Arogya Top up Policy

Life is unpredictable and so are medical costs, especially in case of serious illness or accident. Medical costs sometime surpass the insured value of your normal health insurance policy. SBI General’s Arogya Top Up Policy lets you add extra protection at low premium so you can smoothly overcome the rising medical costs over and above your pre- decided medical cost.

Key Feature

  • No pre-policy medical test up to the age of 55 years for people with no medical history.
  • 142 Day Care expenses covered.
  • Coverage of 60 days for Pre Hospitalisation & 90 days Hospitalisation.
  • Maternity Expenses covered after first 9 months waiting period.
  • Covers organ donor expenses.
  • Reinstatement of Sum Insured on payment of additional premium.
  • Wide coverage – From INR 1,00,000 up to INR 50,00,000 with deductible option of INR 1,00,000 to INR 10,00,000
  • Save tax under Sec. 80 D (Tax benefits are subject to change in tax laws).
  • Ambulance expenses upto Rs. 5,000 per valid hospitalisation claim event.
  • Alternative treatment under AYUSH covered.

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.
  • 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 cover up to 142 Day Care Procedures.
  • Ambulance expenses up to INR 5,000 per valid hospitalisation claim event.
  • 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.
  • Organ Donor Expenses.

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. Maternity Expenses shall be payable after coverage of 9 months from the date of inception of the Policy.
  • 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 recognised 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.
  • Outpatient department treatment.
  • 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. In case insured wants to opt deductible of INR 5,00,000 or more then maximum entry age will be extended up to 70 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 or 3 years.

Sum Insured: Minimum SI: INR 1,00,000 and Maximum SI: INR 50,00,000 subject to underlying deductible ranging from INR 1,00,000 to INR 10,00,000. Sum Insured of dependents will either be less than or equal to Proposer/ Primary Insured’s Sum Insured.

Deductible / Co-Pay: Insured will have to exercise option to select deductible from INR 1,00,000 to INR 10,00,000 in multiple of 1,00,000.

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, however there is a deductible under the policy that needs to be exhausted before you claim in this policy.

  • Is portability allowed under this policy?

    Yes you can port your existing Top up 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.

  • What are the tax benefits that can be availed on this plan?

    Deduction u/s 80 D of income tax act is available from taxable income for premium paid towards health insurance
    For self, spouse and dependent children - Maximum Rs.25000/-
    For Parent(s)- Maximum Rs.25,000/-
    In case Parent(s) are resident senior citizen- Maximum Rs.30,000/-

  • Do I need to undergo Pre-Acceptance Health Check Up compulsorily?

    Pre-acceptance Health check is not mandatory for people who are less than 55 years old and without any history of illness. Insured’s with following condition, acceptance of proposal is subject to a satisfactory medical examination as per SBI General’s requirements:
    Insured with adverse medical history as declared in Proposal Form or,
    Insured aged above 55 years & irrespective of SI.
    The cost of Pre-acceptance medical tests has to be borne by the proposer. However, if the proposal is accepted by Us, we will reimburse 50% of the cost incurred towards the medical tests so undertaken at our advice.

Product code: IRDA/NL-HLT/SBIG/P-H/V.I/477/13-14.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.