SBI Critical Illness Insurance Policy
Stress and unhealthy lifestyle are major contributors to depleting health and increase the risk of critical illnesses. These are serious health conditions, adversely affecting the overall lifespan of the individual.
Treatment of critical illnesses faces hurdles such as rising medical costs, expensive treatment and hospitalization, increasing expenses of medical practitioner visits, frequent health check-ups, recovery aid, etc. SBI Critical Illness Insurance Policy covers all these aspects of health care, thus aiding in a smooth road to recovery.
What is SBI Critical Illness Insurance Policy?
SBI Critical Illness Insurance Policy has been specially designed for individuals diagnosed with specific critical illnesses, resulting in high mortality.
Irrespective of the investment made, the insured is paid the entire lump-sum amount during the policy claim. This covers the complete medical expenses. This is an advantage compared to other policies.
Additionally, the lump-sum amount can be used for paying back loans, EMIs, financing additional requirements, etc. Therefore, SBI Critical Illness Insurance Policy not only finances medical treatment but also covers financial expenses of all areas of life.
Features of SBI Critical Illness Insurance Policy
The salient features of this policy are mentioned below:
Wide Coverage of Critical Illnesses
The policy is not specific for one ailment alone. It covers the diagnosis and treatment of 13 life-threatening diseases
Initial diagnosis of-
- Cancer of a specific grade
- Primary pulmonary arterial hypertension
- Kidney failure with dialysis
- Multiple sclerosis with long-term symptoms
Initial surgery for-
- Major organ or bone marrow transplant
- Open heart replacement and valve repair
- Open Coronary Arterial Bypass Graft
- Aorta graft surgery
The first-time occurrence of-
- Permanent stroke
- First heart attack
- Coma of a specific grade
- Permanent blindness
- Complete paralysis of limbs
Critical illnesses may result in mortality. Therefore, adequate health insurance coverage must be provided for quality treatment. In the event of any fatality, financial support is necessary.
SBI Critical Illness Insurance Policy provides dual coverage –
- Critical Illness (CI) Coverage – For the treatment of the insured
- Life cover – Financial coverage in the event of the death of the insured
After reviewing the insurance plan terms and conditions, withdrawal is permitted within a specific period of the policy purchase. This is known as the free-look period.
Mode of purchase
Online or branch office
Complying with any request for policy termination after the free-look period depends on the discretion of the insurance provider.
Reimbursement of a Medical Check-ups
The workings of SBI Critical Illness Insurance Policy are heavily dependent on the health status of the insured. However, a medical check-up is not required until the age of 45, provided pre-existing illnesses are declared beforehand.
Nonetheless, policy terms state that a medical examination is required beyond the age of 45. Accepted individuals (insured) are refunded 50% of their medical check-up expenses. Therefore, this policy has minimal added costs with respect to the initial investment.
Benefits of the SBI Critical Illness Insurance Policy
The policy comes with a range of benefits which can be described as:
- Flexibility – SBI Critical Illness Insurance Policy caters to individuals from all areas. The sum insured ranges from Rs 2 lakh to Rs 50 lakh. Additionally, non-earning individuals are offered a maximum of 10 lakh sum insured. Individuals aged above 60 have a maximum sum insured of 15 lakh. Compared to other policies, SBI Critical Illness Insurance Policy offers the most flexible and economic plans with respect to critical illness insurance
- Free second opinion – After the completion of the waiting period, if the insured has been diagnosed with a listed critical illness and wishes to seek a second opinion, the insurance provider arranges for it. This is done completely free of cost.
- Premium waiver and lump sum payout – In case the insured is diagnosed with any one of the listed critical illnesses, future premiums on the policy are waived off. This will ensure a proper influx of CI cover funds to finance the medical costs for the insured. Additionally, the diagnosis of the illness results in a lump sum policy payout. This can be extremely beneficial for meeting hospitalization expenses or other financial requirements.
- Tax benefits – All investments made in health insurance are accorded tax deductions, as per Section 80D of the Income Tax Act, 1961. This allows a deduction of Rs 50,000 as tax benefit (Rs 25,000 for self, spouse and children + Rs 25,000 for parents). However, if parents are senior citizens, the maximum deduction is Rs 30,000.
*Tax benefit is subject to change as per the tax laws
Inclusions of SBI Critical Illness Insurance Policy
Inclusions of this policy are:
- The lump-sum payment for a critical illness is made the insurer survives the first 28 days' post-diagnosis of the illness.
