• SBI General Arogya Plus Policy

    Health Insurance
    • Enjoy options to cover yourself, your spouse, kids and even your parents
    • Enjoy access to 10,000+ hospitals for cashless treatment
    • Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

    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:

    • Expenses related to OPD consultation and treatment are allowed up to a specified limit.
    • Flexible coverage options are available for individuals as well as families.
    • This policy covers expenses related to 142 day care procedures.
    • Maternity benefits are also available under this policy up to the OPD expenses limit.
    • Pre-hospitalisation medical expenses are covered for up to 60 days subject to the same condition of hospitalisation.
    • Post-hospitalisation medical expenses are covered for up to 90 days subject to the same condition of hospitalisation.
    • The amount paid as premium for this insurance policy is not subject to income tax as per Section 80D of Income Tax Act.

    Benefits Of SBI General Arogya Plus Policy

    The insured can receive policy benefits related to hospitalisation and OPD medical expenses. The range of benefits available under this cover are as follows:

    Expense type Scope
    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

    Exclusions From SBI General Arogya Plus Policy

    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:

    • Pre-existing diseases for the first 4 years of policy cover
    • Any illness (except for accidental injuries) for the first 30 days of commencement of the policy
    • Maternity expenses for the first 9 months of the policy
    • Conditions like tonsillectomy, external tumor, cataract, hydrocele, hernia, benign prostatic hypertrophy, hysterectomy, hypertension, diabetes, non infective arthritis, calculus diseases, sinusitis, nasal disorders, chronic renal failure, varicose veins, etc. for the first one year of the policy
    • Medical treatments taken outside India
    • Epidemic diseases recognized by the World Health Organization or the government of India
    • Intentional self-injury or injuries resulting from violation of law
    • Injuries caused by war or warlike activities
    • Cosmetic or aesthetic treatments of all kinds
    • Any conditions associated with HIV, AIDS, or venereal diseases
    • Injuries caused while under the influence of alcohol or drugs
    • Treatments related to rehabilitation from alcohol or other drugs
    • Genetic disorders and internal or external congenital diseases
    • Injuries or illnesses sustained while under service as a member of military or police

    Claim Procedure For SBI General Arogya Plus Policy

    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.

    • Duly filled claim form with all the necessary details
    • Valid photo identity card and address proof of the insured
    • 2 photos of the insured or the nominee
    • Original discharge certificate
    • Death certificate (if applicable)
    • Copies of medical treatments and diagnostic tests
    • Investigation reports
    • Original medical bills and receipts

    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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