Treating serious illnesses such as cancer, stroke, and renal failure takes a significant amount of time and money. It calls for very expensive medical hospitalization, doctor appointments, health-check-ups, and recuperation help, among other things. At times, the treatment might jeopardies long-term aims. Purchasing SBI General’s Critical Illness Policy safeguards you from the uncertainties that come with critical illnesses.
Who Can Purchase the Policy?
Account holders at SBI and affiliated banks. The Insured may only have one Policy, regardless of how many accounts he or she has.
Multiple policies for the same insured are not permitted. Even if numerous policies are purchased through one or more SBI or regional rural banks accounts for any reason, our obligation shall be limited to only one policy with the greatest Sum Insured. All other policies are declared null and invalid.
All premiums paid for such insurance will be repaid once administrative charges of ‘150 are deducted. If both account holders choose individual insurance, two separate policies may be produced in the case of a joint account.
What Illnesses Are Included?
If a covered individual under the policy is diagnosed with any of the 13 critical diseases listed below at any time during the policy’s term, the benefit will be payable only if the Insured remains alive for a period of longer than or equal to 28 days (or as precisely specified amount of time in any of the criteria given in policy language) from the date of the initial diagnosis of the Critical illness/ Undergoing surgical operations for the first time.
- Severity of Specified Cancer
- CABG with an open chest
- Aorta Graft Procedure
- Open Heart Surgery or Heart Valve Repair
- Stroke Causes Permanent Symptoms
- First Specified Severity Heart Attack
- Dialysis is required due to kidney failure.
- Primary pulmonary arterial hypertension (PPAH)
- Transplantation of a major organ or bone marrow.
- Multiple Sclerosis with Prolonged Symptoms
- Specified Severity Coma
- Complete blindness
- Limb paralysis for life
What Doesn’t the Policy Cover?
- Any Insured Event that occurs during the waiting period, including pre-existing conditions and their consequences
- Any illnesses that cause the insured’s death during the specified survival time
- Any congenital diseases or conditions
- Suicide attempt or purposeful self-inflicted injury or illness
- Sexually transmitted diseases
- A mental or neurological condition
- Acquired Immune Deficiency Syndrome (AIDS) and its sequelae
- Intoxicating medications or alcohol use/abuse
- Associated Covered Critical Illness resulting from birth control treatments and/or hormone replacement therapy, as well as any sequelae.
- Any treatment/surgery for gender transition or cosmetic surgery, as well as any complications/illness resulting from such treatment/surgery.
What Is the policy’s minimum and maximum coverage?
- The maximum Sum Insured would be limited to 60 months gross income for the Insured OR a maximum of ’10 lakhs, providing the insured is the earning member of the household, and in such circumstances, we may seek income verification.
- In the case of non-earning Insured, the Sum Insured would be limited to 50% of the Sum Insured based on Proposer Income, with a maximum of Rs. 5,000,000.
Fixing the Insured Sum
- Minimum Sum Insured: INR 200,000
- The maximum sum covered would be limited to 60 months gross income for the insured or a maximum of INR 5,000,000/- if the insured is the earning member of the household; in such circumstances, we may need income verification. In the case of a non-earning insured, the sum insured would be limited to 50% of the sum insured based on the proposer’s income, up to a maximum of 10 lacs. Where the sum insured is a fraction of a lac, the insurer has sole discretion in determining the sum insured under the policy.
- Unless otherwise approved by the insurer, the maximum sum covered will be INR 1,500,000/- for insured individuals aged 60 and above taking out a policy with us for the first time.
- The proposer may be required to undergo a medical examination according on their medical history, sum insured, and age. Acceptance of proposal is subject to a satisfactory medical examination as per our company’s standards for proposed covered individuals above the age of 45, regardless of sum insured selected or rollover/renewal from another insurer.
- The applicant is required to reveal any current policies and applications for Critical Illness cover with SBI General and other insurers in the Indian market. The maximum amount of insurance that may be awarded to any individual is INR 5,000,000, which includes all policies and applications, whether with SBI General or other insurers in the Indian market.
A medical examination will be necessary for the proposal to be accepted based on the proposer’s medical history, sum insured, and age, as per our requirements. Medical examination is required for all people aged 45 and up, regardless of the sum insured chosen, and pre-acceptance medical examinations are at the proposer’s expense. However, if the proposal is accepted, the insurer will cover 50% of the costs expended for medical tests performed on the insurer’s suggestion.
What Is the Renewal Policy of SBI General?
- Every year, by mutual agreement, this Policy may be renewed.
- Renewal premiums must be paid to the insurer on or before the expiration or renewal date.
- The coverage can be renewed anytime, within a 30-day grace period.
- Coverage is not provided during the time when no premium is paid.
In most cases, the insurer will not refuse to renew this policy or invoke cancellation unless there is fraud, moral hazard, or misrepresentation. If a renewal premium is paid and accepted for this policy, it is contingent on the specific understanding that the facts outlined in the Proposal or declaration aforementioned have not changed and that the insured knows of nothing that could increase the risk to the insurer under the coverage provided hereunder. At the time of renewal, information regarding any disease or illness contracted within the preceding 12 months of the Policy’s commencement is required, regardless of whether a claim has been filed with the Insurer. At the end of the Policy Period, the policy will automatically expire, and we are not obligated to notify you that it is due for renewal. At the time of renewal, the premium for renewal will be determined by the age, amount insured, and policy period; However, the same thing can be altered, as described under the product revision heading.
The benefits of the Waiting Period and coverage for pre-existing conditions will not be lost if a policy expires or is not renewed with the insurer before the end of the insurance period and is renewed upon specific acceptance by the insurer within 30 days of the insurance period’s expiration. However, there is no coverage for any critical illness or disease contracted or arising from an illness or disease or accident contracted or inflicted during the period of insurance break between the end of the original policy’s insurance period and the start of the policy renewed within days of the policy’s expiration. After 30 days have passed since the policy’s expiration, any subsequent renewal will be considered a new policy with all of its terms and conditions in effect.
Policy Cancellation
The Critical Illness insurance policy will terminate on the earliest of the following events:
- Payment of the first Critical Illness Benefit under this Policy or another Critical Illness Insurance Policy issued by SBI GIC.
- The date on which the Insured terminated the Policy.
Portability
According to the Insurance Regulatory and Development Authority (Health Insurance) Regulation, 2013, this policy is portable, and you should initiate action to approach another insurer to take advantage of portability well before the renewal date to avoid any gaps in policy coverage caused by a delay in acceptance of the proposal by the other insurer.