- According to SBI Critical Illness Insurance Policy, the maximum lump-sum payout from the policy is Rs 50 lakh, which is a one-time payment. This covers the entire cost of hospitalization, including second opinion (if any), diagnostic tests, medical equipment, and treatment.
- The list of critical illnesses covered includes cancer and cardiovascular disorders along with the other 13 critical illnesses. These are the most common causes of mortality today. The coverage of these illnesses ensures that rising medical costs and extended hospitalization do not become an impediment to accessing the best quality health care being available.
Exclusions of SBI Critical Illness Insurance Policy
Under SBI Critical Illness Insurance Policy, the following claims are excluded:
- Any ailment that manifests during the waiting period
- A pre-existing disease that may or may not has been declared during policy purchase
- A congenital disease or any ailment existing before the insured turned 18 years of age
- Effects of alcohol or drug overdose, or the consumption of drugs not prescribed by a medical personnel
- Any ailment or illness arising from HIV / AIDS
- Any illness arising from involvement in war, rioting, strikes, or civilian commotion
- Participation in adventure sports, scuba diving, and racing activities
- Delay in medical treatment or non-adherence to medical advice
- Any illness resulting from exposure to nuclear radiation, biological contamination, or chemicals
- Treatment other than allopathy – Medical intervention under AYUSH is excluded
- Pregnancy, childbirth, and associated complications
- Any illness arising in the donor due to organ donation
- Diagnosis of any ailment or treatment outside India
If the insured suffers from an ailment that is listed in the policy but was diagnosed either before policy purchase or during the waiting period, that ailment will not be eligible for coverage.
Eligibility Criteria to Buy SBI Critical illness life insurance policy
Eligibility criteria to apply for the plan are –
- Depending on the insured, variants of SBI Critical Illness Insurance Policy are:
- The insured can be a single individual (self)
- Family coverage includes self, spouse, parents, and dependent children.
The insured for this policy cannot be a child as the minimum age of entry is 18 years. However, if children are required to be covered, either one or both parents are required to be included as well.
- Policy tenure – 1 year and 3 years
- Sum insured -
Special conditions –
Maximum sum insured
Above 60 years
15 lakh (new investors)
Waiting Period –
- Period for lump-sum payment – 28 days from the day of diagnosis of illness
- Lump-sum payout – Rs 50 lakh (one-time)
- The policy has lifelong renewability. In other words, if any claim has not been made, the insured can renew the policy with no period of expiration.
Claim Process for SBI Critical Illness Insurance Policy
SBI Critical Illness Insurance Policy has a one-time claim process. In other words, once the claim for coverage has been accepted, the policy cannot be renewed further. This is because the entire lump-sum payout is done at one go (Rs 50 lakh), irrespective of the sum insured.
The insurance provider either approves or rejects the claim application through verification of details. The sum insured for a health insurance policy can be claimed by two methods - cashless (during treatment) and reimbursement (post-treatment).
The health insurance provider bears cashless claim for all medical expenses related to hospitalization, provided the treatment is availed from a network hospital. For this, the claim steps are:
- The health insurance provider or TPA should be informed regarding the hospitalization through the helpline number provided in the card.
- The health card is submitted along with a photo identity verification. The cashless claim request form is filled up.
- Obtain a pre-authorization letter signed by the medical personnel. This will be sent to the insurance provider by the hospital. Depending on the relevance of the claim, it may either be accepted or rejected.
- Original bills and reports should be retained for future reference.
- Medical expenses, as stated in the policy, will be taken care of by the insurer as per the norms of SBI Critical Insurance Policy.
For claiming a reimbursement during medical treatment, the steps to be followed are -
- Post-discharge, a claim should be filed, and the health insurance provider should be informed.
- The claim form, with a valid photo identity, should be submitted.
- In some cases, SBI Critical Illness Insurance Policy can reject the reimbursement claims. However, the insured can still claim reimbursement.
- During emergency hospitalization, the closest relatives of the insured should contact the health insurance provider.
- All medical dues should be settled; all original documents are to be retained for policy claim submission.
- The duly-filled claim form should be submitted with the relevant medical documents.
Required Documents for Claim Submission
The following original documents are required to be submitted for policy claim:
- For a non-network hospital (reimbursement claim), the hospital details may be required regarding the treatment provided and the medical personnel.
- Bills covering all medical expenses should be duly signed and stamped by the required medical personnel in the hospital. These should be submitted along with the claim form.
