SBI Group Health Insurance
A group health insurance plan is where several people are insured against any medical eventuality. As such, the SBI Group Health Insurance scheme covers individuals along with their whole family to assist in case of any health issues of a family member financially. The policy covers costs incurred due to hospitalization, critical illness, and accidents. It helps its customers not only with better access to healthcare but also a sense of security and mental well-being.
What’s SBI Group Health Insurance Policy?
SBI Group Health Insurance policy is a robust mechanism that covers a wide range of medical benefits for every individual of the group insured. The policy comes with the following characteristics:
- Comprehensive health cover for your family.
- The scheme casts a wide net in terms of the SI amount, with multiple options ranging from Rs 1 lakh to Rs 5 lakh.
- Individuals up to the age of 65 with no medical history, no pre-medical tests can avail the policy.
- It covers every individual in the family, even children, and seniors who are financially dependent on the earning members of the family.
- SBI Group Health Insurance covers a part of the ambulance charges, along with room, boarding, nursing, and ICU charges.
- Pre-existing diseases are covered after 4 years from the active policy date
- It comes with a guaranteed renewal clause.
- Domiciliary hospitalization expenses are covered if it continues for more than 3 days.
- Cashless treatment is available in over 3000+ network hospitals across the country.
- The option of add-on cover is available which enhances the policy coverage.
- Daily cash allowance for expenses incurred on non-medical expenses.
Features & Benefits of SBI Group Health Insurance
Key features and benefits of this plan are as follows:
- Entry age for adults is 18 to 65 years, while the entry age for a child is from 3 months to 30 years.
- Cashless treatment is available in network hospitals.
- Pre-existing diseases are covered after 4 years of initiation of the policy.
- There is a one year waiting period in case of specified diseases.
- Individual, family, and floater options for sum insured available for coverage.
- Lifelong renewability benefit is offered.
- Health check-ups offered at the end of completion of 4 claim-free years free of cost.
- Tax savings under Section 80D of The Income Tax Act, 1961.
Inclusions of SBI Group Health Insurance Plan
Compensations available for the insured covers the following medical expenses:
- Medical practitioner and specialist’s fees
- Pre-hospitalization expenses limited to 30 days before admittance in hospital
- Post-hospitalization up to 60 days following the discharge from hospital
- Daycare surgeries with less than 24 hours of hospitalization, including tonsillectomy, dialysis, chemotherapy, radiotherapy, eye surgery, etc.
- Ambulance charges up to Rs 1500/- or 1% of sum insured (whichever is less)
- The admissible claim limit up to 10% co-payment
- Domiciliary hospitalization up to Rs 20,000/- or 20% of sum insured (whichever is less)
- 10% co-payment on claims on all eligible admissible claims in non-network hospitals
- Room boarding and nursing charges to be covered at 2% per day for ICU
- Room boarding and nursing charges to be covered 1% per day for non-ICU
- All costs incurred towards blood, oxygen, anesthesia, OT charges, surgical instruments, diagnostic material, medicines, physiotherapy, dialysis, and X-Ray are covered under the policy, including cover charges on radiotherapy, chemotherapy, pacemaker cost, prosthesis and/or any expenses incurred on the operation
- There is an option of add-on covers in the policy. The benefits include zero sub-limits on room rent and ICU rent, doctor’s fee, etc.
Please note that all coverage benefits are subject to sub-limits, as mentioned in the policy contract. The applicants may choose to avail the option of add-on covers, which includes zero sub-limits on some of the costs mentioned above.
Exclusions of SBI Group Health Insurance Plan
The insured party cannot claim claims arising due to the following:
- Diseases diagnosed during the first 30 days of policy purchase
- Pregnancy treatment and complications arising out of such, including abortion, miscarriage or prenatal and/or postnatal treatment
- Congenital diseases diagnosed during or before the policy period
- HIV AIDS and other sexually transmitted diseases
- Depression, mental disorders, or self-inflicted injuries
- The intoxication of drugs and overdose of alcohol consumption
- Any form of alternative treatments like homeopathy, Ayurveda, acupuncture, naturopathy, aromatherapy or reflexology
What are the sub-limits under the SBI Group Health Insurance Policy?
Sub-limits are the limitations on the sum assured under specific coverage, as mentioned above. Following are the sub-limits imposed by the SBI Group Health Insurance Policy:
- Room rent can be availed up to a maximum of 1% of the sum insured. There is an option to choose for a higher room category, but in such a case, the policyholder has to bear all other incremental expenses by himself
- 10% of the co-pay applies to admissible claims upon treatment availing from a non-network hospital. One can also opt for voluntary co-pay as an add-on benefit.
