Arogya Plus Policy

Financial planning can go for a toss when serious illness/ accident adds up to routine health problems. Managing medical expenses becomes more challenging with rising medical costs. SBI General’s Arogya Plus Policy is a financial protection against rising OPD medical expenses and hospitalisation expenses. It allows you to focus on your treatment by taking care of medical expenses better.

Key Feature

  • No pre-policy medical test up to the age of 55 years for people with no medical history.
  • Multiple coverage options - Individual & Family Floater options.
  • OPD expenses as specified in the policy schedule.
  • 142 Day Care expenses covered.
  • Coverage of Pre and Post Hospitalisation Expenses - 60 days before and 90 days after the hospitalisation.
  • Maternity Expenses covered up to the OPD limit.
  • Sum Insured option of INR 1,00,000, INR 2,00,000 & INR 3,00,000.
  • Save tax under Sec 80 D (Tax benefits are subject to change in tax laws).

Coverage

This Health Insurance policy covers the following subject to the terms and conditions:

  • Eligible hospitalisation expenses as under:
    • Room rent, boarding expenses
    • Medical practitioners fees
    • Intensive care unit
    • Nursing expenses
    • Anesthesia, blood, oxygen, operation theatre expenses, surgical appliances, medicines & consumables, diagnostic expenses and x-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, prosthesis/internal implants and any medical expenses incurred which is integral part of the operation
    • Physiotherapy as inpatient care and being part of the treatment
    • Drugs, medicines and consumables consumed during hospitalization period
    • Diagnostic procedures
    • Dressing, ordinary splints and plaster casts
  • OPD treatment: - expenses for OPD consultation and treatment up to limit specified.
  • Pre-hospitalisation expenses up to 60 days for each of the admitted hospitalisation claim under the Policy.
  • Post-hospitalisation expenses up to 90 days for each of the admitted hospitalisation claim under the Policy.
  • Day Care expenses for 142 Day Care Procedures.
  • Ambulance expenses up to INR 1500.
  • Alternative treatment taken in a government hospital or in any institute recognized by government and/or accredited by quality council of India/national accreditation board on health.
  • Domiciliary hospitalisation.
  • Maternity Expenses covered under the OPD Benefit only.

Exclusion

  • Waiting Period: 30 days from first inception of the health insurance policy.
  • Time bound Exclusions: Pre-existing diseases covered after first 4 years of coverage, specified diseases or conditions covered after one year of coverage. First 9 months exclusion for Maternity expenses.
  • Treatment taken outside India.
  • Injury/disease directly or indirectly caused or contributed due to nuclear weapons/materials.
  • War, invasion, acts of foreign enemy, hostilities, etc.
  • Epidemic disease recognized by WHO or Indian government.
  • Intentional self injury or violation of any law.
  • Cosmetic or aesthetic treatments of any description, lasik treatment for refractive error. Any form of plastic surgery (unless necessary for the treatment of illness or accidental bodily injury).
  • Treatment for de-addiction from drug or alcohol or other substance.
  • Any condition directly or indirectly caused by or associated with human immunodeficiency virus or variant/mutant viruses and or any syndrome or condition of a similar kind commonly referred to as AIDS.
  • Vaccination or inoculation except as part of post-bite treatment for animal bite.
  • Treatment for any mental illness or psychiatric or psychological ailment / condition.
  • Genetic disorders and stem cell implantation / surgery / storage.
  • Treatments in health hydro, spas, nature care clinics and the like.
  • Experimental and unproven treatment.
  • Disease / illness or injury whilst performing duties as a serving member of a military or police force.

Sum Insured

Age:Minimum entry age is 3 months and maximum entry age is 65 years. There is no exit age.

Insured:Individual/ Family {For Family Insurance Policy - Family means the spouse, dependent children, parents and parents in law. For Family Floater Insurance Policy - Family means the spouse and dependent children}

Policy Term:1, 2 and 3 years.

Sum Insured:Hospitalisation sum insured options are 1, 2 and 3 Lakhs. OPD sum insured will depend on the age, premium and family type. Sum Insured of dependents will either be less than or equal to Proposer/ Primary Insured’s Sum Insured.

Premium:The premium for this product is flat Rs. 8,900, Rs. 13,350 or Rs. 17,800 per annum respectively for a sum Insured of 1, 2 or 3 lakhs.

FAQ

  • What do you mean by Co-payment? Is there any co- pay in this policy?

    Co-payment refers to the amount expected to be paid by the insured for a medical services covered by the plan. This policy does not have any co-pay.

  • Is portability allowed under this policy?

    Yes you can port your existing health indemnity Policy, into this policy.

  • Does this policy cover treatment by Ayurvedic method?

    Alternative Treatment, like Ayurvedic, Homeopathy or Unani, taken in a government hospital or in any institute recognised by government and/or accredited by Quality Council of India/ National Accreditation Board on Health) is covered under the policy up to Sum Insured.

  • Is the claim payable in the grace period if the premium is still to be paid?

    The claim in the grace period is not payable unless the premium has been paid for renewal of the policy. In case of non payment of renewal policy, it will be considered as a break in policy.

  • Is there any grace period for renewal of the policy?

    Yes, there is a grace period of 30 days for renewal of the policy.

Product Code: IRDA/NL-HLT/SBIG/P-H/V.I/473/13-14. Disclaimer: The above information is only indicative in nature. For full details of the coverage & exclusions please contact our nearest office and refer to the policy documents and sales brochure carefully before concluding a sale.