SBI General Health Edge Insurance Plan

SBI General Health Edge is a health insurance plan sold by SBI General Insurance Company Limited. The plan encompasses comprehensive coverage along with a wide variety of benefits, features, and add-ons to match your healthcare needs - so you can focus on getting better rather than worrying about the medical costs.

Are You Eligible?

?Minimum Entry Age

• Adults: 18 years        
• Dependent Children: 91 days

?Maximum Entry Age

• Adults: 65 years        
• Dependent Children: 30 years

An Overview Of The Plan’s Benefits & Limits

The SBI General Health Edge Plan covers the inpatient hospitalisation expenses you incur when you are admitted to the hospital for more than 24 hours. This includes room costs, nursing care, doctor's fees, prescribed medications, ICU services, and other related costs.
Here are some of the other expenses covered under the SBI General Health Edge Plan -

• Pre & Post-Hospitalisation Expenses
  You may have to undergo certain medical procedures before and after you are hospitalised, like doctor consultations, diagnostic tests, check-ups, physiotherapy, and more. The SBI General Health Edge Plan covers pre-hospitalisation expenses for up to 30 days before you are hospitalised and post-hospitalisation expenses for up to 60 days after you are discharged - up to the sum insured. It’s important to note that the plan will cover these costs only if they’re related to the health condition for which you’re hospitalised and are approved under inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Certain healthcare treatments, in the past, used to require extended hospital stays but can now be done within 24 hours, thanks to progress in medical technology. They are known as daycare treatments. The SBI General Health Edge Plan covers all daycare treatments up to the sum insured.
   
• Modern Treatment Coverage
  The arena of healthcare is seeing rapid transformations, and we can see new types of treatments mushrooming, which were thought to be impossible in the past. These modern treatments have paved the way to better and more effective healthcare for conditions that were considered incurable. The SBI General Health Edge Plan keeps up with such advancements by covering modern treatments up to the sum insured.
   
• Non-Medical Expenses Coverage
  When you are hospitalised, you also incur some non-medical expenses for the consumables that are used during the treatment. These include equipment like masks, gloves, syringes, cotton swabs, gauze, and more, which can quickly add up over the course of your hospital stay and ultimately get heavy on the pocket. The SBI General Health Edge Plan provides a sense of relief by covering these non-medical costs up to the sum insured, if you opt for an add-on.
   
• No Claim Bonus
  A No Claim Bonus is a reward you get from the insurance company for maintaining good health and not making claims under your plan. It is given when you renew your policy. The SBI General Health Edge Plan gives you a No Claim Bonus of 50% of the sum insured, which can accumulate up to a maximum of 200% of the sum insured, for every claim-free year. But, if you make a claim, the bonus will reduce at the same rate at which it accrued.
   
• Restoration Benefit
  The Restoration Benefit is a pretty useful feature. It restores or replenishes your sum insured once it has been used up during a policy year so that you can enjoy uninterrupted coverage. The SBI General Health Edge Plan offers 100% restoration of the sum insured under this benefit.
  Under the plan, the restoration benefit -
• 1. Kicks in when the base sum insured and any applicable no-claim bonus are partially or completely utilised.
  2. Comes into effect from the first paid claim during a policy year.
  3. Can be utilised unlimited times in a policy year.
  4. Can be used for both related and unrelated illnesses.
      
• Room Rent Limit
  The room rent limit is the maximum amount of money that your insurance company will pay for the hospital room you are admitted to. If you choose a room that falls within this limit, you won’t have to worry about out-of-pocket costs. However, if you pick a room beyond the limit stated in your health insurance plan, you will be liable to pay a proportionate share of the total bill you’ve incurred and not just the difference in the room rents. The good news is that the SBI General Health Edge Plan imposes no such limits, so you are free to pick a room of your choice and comfort!
   

Other Cool Features Of The SBI General Health Edge Plan!

• Vector Borne Fixed Benefit
  The SBI General Health Edge Plan comes with a really useful feature called the ‘Vector Borne Fixed Benefit’. It covers expenses associated with illnesses like malaria, dengue, etc., that are spread via vectors, such as flies, mosquitoes, and more.
  Some conditions you should be aware of -
  1. The benefit will provide a lump sum of Rs 50,000 or Rs 1 lakh, depending on the option you choose.
  2. A continuous hospitalisation of 48 hours is needed for the treatment of a vector-borne disease.

Note: There are more T&Cs associated with this benefit.
 

• Domestic Help/Staff Indemnity
  This feature offers coverage for people who work as domestic helpers or staff, whom you have hired for household chores and work, like driving, cleaning, and more, to make sure they have healthcare coverage during a medical emergency. This cover functions independently, and you have the option to choose between two sum insured options - Rs 50,000 or Rs 1,00,000.
   
