SBI General Arogya Premier Health Insurance Plan for Families

Are you worried about the rising cost of healthcare? Are you stressed about uncertain medical expenses? Here is a solution to your worries. The length of human life has increased, thanks to developments in medical research. But it has also raised the cost of health care. Any unexpected illness or hospitalization can deplete your savings. You can choose Family health insurance to stay away from this circumstance. A high-value health plan to cover hospitalization and treatment costs is the SBI General Arogya Premier Policy.

What is the SBI General Arogya Premier Health Insurance Plan for Families

People are now aware of the value of having the proper health insurance coverage to safeguard themselves from unplanned medical bills as a result of the rising cost of healthcare. A health insurance program called SBI General Arogya Premier caters to the unique medical requirements of HNIs (High Networth Individuals) and upper and lower-middle-class people. Access to the greatest medical care is made possible by this policy, which offers a variety of flexible options.

Eligibility criteria for SBI General Arogya Premier Health Insurance Plan for Families

The following are the requirements for SBI General Arogya Premier:

  • Entry requirements include a three-month minimum and a 65-year-old upper age limit.

  • A pre-insurance medical check is not necessary for those under the age of 55 who have no medical history.

  • Families and/or individuals may purchase this policy.

  • A family floater policy covers you, your spouse, and two dependent children up to the age of 23.

If you are covered by this medical insurance policy, you can take advantage of a number of coverage benefits, including alternative treatments, domiciliary expenses, maternity expenses, health checks, daycare expenses, ambulance expenses, in-patient hospitalization expenses, pre-hospitalization, and post-hospitalization expenses.

What is covered in the SBI General Arogya Premier Health Insurance Plan for Families?

  • In-patient Treatment: This covers all hospitalization costs, such as accommodation and board, doctor fees, operating room, intensive care unit (ICU), nursing fees, and medications used during the hospital stay.

  • Maternity: After 0 years, maternity expenditure can only be claimed. The most you can deduct for maternity costs is Rs. 5,00,000.

  • Newborn coverage: Newborn coverage is given for up to 9 months from the date of the initiation of the policy.

  • Pre-hospitalization: Medical expenses up to 60 days before admission will be covered.

  • Post-hospitalization: Post-hospital costs are accrued for a maximum of 90 days beginning with the day of hospital discharge.

  • For ambulance charges, you can claim Rs. 1,500 per hospitalization, up to a maximum of Rs. 1,00,000.

  • Health Check-up: After four years, if you haven’t made a claim, this plan offers a free health check-up worth up to Rs. 5000.

  • If hospitalization is not an option, home hospitalization refers to any medical treatment received at home. This unusual situation is known as “domestic hospitalization.” This plan will pay up to Rs 5,00,000 in expenses in such a case.

  • Daycare: Only hospital stays longer than 24 hours are covered by health insurance for medical expenses. Due to advancements in technology, medical treatments performed in a hospital that last less than 24 hours are referred to as “day care procedures. This policy covers various daycare procedures.

  • Ayush Cover: Sidha, Ayurvedic, Homeopathic, and Unani are covered up to a sum of Rs 5,00,000.

  • Organ Donor: This plan will pay for the hospitalization costs of the organ donor and the surgical costs associated with harvesting the organ in the event that an organ transplant is necessary. Finding a donor’s costs, however, are not reimbursed.

    The scope of coverage is stated below:
  • The organ donor is any person whose organ has been made available in accordance with the Transplantation of Human Organs Act 1994, and the organ donated is for the insured’s use.

  • The insurer has accepted an inpatient hospitalization claim under “Inpatient care” as mentioned under “Eligible hospitalization expenses”.

  • A Renewal Bonus: For each year without a claim, a renewal bonus is applied to the amount covered. This policy provides a no-claim bonus of up to a maximum of 50% of the insured amount.

  • Restore benefits: Restoration of the Sum Insured: Up to 100% of the basic sum insured will automatically be reinstated when it gets exhausted due to a claim. If you use up your coverage within a policy year, this plan reinstates your basic coverage. Only unrelated claims can be restored.

Eligible Hospitalization Expenses are as follows

While the insured was under inpatient care, medical expenses were incurred for:

  • Room rent, and board expenses.

  • Medical practitioner’s fees.

  • Intensive Care Unit.

  • Nursing expenses

  • Anesthesia, blood, oxygen, operating theatre expenses, surgical appliances, medicines, consumables, diagnostic expenses, x-ray, dialysis, chemotherapy, radiotherapy, cost of the pacemaker, prosthesis, internal implants, and any medical expenses incurred which are integral parts of the operation.

  • Physiotherapy as inpatient care is part of the treatment.

  • Drugs, medicines, and consumables consumed during the hospitalization period.

  • Diagnostic procedures.

  • Dressings, ordinary splints, and plaster casts.

What is not covered in the SBI General Arogya Premier Health Insurance Plan for Families?

  • Gender change treatments and procedures.

  • Maternity expenses for the first 9 months of the policy.

  • Expenses related to the treatment of obesity, weight loss, or weight management.

  • Hospitalization primarily for rest, cure, rehabilitation, and respite care is not covered.

  • Treatments taken outside the country are not covered.

  • Treatments carried out related to any investigations or evaluations are not covered.

  • Organ donor expenses are not covered.

  • Mental illnesses and psychiatric disorders.

  • Cosmetic surgery or plastic surgery is not covered.

  • War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power, confiscation or nationalization, requisition of or damage by or under the order of any government or public local authority

  • Treatment related to any injury caused by nuclear weapons or nuclear war will not be covered.

  • Injuries or illnesses caused by radioactivity

  • Treatments for congenital or genetic disorders, whether internal or external,

  • Rehabilitation from drugs and alcohol-related treatments

  • Infertility or sterility is not covered in the plan.

