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SBI Health Insurance Arogya Supreme Policy

SBI Arogya Supreme is a comprehensive health insurance policy that has come up with 20 basic covers and 8 optional covers to safeguard you and your family from different types of health hazards and risks. This plan is a complete solution for all of your tensions related to your health. It offers many unique benefits such as sum insured refill, e-opinion, recovery benefits, including various discounts, and many more.

Eligibility Criteria

ParametersDetails
Minimum entry age

Adults – 18 years

Dependent child – 91 days

Maximum entry age

Adults – 65 years

Dependent child – 25 years

Family combinationSelf, spouse, dependent children, parents, and parents-in-law
Policy variants

Pro plan

Plus plan

Premium plan

Grace period30 days
Policy tenure1, 2, and 3 years
Waiting period

Generic Policy Waiting Period – 30 days, except for accidents

Certain Specific Illnesses – 2 years

Pre-existing diseases – 4 years

Hypertension, Diabetes, Cardiac Condition – 90 days except if these diseases are pre-existing and disclosed at the time of Policy

Major illness benefit – 90 days

Covid-19 – 15 days

RenewalLifelong renewability
Sum insured range

Pro plan – Rs. 3 lakhs to Rs. 5 lakhs

Plus Plan – Rs. 6 lakhs to Rs. 20 lakhs

Premium Plan – Rs. 25 lakhs and above

SBI Arogya Supreme Policy Coverage Details

This policy is a power-packed health insurance plan with lots of benefits and facilities. Keep an eye on the following table to know the general details of the policy.

ParametersProPlusPremium
In patient hospitalizationCovered
Room rent

For Rs. 3 Lakhs & Rs. 4 Lakhs – Single Private AC Room (1% restriction as an option available)

For Rs. 5 Lakhs – Single private AC Room (upgrade option available)

Single Private AC Room

(Upgrade option available)

Actuals up to Sum Insured
ICU/ICCU

For Rs. 3 Lakhs & Rs. 4 Lakhs – as per actual ICU/ICCU expenses provided by Hospital (2% restriction as an option available)

For Rs. 5 Lakhs – as per actual ICU/ICCU expenses provided by Hospital

As per actual ICU/ICCU expenses

provided by Hospital

Actuals up to Sum Insured

Internal Congenital Anomaly

(24 months waiting period)

25% of the sum insured
HIVUp to sum insured
Advanced Procedures25% of the sum insured
Pre-hospitalization cover30 days60 days60 days
Post-hospitalization cover60 days180 days180 days
Cataract (24 months waiting period)Rs. 50,000 per eyeRs. 1 lakh per eyeRs. 1 lakh per eye

Domiciliary Hospitalization

(Including pre and post hospitalization cover)

Up to sum insured
Day Care Procedures (537 Day Care Procedures Covered)Covered up to Sum Insured as per indicative Day care list
Emergency road ambulance coverUp to Rs. 3000 per hospitalizationUp to Rs. 5000 per hospitalizationUp to Rs. 7000 per hospitalization
Organ donor expensesCovered up to the sum insured
Alternative Treatment / AYUSHCovered up to the sum insured

Domestic Emergency Assistance Services

(Including Air Ambulance)

Not coveredUp to Rs. 5 lakhsUp to Rs. 10 lakhs
Compassionate VisitNot coveredIf hospitalization exceeds 5 days, the cost of an economy class air ticket, 1% of the Sum Insured or a Maximum up to Rs. 20,000 whichever is lower
Deductible
  1. Rs. 10,000
  2. Rs. 25,000
Discount optionsFamily discount Loyalty discount
Long term policy discount
Optional covers (Add-Ons)
Hospital cash benefitRs. 500; Rs. 1000; Rs. 2500; Rs. 5000 for 5/10/15/45 days

Major Illness – Benefit (Survival – 30 days; WP – 90 days)

(Eligibility =>18 years)