- 2% of the sum insured is the maximum cap for ICU charges per day
- Expenses arising out of domiciliary hospitalization are capped up to 2% of the sum insured or Rs 20,000/- per day
- Ambulance charges capped up to 1% of the sum insured to a maximum of Rs 1,500/- for each policy period
- Health check-up benefit limited to 1% of the amount assured to a maximum of Rs 2,500/-
- Ayurvedic treatment expenses are covered up to a maximum of 15% of the sum insured not above Rs 20,000/- in a policy period
- Homeopathy and Unani treatment expenses up to 10% of the sum insured in a policy period, up to Rs 15,000/-
- Dental treatment expenses are covered up to a maximum of 2% of the sum insured.
What are the Add-on Covers Available under the Scheme?
Add-on covers are the additional benefits available to a policyholder upon extra payment. These cover remove the sub-limits on certain expenses covered under the policy. The SBI Group Health Insurance provides the following add-on benefits to policyholders:
- Outpatient treatment up to 2% of the sum insured
- Maternity benefit is also available as an add-on cover, and the delivery of the first 2 living children are covered by it (and the operational costs arising out of such). However, any policyholder with more than 2 living children cannot avail this benefit
- Cover for a newborn is also available for injury, illness, sickness, or disease
Eligibility Criteria to Buy SBI Group Health Insurance
18-65 years (adults)
3 months/30 years (children)
Individual & family
Pre policy medical screening is required for applicants above 65 years of age
How to claim compensation under the scheme?
The SBI Group Health Insurance Policy can be claimed in two ways; cashless or reimbursement:
- The policyholder shall follow the treatment and advice of the medical practitioner without any undue delays
- Post-hospitalization claims to be filed within 15 days of the completion of post-hospitalization treatment
- The policyholder must undergo a medical examination as required by the scheme, the cost of which shall be borne by the insurance provider
- The policyholder should submit all medical receipts, bills, certificates, investigation reports, and other such information attained from the hospital/doctor/diagnostic laboratory
- In addition to the above, the policyholder also needs to submit the patient’s identity card, health card and FIR copy (if any)
- On receipt of such claim, the insurance provider will examine and gather information about the disease/injury that required hospitalization of the policyholder
The insurance company will provide an identity card and user guide to the policyholder. The user guide contains the following details:
- Claim submission guidelines
- A detailed list of SBI network hospitals with contact details
- Process of availing cashless benefits in network hospitals
- Contact details and website details of the administrator
What is the Renewal Process of the SBI Group Health Insurance Plan?
The renewal process of the SBI Group Health Insurance Policy is quick and straightforward. The employer completes the process on behalf of the group which can be initiated by approaching an agent. However, the easiest one is to visit the Paisawiki.com website. There is an option of ‘Renew Policy’ on the home page, after which the person can renew his policy by paying the renewal fees digitally, or by other means as listed there.
The person will soon get an acknowledgment receipt on their registered email address, confirming the renewal of their health insurance scheme.
How to Buy the SBI Group Health Insurance Policy?
The individual looking to purchase this policy should carefully consider his family needs related to health insurance. Factors such as coverage, benefits, policy term, and the premium amount should be particularly identified. It would also be advisable to compare health insurance policies online.
One can easily apply for SBI Group Health Insurance Policy offline:
- Visit the nearest SBI branch.
- The Insurance Officer in the help desk will provide an application form.
- Fill in the required details and submit the form to the concerned department.
- The application will be forwarded for further processing with regular notifications of its progress will be shared on the registered email address.
- The verification team will verify the details.
- Upon successful verification, you will receive your policy document.
In order to buy the policy online, approach Paisawiki.com, go to the ‘buy’ option, follow the instructions given on the website, calculate the premiums and pay online to buy the policy.
Documents Required to Buy the SBI Group Health Insurance
Any savings or current bank account holder in SBI can apply for the SBI Group Health Insurance policy.
The list of the documents needed to apply for the policy are:
- Valid photo identity issued by the government
- Proof of residence and recent photographs of the insured members
- Medical certificates (if required)
FAQs About SBI Group Health Insurance
Ans: The policy premium can be paid online and offline. For online payment, the policyholder can visit the SBI website and pay the premium through his credit card, debit card, net banking, etc.
Ans: The policyholder must initiate the claim within 15 days of the discharge of the patient. The discharge letter also needs to be provided as along with the intimation of the claim.
Ans: Family floater policies are the ones that cover an individual and his or her immediate family members under a single premium. Premiums are calculated based on the age of the oldest member of the family.
Ans: It covers accidental deaths occurring anywhere in the world.
Ans: There is no maximum exit age in this policy.
Ans: Tax benefits up to Rs 50,000/- are given in favor of the premiums paid under Section 80D of The Income Tax Act, 1961. The income tax benefits are subject to as per the prevailing tax laws.
Ans: If the patient is not in the condition to be moved to a hospital or the hospital lacks accommodation facilities, the patient will be treated at home. This process is known as domiciliary hospitalization.
Ans: The treatment should last more than 3 days at home. Additionally, one of the following criteria must be fulfilled-
- The hospital bed or room was not available for hospitalization
- The patient's health condition is feeble, and as such, it is not feasible to move him to a hospital
- A medical practitioner must approve the treatment
Written By: Paisawiki - Updated: 22 September 2020