About SBI General Insurance Company
SBI General Insurance, a rapidly growing private insurer backed by the trusted legacy of the State Bank of India, has established itself as a reliable name in the general insurance industry. Since its inception in 2009, the company has expanded significantly, growing from 17 branches in 2011 to over 146 branches nationwide. In FY 2023-24, SBI General recorded remarkable growth, achieving a 17% rise in Gross Written Premium (GWP) to INR 12,731 crores.
With a workforce exceeding 8,000 employees and a robust multi-channel distribution model—including Bancassurance, Agency, Broking, Retail Direct, and Digital partnerships—SBI General ensures widespread access to its services. Supported by a network of over 22,518 touchpoints, including SBI branches, agents, financial partners, OEMs, and digital collaborators, the company serves urban and rural areas alike. Its diverse portfolio caters to Retail, Corporate, SME, and Rural segments, offering seamless accessibility through both online and offline channels.
Key Features of the SBI General Group Health Insurance Plan
The major benefits of buying an SBI Group Health Insurance policy are listed below:
- The entry age for health insurance coverage is 18 to 65 years.
- Entry age for a child ranges from 3 months to 30 years.
- Sum assured limit from Rs.1 lakhs to Rs.5 lakhs.
- Pre and post-hospitalisation expenses 60 days after and 30 days before hospitalisation.
- Get cashless treatment in network hospitals.
- Coverage of pre-existing diseases after 4 years.
- One year of the waiting period in case of specified diseases.
- Multiple Coverage Options - Individual & Family Floater options for Sum Insured.
- Lifelong renewability.
- Tax saving under sec 80/D.
SBI General Group Health Insurance Plan Inclusions
The insurer shall offer compensation for the following medical expenses:
- Medical practitioner and specialists' fees.
- Ambulance charges up to Rs. 1500 or 1 per cent of the Sum Insured.
- 10% Co-payment up to the admissible claim limit.
- Daycare surgery covers Eye treatment, Dialysis, Tonsillectomy, Chemotherapy, Radiotherapy, etc.
- Domiciliary hospitalisation up to 20% of the sum assured and Rs. 20,000, whichever is less.
- Co-Payment on claims in non-network hospitals 10% on all eligible admissible claims.
- Cashless hospitalisation in the Network Hospitals.
- Selective daycare surgical procedures where less than 24 hours of hospitalisation are required are covered. These include certain specified procedures, such as Tonsillectomy, Dialysis, Radiotherapy, chemotherapy, Dental Surgery (accidental cases), and Eye Surgery.
- Room boarding and nursing charges, including ICU Charges, will be covered at 2 per cent per day and 1 per cent per day for non-ICU charges. The policyholder will bear all incremental expenses related to room rent, doctor's fees, and other incidental expenses.
- Pre-hospitalisation expenses are limited to 30 days before the date of hospital admission.
- Post-hospitalisation expenses are limited to 60 days after getting discharged from the hospital.
- The cost of anaesthesia, oxygen, blood, Operation Theatre charges, Medicines and Drugs, Surgical Appliances, Diagnostic Materials, Physiotherapy, Dialysis, and X-ray is covered. It also covers charges incurred for Radiotherapy, Chemotherapy, the Cost of a Pacemaker, Internal Implants/Prosthesis, and any integral expenses incurred during the operation.
All the coverage benefits are subjected to sub-limits as mentioned in the SBI Group Health Insurance policy contract.
Exclusions of SBI Group Health Insurance Plan
In any case, the insurer shall not compensate claims arising due to the following reasons:
- Any disease that is diagnosed during the first 30 days of the policy purchase date.
- One year of the mandatory waiting period or certain specified diseases like hernia else treatment expenses will not be compensated.
- Pregnancy treatment or complications like abortion, miscarriage, childbirth, or any prenatal and postnatal treatment.
- Any alternative treatment like naturopathy, aromatherapy, acupuncture, homoeopathic, Ayurveda, reflexology, and
- Any type of congenital disease that is diagnosed during or before the policy period.
- AIDS/HIV and other sexually transmitted diseases.
- Self-inflicted injuries and conditions of depression and mental disorders.
- Health treatment for drug intoxication and an overdose of alcohol consumption.
SBI Group Health Insurance Claim Procedure
The procedure to lodge a claim with SBI Health Insurance Company is quite simple. You can file both cashless and reimbursement claims. The process is listed below:
SBI Group Health Insurance Reimbursement Claims
- The policyholder shall follow the treatment recommended by the doctor without any delays.
- In the case of post-hospitalisation claims, the claim should be filed within 15 days of completion of the post-hospitalisation treatment. This is subjected to a maximum of 75 days of getting discharged from the non-network hospital.
- The policyholder must undergo a medical examination as the SBI Health Insurance Company requires. The insurance provider shall bear the cost of the medical tests (subject to terms and conditions).
- The policyholder shall submit all the medical receipts, bills, pieces of evidence, certificates, and information from the attending hospital/medical practitioner / diagnostic laboratory as required by the SBI health insurance company.
- When the insurance provider receives intimation from the policyholder regarding a claim under the policy, it is allowed to examine and gather information about a disease or injury requiring hospitalisation of the policyholder.
SBI Group Health Insurance Cashless Claim
Follow the steps below to file SBI General Group Health Insurance claim:
- Access the cashless treatment facility at the nearest SBI General Network hospital. Provide your SBI General health card at the hospital's insurance desk.
- The hospital will verify your identity and submit a completed pre-authorisation form and the necessary documents to SBI General Insurance.
- Once approved, you can proceed with admission and receive cashless treatment per your policy coverage.
- After discharge, the hospital will forward the claim documents to SBI General Insurance for the final settlement of hospitalisation costs
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