SBI General Arogya Supreme (Plus)

SBI General Arogya Supreme (Plus) Plan is a health insurance policy by SBI General Insurance Company Limited. 

The SBI General Arogya Supreme (Plus) Plan provides extensive coverage that goes above and beyond mere hospitalization expenses. From bariatric surgery to treatments for external birth defects after a specified waiting period, it's designed to address diverse medical needs. Plus, there are multiple options available for premium discounts, adding more value to your investment.

However, while this plan offers exceptional benefits, it also comes at a higher price compared to other options in the market. Additionally, it lacks the flexibility of a monthly premium payment option.

What's more, our research has uncovered a concerning trend: the insurer has received a notable number of complaints regarding both claim settlements and policy purchases. This raises questions about their overall service quality and reliability.

What are the benefits offered by the SBI General Arogya Supreme (Plus) Plan?

• Inpatient hospitalisation coverage: The SBI General Arogya Supreme (Plus) plan offers you coverage for expenses associated with inpatient hospitalisation. These expenses include the costs incurred when you are admitted to a hospital for more than 24 hours. This means that the plan covers the expenses of your hospital room, nursing care, consultations, prescription medications, ICU charges, and any other relevant expenses.
• Pre-hospitalisation coverage: Prior to your hospital admission, you may encounter various medical expenses referred to as pre-hospitalization charges. These expenses encompass fees for consultations, laboratory tests, checkups, and medical reports, among other things. It's crucial to note that the insurance company will only cover these expenses if they are directly related to the medical condition that necessitates your hospitalization and if the claim is approved as part of your inpatient hospitalization expenses. With the SBI General Arogya Supreme (Plus) plan, you can rest assured that your pre-hospitalisation expenses will be taken care of for a period of 60 days prior to your hospitalisation, up to the sum insured.
• Post-hospitalisation coverage: Once you are discharged from the hospital, you may come across certain medical costs referred to as post-hospitalisation expenses. These expenses typically include consultation fees, check-up charges, medical test costs, and more. It is important to note that for these expenses to be covered, they must be directly linked to your hospital stay and approved as part of your inpatient hospitalisation coverage. With the SBI General Arogya Supreme (Plus) plan, you can enjoy the benefits of comprehensive coverage for post-hospitalisation expenses up to the sum insured for a period of 90 days following your hospital discharge.
• Daycare treatment coverage: With the SBI General Arogya Supreme (Plus) plan, you can now enjoy comprehensive coverage for 537 daycare treatments without any limit up to the sum insured. As medical procedures or surgeries that used to require an extended hospital stay can now be completed within 24 hours, thanks to advancements in medical technology, the plan ensures you are covered through it all.
• Domiciliary treatment coverage: Domiciliary treatments refer to medical care for illnesses or injuries that necessitate immediate attention in a hospital but are provided at home due to the patient's severe condition, making transportation to a hospital unsafe. This coverage is also applicable if there are no available hospital beds in the patient's vicinity. With the SBI General Arogya Supreme (Plus) plan, you can have peace of mind knowing that all expenses associated with domiciliary treatments (excluding 15 specified illnesses listed in the policy document) are fully covered up to the sum insured. 
• Organ donor coverage: The SBI General Arogya Supreme (Plus) plan offers coverage for organ donor expenses. It takes care of the expenses related to inpatient costs up to the sum insured, when you are the recipient.
• Modern treatment coverage: With the constant advancement of medical technology, you now have access to previously unimaginable innovative treatments. Procedures like stem cell therapy and radio surgeries are specifically designed to treat conditions that were once considered untreatable. The SBI General Arogya Supreme (Plus) plan is tailored to keep up with these developments and covers the expenses associated with these modern treatments up to 25% of the sum insured.
• Non-medical expenses coverage: Non-medical expenses include consumables like gloves, nebulization kits, oxygen masks, and other essential items needed for your treatment. The SBI General Arogya Supreme (Plus) plan does not cover non-medical expenses.
• No Claim Bonus: If you don't make any claims during your policy period, the insurance company will reward you with a No Claim Bonus. With the SBI General Arogya Supreme (Plus) plan, you can accumulate a bonus of 100% of your sum insured. You can get a maximum of 15% bonus every year though there is a reduction in accumulated bonus due to any claims that are made in the previous year.
• Super No Claim Bonus: The Super No Claim Bonus is an enhanced version of the No Claim Bonus that works in a similar way. The SBI General Arogya Supreme (Plus) plan is one of the few plans that does provide this benefit as an add-on. You can have a maximum of 50% annual bonus that can be accumulated to a maximum of 200% provided no claims are made. A reduction in bonus is applicable if claims are made in the previous year. But it is crucial to note that once you choose the Super No Claim Bonus benefit, you cannot opt out of it during subsequent renewals
• Restoration Benefit: The restoration benefit is designed to restore your sum insured after you exhaust it within a policy year. When you choose the SBI General Arogya Supreme (Plus) plan, you can take advantage of this benefit for both related and unrelated illnesses. This helpful feature kicks in when both your sum insured and no claim bonus have been partially utilised. You can use this benefit once in a policy year, starting from the first paid claim.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

