SBI General Arogya Plus Plan

Let’s Get To Know The Plan Better

The SBI General Arogya Plus Plan is a health insurance policy from SBI General Insurance Company Limited. This health insurance plan is crafted to offer financial aid during tough times. It comes with a variety of benefits and discounts tailored to enhance your experience and maximise your savings. So, you can rest easy knowing your loved ones are safeguarded, no matter what health challenges come your way.
 

Who Is Eligible To Buy The SBI General Arogya Plus Plan?

• Minimum Age To Join:

  • For Adults: They can join from 18 years.
  • For Dependent Children: They can join as young as 3 months.
• Maximum Age To Join: 65 years.
   

Benefits And Limits Of The SBI General Arogya Plus Plan

In addition to covering inpatient expenses for when you are staying in the hospital for more than 24 hours, like room charges, nursing fees, doctor's fees, medication costs, ICU fees, and other related expenses, let's take a quick look at some other expenses covered by the SBI General Arogya Plus Plan.

• Pre & Post Hospitalisation Expenses
  Before and after your hospital stay, the SBI General Arogya Plus Plan takes care of expenses like lab tests, doctor consultations, medications, etc. This coverage includes costs for 60 days before admission and 90 days after discharge, up to the cover amount. However, remember these expenses are only covered if they are related to the medical condition for which you are hospitalised, and they must be approved as part of your inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  The SBI General Arogya Plus Plan covers daycare treatments, which are medical procedures or surgeries that used to need a long hospital stay but can now be done in less than 24 hours because of the advancements in medical technology. There are 141 such procedures covered by the SBI General Arogya Plus Plan, and all expenses for these treatments will be covered up to the cover amount.
   
• Domiciliary treatment coverage
  The SBI General Arogya Plus Plan covers domiciliary treatments, which are medical treatments given at home for illnesses or injuries that usually need hospital care. This could be because the patient is too sick or injured to go to the hospital safely, or there aren't any hospital beds nearby. The plan covers expenses for these treatments, including pre- and post-hospitalization costs, up to the sum insured.
   
• Modern Treatment Coverage
  The SBI General Arogya Plus Plan keeps up with the latest healthcare breakthroughs. It covers the costs of modern treatments, which were once thought impossible. As technology advances, so does medicine, and this plan ensures you have access to these new treatments. It covers up to 50% of the sum insured for these modern treatments.
   
• Room Rent Limit
  This is the highest amount your insurance will pay for the room during your hospital stay. If you choose a room within this limit, you will not have any extra costs. But if you pick a pricier room, you will need to pay a share of the bill, not just the difference. With the SBI General Arogya Plus Plan, you have the freedom to select any room – shared, single, deluxe, or any available room. There are no restrictions on room rent, so you can focus better on your health without worrying about room expenses.
   

Other Significant Features Of The SBI General Arogya Plus Plan

• Maternity Benefit
  The SBI General Arogya Plus Plan provides financial support for the arrival of a new family member. It helps expecting mothers and their families enjoy this special time without worrying much about finances. Pregnancy-related expenses are covered up to a certain limit, but remember, this coverage is only available for outpatient department (OPD) costs.

• OPD Treatment And Teleconsultation
  With the SBI General Arogya Plus Plan, you will be covered for medical care without needing to stay in the hospital. This includes consultations outside of the hospital, whether at a clinic or hospital or through teleconsultation from home. The plan pays for these consultations up to a certain limit, so you can deal with minor health concerns quickly and efficiently.
   
• Mental Illness Cover
  You should know that your mental health is as vital as your physical health for a happy life. This is why the SBI General Arogya Plus Plan includes coverage for certain mental disorders like bipolar disorder, panic disorder, and personality disorder. It covers expenses for these conditions up to Rs. 50,000. Plus, it also takes care of pre- and post-hospitalization costs within the overall limit.
   

Understanding Waiting Periods

When you get a health insurance policy, there is a specific time when certain illnesses and diseases are not covered called the waiting period. After this time passes, you can claim for these conditions. There are different types of waiting periods, including –

• Initial Waiting Period
  When you first get health insurance, there is an initial waiting period of 30 days for all medical conditions except accidents. This means you cannot claim hospitalisation in the initial 30 days of your plan unless it is due to an accident.
   
• Waiting Period For Pre-Existing Disease
  Any health condition you have had in the 36 months before getting the insurance is called a pre-existing disease. With the SBI General Arogya Plus Plan, there is a 48-month waiting period for pre-existing diseases. During this time, the policy will not cover expenses related to these conditions.
   
