SBI Health Insurance – Should you opt for this plan?
SBI Health Insurance Plan Review
In the modern age, Health Insurance Plans have become an inevitable thing due to the rising cost of the medical expenses. Generally, people know SBI for its banking services, but very few are aware with the fact that State Bank of India also offers insurance services in the name of SBI General Insurance Company Limited which is a joint venture between the SBI and Insurance Australia Group (IAG). What are the key features of SBI Health Insurance Plan? What is covered and excluded in SBI Health Insurance Policy? This post is based on request from Ajay Kaikala on Suggest a Topic.
What is health insurance plan?
You can skip this section if you are already aware of health insurance plan. Health insurance plans are those plans that insures you against unexpected medical emergencies and keeps you financially stable in these difficult times. It takes care of our medical expenses and ensures that the expenses incurred are curtailed at least till the sum assured. It helps us to take the cashless treatment at the network of hospitals of the insurance company.
Key Features of SBI Health Insurance Policy
The key features of the SBI Health Insurance plan are as under:
1) It offers a wide coverage from Rs 50,000 to Rs 5 Lakhs. The maximum sum insured is restricted to Rs 2 Lakhs to insured persons aged 60 and above and taking the policy with the insurance company for the first time. The minimum sum insured for the family floater policy would be Rs 2 Lakhs.
2) There is no medical test required up to the age of 45 if the individual has no medical history.
3) Pre and post hospitalization expenses are covered for 30 and 60 days respectively.
4) Family Floater Benefit is provided under a single plan in a comprehensive manner.
5) There are three flexible plan options- Metro Plan, Semi Metro Plan and Rest of India.
6) There is a network of hospitals on which cashless facility is available.
7) Free medical check-up for every 4 claim free years up to Rs 2,500.
8) The current health insurance policy with any insurer can be renewed by SBI General Insurance.
9) Medical insurance premium paid here is exempted from section 80D of income tax act.
What are various Benefit Plan Options in SBI Health Insurance Plan?
There are three benefit plans available:
The percentage of the amount shown in the above table is with respect to the admissable claim amount. The company will make payments only after being satisfied with the necessary bills and documents.
What is covered under SBI Health Insurance?
This policy covers the following major heads of expenses with certain terms and conditions:
Pre-hospitalization charges: Up to 10% of the eligible hospitalization expenses incurred 30 days prior to date of admission into the hospital.
Post-hospitalization charges: Up to 10% of the eligible hospitalization expenses incurred 60 days after the date of discharge from the hospital.
Ambulance charges: 1% of the sum assured (SI) up to a max of Rs. 1500 is covered under this.
Medical treatment with room, board and nursing expenses and service charges, etc.: – Up to 1% of the Sum Insured per day.
Medical treatment in ICU (Intensive Care Unit): Up to 2% of the SI per day.
Consultant and specialists fee: Up to 40% of the SI per illness or injury per claim.
Anesthesia, blood, oxygen, OT charges, Surgical Appliances: Up to 40% of the SI per illness or injury per claim.
What are various exclusions in SBI Health Insurance?
The company cannot be held liable under the policy for the expenses incurred under the following heads:
1) Any disease contracted during the first 30 days of commencement of policy.
2) Any expense incurred on the ailment of existing diseases unless 2 consecutive years of the policy has elapsed.
3) Certain diseases or surgeries like Hernia, Hydrocele etc. shall be covered after a waiting period of 1 year.
4) Few diseases like cataract, Hysterectomy shall be covered after a waiting period of 2 years from commencement of policy.
5) Joint replacement surgery shall be covered after a waiting period of 3 years from the commencement of the policy with an exception due to an accident.
6) Treatment through alternative therapies like naturopathy, osteopath, acupressure, acupuncture, aromatherapy etc.
7) Any expenses incurred or related to pregnancy or childbirth or prenatal or postnatal care.
8) Congenital disease
9) All expenses incurred on AIDs and other related diseases.
10) Use or abuse of alcohol or intoxicating drugs.
How are the premiums looking like in this health insurance plan?
1) For a 19-35 years old individual residing in Mumbai and Delhi and for a plan of Rs 5 Lakhs health insurance, premium works out to be 5,689.
2) For such individuals in other major cities like Chennai, Bangalore, Kolkata, Ahmedabad, Hyderabad and Pune, the premium is at Rs 4,913.
3) For the rest of the India it is Rs 4,654.
How are the premiums looking like for a Senior Citizen in this health insurance plan?
1) For a 61-65 years old individual residing in Mumbai and Delhi and for a plan of Rs 5 Lakhs health insurance, premium works out to be 21,503.
2) For such individuals in other major cities like Chennai, Bangalore, Kolkata, Ahmedabad, Hyderabad and Pune, the premium is at Rs 18,571.
3) For the rest of the India it is Rs 17,593.
Some of the FAQs in SBI Health Insurance Plan
Here are some of the common FAQs about SBI Health Insurance Plan.
1) When pre-existing diseases are covered?
Pre-existing diseases has waiting period of 4 years (48 months).
2) What do you mean by Co-payment? Is there any co-pay in this policy?
Co-payment refers to the amount expected to be paid by the insured for a medical service covered by the plan. This policy has plan based co-pay (between 20-30%) which depends upon the geographical location of the hospitalization. Also, the policy attracts co-pay of 10% in case of hospitalization in the non-network hospital.
3) Does this policy cover homeopathy treatment?
Alternative treatments like Ayurvedic, Homeopathy or Unani, taken in a government-recognized institution is covered under the policy. Ayurvedic treatment is covered maximum up to 15% of sum insured per policy period up to a maximum of Rs. 20,000 and Homeopathy/ Unani Treatment is covered up to the maximum of 10% of sum insured per policy period up to maximum of Rs. 15,000.
4) Do I get some additional benefit on hospitalization due to accident?
In case of hospitalization due to accident, your remaining sum assured will become 125%, subject to maximum of Rs 1 Lakh.
5) How can one check policy status for SBI health insurance?
For registered SBI Health Insurance online users, login to the website with your policy details and check the status.
6) What is the company’s process to settle the claim?
You need to intimate the company on the toll free number or you can send the i-claim on company’s email id. Upon completing all the legal formalities related to documentation, the claim is settled within 30 days.
7) What is the renewal process for the policy?
There are two ways to renew the policy. Log in to the website of the company with your policy details. Select the policy and the mode of payment and proceed to pay. Print or save the cyber receipt of your payment to confirm your renewal. Alternatively, pay via cheque/ debit at the nearest branch for your SBI Health Insurance Renewal.
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8) What are the Add-On covers available with this policy?
On payment of additional premium, the following add-on covers are available with his policy. Any one or both the add-on covers can be opted by the primary insured and is applicable to all the members in the family- (1) Removal of room and ICU rent sub-limits (2) removal of sub-limits on the operation and consultancy charges.
SBI Health Insurance – Should you opt for this plan?
SBI Health Insurance comes with several good features. The premiums are also similar to other health insurance plans. However, co-payment and 4 years waiting period are the major drawback. If you are okay for these drawbacks, you can consider taking this plan. Alternatively you can consider health insurance plans that provide lower waiting period for pre-existing disease and has less terms and conditions. We would be short listing some of such health insurance plans and provide them in coming weeks.
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SBI Health Insurance Plan Review