• SBI General Arogya Top up Policy

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    Health Insurance
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    Medical costs are among the most unpredictable of expenses one can encounter in his/her lifetime. There are times in which a medical insurance policy coverage may be inadequate for a particular illness or injury. During these unpredictable times, an additional policy coverage may come in hand. SBI General Arogya Top up Policy is one such cover that provides additional cover against rising medical expenses.

    Eligibility for SBI General Arogya Top up Policy

    The following eligibility criteria applies to SBI General Arogya Top up Policy:

    • Anyone between the age of 3 months to 65 years can opt for this policy cover.
    • By choosing a deductible of Rs.5 lakh, the maximum entry age can be extended to 70 years.
    • Pre-insurance medical examination is not required for anyone below the age of 55 years provided there is no prior medical history.
    • Family of the insured can be covered (on a floater basis) under this policy.

    Sum Insured & Premium Charges

    The sum insured for SBI General Arogya Top up Policy ranges from Rs.1 lakh to Rs.50 lakh. Deductible options for this cover ranges from Rs.1 lakh to Rs.10 lakh. With such wide coverage, the premium charges vary significantly based on the insured’s age group, sum insured chosen, and deductible opted for.

    Features of SBI General Arogya Top up Policy

    As an additional health insurance cover, SBI General Arogya Top up Policy comes with a range of features. Some of the key features of this insurance policy are listed below:

    • It covers about 142 day care treatment procedures.
    • It covers alternative treatment under AYUSH (short for ayurveda, yoga & naturopathy, unani, siddha, and homeopathy).
    • This cover can be availed in three different policy terms - 1 year, 2 years, and 3 years.
    • It offers many flexible covers under different co-payment options.
    • The sum insured offered under this cover can be reinstated after a claim by paying additional premium charges.
    • People subscribing to this cover can avail tax benefit under Section 80D of Income Tax Act.
    • Pre-hospitalisation expenses are covered for up to 60 days subject to the same condition of hospitalisation.
    • Post-hospitalisation expenses are covered for up to 90 days subject to the same condition of hospitalisation.
    • There is a free-look period of 15 days to decide whether the policy terms are satisfactory. Proposers can cancel the policy anytime during this period provided they have not filed any claim.

    Benefits Of SBI General Arogya Top up Policy

    This policy cover comes with a range of benefits related to hospitalisation expenses. Some of the major benefits offered by SBI General Arogya Top up Policy are as follows:

    Type of expenses Scope
    Hospitalisation expenses covered Room rent, boarding expenses, intensive care unit stay, nursing expenses, diagnostic procedures, drugs, medicines, physiotherapy as part of the primary treatment, medical practitioner fees, etc.
    Expenses related to medical treatment Anaesthesia, blood, surgical appliances, oxygen, medicines and consumables, diagnostic expenses, operation theatre charges, x-ray, pacemaker, etc.
    Examples of day care procedures covered Dialysis, chemotherapy, radiotherapy, etc.
    Ambulance charges Actual ambulance expenses or Rs.5,000 per valid hospitalisation (whichever is lower)
    Domiciliary hospitalisation Reasonable and customary charges
    Organ donor hospitalisation Expenses related to an organ donor’s (insured) treatment

     

    Exclusions From SBI General Arogya Top up Policy

    There is a list of exclusions for which SBI General is not liable to pay any compensation to the insured. Some of the possible exclusions under the Arogya Top up Policy are as follows:

    • All pre-existing diseases for the first 4 years of continuous policy coverage
    • Any illness or disease arising within the first 30 days of commencement of the policy (not applicable for accidental injuries)
    • Maternity expenses for the first 9 months of the policy
    • Conditions such as gastric or duodenal ulcers, benign prostatic hypertrophy, hernia, hydrocele, calculus diseases, chronic renal failure, tonsillectomy, sinusitis, non infective arthritis, surgery of varicose veins, gall bladder stone, diabetes, etc. for the first one year of the policy
    • Expenses for treatments taken outside India
    • Injuries caused by wars or warlike activities
    • Cosmetic or aesthetic treatment of all kinds
    • Intentional self-injuries, suicide, or attempt to suicide
    • Venereal disease or any other sexually transmitted diseases
    • Treatments related to obesity, weight loss, and weight management
    • Any kind of convalescence or comfort expenses related to hospital stay
    • Injuries sustained while under the influence of alcohol or drugs
    • Injuries sustained by exposure to nuclear weapons or radioactivity
    • Injuries sustained during service under military or police
    • Treatments taken in hydro, spas, nature care clinics, etc.

    Claim Procedure For SBI General Arogya Top up Policy

    The claim process for this policy is similar to that of other health insurance policies by SBI General. For cashless treatment facility, the insured must notify the administrator regarding the claim and get pre-authorisation. The ID card issued along with the policy must be produced at the hospital along with the authorisation letter. The insurer will also ask for the original bills and evidence of treatment from the network hospital.

    For other hospitalisation claims, the insured will have to produce a list of documents while submitting the claim. Some of the documents required for this include:

    • Claim form filled by the insured
    • Photo identity card and 2 photos of the insured
    • Original discharge card
    • Death certificate, if applicable
    • Copies of all medical tests and evidence of treatment
    • Any other documents requested by the insurer

    Once these documents are submitted to the insurance company, the claim process will begin. The insurer will notify the insured regarding the acceptance or rejection of the claim. If repudiated, a valid reason will be provided in writing. Following the acceptance of the claim, the compensation amount will be paid in 7 days.

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