SBI General Super Health (Prime)

SBI General Super Health (Prime), offered by SBI General Insurance Company Limited, is designed as an all-round health insurance solution for individuals and families. It goes beyond basic hospitalisation coverage by also including pre- and post-hospitalisation expenses, helping to ease financial strain during health emergencies. Moreover, this plan does more than just cover costs, it aims to promote wellness by integrating fitness benefits that support a healthier lifestyle. With its adaptable structure, wide-ranging features, and a variety of optional add-ons, the policy is tailored to suit diverse healthcare needs across age groups and family sizes.

Positioned as an affordable, value-driven option, Super Health (Prime) includes crucial coverages such as consumables and bariatric surgery, in addition to standard hospitalisation benefits. However, it’s worth noting that the insurer has received a relatively high number of complaints at both the policy purchase and claim settlement stages. This may indicate challenges in customer service and claim handling, especially when compared to peer insurers.

What are the benefits offered by SBI General Super Health (Prime)?

• Inpatient hospitalisation coverage: Inpatient coverage kicks in when a patient is hospitalised for over 24 hours. It takes care of essential expenses like room charges, nursing care, doctor consultations, prescribed medicines, ICU fees, and other necessary medical costs. Hospital bills can be overwhelming, but this plan takes care of those big expenses so the focus stays on getting better. The SBI General Super Health (Prime) plan covers inpatient hospitalisation costs. That means no worrying about limits, just the freedom to choose the level of care and comfort that feels right.
• Pre-hospitalisation coverage: Before a hospital stay, there are often medical expenses to take care of, known as pre-hospitalisation costs. These usually cover things like doctor visits, lab tests, routine checkups, and medical reports, all adding up before treatment even begins. The expenses will only be covered if they are directly linked to the condition treated and if the main hospitalisation claim gets approved. With the SBI General Super Health (Prime) Plan, pre-hospitalisation expenses are also taken care of for up to 60 days, within the sum insured. 
• Post-hospitalisation coverage: Getting discharged from the hospital is just one part of the recovery journey. What comes next, follow-up checkups, medications, and continued care, can add up quickly. That is where post-hospitalisation coverage steps in, easing the financial strain. But here is the catch: these expenses are only covered if they are directly tied to your hospital treatment for which the in-patient claim is approved. The SBI General Super Health (Prime) Plan ensures full coverage for post-hospitalisation expenses, extending up to the sum insured for a period of 90 days after discharge. You should also know that coverage includes physiotherapy expenses incurred both before and after hospitalisation.
• Daycare treatment coverage: Medical technology has come a long way, making it possible to complete certain treatments and surgeries in less than a day. These are known as daycare procedures, things that once meant long hospital stays but now get done within 24 hours, saving both time and hassle. The SBI General Super Health (Prime) Plan provides full coverage for all daycare treatments without any financial cap, up to the sum insured. 
• Domiciliary treatment coverage: Domiciliary treatments involve critical medical care given at home rather than in a hospital. This typically happens when a patient’s condition makes hospital transfer unsafe or when no hospital beds are available nearby. The SBI General Super Health (Prime) Plan takes care of all costs related to domiciliary treatments, covering them up to the sum insured. 
• Organ donor coverage: The SBI General Super Health (Prime) Plan steps in to cover organ donor expenses, taking care of the inpatient costs involved in the transplant procedure. It provides financial support up to the sum insured, easing the financial burden during an already challenging time. 
• Modern treatment coverage: Modern medicine has made incredible strides, providing treatments for conditions that were once considered impossible to cure. Innovations like stem cell therapy, radiosurgery, and robotic-assisted procedures are transforming healthcare, offering highly personalised solutions tailored to each patient’s needs. The SBI General Super Health (Prime) Plan is designed to keep pace with these medical advancements, covering the costs of modern treatments without any financial restrictions.
• Non-medical expenses coverage: Coverage for non-medical expenses takes care of essential items like vaccinations, gloves, nebulisation kits, oxygen masks, medical footwear, urine bags, hospital gowns, and more. This ensures you are not weighed down by these extra costs while focusing on your treatment. The SBI General Super Health (Prime) Plan gives you peace of mind by covering non-medical expenses without any financial limits, so you can focus on your recovery without worry.
• No Claim Bonus: The No Claim Bonus is a benefit offered by the insurance company as a reward for not filing any claims during the policy term. Under the SBI General Super Health (Prime) Plan, the No Claim Bonus rewards you with a percentage-based bonus each year. If no claims were made in the previous year, an annual bonus of 50% is added to your coverage. You can accumulate a maximum bonus of 100%. However, there can be a reduction in accumulated bonus if you file a claim in a policy year.
• Super No Claim Bonus: The Super No Claim Bonus takes the benefits of the standard No Claim Bonus to the next level, providing even greater rewards for claim-free years. It enhances your coverage more significantly, ensuring you get an even higher bonus without losing its advantages. However, the SBI General Super Health (Prime) Plan does not have the provisions for a super no-claim bonus.
• Restoration benefit: The restoration benefit is a valuable feature that replenishes your sum insured if you’ve used it all during the policy year due to unexpected medical expenses. Under the SBI General Super Health (Prime) Plan, the Refill Benefit ensures that your sum insured is reinstated if it gets depleted during the policy year. This benefit can be used unlimited times for subsequent claims in a policy year that is triggered when a first paid claim takes place. It applies to both related and unrelated illnesses, ensuring continued coverage for medical expenses. The reinstatement of the sum insured benefit is available, offering financial security throughout the policy term.

