SBI General Arogya Plus Policy : Eligibility, Features, Claim Process

Updated: 07-02-2019 07:50:01 AM

The best laid financial plans can go awry when there is a medical emergency. These moments can take a heavy financial toll if one is unprepared. Managing such unexpected, additional and immediate medical expenses with a traditional insurance plan is difficult and challenging. SBI General Arogya Plus Policy by SBI General Insurance is designed to provide the policyholder with financial stability and support against rising medical and hospital expenses.

What is SBI General Arogya Plus Policy?

SBI General Arogya Plus Policy is a protection plan that covers OPD medical and hospitalization expenses so that the insured can focus on treatment. One can avail this plan individually or simply go for family floater option to provide them with financial protection against certain medical contingencies.

Eligibility of SBI General Arogya Plus Policy 

SBI General Arogya Plus Policy is for anyone who wishes to protect himself and his family from the medical contingencies provided they fulfill the eligibility criteria of age mentioned below:

Particular	Min-Max
Entry Age	Child: 3yrs Adult : 18-65 yrs

Features of SBI General Arogya Plus Policy

• SBI General Arogya Plus Policy offers tax benefits under section 80D of the prevailing Income Tax Act
• 50% of the cost incurred towards the medical tests taken by the policy seeker above the age of 55 will be reimbursed by the insurance company
• Free look period of 15 days is provided under this policy
• The policy holder have the option to choose between Rs 1 Lakh/ Rs 2 Lakh/Rs 3 Lakh for sum insured

What SBI General Arogya Plus Policy includes? 

This policy covers the following expenses:

• Room rent, boarding expenses
• Maternity expenses covered under the OPD Benefit
• OPD consultation and treatment up to limit
• Day care expenses
• ICU, nursing expenses
• Physiotherapy 

Documents Required For Claim Process 

Following are the documents which the insured have to submit to the insurance company to process claim:

• Duly filled claim form
• Valid Identity card proof with 2 recent photos of insured
• Original Discharge card/certificate/death summary
• Copies of prescription for diagnostic test
• Original hospital bill

Claim Settlement

The insured needs to intimate the administrator within 48 hrs from the date of hospitalization and within 15 days of discharge; he needs to provide the company with claim form along with the original bills, and other documents. In case of post hospitalization claims, the administrator must be informed within 15 days from the completion of post hospitalization treatment.

Cases where you can’t claim this plan (Exclusions)

Even though this insurance plan offers number of benefits to its customers, it comes with several exclusions as well mentioned below:

• Pre-existing conditions prior to the issued date of this policy
• Treatment taken outside India
• Disease or injury whether directly or indirectly caused by a nuclear material, weapon, invasion, war, hostilities, acts of foreign enemies, etc.
• Epidemic diseases listed by the World Health Organisation (WHO) or Government of India
• Intentional self-injury
• Aesthetic or cosmetic treatments, lasik treatment and plastic surgery (unless mandatory for the treatment of accidental or any sort of bodily injury)

How long does it take to pay out a claim?

The insurance company will assess the claim document upon receiving. Upon satisfactory assessment of the claim, the insurer will make the payment of claim. In case, it is repudiated, the same will be communicated to the policyholder with reason. 

Renewal Process of SBI General Arogya Plus Policy

This policy can be renewed every year and the required premium should be paid to the insurance company before the due date of the insurance policy. In case, the policyholder forgets to renew his policy, he has the option to pay the premium under 30 days grace period counted from the premium due date.

Advantages Of Buying SBI General Arogya Plus Policy

• Not many health insurance policies covers OPD medical expenses, however, this one covers to ensure our financial planning doesn’t get affected
• There is no need of undergoing pre-policy medical tests and examinations for the people of 55 years of age provided they have no medical history 

Important Aspects (Critical things you shouldn’t ignore) 

• There is an initial waiting period of 30 days for all illness and one year for some disease and surgeries
• Basic premium will be loaded by 5% for habit of smoking, alcohol, and any other type of tobacco
• The OPD limit is part of the sum insured. In case, the policy holder takes reimbursement for OPD medical expenses, the total sum insured will be reduced by that amount
• Increase and decrease in sum insured is not allowed in mid term
• Maternity hospital expenses are not covered. However, the OPD limit covers the maternity expenses 

Features
Claim Type (In-House or TPA)	TPA
Pre-Hospitalization	60 days before the hospitalization
Network Hospital Count	5800+
Post-Hospitalization	90 days after the hospitalization
Room Eligibility	Covered
Share Claim Payments	Not covered
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	Up to Rs 1500
Worldwide Coverage	–
Maternity Cover	NA
Hospitalization at Home	Covered
Day Care Treatment	142 day care  expenses
Non-Allopathic Treatment Coverage	Covered under AYUSH
Emergency Ambulance	NA
Health Check-up	NA

 

FAQ’s

Q1. Does General Arogya Plus Policy cover Ayurveda and Homeopathy treatments? 

Yes, alternative treatment methods such as Ayurveda, Homeopathy and Unani are covered under this health policy. However, the treatment must be taken in a government hospital accredited by the National Accreditation Board on Health (NABH) or the Quality Council of India.

Q2. Is claims payable during the grace period if the premium is still to be paid?  

Claims will only be payable provided all the outstanding premiums have been paid for the renewal. In case of non-payment of policy renewal, it will be consider as a break in policy.

Q3. What tax benefits are payable under section 80D of the Income Tax Act in this policy?

The tax benefits provided under this section of the Income Tax Act and under this plan are listed below:

• For self, partner (spouse) and dependent children: Up to Rs. 25,000
• For parents: Up to Rs. 25,000
• For parents who are the resident senior citizen: Up to Rs. 30,000

Q4. Is there any additional benefit of taking this policy for long-term?

 Yes, it provides the policyholders with certain discounts. If the policyholder chooses 2 years policy term, they will be provided with 5% discount, while for 3 years policy term, the discount rate is 7.5%.

Q5. Can an individual cover their parents in the Family Floater Policy?

No. Family Floater Policy is designed for 2 adults and maximum 2 children. In this case, the person will not be able to cover their parents under this policy. However, they can go for a separate Family Policy to cover their parents.