Cover up to 100% of Sum Insured or maximum up to Rs. 25 Lakhs whichever is lower
Enhanced Cumulative Bonus25% up to a maximum of 200%50% up to a maximum of 200%
(No Claim Bonus) NCB ProtectorNCB Protector (if claim less than Rs. 50,000)
Co-payment10% / 20% Co-payment available
Any Room Upgrade

Covered – for Rs. 5 Lakhs Sum Insured

Upgrade to any room excluding suite & above

Covered

Upgrade to any room excluding suite & above

Not applicable
Additional SI for Accidental Hospitalization1.5x or 2x of the base Sum Insured
Renewal benefits
Preventive Health Check up

Haematology: CBC + Haemoglobin

Diabetes Profile: Fasting Blood Sugar or random Blood Sugar

Lipid Profile: Total Cholesterol

Liver Function: SGOT + SGPT

Kidney / Renal Function: Bun and

Creatinine

Haematology: CBC + Haemoglobin

Diabetes Profile: Fasting Blood Sugar or random Blood Sugar

Lipid Profile: Total Cholesterol + HDL + LDL + Triglycerides

Liver Function: SGOT + SGPT + Bilirubin

Total Kidney / Renal Function: Bun and Creatinine + Uric Acid

Thyroid: TSH

Haematology: CBC + ESR + Haemoglobin + PS

Diabetes Profile: Fasting Blood Sugar + HbA1c

Lipid Profile: Total Cholesterol + HDL Cholesterol + LDL Cholesterol

+ Triglycerides

Liver Function Tests: SGOT + SGPT +

Bilirubin

Total

Kidney / Renal Function: Bun and

Creatinine + Uric Acid

Thyroid Profile: T3+ T4+ TSH

Urine Analysis: Urine Complete Analysis

Iron Deficiency: Iron Profile

Cumulative bonus15% up to a maximum of 100%

Major Benefits Of SBI Arogya Supreme Policy

This Arogya Supreme policy of SBI General Insurance has presented some unique features that have made the policy special and the most suitable one for senior citizens. Here are the mentions of those major benefits.

Mental Healthcare / Psychiatric illness Cover – Medical expenses occurred due to hospitalization for any Mental Illness that has been contracted during the Policy Period will be covered by this policy up to the sum insured. The sub-limit is 10% of the sum insured or Rs.50,000, whichever is lower. This is applicable for a few listed conditions. 

Genetic Disorders – Any medical expenses occurred due to the hospitalization for any kind of genetic disorder illness, the policy will pay up to Rs. 1 lakh. 

Bariatric Surgery (18 years and above) – If you are hospitalized because of conditions mentioned below that require you to undergo Bariatric Surgery during the Policy Period, then the insurer will pay Medical Expenses up to Sum Insured. The conditions are as followed.

  • Body Mass Index (BMI):
  • greater than or equal to 40 or
  • greater than or equal to 35 in conjunction with any of the following severe co-morbidities following the failure of less invasive methods of weight loss:
    1. Obesity-related cardiomyopathy
    2. Coronary heart disease
    3. Severe Sleep Apnea

Recovery Benefit – I the hospitalization exceeds 10 continuous and consecutive days; the policy will pay the recovery benefit. The limit for this benefit is Rs. 5000 for Pro Plan, Rs. 10,000 for Plus Plan, and Rs. 15,000 for Premium Plan per hospitalization. This feature is not applicable for domiciliary hospitalization. 

Sum insured refill – The policy promises to refill 100% Basic Sum Insured on complete or partial utilization of your existing Policy Sum Insured in a Policy Year. This includes a Cumulative Bonus or Enhanced Cumulative Bonus.

E-Opinion – You can avail of the E-Opinion facility under this policy from the experienced and enlisted doctors of the company. for Pro and Plus Plan you can enjoy 4 E-Opinions, and for Premium Plan, it is unlimited.