Please note that these benefits, along with their limitations and conditions, are applicable for a sum insured of Rs 10 lakhs.

SBI General Super Health (Prime): Financial Limits

• Room rent limit: The room rent limit is the highest amount your insurance will cover for hospital room expenses. As long as you stay within this limit, you won’t have to pay anything extra. But if you choose a more expensive room, your insurer will apply a proportionate deduction to your claim. The SBI General Super Health (Prime) Plan gives you the freedom to choose any hospital room without any limitations. 
• ICU rent limit: The ICU rent limit decides how much of your hospital’s intensive care unit charges your insurance plan will cover. With the SBI General Super Health (Prime) Plan, there’s no cap on ICU expenses. No restrictions, no worrying about extra costs, just comprehensive coverage.
• Copayment: Copayment, or copay, is the part of the approved claim that you need to pay from your pocket. Once you cover your share, the insurer takes care of the rest. The SBI General Super Health (Prime) Plan comes with zero copayment, meaning you don’t have to pay a share of the claim amount.
• Deductible: The deductible is the portion of medical expenses you need to pay from your own pocket before your insurance starts covering the rest. Under the SBI General Super Health (Prime) Plan, there are no applicable deductibles.
• Limits on surgeries/treatments: When going through your health insurance policy, it’s crucial to check the coverage limits for surgeries and treatments. These limits define the maximum amount your insurer will pay for specific medical procedures. While some plans set fixed limits on certain procedures, others offer more flexibility. The SBI General Super Health (Prime) Plan covers joint replacement surgeries and cataract treatment up to the full sum insured. 

Please keep in mind that the financial limits mentioned earlier are based on a 30-year-old individual selecting a sum insured of Rs. 10 Lakhs.

SBI General Super Health (Prime): Waiting Periods & Exclusions

👉Waiting period

The waiting period is the time after buying a policy when specific illnesses and medical conditions aren’t covered. You can only file claims for these conditions once this period is over. The duration of the waiting period isn’t the same for every insurer. It varies based on your insurance provider and the specific policy chosen. The different types of waiting periods include:

• Initial waiting period: A 30-day waiting period applies to all medical conditions except accidents. During this time, you can’t file a claim for hospitalisation unless it results from an accident. 
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any health issue or illness you’ve had in the 36 months before buying a health insurance policy. For the SBI General Super Health (Prime) Plan, the waiting period for pre-existing diseases is 24 months. 
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers have a separate list of medical conditions that come with their own waiting periods. These apply no matter what your medical history looks like. Even if you're in perfect health, you’ll still need to wait before making a claim for these specific illnesses. The length of these waiting periods is set by the insurer and doesn’t change based on your current health status. The SBI General Super Health (Prime) Plan also includes a 24-month waiting period for certain specific diseases.

👉Exclusions

Exclusions in health insurance refer to specific medical conditions or situations that the policy doesn’t cover. Here are some of the typical examples of such exclusions:

• Standard Permanent Exclusions: Every insurance company must adhere to the 'standard permanent exclusions' outlined by IRDAI. These exclusions include:

