms and conditions.
Plan B - 100% of the admissible claim amount for Locations B and C,
and 80% for Location A subject to the Policy terms and conditions.,
Plan C - 100% of the admissible claim amount for Locations C, 80%
for Location B and 70% for Location A subject to the Policy terms and
conditions.
The percentage of amount shown in the above table is with respect to
the admissible claim amount. The Company will make payments only
after being satisfied, with the necessary bills and documents.
