SBI General Arogya Plus Policy

Managing medical expenses can seem like a challenging task, considering that medical inflation is moving up rather quickly. SBI General’s Arogya Plus Policy is a comprehensive health insurance product that provides financial protection against rising OPD and hospitalization expenses. This allows the policyholder to completely focus on the treatment and recover without having to worry about the medical expenses.

(Note: All the information in this article has been sourced from the official website of SBI General Insurance.)

Features and Benefits of SBI General Arogya Plus Policy

Following are the features and benefits of SBI General’s Arogya Plus Policy:

  • For people with no medical history, pre-policy medical test is not required up to the age of 55 years.
  • Individuals can choose from multiple coverage options - Individual and Family Floater options.
  • OPD expenses are covered, as specified in the policy schedule.
  • 142 Day Care expenses are covered.
  • Pre and post hospitalization expenses are covered - 60 days before hospitalization and 90 days after hospitalization.
  • Maternity expenses are covered, up to the OPD limit.
  • Choice of sum insured - Rs. 1,00,000, Rs. 2,00,000 and Rs. 3,00,000.
  • Tax deduction under Section 80D of the Income Tax Act, 1961, can be claimed on premiums paid.

Inclusion of SBI General Arogya Plus Policy

SBI General Arogya Plus Policy covers the following: Eligible Hospital Expenses:

  • Room rent, boarding expenses, medical practitioners fees
  • Nursing expenses
  • Intensive care unit
  • Anaesthesia, surgical appliances, operation theatre expenses, cost of pacemaker, radiotherapy, blood, oxygen, medicines & consumables, diagnostic expenses and x-ray, dialysis, chemotherapy, prosthesis/internal implants and any medical charges incurred which is integral part of the operation.
  • Medicines, drugs, and consumables consumed during hospitalization.
  • Physiotherapy as inpatient care and being part of the treatment.
    • OPD Treatment - Covers expenses for OPD consultation and treatment, up to specified limit.
    • Pre-hospitalisation expenses coverage - 60 days before the date of admission into the hospital.
    • Post-hospitalisation expenses coverage - 90 days following the date of discharge from the hospital.
    • Day Care Expenses - Covers 142 day-care expenses.
    • Ambulance Expenses - Up to Rs. 1,500.
    • Alternative Treatment - Reimbursement of alternative treatment under AYUSH taken in a government hospital or in any institute recognised by government and/or accredited by quality council of India/national accreditation board on health.
    • Domiciliary Hospitalisation - Reasonable charges on domiciliary hospitalisation.
    • Maternity Expenses - Covers maternity costs up to the OPD limit in the policy.

Exclusion of SBI General Arogya Plus Policy

Benefits shall not be payable for the following circumstances:

  • Any condition, ailment or injury or related condition(s) for which the individual has been diagnosed, received medical treatment, had signs and/or symptoms, before the first policy’s inception, until 48 straight months have elapsed, following the date of inception of the first policy.
  • Initial 30 days exclusion for sickness except hospitalization on account of accident.
  • Initial 9 months exclusion for maternity expenses.
  • Treatment taken outside the country.
  • Injury or disease as a result of nuclear weapons/materials
  • War, acts of foreign enemy, invasion, hostilities, etc.
  • Epidemic disease that has been recognized by WHO or the government.
  • Intentional self-injury or violation of any law.
  • Cosmetic or aesthetic treatments and Lasik treatment for refractive error. Any kind of plastic surgery (unless required for treating illness or accidental injury).
  • Treatment for de-addiction from alcohol, drugs or other substance.
  • Vaccination or inoculation, unless as part of post-bite treatment for animal bite.
  • Treatment for mental illness and psychiatric or psychological condition.
  • Any condition that is caused by or associated with HIV or variant/mutant viruses and or any syndrome or condition of a similar kind, commonly referred to as AIDS.
  • Genetic disorders and stem cell implantation, surgery or storage.
  • Treatments in health hydro, nature care clinics, spas and the like.
  • Experimental and unproven treatment.
  • Disease, illness or injury while undertaking duties as a serving member of a military or police force.

Eligibility Criteria & Documents Requirement

Eligibility Criteria - SBI General Arogya Plus Policy

  • Minimum Entry Age: 3 months
  • Maximum Entry Age: 65 years

Documents Required to Buy SBI General Arogya Plus Policy

  • ID Proof (PAN card, Passport, Driving License, etc.)
  • Address Proof (Passport, Driving License, Electricity Bill, Telephone Bill, etc.)