SBI General Arogya Supreme (Plus): Financial Limits

• Room rent limit: The room rent limit is the maximum amount that your insurance provider will cover for your hospital room expenses. When you choose a room within this limit, you won't have to pay any extra charges. However, if you decide to go for a more expensive room, you will be responsible for a proportionate portion of the total hospital bill, not just the difference in room rent. With the SBI General Arogya Supreme (Plus) plan, you can avail of this benefit as an add-on, once you do you can select any room type except for the suite.
• ICU rent limit: In the SBI General Arogya Supreme (Plus) plan, you won't have to worry about any limits on your ICU rent. This means that your plan will cover the full cost of your stay in the intensive care unit at the hospital, up to the maximum amount insured.
• Copayment: In the SBI General Arogya Supreme (Plus) plan, you have copayments with 10%/20% as an option. A copayment is usually a portion of the approved claim amount that you would be responsible for paying out of pocket. But with this plan, once you make your payment, the insurer will cover the remaining expenses without any additional cost to you.
• Deductible: A deductible is an amount that you must pay out of your own pocket before your insurance coverage comes into effect to cover the remaining costs. With the SBI General Arogya Supreme (Plus) plan there are options of 10K and 25K as deductibles.
• Limits on surgeries/treatments: When it comes to your health insurance policy, it's important to understand the limits on surgeries and treatments. These limits refer to the maximum amount that your policy will cover for specific medical procedures or treatments. Some plans have predetermined limits on the amount they'll cover for certain procedures, while others do not. With the SBI General Arogya Supreme (Plus) plan, you can rest assured knowing that joint replacement surgeries are covered up to the sum insured. Cataract surgeries have a cap of up to 1 Lakh per eye per policy year.

Please note that the above financial limits are taken for a 30-year-old individual opting for a sum insured of Rs. 10 Lakhs.

SBI General Arogya Supreme (Plus): Waiting Periods & Exclusions

👉Waiting period

During a waiting period, certain illnesses and medical conditions are not immediately covered by your health insurance policy. It's important to note that claims for these specific conditions can only be made once the waiting period has passed. Here are some types of waiting periods to be aware of:

• Initial waiting period: There is an initial waiting period for all medical conditions, except accidents for the first 30 days from policy purchase. During this time, you won't be eligible to make a claim for any hospitalisation, except in cases of accidents.
• Waiting period for pre-existing conditions: In the SBI General Arogya Supreme (Plus) plan, you need to be aware of the waiting period of 36 months for pre-existing conditions. This means that if you have experienced any medical condition or illness within the 36 months before purchasing your health insurance policy, you will not be eligible to make any claims for costs associated with your pre-existing disease during this waiting period.
• Waiting period for specific diseases: In addition to your pre-existing conditions, insurers have a list of specific medical conditions or illnesses that require waiting periods, regardless of whether you have had those diseases before or not. The waiting period is set by the insurer and is not based on your current health status. With the SBI General Arogya Supreme (Plus) plan, there is a waiting period of 24 months for specified illnesses.

