SBI General Health Insurance – What’s covered and what’s not?

Coverage

Limit of Coverage

Medical Expenses including room rent, board and nursing expenses, and service charges.

Not more than 1 per cent of the Sum Assured per day

Medical Handling Expenses in the I.C.U. (Intensive Care Unit)

Up to two per cent of the Sum Assured per day

All acceptable claims as specified above during the term of the policy.

Not more than 25 per cent of the Sum Assured per injury or illness per claim

Fees of the Specialists and Consultants

Not more that 40 per cent of the Sum Insured per injury or illness per claim.

Surgical Appliances , Blood, Anesthesia, OT Charges, Oxygen, etc.

Equal to or more than 40 per cent of the Sum Insured per injury or illness per claim.

Pre-Hospitalization Expenses

Up to ten per cent of qualified hospitalization expenses incurred 30 days before the date of hospitalization.

Post-hospitalization Expenses

Up to ten per cent of the qualified hospitalization expenditures incurred 60 days post the discharge date from hospital.

Ambulance Expenses

1 per cent of the Sum Insured subject to a maximum of Rs. 1,500.

Free Healthcare checkup

1 per cent of the Sum Insured subject to a maximum of Rs. 2,500 against 4 claim free years.

Parental Care Expenses: nursing charges of the attendant for taking care of your parents; if over the age of 60 years.

Available to parents over the age of 60 years. Attendant’s nursing charge post discharge from hospital equal to Rs. 500 or expenses actually incurred (whichever is lower) per day for a maximum of 10 days after every hospitalization. These charges are repayable for a term not more than a total of 15 days while the entire term of the policy.

Child Care Expenses: escort charges of the attendant for taking care of the children below the age of 10 years.

Available the children below the age of 10 years. Attendant’s escort charge equal to Rs. 500 per each complete day of the hospitalization up to max 30 days in the entire term of the policy.

Treatment Expenses for Cataract

15 per cent of the Sum Assured up to a maximum of Rs. 25,000 for each eye; subject to the first 2 years’ exclusion.

Hospitalization Expenses in case of an accident

In case of hospitalization due to accident, the limit of sum assured under the scheme shall be increased by 25 per cent of the remaining available sum insured. However, the same shall be subject to a maximum of Rs.1 Lakh and payable once per person under a policy.

Alternative Treatment Expenses (only in case of treatment taken from an Ayurvedic hospital matching the hospital’s definition as mentioned in the policy and registered with a local government body)

Reimbursement against the expenses incurred on Ayurvedic Treatment subject to a max of 15 per cent of the Sum Assured per term of the policy and subject to Rs. 20,000 at the max.

The same shall be 10 per cent of the Sum Assured in case of Unani and Homeopathic treatment and a max of Rs. 15,000 per term of the policy.

Domiciliary Hospitalization Expenses

Customary and Reasonable expenses incurred on Domiciliary Hospitalization as specified in the policy document up to 20 per cent of Sum Assured or Rs.20000; whichever is less.

Convalescence Benefit (available to the policyholder over the age of 10 years and below the age of 60 years).

Convalescence expenses are covered up to a maximum of Rs. 5,000 per person in case of hospitalization due to an illness or bodily injury that is covered as per the policy, for 10 or more successive days. However, the same can be availed only once through the term of insurance.

Co-Payment against all the eligible claims in the non-empanelled hospitals

10 per cent against every eligible claim.

Cashless Treatment Facility

Across all the hospitals listed under SBI General's Hospital Network

Coverage against selected Day Surgeries that require not more than 24 hours of hospitalization.

Selected Day Surgeries or Procedures that require a maximum of 24 hours of hospitalization, such as Chemotherapy, Dialysis, Radio therapy, Dental Surgery (accidental), Tonsillectomy, Eye Surgery, etc. shall be covered.