Exclusions Under SBI Arogya Supreme Policy

You should never buy a policy without understanding the exclusions of that policy explicitly, otherwise, you may have to face problems in the future. So, to have a comprehensive idea of the policy, here are the exclusions of the Arogya Supreme Plan.

  • If you have admission to a hospital for primary investigation and evaluation, the policy does not cover the expenses.
  • If you take part in hazardous activities or adventurous sports like skiing, para-gliding, scuba diving, etc., the policy will not take any responsibility for that.
  • Rest cure, rehabilitation, and respite care are excluded from the policy permanently.
  • If you take any kind of surgical treatment for obesity control and if it does not fulfill the conditions of the company, you will not get any reimbursement for the expenses.
  • Expenses related to any gender treatment, plastic surgery, or cosmetic surgery will not be compensated by the company.
  • If you obtain the policy from excluded providers or in case of any breach of law, the company is not liable to cover the loss.
  • Any treatment related to the consumption of alcohol, drugs, or any intoxicating substances will also fall under the category of exclusions.
  • OTC dietary supplements and substances are excluded from the policy.
  • Refractive error, treatments related to circumcision, maternity, sterility, and infertility are excluded from SBI Arogya Supreme Policy.
  • Expenses incurred due to any injuries related to the war, strike, war-like situations, riots, public unrest, etc. will not be compensated by the policy.
  • Medical expenses related to injury or disease caused by or contributed to by nuclear weapons/materials are also excluded from the policy.

Premium Calculation Of SBI Arogya Supreme Plan

To have an overall idea of the policy and to plan your budget it is very much important to know the premium amount that you have to pay for the chosen policy. Therefore, for your better understanding, here is an illustration.

Suppose, Mr. Mishra a 36-years-old, Kolkata-based businessman has bought SBI Arogya Supreme Policy for himself and his wife. Let us find out how much premium amount he has to pay for the given data for choosing different policy tenure options.

Number of peopleAge of the insured personsPlan typePlan variantSmoking, or drinking habitSelected optionSum insuredPolicy tenurePayable premium amount
2 (Self and Spouse)

Mr. Mishra – 36 years

Mrs. Mishra – 34 years

Family floater policyPlus planNo

Option 2

(No Claim Bonus Protector,

Enhanced Cumulative Bonus 50%, Major Illness)

Rs. 15 lakhs1 year

Rs. 41,444

(Gross premium – Rs. 35,122

Applicable taxes – Rs. 6322)

2 years

Rs. 84,396

(Gross premium – Rs. 71, 499

Applicable taxes – Rs. 12870)

3 years

Rs. 126265

(Gross premium – Rs. 107004

Applicable taxes – Rs. 19261)

Frequently Asked Questions

You can renew Arogya Supreme Policy every year by paying the premium amount before the expiry.

If your hospitalization exceeds 5 consecutive days, your immediate family member can visit you. The transportation cost of that visit will be reimbursed by the insurer up to a certain limit that is mentioned in the above table.

Yes, this comes under the category of Domestic Emergency Assistance Services. In that case, the distance has to be 150 kilometers within India.

The following advance procedures are covered by this policy:

  • Uterine Artery Embolization and HIFU
  • Balloon Sinuplasty
  • Deep Brain Stimulation
  • Oral Chemotherapy (covered as OPD also)
  • Immunotherapy – Monoclonal Antibody to be given as an injection
  • Intra Vitreal Injections
  • Robotic Surgeries
  • Stereotactic Radio Surgeries
  • Bronchial Thermoplasty
  • The vaporisation of the Prostrate (Green laser treatment or holmium laser treatment)
  • IONM (Intra Operative Neuro Monitoring)
  • Stem Cell Therapy (Haematopoietic stem cells for bone marrow transplant for hematological conditions to be covered)

Yes, this plan will pay the expenses for prosthetic devices or equipment if that is implanted internally during a surgical procedure.

No, the policy offers coverage if and only the treatments are received within the country.

Yes, you can buy this policy online. 

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