1. Investigation and evaluation: Hospital stays meant only for evaluation and observation, without any active medical treatment, are not covered.
2. Rest, rehabilitation, and respite care: Services focused on rest, rehabilitation, or long-term care, rather than active treatment or surgery, are excluded.
3. Obesity/weight control: Any procedures or treatments aimed at weight loss or obesity control, including bariatric surgery, are not covered.
4. Gender reassignment: Medical treatments or surgeries related to gender reassignment or altering gender identity are excluded.
5. Plastic/Cosmetic surgery: Any plastic or cosmetic surgeries performed solely for enhancing appearance, unless medically necessary, are not covered.
6. Profession in adventure or hazardous sports: Medical expenses for injuries sustained while professionally engaging in adventure or extreme sports like river rafting, mountaineering, or scuba diving are not covered.
7. Breach of law: Treatment costs for injuries or health issues arising from involvement in criminal activities or unlawful acts are excluded.
8. Excluded providers: Expenses for medical treatments received from doctors or hospitals that are not recognised under the insurance policy will not be reimbursed.
9. Narcotics: Costs related to the treatment of addiction or health issues caused by alcohol, drugs, or other controlled substances are not covered.
10. Treatments in establishments arranged for domestic purposes: Medical expenses for treatments in nursing homes or similar establishments meant primarily for long-term domestic care rather than active medical treatment are excluded.
11. Dietary Supplements: Expenses for vitamins, minerals, and other over-the-counter supplements that are not medically prescribed are not covered.
12. Refractive error: Costs for treating refractive errors up to 7.5 diopters, such as LASIK or other corrective procedures, are excluded.
13. Unproven treatments: Any medical procedures, surgeries, or therapies lacking scientific validation or proven effectiveness are not covered.
14. Expenses related to sterility, birth control, and infertility: Expenses related to contraception, sterilisation, artificial insemination, and assisted reproductive techniques like IVF, GIFT, ZIFT, ICSI, and surrogacy are excluded.
15. Maternity expenses: Hospitalisation expenses for childbirth, including prenatal and postnatal care, as well as delivery costs, are not covered under the policy.

• Additional permanent exclusions: Insurance companies can impose extra exclusions for certain health conditions or situations beyond the standard permanent exclusions. If an insurer views a particular illness or serious medical condition as too high-risk, they may decide to exclude it from your policy permanently.  Health insurers must follow the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), which outlines specific illnesses eligible for permanent exclusions. They cannot permanently exclude any medical condition that isn’t on this approved list. 
• Non-standard exclusions (Specific exclusions): Non-standard exclusions are extra conditions that insurers choose to leave out, apart from the standard permanent ones set by IRDAI. They are not always the same for each & every policy; each insurer has its own rules, and what’s excluded depends entirely on the terms they’ve set. Here are the most important specific exclusions listed under the SBI General Super Health (Prime) Plan -

1. Medical treatments received outside India are not covered.
2. Circumcision is excluded unless it's required due to an illness or injury.
3. Expenses related to convalescence, general weakness, fatigue, rest cures, or treatment for external congenital anomalies are not included.
4. Costs for vaccinations or inoculations are excluded, except when administered as part of post-animal bite care.

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

• Speed of claims settlement: SBI General Insurance Company Limited has ensured a prompt and effective claim payment process by settling 93.46% of its claims within 30 days. 
• Claim-related complaints: Based on our research, SBI General Insurance Company Limited has a claims complaint rate of 0.23%, which is higher compared to other insurers. 
• Claims incurred ratio: The claims incurred ratio reflects an insurer's financial stability by measuring the percentage of claims paid against the total premiums collected in a given year. SBI General Insurance Company Limited has a claims incurred ratio of 87.86%. 
• Claim settlement ratio: SBI General Insurance Company Limited has a claim settlement ratio of 85.62%, indicating the percentage of claims successfully processed out of the total received in a given financial year.
• Network hospitals: With a network of over 16,625 hospitals, SBI General Insurance Company Limited makes cashless treatment easily accessible. This wide coverage allows you to get the medical care they need without the burden of upfront payments.

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

• Policy purchase-related complaints: Our research indicates that only 0.00% of complaints have been reported regarding SBI General Insurance Company Limited's after-sales service.
• Response on Toll-Free: In comparison to other insurers, our study indicates that SBI General Insurance Company Limited's toll-free number response time is average.    
• Response on Twitter(X): Our research shows that SBI General Insurance Company Limited has a slow response time on Twitter (X) when compared to other companies. 

About the 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), bringing together trusted expertise from both domestic and international markets. Established in 2009 and headquartered in Mumbai, Maharashtra, the company has steadily expanded its footprint in the Indian insurance sector. Catering to a wide spectrum of insurance needs, SBI General offers an extensive portfolio. In the retail segment, it covers essentials like Motor, Health, Travel, Cyber, and Personal Accident insurance. On the corporate front, the offerings include Fire, Marine, and other specialised insurance products, addressing diverse risk management needs across sectors. Mr. Kishore Kumar Poludasu is at the heart of the company, serving as the Managing Director and Chief Executive Officer, guiding its vision and operations.