SBI General Health Insurance

Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.

SBI General has an extensive network of 6000+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the hospital closest to them by going through the SBI General network hospital list available on SBI General Health Insurance

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.

A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.

In case of hospitalisation due to accident, your remaining Sum insured will become 125%, subject to maximum of INR 1,00,000/-

If you do not claim in any policy period then you will not get any refund, however you are eligible for a “Cumulative Bonus” of 5-10% which can be accumulated up to 25-50% depending on the plan you have chosen.

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.

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. The Policy holder can port the following accrued credits: General waiting period Waiting periods pertaining to the coverage of pre-existing diseases/conditions Any time bound exclusions.

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. No renewal receipt shall be valid unless it is on the printed form of Insurer and signed by an authorised official of Insurer. 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.

It refers to payment of the Medical Expenses incurred by the insured, immediately 30/60 days before and 60/90 days after Hospitalization.

It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.

Pre-acceptance Health check is not mandatory for people who are less than 45 years old and without any history of illness. Insured’s with following condition, acceptance of proposal is subject to a satisfactory medical examination as per SBI General’s requirements: Insured with adverse medical history as declared in Proposal Form or, Insured aged above 45 years & irrespective of SI. The cost of Pre-acceptance medical tests has to be borne by the proposer. However, if the proposal is accepted by Us, we will reimburse 50% of the cost incurred towards the medical tests so undertaken at our advice.

The medical tests can be conducted at any designated centers identified by SBI General.

Premium for Family Floater Policy is calculated basis the age of the oldest member of the family to be insured.

Individual plan has to be separate for every individual. Floater covers all in family (max. 2 Adults and 2 Children) and provides one sum insured to all, hence there is saving of premium.

There is No maximum exit age for this policy.

The minimum age of entry for SBI General’s 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 General’s Health Insurance Policy - Retail. The Maximum age of entry for the policy is 65 years.

In a floater option single policy under one Sum Insured covers all in the family for e.g. 2Adults, 2 A 1C, 2A 2C, 2A, 1A2C , 1A 1C. The Sum Insured can be used by anyone in the family or all covered in the policy for multiple number of times till the time the Sum Insured limit is exhausted.

Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.

Yes, waiting periods will be applicable afresh in relation to the amount by which the Sum Insured has been enhanced. For example, if the waiting period for pre- existing disease is 4 years, any expenses under this cover can be claimed only after 4 years from the date of policy inception.

The duration only after which a claim can be made is called the waiting period.

Sum Insured is the maximum amount that an insurance company will pay to the insured, according to the insurance contract, in the event of a claim.

A medical checkup may be necessary when you sign up for a new health insurance policy. However, medical checkups are not usually needed for renewal of policies. It is in your best interests to undergo a medical check-up at the time of enrollment so that when you need us, we‘re there to provide speedy and efficient support and faster settlement of claims.

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

No, it is not possible to revise the sum insured during the policy period, the same can be carried out at the time of renewal of the policy.

Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs

A waiting period is the length of time you, the insured, will have to wait before the benefits under the health policy can be utilised.

A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.

A grace period refers to a period of 30 days immediately following the premium due date of the medical insurance policy. During this period you can pay the premium of your expired policy and avail continuity benefits such as waiting periods and coverage of pre-existing disease.

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.