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Health Insurance Policy- Retail

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, it’s 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 General’s Health Insurance Policy – Retail, you can be in control by making medical treatment expenses more manageable and ensuring quality health & happiness for your family.

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A few details to start with

More details about Health Insurance Policy- Retail

  • Wide Coverage – From Rs.50,000 up to Rs.500,000
  • No medical test up to the age of 45 for people with no medical history
  • Family Floater benefit giving comprehensive protection to your family members under one single Policy
  • Flexible Plan Options–Metro Plan, Semi Metro Plan & Rest of India
  • Assured renewal
  • You can now renew your current Health Insurance Policy (any Insurer) with us
  • 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)
  • Coverage of Pre and Post Hospitalisation Expenses - 30 days before and 60 days after the hospitalisation
  • Free Medical check-up for every 4 claim free years up to a maximum limit of Rs.2,500
  • Add-on Covers available including removal of sub-limits on Room & ICU rent, Operation and Consultancy charges

This policy covers the following subject to the terms and conditions:

S. No. Expense Heads Expense Limit (Rs.)
1 Medical Treatment with Room, Board & Nursing Expenses & Service Charges etc. Up to 1% of the Sum Insured per day
2 Medical Treatment in Intensive Care Unit Up to 2% of the Sum Insured per day
3 All admissible claims under 1 & 2 during the policy period Up to 25% of the SI per illness/injury per claim
4 Consultants & Specialists Fees Up to 40% of the SI per illness/injury per claim.
5 Anaesthesia, Blood, Oxygen, OT Charges, Surgical Appliances Up to 40% of the SI per illness/injury per claim.
6 Pre-hospitalisation Up to 10% of the eligible hospitalisation expenses incurred 30 days prior to date of admission into the hospital.
7 Post-hospitalisation Up to 10% of the eligible hospitalisation expenses incurred 60 days after the date of discharge from the hospital.
8 Ambulance charges 1% of SI up to a max of Rs. 1500.
9 Free Medical Check up Free medical check-up - 1% of SI up to a max of Rs. 2500 for every 4 claim free years.
10 Parental Care: Attendant nursing charge to take care of you parents who are above 60 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.
11 Child Care: Attendant escort charges to take care of child below 10 years of age. 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.
12 Limit of Cataract 15% of sum insured subject to maximum of 25000 per eye subject to first two years exclusion.
13 Accidental Hospitalisation 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.
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) Reimbursement of Ayurvedic Treatment up to a maximum of 15% 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.
15 Domiciliary Hospitalisation 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.
16 Convalescence Benefit- Benefit available for Insured above 10 years & below 60 years. 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 eligible admissible claims in non-network hospitals 10% on all eligible admissible claims.
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.

Only one Critical Illness claim can be allowed by us during the lifetime of the Insured. The Critical Illness policy terminates immediately on the payment of first Critical Illness benefit under the policy. The maximum benefit amount under Critical Illness cover to any individual is INR 5,000,000 including all policies that are issued by the Insurer.

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-
    • 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.

What Add-on Covers are 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

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 Treatment Location A Mumbai & Delhi Treatment Location B Chennai, Kolkata, Bangalore, Ahmedabad & Hyderabad Treatment Location C Rest of India
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.

The Company will not be liable under the Policy in respect of payment towards treatment taken due to:

  • 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 disease contracted during the first 30 days of commencement of the policy.
  • Certain diseases/surgeries like Hernia, Hydrocele etc shall be covered after a waiting period of 1 year.
  • Certain diseases like Cataract, Hysterectomy shall be covered after a waiting period of 2 years from commencement of Policy.
  • 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
  • All expenses related to AIDS and related diseases.
  • Use/Abuse of intoxicating drugs or alcohol.

What are the major Exclusions in the policy

  • Any hospital admission primarily for investigation / diagnostic purpose Exclusions.
  • Pregnancy, infertility, congenital/genetic conditions.
  • Epidemics recognized by WHO or/and Indian government. Government screening programs.
  • War, invasion, acts of foreign enemy, hostilities, etc.
  • Epidemic disease recognized by WHO or Indian Government.
  • Treatment taken outside India.
  • Circumcision, sex change surgery ,cosmetic surgery & plastic surgery.
  • Refractive error correction, hearing impairment correction, corrective & cosmetic dental surgeries.
  • Vaccination or inoculation except as part of post-bite treatment for animal bite.
  • Substance abuse, self-inflicted injuries, STDs and HIV / AIDS.
  • Participation in hazardous sports, war and allied perils.
  • Treatment for any mental illness or psychiatric or psychological ailment / condition.

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.