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Group Health Insurance

Group Health Insurance

Introduction:

Your greatest wealth is your health & everybody has differing levels of control over their own wellbeing. Life follows no fixed pattern and sudden illness or bodily injury can sometimes leave you financially hurt and highly stressed. SBI General's Group Health Insurance Policy helps you to be in control by protecting and making medical treatment expenses more manageable thus ensuring quality health care for you and your family.

Key Features

This policy covers the following benefits:

  • Room, Board & Nursing Charges 1% of sum insured max Rs.1500/- per day for Normal Room & of sum insured max Rs.2500/- per day for ICU.
  • Medical Practitioner and Specialists Fees.
  • Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, prosthesis/internal implants and any medical expenses incurred which is integral part of the operation.
  • Pre-hospitalisation Expenses - Insurer shall pay for expenses incurred 30 days prior to the date of admission into the hospital.
  • Post-hospitalisation Expenses - Insurer shall pay for expenses incurred 60 days after the date of discharge from the hospital.
  • Day Care Expenses - Insurer shall pay for Day Care expenses incurred on advanced technological surgeries and procedures requiring less than 24 hours of hospitalisation as per the attached list and subject to the condition that prior approval is obtained by the Insured Person/Insured from the Administrator/Insurer for such a Day Care Procedure/Expense.
  • Domiciliary Hospitalisation- Insurer will cover Reasonable and Customary Expenses towards Domiciliary Hospitalisation as defined in definition subject to 20% of the Basic Sum Insured or a maximum of up to Rs.20000, whichever is lesser.

Additional Coverages

We will pay charges associated with the following additional covers subject to additional premium paid by Insured to us and conditions as applicable:

  • Ambulance charges, Maternity Cover with Nine months waiting period and without 9 months waiting period.
  • Infant Covered from day one, Family Floater Cover.
  • Pre-existing Disease coverage from Day One.
  • Waiver for waiting period for first 30 Days & and specific diseases for First year.
  • Coverage for Ayurvedic, Homeopthic and Unani medicine.
  • The above are some of the add on covers and for the full covers available please contact our nearest office.

Premium & Eligibility

Premium:

  • The rate of premium shall depend upon the Age, Gender, Sum Insured and Location.

Age & Sum Insured Eligibility:

  • Minimum Entry Age: 3 months old.
  • Minimum Sum Insured: Rs.50,000/-
  • Maximum Sum Insured: Rs. 750,000/-

Exclusions

The Company will not be liable under the Policy in respect of payment towards treatment taken due to:

  • Any condition, ailment or injury or related condition(s) for which you have been diagnosed, received medical treatment, had signs and / or symptoms, prior to inception of your first policy, until 48 consecutive months have elapsed, after the date of inception of the first policy with us.
  • Any disease/ailment contracted during the first 30 days of commencement of the policy and charges for admission, discharge, administration, registration, documentation and filing, service expenses/surcharges.
  • Non-allopathic treatment, Treatment arising from or traceable to pregnancy childbirth, miscarriage, abortion or complications of any of this, including caesarian section. However, this exclusion will not apply to abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and certification by Gynaecologist that it is life threatening.
  • Congenital diseases, All expenses related to AIDS and related diseases. Ailments / Complications arising out of use/abuse of intoxicating drugs or alcohol.
  • For more details & full list of exclusions, please refer to the policy document.
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