As a comprehensive medical policy, the SBI General Arogya Plus Policy comes with a range of features. Some of the key features of this policy are as follows:
The insured can receive policy benefits related to hospitalisation and OPD medical expenses. The range of benefits available under this cover are as follows:
|Hospitalisation expenses cover under this policy||Room and boarding expenses, medical practitioner fees, nursing expenses, diagnostic procedures, intensive care unit expenses, anaesthesia, blood, oxygen, surgical appliances, medicines, etc.|
|OPD treatment||Up to the limit specified in the policy|
|Ambulance charges||Actual ambulance expenses or Rs.1,500 (whichever is lower)|
|Alternate treatment||Applicable only for treatments taken in government hospitals or any other institutes recognized by the government|
|Domiciliary hospitalisation||Reasonable charges applicable towards the treatment|
While this policy provides comprehensive health insurance cover, it also comes with a list of exclusions for which the insurer is not liable to provide any compensation. Some of the key exclusions from the policy are as follows:
Cashless hospitalisation facility is covered under the SBI General Arogya Plus Policy. In order to avail cashless treatment, the insured must call the insurer and request pre-authorisation in writing. If satisfied with the claim, the insurer will send an authorisation letter to the insured or the hospital facility. The insured must also provide the ID card issued along with the policy to get cashless treatment. Once the treatment is over, the insured must send all the original bills and receipts to the insurer for validation.
For other hospitalisation claims, the insurer must be notified immediately after an event that may give rise to a claim. The documents required for making the claim must be submitted to the insurer following discharge from the hospital. The following documents may be required while making the claim.
Once these documents are submitted to the insurer, the claim proceedings will begin. The insurer may assess the validity of the claim by verifying all the submitted documents. The insurer will inform the claimant regarding the acceptance or repudiation of the claim. If repudiated, the insurer will provide a reason for doing so. Once the claim is accepted, the insurer will settle the payment within 7 days from the date of acceptance.
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