SBI General Arogya Top Up Policy : Coverage, Claim & Renewal

Updated: 07-02-2019 07:48:38 AM

One never knows when medical emergencies can happen but they surely take a toll on our mental and financial health. In situations like accident or sudden serious illness, medical expenses can pile up and exceed the cover provided by a traditional health insurance plan. During these unpredictable times, top up policy coverage can provide protection to the policyholder and its family. One such top up plan is SBI General Arogya Top Up Policy which is created to provide cushion to the policyholder overcome the rising medical costs over and above your pre-decided medical cost

What is SBI General Arogya Top Up Policy?

Medical costs sometimes exceed the insured value of your normal health insurance policy. SBI General Arogya Top Up Policy provides the insured extra protection at a very low premium. This will help them overcome rising medical expenses over and above that of an individual’s pre-determined budget.

Eligibility Criteria 

Like any other health insurance plan, this insurance policy is also designed for a specific customer base. Look at the following table to find out more about eligibility criteria of SBI General Arogya Top Up Policy:

Particular	Details
Plan Options	·         Individual Plan ·         Family Insurance Policy- This plan covers the policyholder, spouse, dependent children, parents and parents-in-law ·         Family Floater Policy- This plan is for self, spouse and maximum 2 dependent children
Entry Age	Minimum entry for this plan is 3 months and maximum is 65 years.   (The maximum entry age can be extended up to 70 years, if the policyholder opts for deductible of Rs. 5 lakh and above.)
Exit Age	No exit age
Policy Term	1, 2 and 3 years
Sum Insured/ Sum Assured	Rs. 1 lakh to Rs. 50 lakh (Sum Insured)
Deductible or Co-Payment	Rs. 1 lakh to Rs. 10 lakh (in the multiples of Rs. 1,000)

Features Of SBI General Arogya Top Up Policy 

• No need to undergo pre-policy medical tests for the applicants up to age 55 years provided they have no medical history
• Both pre and post-hospitalization expenses for 30 and 90 days respectively up to the sum insured will be covered under XYZ
• Maternity expenses are covered after nine months of waiting period
• The plan covers alternate treatments methods such as AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy)
• Sum insured can be reinstated on payment of pro rata additional premium
• Policyholder needs to select deductible for co-payment from Rs 1 lakh to Rs 10 lakh

 What all SBI General Arogya Top Up Policy includes?

The insurance company will reimburse following medical expenses: 

• Day care surgery expenses
• Organ donor expenses
• Ambulance Expenses
• Hospitalization expenses such as room rent, boarding room, ICU, nursing expenses
• Pre and post hospitalization 30 and 90 days respectively
• Domiciliary hospitalization (Hospitalization at Home)

Documents required for claim process 

In case of reimbursement, insured first needs to consult a doctor without wasting any time and need to intimate the TPA within 48 hours from the date of hospitalization. Afterwards, S/he need to file the claim with following documents within 15 days of discharge from the hospital:

• Claim form duly signed
• Copy of attested hospital summary or discharge summary
• Copy of medical reports and records as well
• Doctor’s certificate
• Valid Identity card proof with 2 recent photos of insured
• Any other relevant information

In case of post-hospitalization, claims must be submitted within 15 days from the completion of post hospitalization. If the insured have opted for the cashless claim settlement, S/he needs to take pre-authorization from the TPA.

Cases where you can’t claim SBI General Arogya Top Up Policy

SBI General Insurance is not liable to pay if hospitalization happens due to the following conditions:

• Any disease or injury directly or indirectly caused by a weapon, nuclear material, hostilities, invasion, war, acts of foreign enemies, etc
• Epidemic disease listed by the Government of India and World Health Organisation are also not covered
• Intentional self-injury
• Treatment for any mental illness
• Any type of cosmetic or aesthetic treatment, plastic surgery (unless it is the last option for the treatment of accidental injuries or illnesses), lasik treatment

How long does it take to pay out a claim?

After getting the acceptance of an offer of settlement by the insured, the due amount shall be made within 7 days to settle claims. In case of any delay in the payment, company will be liable to pay interest which is 2% above the bank rate

Renewal Process Of SBI General Arogya Top Up Policy

SBI General Arogya Top Up Policy can be renewed every year by paying the required premium to the insurance company. In case, the policyholder is not able to pay the premium, S/he can pay it under 30 days grace period from the premium due date.  

Advantages of SBI General Arogya Top Up Policy

• The health plan does not require the applicant to go through pre-policy medical check-up
• There is a free look period under this policy where the policyholder can review the terms and conditions related with this policy and return the same if not acceptable within 15 days
• Discount of 5% and 7.5% will be given for 2 and 3 year policy term to the policyholder 

Important Aspects of this plan

• The policy does not provide coverage on any treatment taken outside India
• There is a waiting period of one year and 48 months for some disease, surgeries and pre-existing diseases to be covered under this policy
• Loading of 5% in the premium if insured smokes and consume alcohol, tobacco

Features
Claim Type (In-House or TPA)	Both
Pre-Hospitalization	Up to 60 days
Network Hospital Count	5800+
Post-Hospitalization	Up to 90 days
Room Eligibility	Covered
Share Claim Payments	No (terms and conditions applied)
Restoration of Cover	Yes, by paying the additional premium
No Claim Bonus	NA
Ambulance Charges	Up to Rs. 5,000
Worldwide Coverage	No
Maternity Cover	Covered after 9 months of waiting period
Hospitalization at Home	Covered
Day Care Treatment	Up to 142 day care expenses
Non-Allopathic Treatment Coverage	Covered
Emergency Ambulance	NA
Health Check-up	NA

 FAQ’S 

Q1. Are there any tax benefits the policyholder can avail with this plan?

The premiums paid towards this policy are eligible for tax deduction under section 80D of the Income Tax Act. Look at the following for more:

• 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

 Q2-Does this plan have co-payment feature?

Co-payment is the amount that is expected to be borne by the policyholder for the medical services/ facilities covered/ provided by the health plan. This health policy does not have co-pay at the moment; however, there are certain deductibles under the plan that needs to be exhausted prior to the claim intimation.

Q3-What is the process of cancellation of this policy?

The policyholder may at any time cancel this policy by intimating the insurance company. The insurer will process refund of premium at short period rate only as per the table below provided no claim has occurred up to the date of cancellation:

Period on risk	Rate of premium refunded
Up to one month	75% of annual rate
Up to three months	50% of annual rate
Up to six months	25% of annual rate
Exceeding six months	NIL

 

Q4- Does this policy offer any discount to the insured? 

Yes, based on type of family cover, number of family member covered and policy duration, following discount will be applied to the plan:

1. Family floater discount

• 2 members = 10% discount
• 3 members = 15% discount
• 4 or more members = 20% discount

2. Family Non floater discount

• 2 members = 5%
• >2 members = 7.5%

3. Long term discount

• 2 year = 5%
• 3 members = 7.5%