👉Exclusions

Health insurance policies do not provide coverage for specific medical conditions or situations known as exclusions. Let's take a look at some of these exclusions:

• Standard Permanent Exclusions: All insurance providers are required to adhere to the ‘standard permanent exclusions’ established by IRDAI. These include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite sex. 
5. Plastic/Cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Any Treatment expenses resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc. as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to the treatment received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
13. Unproven treatments: Surgeries, any medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, and infertility: Contraception, sterilisation, artificial insemination, any advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance providers have the authority to impose additional exclusions for specific medical conditions or circumstances, in addition to the standard permanent exclusions. If you happen to have certain diseases or severe medical conditions that insurers consider too risky to cover, they may choose to exclude them from your policy permanently. It is important to note that health insurers are bound by certain restrictions when it comes to applying permanent exclusions. These restrictions are defined by the Insurance Regulatory and Development Authority of India (IRDAI) and pertain specifically to a list of illnesses for which exclusions can be applied. It is worth mentioning that insurers are not permitted to impose permanent exclusions for illnesses or diseases that fall outside of this designated list.
• Non-standard exclusions (Specific exclusions): You may come across specific exclusions that go beyond the standard permanent exclusions outlined by the IRDAI These exclusions can vary among insurance companies and are based on the terms and conditions of the policy. Some of the specific exclusions listed under the SBI General Arogya Supreme (Plus) plan are as follows -

1. Injury or disease resulting from war, invasion, acts of foreign enemies, or warlike operations.
2. Injury or illness arising from nuclear, chemical, or biological attacks or weapons.
3. Circumcision unless deemed necessary for treating a disease or injury.
4. Convalescence, general debility, run-down condition, rest cure, or external congenital anomalies.
5. Vaccination and inoculation costs (except post animal bite treatment).
6. Dental treatment and surgery of any kind except for treatment requiring hospitalisation.
7. Treatment related to intentional self inflicted Injury or attempted suicide by any means.

What to expect in terms of claims experience if you buy from SBI General Insurance Company?

• Speed of claims: SBI General Insurance Company Limited has settled  93.46% of its claims within 30 days.  This assures you of a smooth and timely claim settlement experience. 
• Claim-related complaints: As per our research, we found that SBI General Insurance Company Limited has a complaint rate of  0.23% for claims in comparison to other insurance providers. This indicates that their claim settlement process is quick.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurer's financial performance. It shows the total claims paid out in relation to the premiums received in a specific fiscal year. SBI General Insurance Company has a claims incurred ratio of 87.86%.
• Claim settlement ratio: SBI General Insurance Company Limited’s claim settlement ratio stands at 85.62%. This figure reflects the proportion of total claims received to those successfully settled by the company in a specific fiscal year.
• Network hospitals: SBI General Insurance Company Limited provides access to an extensive network of 16,625+ hospitals. This broad network allows customers to receive cashless treatment without any financial worry.

How is the customer service of SBI General Insurance Company Limited?

• Policy purchase-related complaints: Based on our research, SBI General Insurance Company Limited has received 0.00% of complaints related to its after-sales service, which is lower than other insurance companies. 
• Response on Toll-Free: Our research suggests that SBI General Insurance Company Limited’s response time on their toll-free is average, as compared to other insurers. 
• Response on Twitter: As per our research, SBI General Insurance Company Limited has a slower response time on Twitter, as compared to others.

About SBI General Insurance Company Limited

SBI General Insurance Company Limited stands as a collaborative effort between the State Bank of India (SBI) and the Insurance Australia Group (IAG). Renowned for its diverse offerings, the company provides an extensive array of general insurance products catering to various needs. From retail-focused offerings such as Motor, Health, Travel, Cyber, and Personal Accident insurance to corporate solutions including Fire, Marine, and other specialized products, SBI General Insurance caters to a broad spectrum of customers.

Established in 2009, the company's headquarters is located in Mumbai, Maharashtra. Leading the helm as CEO and MD is Mr. Kishore Kumar Poludasu, steering the company's vision and growth strategies forward.