SBI General Health Edge Plan is a health insurance policy offered by SBI General Insurance Company Limited.
The SBI General Health Edge plan offers a wide array of unique and beneficial features to cater to diverse needs. It covers essential expenses like maternity, infertility treatment, bariatric surgery for weight loss, and consumables. Additionally, it provides a lump sum payment for hospitalization due to vector-borne diseases and coverage for medical expenses for domestic staff.
While the plan lacks a monthly premium payment choice, the insurer stands out for its seamless purchase experience with minimal complaints. However, it is worth noting that there have been higher complaints about claim settlement, indicating room for improvement in the claims service.
What are the benefits offered by the SBI General Health Edge Plan?
- Inpatient hospitalization coverage: The SBI General Health Edge Plan provides coverage for inpatient hospitalization. Meaning, it takes care of the costs incurred while being admitted in the hospital for more than 24 hours. These expenses include room charges, nursing fees, doctor's fees, prescribed medicines, ICU charges, and other related costs.
Please note that hospitalization expenses are covered only up to a fixed number of days. To get coverage for unlimited days in the hospital, you'll need to pay an extra cost.
- Pre-hospitalization coverage: You may incur certain medical expenses before hospitalization known as pre-hospitalization charges. These expenses include consultations, tests, checkups, lab reports, etc. The insurer will cover these expenses for 30 days up to the sum insured, but only if they are related to the medical condition that ultimately leads to your hospitalization. To get coverage for pre-hospitalization charges, your claim must be approved as part of the inpatient hospitalization coverage.
- Post-hospitalization coverage: After you get discharged from the hospital, you may still have medical costs to deal with, known as post-hospitalization expenses. These costs could include follow-up visits to your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and so on. SBI General Health Edge Plan covers post-hospitalization expenses for 60 days after hospitalization up to the sum insured. To be eligible for coverage, the expenses must be related to the condition for which you were hospitalised, and your claim should be approved as part of the inpatient hospitalization coverage.
SBI General Health Edge also covers the post-hospitalization medical expenses for physiotherapy.
- Daycare treatment coverage: Daycare treatment includes medical procedures or surgeries that used to require a lengthy hospital stay but can now be completed within 24 hours due to medical advancements. The SBI General Health Edge Plan covers all such daycare procedures. The best part is that there are no limits on expenses for daycare treatments. This means all these treatments will be covered up to the sum insured without any restrictions.
Please note that under this plan, a daycare treatment is covered only if your admission lasts for 2 hours or more.
- Domiciliary treatment coverage: Domiciliary treatments are treatments or procedures that are administered at home if the severity of your medical condition prevents you from moving to a hospital or medical facility or there is a lack of availability of hospital beds in the vicinity. Unfortunately, the SBI General Health Edge Plan does not cover the costs of domiciliary treatments.
- Organ donor coverage: The SBI General Health Edge Plan does not offer coverage for organ donor expenses.
- Modern treatment coverage: Technology is rapidly transforming healthcare, bringing forth modern treatments that were once unimaginable. Treatments like radio surgeries, stem cell therapy, etc. now aim to cure diseases that were previously considered incurable. To keep up with these advancements, the SBI General Health Edge Plan offers coverage for the expenses associated with these modern treatments up to the sum insured without any financial limits.
- Non-medical expenses coverage: Non-medical expenses refer to the cost of essential items used in treatment, such as gloves, nebulisation kits, oxygen masks, and other necessary supplies. These consumables can add up to a significant amount. Luckily, the SBI General Health Edge Plan offers coverage for non-medical expenses as an add-on, without any limits.
- No Claim Bonus: You receive a No Claim Bonus as a reward if you don't make any claims during a policy year. Under the SBI General Health Edge Plan, this bonus is given as 50% of the sum insured. However, if you claim during the policy period, the accumulated bonus will be reduced. The maximum bonus you can accumulate under this plan is 200% of the sum insured.
