General Group Health Insurance Policy

Group health insurance policies are used to provide medical cover for members of a particular group under a single cover. It is usually taken by companies to provide health insurance for their employees under a single policy. General Group Health Insurance Policy is developed with this in mind, and it provides health insurance cover for a group against a range of unexpected illnesses and injuries. With additional benefits like infant cover and family floater, this policy ensures that comprehensive protection is offered for group members as well as their families.

Eligibility For General Group Health Insurance Policy

SBI General’s Group Health Insurance Policy can be taken by anyone between the age of 18 and 65 years. There is no pre-insurance medical examination for people below the age of 65 years subject to the condition that they have no medical history. As a group cover, this policy provides insurance coverage for an association of persons who assemble together with a commonality of purpose. Groups like employees of a company typically avail this cover.

Features Of General Group Health Insurance Policy

This cover can be used to protect the primary insured individual as well as his/her family. Some of the key features of SBI General Group Health Insurance Policy are listed below:

  • It provides coverage for hospitalization expenses and domiciliary hospitalization expenses for a range of illnesses and injuries.
  • It offers multiple coverage options for the insured including family floater cover.
  • The insured can avail cashless treatment facility at over 3,000 network hospitals.
  • The premium paid for this policy is exempt from income tax under section 80D of the Income Tax Act.
  • The policy is valid for a period of one year. It must be renewed every year in order to enjoy continuous coverage.
  • Pre-existing diseases can be covered after 4 years of continuous policy coverage and renewal.
  • There is an initial waiting period of 30 days for all conditions while taking this policy for the first time. However, this is not applicable for accidental injuries.

Exclusions From SBI General Group Health Insurance Policy

SBI General Group Health Insurance Policy comes with a few exclusions for which the company is not liable to compensate the insured. For instance, the pre and post hospitalization expenses incurred during domiciliary hospitalization treatment are not covered under this policy. Domiciliary hospitalization treatment for a range of diseases including asthma, hypertension, epilepsy, diarrhea, influenza, tonsillitis, arthritis, diabetes mellitus, and diabetes insipidus are also not covered. Apart from these, the following list of exclusions are applicable:

  • All injuries and illnesses that existed before the commencement of the policy
  • All conditions (except for accidental injuries) for the first 30 days of the policy
  • Conditions like gastric or duodenal ulcers, tonsillectomy, cataract, hernia, hydrocele, benign prostatic hypertrophy, non-infective arthritis, renal failure, diabetes, hypertension, heart diseases, sinusitis, and varicose veins for the first one year of the policy
  • Medical treatments that happened outside the country
  • Injuries caused by war or warlike activities
  • Circumcision and cosmetic surgery of any kind unless required for a specific medical condition
  • Expenses related to spectacles, hearing aids, wheelchairs, crutches, dentures, and artificial teeth
  • Complications caused by substance abuse or alcohol
  • Conditions associated with HIV, AIDS, and other venereal diseases
  • Treatments associated with pregnancy, childbirth, and miscarriage

Claim Process For SBI General Group Health Insurance Policy

For cashless treatments, all claimants will be issued a user guide and identity card. The insured must follow the procedure provided in the user guide for availing cashless treatment facility at network hospitals. For other claims, the insured must notify the company immediately within 48 hours of hospitalization. After verification of evidence, the company may record the request and proceed with the process. All documents related to the claim must be submitted to the insurer within 30 days of discharge from the hospital. The following claim documents are required in order to file a claim with the insurer.

  • Claim form filled with all the required details
  • Photo identity card of the insured person
  • Hospital records, original medical bills, and receipts
  • Copies for diagnostic tests, medical references, and treatment advice
  • Discharge summary and certificate
  • Death certificate or post mortem report (if applicable)
  • Any other document requested by the insurer

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