- The original discharge report should be signed and stamped accordingly.
- Original diagnostic reports, such as blood tests and other investigations, should be submitted in original.
- The insured is required to furnish details regarding follow-up and treatment.
How to Buy SBI Critical Illness Insurance Policy?
SBI health insurance policy can be bought online without any hassle. For this, one can go to the insurers portal or directly buy it from Paisawiki.com.
The steps of online purchase of SBI Critical Illness Insurance policy include-
Premium Amount Calculation
- Visit the official website at com. Choose ‘Critical Illness Insurance’ under ‘Health’. Please enter the name, gender, and contact number of the person making the registration.
- If any family member is to be included to the SBI Critical Illness Insurance Policy, provide details of the family members.
- Check the policy features and benefits.
- Use the premium calculator to check the required payable amount.
- Provide the contact details to be submitted to SBI Critical Illness Insurance Policy.
- Supply details such as name and gender of the person buying the policy. In case of a family being covered, provide details of the adults and children being covered.
- Provide city of residence. Next, plans related to critical illness will be listed. Clicking on ‘View Features’ provides all the details.
- Details related to the monthly cover, claim settlement ratio, monthly premium, claim process, and hospitals covered are provided. Plan comparison helps in determining the most appropriate plan available.
- Select “Proceed to Buy”.
- Full details of the selected insurance plan are shown, along with individuals covered. There is no family floater plan available in this policy. Two brochures are also made available for download – policy wording (terms and conditions) and the selected plan. This is to ensure that the customer is fully aware of the plan details before finalizing the payment. A three-year policy enables saving as compared to a single-year.
*All savings provided by the insurer are as per the IRDAI approval. Standard T&C apply
- After details are finalized, select “Proceed”.
- If the family is covered, the ages of additional members are required. Please provide details and select "Done".
- Full plan details are shown again with the updated details. Verify all details and select “Proceed”.
- The next page requires additional information - insured details (name, height, weight, occupation), contact details, medical status, nominee selection and agreeing to the declaration.
- Verify the provided details and upload the documents. Enable plan payment.
Payment of Policy
Payment can be made digitally. GST of 18% is levied on health insurance premiums. Offline purchase can be made by visiting the nearest branch office of the insurance provider.
Documents Required for Purchasing SBI Critical Illness Insurance Plan
The documents required for purchasing the health insurance policy SBI General are:
- Identity proof – PAN card, Aadhar card, driving license, passport, voter I-card
- Age proof – Birth certificate, passport, PAN card
- Address proof – Aadhar card, driving license, passport, ration card
- Passport-sized photographs
Further documents may be required in the following cases –
- Income proof for the insured - Non-earning insured have a cap of Rs 10 lakh sum insured
- Medical reports/tests in the event of pre-existing illnesses
- Mandatory medical test for the insured aged above 45 years
Renewal Process for SBI Critical Illness Insurance Policy
If no claim is made, SBI Critical Illness Insurance Policy can be renewed for lifelong. Policy renewal increases the CI cover. To renew the cover
- Visit the website of Paisawiki. Select “Renewal”, followed by “Health Renewal”. Or, log in and select “Policy Renewal”.
- Provide details such as policy number and date of birth.
- Click on “Plan Renewal”. Choose the required option regarding the policy period. Update any changes in the policy.
- The updated premium amount is paid, and the policy is renewed.
- Policy premium for renewal can be paid through debit card or UPI, or automatically deducted from the linked bank account.
- Alternatively, the premium amount can be paid offline through cheque or demand draft at the nearest branch office of the health insurance provider.
- Please note that the SBI Critical Illness Insurance Policy can be renewed for 3 years only till the age of 57 years. All subsequent renewals are yearly.
Frequently Asked Questions
Ans: Under this policy, portability is valid only if the transfer is taking place from a critical illness insurance policy of another insurance provider.
As per SBI Critical Illness Insurance Policy, there are two conditions for a mandatory medical check-up –
- The customer has declared a pre-existing illness.
- The customer is above 45 years of age.
In case the medical check-up results are satisfactory, and the customer accepts the policy (becoming the insured), 50% of the medical check-up expenses are reimbursed.
Ans: The investment in a critical illness insurance plan depends on the age, lifestyle, annual income, and family history of the insured.
A critical illness insurance plan is majorly required for the following individuals
- Those with a family history of critical illnesses
- The breadwinner of the family
- High-stress jobs
- Those above the age of 45 years
Written By: Paisawiki - Updated: 12 February 2021