- Super No Claim Bonus: The Super No Claim Bonus works similarly to the regular No Claim Bonus, but it is an accelerated version. Unfortunately, the SBI General Health Edge Plan does not come with a Super No Claim Bonus.
- Restoration Benefit: The Restoration Benefit is a helpful feature in the SBI General Health Edge Plan that restores your sum insured to its original amount if it gets used up during a policy year. This benefit is applicable for both related and unrelated illnesses. It gets activated when there is a partial exhaustion of the sum insured and no claim bonus. You can apply for the refill from the first paid claim. Please note that this restoration benefit is applicable multiple times in a policy year.
Please note the limits and conditions mentioned in the above benefits and features are for a sum insured of Rs. 10 lakhs.
SBI General Health Edge Plan: Financial Limits
- Room rent limit: The room rent limit is the maximum amount your insurance company will pay for the hospital room you choose to stay in during your hospitalization. If you pick a room within this limit, you won't have to pay any additional charges. However, if you opt for a room with a higher rent than your eligibility, you will be liable for a proportionate deduction. This means you'll be responsible for paying a proportionate share of the total bill, not just the difference in room rent. The SBI General Health Edge Plan has no limit on the room rent, providing more flexibility in your choice of room during hospitalization.
- ICU rent limit: The ICU rent limit is the maximum amount covered by your health insurance policy for your stay in the Intensive Care Unit (ICU) of a hospital. It's important to note that the SBI General Health Edge Plan imposes no limit on the ICU rent.
- Copayment: A copayment, or copay, is a part of the approved claim amount that you need to pay out of your pocket. The insurance company will cover the remaining amount. Certain plans let you voluntarily opt for a copay and, in turn, your premium will reduce. You can choose between an optional copay limit of either 10% or 20% under the SBI General Health Edge plan - if you want to lower your premium. If not, you can buy it without the copay.
- Deductible: A deductible is the amount you must pay from your end before your health insurance begins to cover your medical expenses. The SBI General Health Edge Plan does not have a deductible limit.
- Limits on surgeries/treatments: Typically, there is a maximum amount up to which health insurance policies cover certain medical procedures or treatments. While some policies may have such limits for specific procedures, others may not. In the SBI General Health Edge Plan, expenses for cataract treatment and joint replacement surgery are covered up to the sum insured. This means the policy covers the full cost of these treatments without any cap.
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 Health Edge Plan: Waiting Periods & Exclusions
When you purchase a health insurance policy, there is a specific period of time during which certain illnesses and diseases will not be covered. This timeframe is called the waiting period. Once this waiting period is served, you can claim these specific conditions. There are different types of waiting periods including -
- Initial waiting period: There is an initial waiting period of 30 days for all medical conditions except for accidents. This means you won't be able to make any claims for hospitalization during the first 30 days, except in the case of accidents.
- Waiting period for pre-existing diseases: A pre-existing disease is any illness or health condition you had in the 48 months before getting health insurance. With the SBI General Health Edge Plan, there's a 24-month waiting period for pre-existing diseases. This means during this period, the policy won't cover any expenses for your pre-existing medical conditions.
- Waiting period for specific diseases: Insurers will have a list of medical conditions or illnesses entailing a waiting period. This waiting period is fixed by the insurer and does not depend on your current health condition. Under the SBI General Health Edge Plan, there is a waiting period of 24 months for specific diseases.
Exclusions refer to specific circumstances and situations that will not be covered under health insurance at any cost. These include-
- Standard permanent exclusions: IRDAI (Insurance Regulatory and Development Authority of India) outlines a set of 'standard permanent exclusions' that must be enforced by all insurers. Some of these include -
- Investigation and evaluation: Hospital admission for observation or monitoring only.
- Plastic/cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
- Profession in hazardous or adventure sports: Treatment expenses incurred while engaging in risky activities like river rafting, mountaineering, scuba diving, horse racing, etc. as a professional.
- Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest without undergoing any active treatment.
- Obesity/weight control: Treatment or surgery intended to reduce weight or obesity. A few companies have now started offering coverage for these procedures.
- Change of gender treatment: Treatment to change the body's characteristics to those of the opposite sex.
- Excluded providers: Treatment from a medical practitioner or hospital not covered by the insurance company.
- Breach of law: Expenses related to the treatment of a person who has attempted to or violated the law with criminal intent.
- Narcotics: Treatment for addictions like alcohol addiction, drug usage, etc.
- Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Maternity expenses: Pre/post-natal costs, childbirth-related hospitalization expenses, etc.
- Treatments in establishments arranged for domestic purposes: Expenses of treatment administered in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic purposes.
- Refractive error: Costs of correcting refractive errors of up to 7.5 diopters to improve eyesight.
- Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be successful.
- Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a medical professional.
- Additional permanent exclusions: In addition to the standard permanent exclusions we discussed earlier, insurance companies have additional exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers consider risky, they may apply permanent exclusions for them. However, it is worth noting that insurers are permitted to exclude only a list of illnesses specified by the Insurance Regulatory and Development Authority of India (IRDAI). They don’t have the power to apply such exclusions to illnesses or diseases outside this list.
- Non-standard exclusions (Specific exclusions): These are specific exclusions that go beyond the standard permanent exclusions established by the IRDAI. The list can vary among insurance companies and is based on the terms and conditions of each policy. Here are some of the specific exclusions under the SBI General Health Edge Plan -
- Injury or disease resulting from war, invasion, acts of foreign enemies, and warlike operations.
- Injury or illness caused by nuclear, chemical, or biological attack or weapons.
- Circumcision, except when medically necessary for treating a disease or injury.
- Convalescence, general debility, ‘run-down’ condition, rest cure, or external congenital anomaly.
- Vaccination or inoculation costs, except for post-animal bite treatment.
- Treatment for hospitalization at home.
- Treatment for intentionally self-inflicted injuries or attempted suicide by any means.
What to expect in terms of claims experience if you buy from SBI General Insurance Company Limited?
- Speed of claims: SBI General Insurance Company Limited has an 84.51% success rate in settling claims within 30 days. This means they need to expedite their claim settlement process.
- Claim-related complaints: Our research shows that SBI General Insurance Company Limited has received a higher number of complaints about claims when compared to other insurance companies. This suggests that their claims settlement process can have bumps.
- Claims incurred ratio: The claims incurred ratio is a way to measure the financial performance of insurance companies. It indicates the total amount of claims paid out by the insurer compared to the total amount of premiums they collected in a financial year. SBI General Insurance Company Limited’s claims incurred ratio stands at 73.92%.
- Claim settlement ratio: The claim settlement is the percentage of claims an insurer has successfully settled compared to the total number of claims received in a financial year. SBI General Insurance Company Limited’s claim settlement ratio is 85.02%.
- Network hospitals: SBI General Insurance Company Limited has a vast network of 23,000+ hospitals. This extensive network enables you to access various healthcare providers as per your preference. And, with cashless treatment available, you won't have to worry about paying expenses upfront.
How is the customer service of SBI General Insurance Company Limited?
- Policy purchase-related complaints: Our research shows that SBI General Insurance Company Limited has a remarkable rate of post-sales service complaints at 0.00%. This highlights the company's efforts to provide efficient and reliable customer service.
- Response on Toll-Free: -
- Response on Twitter: -
About SBI General Insurance Company Limited
SBI General Insurance Company Limited is a joint venture between the State Bank of India (SBI) and Insurance Australia Group (IAG). They provide a diverse range of general insurance products, including motor, health, travel, cyber, personal accident insurance, etc. for individuals. They also offer fire, marine, and other insurance options for corporate clients. Established in 2009, the company's main office is in Mumbai, Maharashtra. Mr. Kishore Kumar Poludasu is the company's CEO and MD.