• OPD Cover
  The SBI General Health Edge Plan also provides an add-on that offers coverage for various outpatient procedures like vaccinations, medication, consultations, small treatments administered out of the hospital, and more. This benefit offers coverage up to Rs 5000 per insured person and gives you the peace of mind of not fretting about outpatient medical expenses.
   

Understanding Waiting Periods

Did you know your complete health insurance coverage doesn’t begin from day one? Well, yes, it’s true!

Once you buy a health insurance plan, some illnesses or treatments will not be covered for a specified time span, known as a ‘waiting period’. You can make a claim for these conditions/procedures once you serve the entire waiting period.

Here are some types of waiting periods -

• Initial Waiting Period
  After purchasing health insurance, the insurer will impose a 30-day waiting period for all medical conditions and treatments, with the exception of accidents. So, during this time span, you will not be able to make a claim for any treatment, unless it is associated with an accident.

• Waiting Period For Pre-Existing Diseases
  A pre-existing disease is a medical condition that you have had in the 48 months before purchasing health insurance. The SBI General Health Edge Plan comes with a waiting period of 24 months for pre-existing diseases. The policy will not cover any expenses related to the condition during this time span.

• Waiting Period For Specific Diseases
  Insurers can also levy a waiting period for specific diseases and treatments even if you don’t have a history of them. This type of waiting period is based on the insurer’s discretion and not your present-day health status. The SBI General Health Edge Plan comes with a waiting period of 24 months for specific diseases.

What Is Not Covered Under The SBI General Health Edge Plan?

Exclusions are situations or conditions that your health insurance policy will not cover. Here are some of the types of exclusions you should be aware of:

1. Standard Permanent Exclusions
   The IRDAI has laid down some ‘standard permanent exclusions’ that all insurance companies must adhere to. Some of them include -

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

2. Additional Permanent Exclusions
   Along with the abovementioned standard permanent exclusions, insurers may impose additional exclusions under your health insurance plan. If you have a certain illness or severe health condition and the insurer finds your profile risky to cover, they may choose to exclude these conditions from the coverage permanently. However, in India, insurers are required to abide by a specific list of permanent exclusions laid down by the IRDAI. They cannot exclude anything beyond this list.
    
3. Non-Standard Exclusions (Specific Exclusions)
   The SBI General Health Edge Plan also levies specific exclusions, beyond the standard permanent exclusions fixed by the IRDAI. These exclusions can vary across insurance providers and are based on the plan’s T&Cs.
   Let’s have a look at the various specific exclusions under the SBI General Health Edge Plan -

• War, invasion, mutiny, seizure, restraints and similar situations.
• Any nuclear/biological/chemical attack or weapons and associated causes or events that result in a loss, claim, or expense.
• The procedure of circumcision, unless required for the treatment of an illness/injury or because of an accident.
• Convalescent conditions, rest cure, general debility, run-down conditions, and external congenital anomalies.
• Any sort of vaccination/inoculation (unless as a part of a post-bite medical procedure for an animal’s bite).
• Costs associated with domiciliary treatments.
• Breach of law with criminal intentions (committed or attempted), deliberate self-injury, or attempted suicide in either a sound or unsound state of mind.
   

A Quick Recap Of The Benefits & Limits

The OG Reading Material for Your Reference

• • Brochure: https://content.sbigeneral.in/uploads/282171a1c5be48c79563312886aba812.pdf
     
• • Policy Wording: https://content.sbigeneral.in/uploads/c884e2e2d9674c8da60f17c9422000f0.pdf
     

FAQs

1. What is the maximum coverage available under the SBI General Health Edge Plan?
   The SBI General Health Edge Protect & Advantage Plan offers health insurance coverage up to Rs 25 Lakhs.
    
2. Does SBI General Health Edge offer a critical illness add-on cover?
   Yes, the SBI General Health Edge Plan offers a critical illness add-on cover.
    
3. Does the SBI General Health Edge Plan cover OPD expenses?
   Absolutely! Costs related to outpatient department procedures are covered by the Health Edge Plan if you go for an add-on.
    
4. Are AYUSH treatments covered by SBI General Health Edge?
   Yes! The SBI General Health Edge Plan offers coverage for AYUSH treatments, such as Ayurveda, Naturopathy, Unani, Siddha, Homeopathy, etc, up to the sum insured you pick.
    
5. Are consumables covered by SBI General Health Edge?
   Yes, the SBI General Health Edge Plan covers costs associated with consumables like syringes, masks, gauze, gloves, etc., if you opt for an add-on.