  • Any unproven scientific treatments are not covered.

  • Any costs related to medical care for injuries sustained while engaging in adventurous activities.

  • Treatment concerns AIDS, HIV, and venereal diseases.

  • Any damage caused by driving under the influence of liquor or drugs.

  • During the first year that the policy is in effect, the plan will not pay any costs associated with the treatment of conditions like a tonsillectomy, cataracts, sinusitis, nasal disorders, related disorders, gallbladder stones, or chronic renal failure.

  • Unless caused by an accident, surgery for a prolapsed intervertebral disc is not recommended.

  • Vertebro-spinal disorders (including disc) and knee conditions

  • Any outpatient department treatments will not be considered.

  • Suicide-related self-injury, suicide-related injuries, or suicide-related death.

  • Medical expenses incurred in connection with joint replacement surgery due to degenerative conditions, age-related osteoarthritis, and osteoporosis, unless such surgery is necessitated by an accident.

  • Surgery of varicose veins and varicose ulcers

  • Remain in a hospital without receiving any active, ongoing care from a doctor.

  • During the hospitalization expenses caused by the extra comfort and luxury,

  • Any kind of stomach or duodenal ulcer;

  • Adenoidectomy, mastoidectomy, tympanoplasty;

  • Surgery on all internal or external tumors/cysts/nodules/polyps of any kind, including breast lumps;

  • All types of hernia and hydrocele

  • Anal Fissures, Fistula, and Pile

  • Benign Prostatic Hypertrophy

  • Hysterectomy/myomectomy for menorrhagia, fibromyoma, or prolapse of the uterus;

  • Hypertension, heart disease, and related complications

  • Diabetes and related complications

  • Vaccination or inoculation, except as part of post-bite treatment for an animal bite.

  • Vitamins, tonics, and nutritional supplements are not unless they form part of the treatment for injury or disease as certified by the attending medical practitioner.

SBI General Arogya Premier Health Insurance Plan for Family Premiums

The coverage options range from Rs. 10 lakhs to Rs. 30 lakhs in SBI General Arogya Premier Insurance. Different premiums are charged for this coverage based on the selected sum insured, insurance type, and the insured’s age group.

Benefits and features of SBI General’s Arogya Premier Health Insurance Plan for Families

The main features and benefits of the SBI Arogya Premier Health Insurance Policy are the following:

  • Up to Rs. 1,000,000 is covered for mental illness and disorders.

  • Conditions and symptoms related to the human immunodeficiency virus are covered up to Rs. 1,000,000.

  • There is a 48-month waiting period for diseases that already exist. For some specific types of illness and ailments, it is 12 months and 90 days, whereas it is 30 days for other specific diseases.

  • Section 80D of the Income Tax Act of 1961 allows for a tax rebate on the premium paid for this policy.

The waiting period for the SBI Arogya Premier Health Insurance Policy

  • After 4 years: After the policy starts, you can claim for any pre-existing conditions.

  • After 30 days, A waiting period of 30 days is needed for all claims. There is an exception for claims arising from accidental injuries.

Procedures to claim the SBI Arogya Premier Health Insurance Policy

The policy offers cashless treatment benefits. Prior to admission to the hospital, contact the administration to request cashless treatment. The administrator must be given thorough information regarding the type of claim. The administrator will give the insured or the hospital institution an authorization letter after validating the information. When requesting cashless treatment, the insured must present both the authorization letter and the ID card that was issued at the time the coverage began.

Within 48 hours of hospitalization, notification of a claim must be made for all other routine claims. However, the insurance administrator has the exclusive option to extend the period for notification of a specific claim up to seven days. The insured must complete the claim form and send it to the administrator with all the required information.

The documents that have to be produced during the filing of the claim are:

  • Valid photo ID card and 2 photos of the insured or nominee.

  • Original investigation report.

  • Discharge certificate.

  • Death certificate, if applicable.

  • Copies of diagnostic tests and treatments

  • Bills and receipts for medicine

  • Any other documents requested by the administrator

The administrator will start the claim process after they have all of the aforementioned documents. Before approving the claim, the administrator will evaluate each condition. The administrator will notify the claimant of the claim’s approval upon successful verification. Within seven days following the claim’s acceptance date, the insurer will make the payment.

Cancellation of the Policy One of the most promising health insurance plans provided by SBI General Insurance is the Arogya Premier Policy.

The following are the circumstances under which SBI General Insurance Company will terminate the SBI Arogya Premier Health Insurance Policy:

Before the coverage expires, the company will give a 15-day notice. This will only occur if the policyholder defrauded the insurer or otherwise falsified any type of information.

This policy terminates at the earliest of the following events:

  1. Cancellation of policy as per the cancellation provision

  2. On the policy expiry date,

The SBI Health Insurance Network Hospital List

31 states in India have an SBI Health Insurance Network. Through its wide network of hospitals, SBI Health Network ensures that you are medically secure, irrespective of the city you reside in.

Take Away

One of the most promising health insurance plans provided by SBI General Insurance is the Arogya Premier Policy. It is a unique plan with a choice of complete coverage created to address special healthcare demands. The plan aims to give people and their families the best possible health insurance coverage. It includes some of the most comprehensive coverage benefits. Therefore, SBI General’s Arogya Premier Policy may be something to consider if you’re seeking an excellent, comprehensive health insurance plan.

Discover some of the specifics of this plan before you purchase the coverage. The plan has a 3-month minimum entry age and a 65-year maximum entry age to be eligible to acquire the plan. There is no obligation for pre-policy medical screening, however, until the age of 55. One of the best policies provided by SBI General is the Arogya Premier Policy, which offers higher sum insured options ranging from Rs. 10 Lakh to Rs. 30 Lakh.