Documents Required to Claim SBI General Arogya Plus Policy

Following are the documents one needs to submit for making a claim:

  • Duly-completed claim form,
  • Valid photo identity card and address proof
  • Copies of prescription for diagnostic tests, treatment advice, medical references
  • Original set of investigation reports
  • 2 recent photos of Insured and/or his nominee
  • Original discharge card/certificate/ death summary
  • Itemized original hospital bills and receipts hospital and related original medical expense receipt
  • Original pharmacy bills with prescriptions

Easy Procedure to Renew SBI General Arogya Plus Policy

A policyholder can easily renew his or her SBI General Arogya Plus Policy online through the website of the insurance company. The individual will have to input certain details like Last Name, Date of Birth and Email ID on the renewal page of SBI General Insurance.

Once this is done, the user needs to click on ‘Continue to Get Quote’ and proceed to renew health insurance cover. The renewal premium has to be paid to SBI General Insurance on or before the date of expiry of the policy or of the subsequent renewal thereof. A grace period of 30 days is allowed for policy renewal. This will be counted from the day immediately after the premium due date during which payment can be made to renew or continue Arogya Plus Policy without losing continuity benefits, like waiting periods and coverage of pre-existing ailments. The continuity of coverage for all the covers under the expiring policy will be subject to premiums being paid in full for the same. Coverage is not provided for the period for which no premium is received.

What is the Claim Procedure for SBI General Arogya Plus Policy?

Cashless hospitalization is a facility available in the SBI General Arogya Plus Policy. If a policyholder wishes to avail medical treatment at a network hospital, he or she must contact the insurer and request pre-authorization in writing. If the insurer is satisfied with the claim, an authorization letter will be sent to the insured individual or the hospital facility. The individual must make sure to provide his or her ID card along with the policy documents, and any other documents necessary (identified in the pre-authorisation letter) at the network hospital before being admitted.

In case of a reimbursement claim, the insured is required to provide intimation to SBI General Insurance right away and in any event within 48 hours from the date of hospitalization. The insured individual must then file a claim with all required documents within 15 days of discharge from the hospital. If the claim is not filed on time and the insured is unable to provide a justified cause for delaying claim submission, the company has the right to not consider the claim for reimbursement. For post hospitalization claims, the insured must lodge the claim within 15 days from the completion of post hospitalization treatment, subject to a maximum of 105 days following the date of discharge from hospital.

Conclusion

Through its Arogya Plus Policy, SBI General Insurance aims to make medical treatments more affordable for its customers. In times of rising healthcare costs, a sudden injury or illness can leave one financially devastated. SBI General’s Arogya Plus Policy helps ensure that such an instance does not arise - giving individuals and families the much-needed financial security in trying times.

Review of SBI General Arogya Plus Policy

Arogya Plus Policy makes it easy to afford quality treatments at some of the top hospitals in the country. It provides users the much-needed financial protection against rising OPD and hospitalization expenses. Lastly, it is a comprehensive medical policy and comes with a range of features.

FAQ's On SBI General Arogya Plus Policy

Is portability allowed under SBI General Arogya Plus Policy?

Yes, this policy is portable as per Insurance Regulatory And Development Authority of India (Health Insurance) Regulation, 2013. The insured has to initiate action to approach another insurance company well before the renewal date so as to avoid any break in the coverage on account of delay in acceptance of the proposal by the other company.

Does this policy cover treatment by Ayurvedic method?

Yes, this policy covers treatment by Ayurvedic method. The alternative treatment has to be taken in a government hospital or in any institute that is recognized by the government and/or accredited by quality council of India/national accreditation board on health.

Is there any grace period for renewal of the SBI General Arogya Plus Policy?

Yes, a grace period of 30 days is allowed for renewal of the policy

Does SBI General Arogya Plus Policy cover smoking, alcohol and tobacco habits?

Yes. However, there is a loading of 5% in the premium for each of the habits

Is there any discount for long term policy?

Yes. A discount of 5% is provided for a 2-year term and 7.5% for a three-year term.

Is the policy available for long term?

Yes, the policy can be availed for up to 3 years.

Is there any pre-medical check-up required?

Pre-acceptance health check is not compulsory for individuals who are less than 55 years of age, without any history of illness.

Is maternity hospitalisation covered under the SBI General Arogya Plus Policy?

No, expenses related to maternity hospitalization are not covered under the policy. However, the OPD limit covers the maternity expenses.

Are ambulance charges payable under the SBI General Arogya Plus Policy?

Yes. An insured individual will be reimbursed the actual ambulance expenses or Rs. 1,500, whichever is lower, for per valid hospitalization claim. This must be for transferring the insured to or between hospitals in the hospital’s ambulance or in an ambulance that has been provided by an ambulance service provider.

What are the types of payment option available?

Individuals looking to avail SBI General’s Arogya Plus Policy can make premium payments online or by visiting one of the insurance company’s branches.

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