• SBI General Group Health Insurance 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**

    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.

    Eligibility For SBI General Group Health Insurance Policy

    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.

    Features Of SBI General Group Health Insurance Policy

    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:

    • It provides coverage for hospitalisation expenses and domiciliary hospitalisation expenses for a range of illnesses and injuries.
    • It offers multiple coverage options for the insured including family floater cover.
    • The insured can avail cashless treatment facility at over 3,000 network hospitals.
    • The premium paid for this policy is exempt from income tax under Section 80D of Income Tax Act.
    • The policy is valid for a period of one year. It must be renewed every year in order to enjoy continuous coverage.
    • Pre-existing diseases can be covered after 4 years of continuous policy coverage and renewal.
    • There is an initial waiting period of 30 days for all conditions while taking this policy for the first time. However, this is not applicable for accidental injuries.
    • Pre-hospitalisation expenses incurred 30 days before the date of hospitalisation and post-hospitalisation expenses incurred 60 days after the date of hospitalisation are also covered under this policy. However, these expenses must be related to the illness or injury for which the insured was hospitalised.

    Benefits Of SBI General Group Health Insurance Policy

    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:

    Expenses Benefits provided
    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.

    Exclusions From SBI General Group Health Insurance Policy

    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:

    • All injuries and illnesses that existed before the commencement of the policy
    • All conditions (except for accidental injuries) for the first 30 days of the policy
    • Conditions like gastric or duodenal ulcers, tonsillectomy, cataract, hernia, hydrocele, benign prostatic hypertrophy, non-infective arthritis, renal failure, diabetes, hypertension, heart diseases, sinusitis, and varicose veins for the first one year of the policy
    • Medical treatments that happened outside the country
    • Injuries caused by war or warlike activities
    • Circumcision and cosmetic surgery of any kind unless required for a specific medical condition
    • Expenses related to spectacles, hearing aids, wheelchairs, crutches, dentures, and artificial teeth
    • Complications caused by substance abuse or alcohol
    • Conditions associated with HIV, AIDS, and other venereal diseases
    • Treatments associated with pregnancy, childbirth, and miscarriage
    • Fertility-related treatments
    • All kinds of congenital internal diseases and illnesses
    • Alternative treatments like acupuncture, acupressure, naturopathy, osteopathy, reflexology, chiropractic, and aromatherapy

    Claim Process For SBI General Group Health Insurance Policy

    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.

    • Claim form filled with all the required details
    • Photo identity card of the insured person
    • Hospital records, original medical bills, and receipts
    • Copies for diagnostic tests, medical references, and treatment advice
    • Discharge summary and certificate
    • Death certificate or post mortem report (if applicable)
    • Any other document requested by 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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