SBI General Critical Illness Plan: Coverage, Claim & Renewal

Published: 07-03-2019 11:44:53 AM

Life is uncertain and sudden critical illness can leave the person financially drained out and highly stressed. SBI General Critical Illness Policy ensures protects the insured financially by providing the coverage against 13 critical diseases. 

What Is SBI General Critical Illness Policy?

The SBI General Critical Illness plan offers coverage if the Insured is diagnosed with any of the 13 critical illnesses and is alive for a period of more than or equal to 28 days from the date of the first diagnosis of the illness subject to the condition that the signs, symptoms and diagnosis occurs for the first time after 90 days from the date of inception of the policy.

Types Of SBI General Critical Illness Policy 

This policy can be issued for 1 year or 3 years. The policy with 3 year can be renewed or offered to the policyholder till the age of 57 years.

Eligibility Criteria 

Particulars	Min-Max
Entry Age	18     Years-65 years
Plan Option	Plan A: One year Plan B: Three years
Sum Insured	Rs.2 lakh- Rs.50 lakh

What SBI General Critical Illness Policy Covers? 

First diagnosis of:

• Cancer of specified severity
• Kidney Failure requiring regular dialysis
• Primary Pulmonary Arterial Hypertension
• Multiple Sclerosis with persisting symptoms

Undergoing first-time surgical procedures:

• Major organ or bone marrow transplant
• Open chest CABG
• Aorta Graft Surgery
• Open heart replacement or repair of heart valves
• The occurrence of medical events:
• Stroke resulting in permanent symptoms
• First heart attack of specified severity
• Coma of specified severity
• Total blindness
• Permanent paralysis of limbs

Claim Process & Document Required For SBI General Critical Illness Policy

If insured is diagnosed or underwent a surgical procedure for the critical illness mentioned in the list, it is the duty of the insured or someone from his/her behalf to intimate the insurance company within 60 days of the insured event by giving the required information and documents for claim settlement process:

• Identity proof of the claimant
• Dully filled Claim form
• Copy of Hospital summary/Discharge card/treatment advise / medical reference
• Copy of Medical reports/records

Cases Where You Can’t Claim SBI General Critical Illness Plan

This insurance plan from SBI General offers coverage for 13 critical illnesses. However, there are exclusions as well mentioned below where insurance company is not liable to pay:

• For Insured Events during the Waiting period
• Any diseases causing the death of the Insured within the survival period
• Congenital illness or conditions
• Expenses attributed to covered critical illness arising from birth control procedures or hormone replacement therapy
• Treatment or surgery for change of sex
• Cosmetic surgeries
• Covered illness arising from any treatment that is no scientifically recognised
• Covered illness arising from any treatment with alternative medicines such as Ayurveda, Homeopathy, etc.
• Medical procedure or treatment not carried out by a Medical Practitioner
• Medical procedure or treatment not deemed medically necessary
• Attempted suicide or intentional self-inflicted injury or illness
• Sexually transmitted conditions, HIV/AIDS, mental disorders, nervous disorders, etc.
• Illnesses attributed to being under the influence of drugs, alcohol, etc. unless prescribed by a Medical Practitioner (and taken as prescribed)

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 within 7 days. In case, it is repudiated, the same will be communicated to the policyholder with reason.

Renewal Process Of SBI General Critical Illness Plan

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 Critical Illness Plan

• Company offers a Free Look period or 15 days from the date of receipt of the policy to the insurer to review the Terms and Conditions of the policy and return it is not acceptable
• Tax benefits are provided to the policyholder under Section 80D, Income Tax Act, 1961

Critical Aspects

• No pre-existing diseases or related conditions are covered under this plan
• There is a waiting period of 90 days before the policyholder can claim under this policy
• It is important to note here that only one critical illness claim is allowed during the lifetime of the Insured and the policy terminates immediately on the payment of the first Critical Illness benefit. The maximum benefit amount payable to any individual is up to Rs. 50,00,000 .
• The Maximum Sum Insured is restricted to 60 months Gross Income of the Insured (earning member) or Rs. 50,00,000 whichever is lower. If the Insured is not an earning member of the family then the Sum Insured is restricted to 50% of the income of the proposer up to Rs. 10,00,000 whichever is lower.

Features
Claim Type (In-House or TPA)	Cashless and TPA
Pre-Hospitalization	NA
Network Hospital Count	5800+
Post-Hospitalization	NA
Room Eligibility	NA
Share Claim Payments	NA
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	NA
Worldwide Coverage	NA
Maternity Cover	NA
Hospitalization at Home	NA
Day Care Treatment	NA
Non-Allopathic Treatment Coverage	NA
Emergency Ambulance	NA
Health Check up	NA

FAQ’s 

Q1- Does this policy provides tax benefits? 

Yes, tax benefits are provided to the policyholder under Section 80D, Income Tax Act, 1961. However, one should know that section 80C benefits are not included in this plan. The deduction under Section 80D for the premium paid towards this insurance plan are:

• Up to Rs. 25,000 for self, spouse, parents or dependent children
• Up to Rs. 30,000 if parents are resident senior citizens

Q2-Is it important to undergo pre-policy medical check-up?

It is not compulsory if the proposer is less than 45 years and no history of illness. However, if the policy seeker is above the age of 45, S/he needs to undergo a medical examination to be eligible for this policy. If the proposal gets accepted by the insurance company, they will reimburse 50% of the cost incurred towards the medical tests. 

Q3- What are the conditions of the termination of this policy?

There are two conditions in which the SBI General Critical Illness policy terminates and they are as follows:

• Payment of the first Critical Illness Benefit under this policy
• The date on which the policy is lapsed by the Insured

Q4- Will the SBI General Insurance company refund my premium if I cancel my Critical Illness Policy?

You can cancel your SBI General Critical Illness policy at any time during the policy term. However, the refund of premium is subject to the fulfilment of certain terms including:

• If the Insurer cancels the policy within the Free Look period i.e. 15 days from the receipt of the policy then the company refunds the premium after deducting any applicable charges.
• If the Insured cancels the policy after giving a 15-day written notice to the Insurer and no claim has been made then the Insurer refunds the premium on short-term rates. Refund rates mentioned in the table here for 1-year Policy term:

Period on Risk	Rate of Premium Refunded
Up to 1 month	75% of annual rate
Up to 3 months	50% of annual rate
Up to 6 months	25% of annual rate
Exceeding 6 months	Nil

Refund rates for 3-year policy term provided no claim has been made:

Period on Risk	Rate of Premium Refunded
Up to 1 month	75% of annual rate
1 – 3 months	50% of annual rate
3 – 6 months	25% of annual rate
6 months – 1 year	Total premium Received – Premium to be Retained
Exceeding 1 year	Total Premium Received x No. of Days on Risk / Total Tenure of the Policy in Days

Q5- Can I renew this policy if I have made a critical illness claim once?

No. The Insurer pays only one critical illness claim during the lifetime of the policy. In fact, if the policyholder holds other insurance plans from the insurer and claims for the critical illness once through any of the policies offered by the Insurer, the policy terminates and cannot be renewed.