• Waiting Period For Specific Diseases
  Insurance providers have a list of medical conditions with a waiting period, separate from pre-existing ones. This waiting period is decided by the insurance company and is not based on your current health conditions. With the SBI General Arogya Plus Plan, there is a waiting period of 12 months for specific diseases. For a few listed conditions like hypertension, diabetes, heart disease, and related complications, the waiting period is 3 months.
   

What Is Excluded Under The SBI General Arogya Plus Plan?

Exclusions are situations not covered by your health insurance policy, and these include –

• Standard Permanent Exclusions: The IRDAI has set rules called 'standard permanent exclusions'. All insurance companies must follow these rules. Some of these exclusions are –
  • Hospitalisation For Observation: Being admitted to the hospital for monitoring purposes only.
  • Bed Rest And No Active Treatment: Staying in a hospital facility for rest without any active medical care.
  • Weight Control And Obesity Treatment: Surgery or treatment that is intended for weight loss or obesity.
  • Gender Change Treatment: Procedures to alter physical characteristics to those of the opposite sex.
  • Cosmetic Surgery: Cosmetic surgeries to change appearance or body features.
  • Hazardous Or Adventure Sports: Treatment costs while engaging in risky activities like mountaineering, river rafting, scuba diving, etc., professionally.
  • Breach Of Law: Expenses related to treating someone involved in illegal activities.
  • Treatment From Excluded Providers: Medical care from practitioners or hospitals not covered by the insurance.
  • Narcotics Treatment: Medical expenses for addiction to substances like alcohol, drugs, etc.
  • Domestic Establishment Treatments: Medical care in health spas or similar places meant for personal use.
  • Non-Prescribed Dietary Supplements: Buying vitamins, minerals, or other supplements/substances without a doctor's prescription.
  • Refractive Error Correction: Treatment for improving eyesight up to 7.5 diopters.
  • Unproven Treatments: Medical procedures or surgeries not proven to be effective.
  • Birth Control And Infertility Treatment: Contraception, artificial insemination, sterilisation, or infertility treatments like IVF, GIFT, ZIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Costs related to pregnancy, childbirth, and post-natal care.
     
• Additional Permanent Exclusions: Some medical conditions might not be covered by your health insurance policy permanently. Insurance companies can add more exclusions for specific situations or diseases they think are too risky. If you have a serious medical condition or illness, they might decide not to cover it forever. But, they can only exclude illnesses approved by the IRDAI from coverage.
   
• Non-Standard Exclusions (Specific Exclusions): Non-standard exclusions, also known as specific exclusions, are additional exclusions beyond the usual permanent exclusions outlined by the IRDAI. Such exclusions can differ among insurance companies and might be based on the terms and conditions of the policy. Let's take a look at some of the specific exclusions found in the SBI General Arogya Plus Plan –
  • Circumcision, unless it is necessary to treat a disease, illness, or injury not excluded here, or if it is required due to an accident.
  • The cost of items like spectacles, contact lenses, hearing aids, crutches, wheelchairs, artificial limbs, dentures, artificial teeth, or other external appliances or devices.
  • Any injury or disease that is directly or indirectly a result of or contributed to by nuclear weapons or materials.
  • Medical equipment used at home after hospitalisation, including instruments for conditions like sleep apnea syndrome, peritoneal dialysis, or bronchial asthmatic conditions.
  • Dental treatment or surgery, unless it is required due to accidental bodily injury to natural teeth requiring hospitalisation treatment.
  • Conditions like convalescence, general debility, a "run-down" state, rest cure, or external congenital anomalies.
  • Intentional self-injury, including the use or misuse of drugs or alcohol.
  • Venereal diseases or sexually transmitted illnesses, except for HIV/AIDS, as mentioned under the scope of cover.
  • Vaccinations or inoculations, except as part of post-bite treatment for animal bites.
  • Hospitalisation for organ donation, including complications arising from the donation.
     

Summary Of The SBI General Arogya Plus Plan

Learn More About The SBI General Arogya Plus Plan With Brochure And Policy Wording Links

• Brochure:
  https://content.sbigeneral.in/uploads/164ebae794c745cf8d4ed328ef234857.pdf

• Policy Wording:
  https://content.sbigeneral.in/uploads/4f0d729aad424a8699f0525e74e01b02.pdf

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