Group health insurance policies are used to provide medical cover for members of a particular group under a single cover. It is usually taken by companies to provide health insurance for their employees under a single policy. SBI General Group Health Insurance Policy is developed with this in mind, and it provides health insurance cover for a group against a range of unexpected illnesses and injuries. With additional benefits like infant cover and family floater, this policy ensures that comprehensive protection is offered for group members as well as their families.
SBI General’s Group Health Insurance Policy can be taken by anyone between the age of 18 and 65 years. There is no pre-insurance medical examination for people below the age of 65 years subject to the condition that they have no medical history.
As a group cover, this policy provides insurance coverage for an association of persons who assemble together with a commonality of purpose. Groups like employees of a company typically avail this cover. However, other non-employee groups like holders of credit cards issued by a particular bank, borrowers of a bank, and professional associations are also treated as a group for this cover.
This cover can be used to protect the primary insured individual as well as his/her family. Some of the key features of SBI General Group Health Insurance Policy are listed below:
This policy offers a wide range of insurance options with sum insured ranging from Rs.1 lakh to Rs.5 lakh. Users can choose the ideal cover based on their specific requirements. Based on the sum insured amount chosen by the policyholder, SBI General Group Health Insurance Policy offers the following benefits:
|Room, boarding expenses incurred during stay at a nursing home or hospital||1% of the sum insured subject to a maximum of Rs.1,500 per day (whichever is less)|
|Expenses related to stay at intensive care unit (ICU)||2% of the sum insured subject to a maximum of Rs.2,500 per day (whichever is less)|
|Domiciliary hospitalisation (at least 3 days)||Up to 20% of the sum insured subject to a maximum of Rs.20,000 (whichever is less)|
|Treatment in non-network hospitals||10% of all eligible admissible claims shall be borne by the insured|
|Ambulance charges||1% of the sum insured subject to a maximum of Rs.1,500 per day (whichever is less)|
Hospitalisation must be at least for 24 hours in order to file a claim under this policy. However, a select range of day care procedures and surgeries (same-day discharge) are also covered under this policy. These procedures include dialysis, chemotherapy, radiotherapy, tonsillectomy, dental surgery following an accident, and eye surgery.
SBI General Group Health Insurance Policy comes with a few exclusions for which the company is not liable to compensate the insured. For instance, the pre and post hospitalisation expenses incurred during domiciliary hospitalisation treatment are not covered under this policy. Domiciliary hospitalisation treatment for a range of disease including asthma, hypertension, epilepsy, diarrhea, influenza, tonsillitis, arthritis, diabetes mellitus, and diabetes insipidus are also not covered. Apart from these, the following list of exclusions are applicable:
For cashless treatments, all claimants will be issued a user guide and identity card. The insured must follow the procedure provided in the user guide for availing cashless treatment facility at network hospitals.
For other claims, the insured must notify the company immediately within 48 hours of hospitalisation. After verification of evidence, the company may record the request and proceed with the process. All documents related to the claim must be submitted to the insurer within 30 days of discharge from the hospital. The following claim documents are required in order to file a claim with the insurer.
The admissibility of the claim will be verified by the insurer after the submission of all the documents. The insurer may also engage subrogation for hospitalisation related to accidental injuries. Once the documents are verified, the insurer will inform the claimant of the acceptance. The compensation amount for hospitalisation expenses will be provided after that.
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