SBI Arogya Sanjeevani Policy

An illness, accident, or pre-existing disease can put a lot of strain on a family’s finances. Hence, it is required to be prepared for any medical emergency by investing in health insurance covering the cost of hospitalization. Having health insurance will not only help in protecting the family’s finances but will also help in getting immediate medical attention through network hospitals.

Arogya Sanjeevani Policy by SBI General Insurance company ltd provides financial protection against medical expenses due to hospitalization. It is a standard indemnity health insurance plan that covers expenses incurred due to hospitalization, daycare procedures, pre and post-hospitalizations and AYUSH treatment.

Below is a list of specific features of the SBI Arogya Sanjeevani Policy:

• Sum Insured - Minimum Rs. 50,000 to maximum Rs. 10 lakhs in multiple of Rs. 50,000.
• Eligibility - Anyone between the age of 18 to 65 years is eligible to buy this policy for themselves and their family.
• No medical check-up - is required upto 55 years of age for people with no medical history.
• Coverage for family - Family includes self, spouse, children, parents and parents-in-law. Policy Term - Annual policy that can be renewed every year for the lifetime of the insured.
• Premium Payment Options - There are multiple options to pay premiums like monthly, quarterly, half-yearly or yearly payments.

• Cumulative Bonus - Cumulative bonus accumulates at 5% for every claim-free policy year, subject to a maximum of 50% sum insured in the current policy year; policy is renewed without a break.

• Waiting Period -

  • Any illness except for accidents: 30 days
  • Certain specific illnesses: 24 months
  • Joint replacement, age-related osteoarthritis and osteoporosis: 48 months
  • Pre-existing diseases: 48 months

• Portability - The policy is portable and can be migrated to other insurers as per IRDAI guidelines.
• Co-payment - 5% of the claim amount for every claim.

Coverage under the policy includes

• Hospitalisation:

  • Hospital room charges, boarding charges, nursing expenses upto 2% of the sum insured
  • ICU and ICCU expenses upto 5% of the sum insured
  • Doctor, Medical practitioner, consultant, specialist fees
  • Medicine expenses, Operation theatre charges, anaesthesia, blood, oxygen, medicines etc., during the hospital, stay

• Ambulance charges

• Pre and Post hospitalization expenses upto 30 and 60 days, respectively
• Cataract treatment
• AYUSH Treatment
• Advanced Treatments as listed in the policy.

The company does not include the following under the policy coverage

• Hospital admission for evaluation and investigation purposes.
• Hospital admission for rehabilitation, rest etc.
• Treatment outside India
• Surgery for obesity treatment
• Gender change procedure
• Cosmetic surgery
• Injury due to adventure sports
• Maternity expenses
• Sterility and infertility procedures

There are several benefits you get if you purchase an SBI Arogya Sanjeevani policy:

• SBI has around 6000+ network hospitals offering cashless treatment for health insurance policies by SBI.
• The sum insured under the policy can opt on an individual and floater basis.
• It has a lower co-payment of 5% only.
• The policy is lifetime renewable so that you can have SBI health insurance for your lifetime.
• The policy offers a non-floater discount of 2.5% for 2 adults and a non-floater discount of 5% for 3 adults.

The insured can either go in for a Cashless treatment wherein the insurance company directly pays the hospital bills or opt for reimbursement of the expenses by submitting relevant documents to the insurance company within 30 days of discharge from the hospital.

Cashless Claim:

For Cashless claims, the insured should avail of the services of a Network hospital of HDFC ERGO. The process is as below:

• An intimation should be sent to the insurance company within 24 hrs if it was a case of emergency hospitalization. In normal circumstances, wherein the hospitalization is planned, the insurance company should be informed 48 hrs in advance.
• On presenting the Health card and valid photo ID of the insured, the hospital will send in the pre-authorization form and other medical details to the Insurance company for approval
• Once the Cashless claim upto the estimated limit is approved by the insurance company, an authorisation letter is issued and sent to the hospital.
• At the time of discharge, the insured will be required to sign the discharge papers. On the basis of these discharge papers and the details submitted by the hospital, the insurance company will clear the hospital bills.

Reimbursement claim:

It may so be possible that the insured opts for a non-network hospital or the Cashless settlement is not authorized for some reason. In such a case, the insured can submit a reimbursement claim to the insurance company, which is settled within 30 days from the date of submission of all required documents.

• An intimation is required from the insured to the insurance company within the time frame specified in the policy.
• Once the insured is discharged from the hospital, the claim for reimbursement of expenses should be filed in 30 days.
• On verification and approval of the claim, the insurance company settles the claim by transferring the amount to the insured.

• The Insured will be required to submit the following documents along with the claim

  • Claim form duly filed and signed.
  • Identity Documents: Photo ID, Health card and other KYC documents
  • Medical Process Details: Discharge Summary, Patients Medical history, Prescription advising hospitalization, Surgeons report detailing the surgical process if any and all diagnostic reports along with related prescriptions.
  • Financial Documents: All receipts are to be submitted in original, along with the cancelled cheque and NEFT details.
  • Any other relevant document needed by the company.

This is all about Arogya Sanjeevani Policy by SBI. for more details, refer to the policy wording. If you do not have health insurance, go ahead without a second thought to secure your family with the comprehensive coverage offered by the SBI Arogya Sanjeevani policy at affordable premiums.