SBI GI
Health Insurance Plans
Comprehensive Health Insurance Plans

Arogya Plus Policy

This is a comprehensive health insurance product that provides financial protection against rising OPD and hospitalization expenses. This allows the policyholder to completely focus on the treatment.

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Wordings
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Key Feature

No medical check-up up to 55 years if you don't have any medical history
Multiple coverages: Individual, Family Floater
141 Day Care expenses covered
Comprehensive coverage: Pre and Post-Hospitalization
Multiple Sum Insured options: INR 1, 2, & 3 Lakhs
IT Exemption: Under Sec 80 D
Outpatient Treatment Covered PD

Coverage

This Health Insurance policy covers the following subject to the terms and conditions:

Your hospital room rent, boarding expenses and doctor fees
Operation Theatre and Intensive Care charges
Nursing expenses
Medicines that you consume during the hospital stay
Pre and Post hospitalization expenses up to 60 and 90 days respectively
Alternative treatment taken in accredited or recognized hospitals
Domiciliary hospitalization.
Outpatient Treatment


Exclusion

Pre existing diseases from inception of the policy up to 4 years of this Policy being in force continuously.
Treatment of illnesses such as Ulcers, Tonsillectomy, Hernia, Cataract, Sinusitis, Gall Bladder Stones, Chronic Renal Failure during the first year of operation of the policy.
Treatment taken outside India
Stay in a hospital without undertaking any active regular treatment by the medical practitioner
Experimental and unproven treatment.
Important Note: The above list of exclusions is illustrative and not exhaustive. For a full list of the exclusions , please refer to policy wordings.

Sum Insured

Age: Minimum entry age is 3 months and maximum entry age is 65 years. There is no exit age.

Insured: Individual/ Family (For Family Insurance Policy - Family means the spouse, dependent children, parents and parents in law. For Family Floater Insurance Policy - Family means the spouse and dependent children)

Policy Term:1, 2 and 3 years.

Sum Insured: Hospitalization sum insured options are 1, 2 and 3 Lakhs. OPD sum insured will depend on the age, premium and family type. Sum Insured of dependents will either be less than or equal to Proposer/ Primary Insured's Sum Insured.

Premium: The premium for this product is flat Rs. 8,900, Rs. 13,350 or Rs. 17,800 per annum respectively for a sum Insured of 1, 2 or 3 lakhs.

Product Features

Day Care Treatments

Insurer shall pay for day care expenses

insurer shall pay for day care expenses incurred on technological surgeries and procedures requiring less than 24 hours of hospitalisation up to the sum insured.

Post-Hospitalization

90 days for each

the maximum amount that insurer will reimburse under this head is limited to 90 days for each of the admitted hospitalisation

Pre-Hospitalization

60 days for each

the maximum amount that insurer will reimburse under this head is limited to 60 days for each of the admitted hospitalisation

Ambulance Charge

insurer will reimburse actual ambulance expenses

insurer will reimburse actual ambulance expenses or INR 1500 whichever is lower for per valid hospitalization claim for transferring insured to or between Hospitals in the Hospital’s ambulance or in an ambulance provided by any ambulance service provider.

Alternate Treatment

Insurer will reimburse expenses

Insurer will reimburse expenses for alternative treatment taken in a government hospital or in any institute recognized by government and/or accredited by quality council of India/national accreditation board on health

Doctor-on-call-Service

Not Covered

Domestic Evacuation

Not Covered

Existing Illness Waiting Period

Not Covered

Health Checkups

Not Covered

Bonus on No Claim

Not Covered

Co-Payment

Not covered

Maternity

Covered

covered but only under OPD section and up to OPD Limit specified in policy schedule.

Domiciliary Hospitalization

Insurer will cover reasonable and customary charges

Insurer will cover reasonable and customary charges towards domiciliary hospitalisation.

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