SBI Arogya Premier Policy Health Insurance

SBI General Arogya Premier as a health insurance plan was designed to address the specific healthcare needs of individuals with a high net worth. The plan comes with several flexible options and provides access to the highest quality medical treatments.

The total policy term can vary from 1 year, 2 years, and 3 years. Purchasing this policy is a great way to stay free from worries related to unforeseen medical expenses. Some benefits provided with this policy are in-patient hospitalization, health check-ups, ambulance cover, organ donor charges, domiciliary hospitalization, pre-hospitalization, and post-hospitalization charges.

Customers also have a lot of choices in this plan in respect to the total sum insured, insurance type, age group of the insured, and other factors. Customers should know that they don’t need to undergo a pre-policy medical test if they are up to the age of 55 years. These individuals should also have no medical history.

The plan comes with 142 different day-care expenses covered for all policyholders. Other key features of this plan are:

• Pre-hospitalization coverage of up to 60 days before being admitted to the hospital
• Post-hospitalization coverage of up to 90 days after being discharged from the hospital
• After a waiting period of 9 months, maternity expenses are also covered
• Organ donor charges cover is provided
• The feature of automatic reinstatement of sum insured on exhaustion is provided
• For every claim-free year, a cumulative bonus of 10% of the sum insured value is provided for up to a maximum of 50%
• The coverage of this plan can range from INR 10 lakh to INR 30 lakh
• One can save taxes under Section 80D of the Income Tax Act, 1961. This tax benefit is subject to the extant rates as specified in the Finance Bill
• Alternative treatment cover for Unani, Ayurveda, Siddha, and Homeopathy is also available under the AYUSH alternate treatment facilities
• No additional value-added benefits are provided in this policy that one can avail of by paying an extra premium amount
• The SBI Arogya Premier plan has a very impressive claim settlement ratio
• The policy comes with a wide range of age limits
• The policy has a hassle-free purchasing process
• A large range of medical conditions and situations are covered under this policy
• All accumulated bonus of the SBI Arogya Premier plan will work to increase the sum assured value which can be used later
• Room rent, medical practitioner’s fees, intensive care unit charges, nursing expenses, and boarding expenses are covered
• Ambulance cover of up to Rs.1 lakh, in case of Air Ambulance, is provided
• Different diagnostic procedures are covered
• Consumables, medicines, and drugs during the hospitalization period are covered
• Physiotherapy as inpatient care and being part of the treatment is covered
• Charges related to oxygen, blood, operation theatre, anesthesia, surgical appliances, x-ray, dialysis, chemotherapy, radiotherapy, pacemaker, internal implants, prosthesis, or other medical charges that are integral to the process of the operation or medical treatment are covered
• Charges of ordinary splints, dressing of wounds, and plaster casts are covered
• Alternative treatments availed at government hospitals or in an institution recognized by the government or the quality council of India are covered
• A health check-up reimbursement of up to INR 5,000 is insured after four consecutive claim-free years
• The sum insured value is reinstated up to a total of 100% if the sum insured is reduced due to placing a claim

The SBI Arogya Premier Policy also has important eligibility criteria. Let’s look at what that criterion is below.

Apart from this, one must also know about the documents that are required to purchase the SBI Arogya Premier policy. These documents are:

• Application or proposal form
• KYC documents
• A medical test or check-up (Only required in select cases)

The process of renewing the SBI Arogya Premier policy is also simple. A grace period of 30 days is provided for the renewal of this policy every year. This period is counted right after the premium amount is due. One can renew the policy without any hassle either by visiting the official website online or by visiting the local branch office of SBI General Insurance.

Further, when it comes to placing a claim request for the SBI Arogya Premier plan one has to initiate the process by calling the administrator before hospitalization. This will allow the administrator to gather the necessary information in regards to the type of claim that has been raised.

After the details have been verified, the administrator will provide an authorization letter to the insured or the hospital facility. Along with the authorization letter, the insured will have to provide his or her ID card that was issued at the start of the policy. In this manner, one can avail of cashless treatments.

In the case of a normal claim, one must notify the administrator within 48 hours of hospitalization. This duration can also be extended to 7 days at the sole discretion of the administrator. After that, the insured will have to fill a form and submit the following documents.

• Discharge certificate
• Original investigation report
• Valid photo identity card
• 2 photos of the insured
• 2 photos of the nominee, if applicable
• Death certificate, if applicable
• Bills and receipts of drugs
• Copies of treatment charges
• Copies of diagnostic test charges
• Any other document requested by the administrator

Once the documents mentioned above are received, the administrator will start the process of settling the claim. All conditions will be assessed by the administrator before providing approval. The payment will be settled within 7 days from the acceptance date of the claim.

Some key inclusions applicable in this policy are:

• Alternative treatment coverage
• Coverage for ambulance charges for a maximum of up to INR 1 lakh
• Pre-hospitalization and post-hospitalization charges
• 142 day-care procedure charges cover

There are also some factors that are excluded from the coverage of this policy. Those factors and parameters are:

• For the first 30 days of the policy, all conditions and illnesses apart from accidental injuries are not covered as the cooling period
• Illnesses caused due to war, warlike activities, nuclear weapons, radioactivity, attempt to suicide, suicide, or self-injury are not covered
• Any type of aesthetic, prosthetic or cosmetic procedure
• Expenses related to comfort during hospitalization
• Any pre-existing medical condition for the first 4 years of the policy
• Maternity expenses for the first nine months of the policy
• Any treatment costs incurred outside of India
• Injuries caused due to alcohol addiction and drug abuse
• Treatments of conditions like hernia, gastric ulcers, duodenal ulcers, diabetes, chronic renal failure, cataract, sinusitis, benign prostatic hypertrophy, and tonsillectomy during the first year of the policy
• Injuries sustained while serving as a member of the police or military force
• Genetic conditions
• Internal or external congenital diseases
• Treatments related to rehabilitation from alcohol or drugs
• Treatments related to HIV, AIDS, and other venereal diseases
• Treatments of weight loss, obesity, or weight management
• Treatments related to psychiatric disorders and mental illnesses