SBI General Group Health Insurance Policy

What is the Plan all About?

Group Health Insurance Policy from SBI General provides health cover for an individual & family. This health plan helps you manage medical expenses easily, so ensures the happiness of your family.

Key Features

Comprehensive health cover for your family
Coverage options for both individual and family floater
Flexible sum insured options
No pre-policy medical check-up up to the age of 65 years

Policy Benefits

In-patient hospitalization expenses, including Room Rent, Boarding, Nursing Expenses, and other related expenses are covered up to 1% of the sum insured per day, subject to a maximum of Rs 1500 for normal room.
ICU charges are covered up to 2% of the sum insured per day, subject to a maximum of Rs 2500.
Pre hospitalization expenses are covered for 30 days before hospitalization and post hospitalization expenses covered for 60 days after hospitalization.
142 Day care procedures or other specified procedures/surgeries as mentioned under the policy are covered, which require less than 24 hours of hospitalization. It is covered upon prior approval from the insurance company/administrator.
Domiciliary hospitalization expenses are covered in case of hospitalization for more than 3 days.
Outpatient treatment is covered up to 2% of the sum insured during the entire policy period. It is an add-on cover.
Maternity benefit is covered and the delivery of the first two living children and operations related to it will be covered, with a waiting period of 9 months. Any insured person having two or more children cannot avail this benefit. It is an add-on cover.
Maternity benefit can also be availed without any waiting period. The delivery of the first two living children and operations related to it will be covered. It is an add-on cover.
New born baby cover is also available from date of birth of the baby, for any illness, injury, disease, or sickness. It is an add-on cover.

Value Added Benefits

Alternative/ Ayurvedic treatment expenses and Homeopathy & Unani treatment expenses are reimbursed. To avail this benefit, the insured needs to be hospitalized for at least 24 hours. It is an add-on cover.
Avail cashless hospitalization across 3000+ network hospitals.
13 specified critical illnesses are also covered. It is an add-on cover.
Ambulance charges are covered.
Health check-up benefit is available.
Coverage for congenital internal diseases.
Tax Benefit under section 80D of Income Tax Act, 1961.

Sub Limits

Room Rent Limit is capped up to 1% of sum insured per day. There is an option to choose a higher room category than his/her eligibility and in such case, all other incremental expenses need to be borne by the insured.
10% or other specified % of co-pay applies for all eligible admissible claims in case of treatment in non-network hospitals. Voluntary co-pay (add-on cover) is also applicable, as per the terms of the plan.
ICU charges are capped up to 2% of the sum insured per day.
Domiciliary hospitalization expenses are covered up to 20% of the sum insured or Rs 20,000 whichever is less.
Ambulance charges are capped to 1% of the sum insured, subject to a maximum of Rs 1500 per insured per policy period.
Health check-up benefit is limited to 1% of the sum insured, subject to a maximum of Rs 2500 in a policy period.
Ayurvedic treatment expenses are reimbursed up to 15% of sum insured in a policy period, subject to a maximum of Rs 20,000. Homeopathy & Unani treatment expenses are reimbursed up to 10% of the sum insured in a policy period, subject to a maximum of Rs 15,000. It is an add-on cover.
Dental treatment expenses are covered up to 2% of the sum insured during the policy period.

Waiting Period Clause

Initial Waiting Period: Claims arising during first 30 days of the policy start date, except accidental claims.
Specific Waiting Period: Some treatments such as Cataract, Hydrocele, Hernia, Hysterectomy, Diabetes, etc. are covered after 1 year from the inception date of the policy.
Pre existing Disease Waiting Period: Any pre-existing disease until 48 months of continuous policy coverage. All specified pre-existing diseases are covered after completion of such waiting period.
Maternity Waiting Period: Maternity benefit can be availed after a waiting period of 9 months.

Who can Buy the Plan?

Factor	Minimum	Maximum
Age (as on last birthday)	Adult: 18 Years, Children: 3 Months	Adult: 65 Years, Children: 18 Years
Sum Assured	1 Lac	5 Lacs
Cover Type	Individual/Family Floater	-
Policy Tenure	1 Year	1 Year
Grace Period	30 Days	-
Free Look Period	15 Days	-
Riders	Ambulance Expenses Cover, Annual Medical Check-up, Maternity Benefit, New Born Cover, Critical Illness Cover, Coverage For Dental Expenses, Coverage For Congenital Internal Diseases, Voluntary Co-pay, Enhancement Of Room Rent Sub-limits, Etc.	-

Exclusions

Intentional self-injury
War, invasion, or act of foreign enemy
Cosmetic or aesthetic treatments
The cost of spectacles, contact lenses, hearing aids, dentures, and artificial teeth
Items for personal comfort
Dental treatment
Congenital internal disease
OPD treatment,etc.