SBI General Arogya Supreme

Let’s Know The SBI Arogya Supreme Plan Better!

The SBI General Arogya Supreme Plan is a health insurance policy provided by SBI General Insurance Company Limited. It offers various benefits and features and provides financial protection against exorbitant medical costs. There are three options to choose from: Pro, Plus, and Premium.

Are You Eligible?

Minimum Entry Age

• Adults: 18 years
• Dependent Children: 91 days

Maximum Entry Age

• Adults: 65 years
• Dependent Children: 25 years

An Overview Of The Plan’s Benefits & Limits

It covers the costs you incur while being admitted to a hospital for more than 24 hours. This includes the cost of the room, nursing fees, fees for doctors, the cost of prescribed medications and drugs, and other expenses. Additionally, the SBI Arogya Supreme Policy covers these expenses as well -

• Pre & Post Hospitalisation Expenses
  You may incur certain medical expenses before and after you get discharged from the hospital, like doctor consultations, diagnostic tests, and more. The SBI General Arogya Supreme Plan ensures you're covered for these costs for a reasonable amount of time.

?Pre-Hospitalisation Coverage

• • Pro Variant - 30 days
  • Plus Variant - 60 days
  • Premium Variant - 60 days

?Post Hospitalisation Coverage

• • Pro Variant - 60 days
  • Plus Variant - 90 days
  • Premium Variant - 180 days

Please remember that the insurer will only pay for these expenses if they are directly related to the medical condition that led to your hospital stay and your claim is approved as part of your inpatient hospital coverage.

• Daycare Treatment Coverage
  These include treatments that used to require prolonged hospital stay in the past, but now they can be completed in just 24 hours, thanks to advances in healthcare technology. With the SBI General Arogya Supreme Plan, 537 daycare procedures are covered up to the sum insured without any limits under all three variants - Pro, Plus, & Premium.

• Domiciliary Treatment Coverage
  Domiciliary treatments are medical treatments for illnesses or injuries that necessitate immediate attention in a hospital but are given at home because the patient is too sick or injured and cannot be moved safely to a hospital or because there are no hospital beds available in the nearby hospital. The SBI General Arogya Supreme Plan covers the costs of domiciliary treatment up to the sum insured specified in your insurance policy under all three variants: Pro, Plus, and Premium.

• Organ Donor Coverage
  The SBI General Arogya Supreme Plan also covers the expenses related to organ donor procedures. It covers the organ donor’s inpatient hospitalisation expenses incurred in the event of an organ transplantation surgery under all 3 variants up to the sum insured you choose under the policy - where you are the organ recipient.

• Modern Treatment Coverage
  The healthcare industry is experiencing rapid transformation thanks to groundbreaking technologies. This led to the development of modern treatments and advanced technological methods to enhance patient care. The SBI General Arogya Supreme Plan is designed to keep up with these changes and covers these modern treatments up to 25% of the sum insured.

• Room Rent Limit
  The room rent limit is the maximum amount that your insurance company will pay for the room you choose while you're in the hospital. If you pick a room that costs less than this limit, you won't have to pay anything extra. But if you choose a room more than your eligibility, a proportionate deduction will apply. So, you'll be responsible for paying a proportionate share of the total bill, not just the difference in room rent.

In the SBI General Arogya Supreme Premium variant, you can choose any room you like - be it a shared room, single room, suite, or any other option available. There are no restrictions on your choice. The SBI General Arogya Supreme Pro and Plus variants come with a room rent limit. You'll need to pay an additional premium if you want to upgrade your room category or the amount (this is available for all sum insured options under the Plus variant, and for a sum insured of Rs 5 lakhs for the Pro variant). You can choose any room except for suites or higher categories if you opt for the add-on.

Here is a table showing the room rent limit applicable under the 3 variants -

• Cumulative Bonus
  Cumulative bonus is a reward given by the insurer for maintaining good health and not making any claims throughout the policy year. The SBI General Arogya Supreme Plan offers a cumulative bonus of 15% of the sum insured under all 3 variants, which can go up to a maximum of 100% of the sum insured. However, if you make any claims, the accumulated bonus will decrease at the same rate it accumulated.

• Sum Insured Refill
  The Sum Insured Refill Benefit is a valuable feature that helps you restore your base sum insured if it runs out in a policy year. This benefit kicks in when you have used up your base sum insured and any cumulative bonus (if any) partially or completely. It is available for subsequent claims during a policy year. It can be used for any kind of illness, whether it's related or unrelated to any previous claim, once in the policy year for a lifetime as long as you renew  your policy on time. Remember that some specific terms and conditions apply to this coverage.
   

Noteworthy Features Under The SBI Arogya Supreme Policy You Should Be Aware Of

• Recovery Benefit
  Recovery benefit is an additional amount you get on top of your basic coverage if you have to stay in the hospital for more than 10 consecutive days. It's meant to help you out financially during a tough time, especially when you’re facing increased medical expenses due to an extended hospitalisation. In the SBI Arogya Supreme Plan, you'll receive a fixed lump sum for each hospitalisation, depending on the specific plan you choose. You have the freedom to use this one-time payment for any expenses you may have, such as medical bills, everyday living costs, or any other needs you may have.
  Here are the associated limits -

1. Pro Variant: Rs 5000/hospitalisation
2. Plus Variant: Rs 10,000/ hospitalisation
3. Premium Variant: Rs 15,000/hospitalisation

Note: These limits are not applicable for domiciliary hospitalisation.

• Enhanced Cumulative Bonus (Super Claim Bonus)
  This is an enhanced version of the cumulative bonus, where you can increase the bonus rate to 25% in Pro variant or 50% in Plus and Premium variants, by opting for the 'Enhanced Cumulative Bonus' add-on. With this add-on, you can receive a maximum of up to 200% of the base sum insured. The Enhanced Cumulative Bonus is invaluable for individuals who focus on staying healthy and want to avoid making claims. It not only rewards you for taking care of your health but also gives you more financial protection for future medical expenses.

• Mental Healthcare/Psychiatric Illness Cover
  This insurance plan understands how important mental health is and makes sure you can get treatment for different mental health disorders. This coverage has become more important due to increased awareness of mental health issues and the associated costs of mental healthcare. With SBI General Arogya Supreme, the expenses related to mental health will be covered up to sum insured under all three variants. However, a sub-limit of either 10% of the base sum insured or Rs. 50,000, whichever is less may be applicable for a few listed conditions.  Please note that this coverage is subject to some limitations.

Understanding Waiting Periods

After purchasing health insurance, certain illnesses and diseases may not be covered for a specific period of time. This timeframe is known as the waiting period. Once this waiting period is over, you can start making claims for these conditions.

Here are some of the types of waiting periods:

• Initial Waiting Period
  Once you've purchased the policy, there's a 30-day waiting period before you can make a claim for any medical condition, except for accidents. During these 30 days, you won't be able to make a claim for any treatment unless it's due to an accident.
• Waiting Period For Pre-Existing Diseases
  A pre-existing disease refers to any illness or medical conditions you have had in the 48 months before you applied for health insurance. Under the SBI General Arogya Supreme Plan, there's a waiting period of 48 months for pre-existing conditions. During this period, the policy won't cover any expenses related to these conditions.
• Waiting Period For Specific Diseases
  Insurance companies may impose a waiting period for specific diseases or medical conditions even if you haven't had them in the past. This waiting period is decided by the insurer and isn't determined by your current health. Under the SBI General Arogya Supreme Plan, there's a waiting period of 24 months for specific diseases.

What Is Not Covered Under The Plan?

Exclusions are situations or conditions that your health insurance policy does not cover. Here are some types of exclusions:

1. Standard Permanent Exclusions
   It's crucial for you to know that the IRDAI has put in place a set of 'standard permanent exclusions' that all insurance companies must adhere to. Some of them include -

• Obesity/weight control: Treatments or surgeries for weight control or obesity.
• Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities like mountaineering, surfing, paragliding, etc. as a professional.
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
• Investigation and evaluation:  Hospital admissions for observation or monitoring purposes.
• Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, without any active treatment.
• Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
• Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
• Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
• Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that haven’t been prescribed by a medical practitioner.
• Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
• Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
• Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, and more.
• Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
• Expenses related to birth control, sterility, and infertility: Some treatments like contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.

2. Additional Permanent Exclusions
   In addition to the standard permanent exclusions listed earlier, insurance companies may also add specific exclusions to your policy for certain situations or medical conditions. If you have certain diseases or severe medical conditions that insurers consider high-risk to cover, they may choose to permanently exclude them from your policy. In India, insurers are allowed to apply permanent exclusions only to a specified list of illnesses provided by the IRDAI. They cannot exclude any illness beyond this list.
3. Non-Standard Exclusions (Specific Exclusions)
   The SBI Arogya Supreme Plan applies specific exclusions apart from the standard exclusions defined by the IRDAI. It's important to know that these exclusions can vary between insurance companies and depend on the terms and conditions of the policy.
   Here are some of the specific exclusions under the SBI General Arogya Supreme Plan:

• Injuries incurred in war, invasion or act by foreign enemies, hostilities, civil war, rebellion, or similar situations.
• Injuries incurred in attacks involving nuclear, chemical, or biological weapons.
• Expenses related to convalescence, general debility, ‘run-down’ condition, rest cure, external congenital anomaly.
• Expenses related to vaccination or inoculation, unless it's for treating an animal bite.
• Expenses related to dental treatment or surgery, unless it requires inpatient hospitalisation.
• Expenses related to treating an insured individual who engages in illegal activities with criminal intent, deliberately inflicts harm upon themselves, or tries to take their own life while in a sound or unsound mental state.

A Quick Recap Of The Benefits & Limits

The OG Reading Material for Your Reference

• Brochure: https://content.sbigeneral.in/uploads/b4b5b31d3fe946df94b712dc09240954.pdf
   
• Policy Wording: https://content.sbigeneral.in/uploads/bdda4fb66b80463fa1434aa12673c7ff.pdf

FAQs

1. What is the maximum coverage available under the Arogya Supreme Plan?
   The Arogya Supreme Plan provides you with a health cover of up to ₹50 Lakhs.
    
2. Does the Arogya Supreme Plan cover expenses for outpatient treatment (OPD)?
   Only the outpatient costs associated with dental and ophthalmic treatments are covered.
    
3. Are AYUSH treatments covered by the Arogya Supreme Plan?
   Yes, the Arogya Supreme Plan provides coverage for AYUSH treatments like Ayurveda Unani, Siddha, and homoeopathy up to the sum insured.
    
4. Does Arogya Supreme provide coverage for expenses associated with genetic disorders?
   Certainly! Arogya Supreme provides coverage for expenses related to genetic disorders or illnesses up to Rs 1 Lakh.
    
5. What are the policy tenure options available under Arogya Supreme?
   Under the Arogya Supreme plan, you have the flexibility to choose policy tenures between 1, 2, and 3 years.