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SBI Divyanga Suraksha Plan

The SBI Divyanga Suraksha Policy is specially made for people with disabilities by The Rights of Persons with Disabilities Act, 2016, and for people living with HIV/AIDS by The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, to give these people some relief and relaxation in regards to their health insurance policies. For medical treatment, including pre and post-hospitalization costs, the insured is covered up to Rs 5 lakh under this insurance plan.

Read on to learn more about the SBI Divyanga Suraksha Insurance Plan in detail!

Eligibility Criteria

Here are the eligibility criteria for the SBI Divyanga Suraksha Insurance Plan.

ParametersDetails
Age

Adults: 18 years to 65 years

Children: Newborn to 17 years

Policy Period1 year
Type of PolicyIndividual
Sum Insured Options₹4 lacs and ₹5 lacs

Coverage Details

Here are the coverage details for the SBI Divyanga Suraksha Insurance Plan.

ParametersDetails
Pre-hospitalization Medical30 days
Post-hospitalization Medical60 Days
Emergency Ground Ambulance CoverRs. 2000 per Hospitalization
Modern Treatments/Advanced Procedures50% of Sum Insured
AYUSH50% of Sum Insured
Cataract TreatmentUptoRs.40,000/-, per each eye in one policy year
Co-Pay20% on all claims unless waiver opted
Specific Disease/ illness waiting period24 months
Initial Waiting period30 days for all claims except those resulting from an Accident
Modern TreatmentCovered for listed procedures up to 50% of the sum insured available for Inpatient Hospitalisation Care
Grace PeriodFor Yearly payment of mode- 30 days Other modes of payment – 15 days

Why Go With SBI Divyanga-Suraksha Plan?

The following are the key features and benefits of considering the SBI Divyanga Suraksha Insurance Plan.

  • Inpatient Care

Hospitalisation costs for the insured person during the policy year will be covered by the company up to the sum insured for room rent, board, and nursing costs as provided by the hospital or nursing home, up to a daily maximum of 1% of the sum insured.

  • AYUSH Treatment

Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy systems of medicine during each Policy Year, up to 50% of the sum insured as specified in the policy schedule, shall be covered by the Company’s indemnification obligations.

  • Pre-Hospitalization Medical Expenses

For a fixed period of 30 days before the date of the admissible hospitalisation covered by the policy during the policy period, the Company shall indemnify Pre-Hospitalization Medical Expenses incurred, related to an admissible hospitalisation requiring inpatient care.

  • Post-Hospitalization Medical Expenses

Following an admissible hospitalisation that is covered by the Policy during the policy period, the Company shall reimburse Post Hospitalisation Medical Expenses incurred, related to an admissible Hospitalisation requiring Inpatient Care, for a fixed period of 60 days from the date of discharge from the Hospital.

  • Emergency Ground Ambulance

By the limit, the policy will pay Reasonable and Customary Charges for costs related to ambulance transportation of an insured person.

  • Cataract Treatment

Up to a maximum of Rs. 40,000 for each eye during a policy year, the company will cover medical costs incurred for treating cataracts.

  • Portability

If the insured person is currently covered and has had continuous coverage under this health insurance plan without any breaks, they will have the option to port the policy to the same product from other insurers by any applicable portability rules.

  • Renewal of Policy

Except in cases of fraud, moral hazard, or misrepresentation by the insured person, the policy must typically be renewable.

  • Free Look Period

The Free Look Period will only be available for brand-new individual health insurance policies, not ones that are renewed. Following receipt of the policy document, the insured person has fifteen days to review the terms and conditions and return the document if they are not satisfactory.

What’s Excluded Under the SBI Divyanga Suraksha Insurance Plan?

Here are the things not included under the SBI Divyanga Suraksha Insurance Plan.

  • Acts of aggression, hostilities (whether or not war has been declared), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power, as well as confiscation, nationalisation, requisition of, or damage by or at the direction of any government or public local authority.
  • Damage or illness brought on by or aggravated by nuclear weapons or materials.
  • Circumcision, unless required for the treatment of a condition not otherwise excluded by this clause, or as may be required as a result of an accident.
  • Alternative medicine treatment, experimental treatment, or any other form of care, including reflexology, aromatherapy, acupuncture, acupressure, magnetic therapy, osteopathy, naturopathy, and osteopathy.
  • Suicide, Intentional self-injury (including but not limited to the use or misuse of any intoxicating drugs or alcohol), and any violation of law or participation in an event/activity that is against the law with criminal intent.
  • Immunisation or vaccination, excluding post-animal bite care.
  • Recuperation, general ill health, the “run-down” condition, rest cure, and congenital external illness/disease/defect.
  • Hormone replacement therapy, non-prescribed medications and medical supplies, outpatient diagnostic, medical, and surgical procedures or treatments, and costs associated with in-home hospitalisation are not covered.
  • Any type of surgery or dental care, unless it is necessary to be hospitalised due to an unintentional bodily injury.
  • Venereal/ Sexually Transmitted disease
  • Stem cell storage.
  • Any kind of service charge, or surcharge levied by the hospital.
  • Goods and services for one’s comfort and convenience, including television, telephones, barber or other guest services, and similar incidental services and supplies.
  • Medical costs directly related to or resulting from any insured person breaking the law with criminal intent or attempting to do so.
  • Treatment costs for correcting vision caused by refractive error are less than 7.5 dioptres.
  • Costs for any unproven treatments, services, or supplies used in or related to treatments. Unproven treatments are those that do not have a substantial body of medical evidence to support their efficacy.

How To Buy the SBI Divyanga Suraksha Insurance Plan?

There is still a long way to go, despite society’s best efforts to promote an inclusive and accessible world for people with disabilities. Many disabled people still struggle to find decent employment and stay in stable financial situations. As a result of emergencies, particularly medical ones, they frequently become impoverished. The good news is that it may be advantageous in these circumstances to purchase a Mediclaim policy, such as SBI Divyanga Suraksha.

If you want to buy the SBI Divyanga Suraksha insurance Policy, listed below are the steps to follow.

  • Visit the official website of SBI General Insurance. 
  • On the top, you will see “Our Products” section. Under “Health” Insurance, you will see “Divyang Suraksha”. Click on it.
  • The moment you click on, you will see “Name”, “Email Id”, and “Mobile Number”. Then, click on “I Agree to the Terms & Conditions”. 
  • After that, click on “Get a Call Back”. Then, a message will be displayed “Thank you for your interest in SBI General Insurance. Our experts will get in touch with you shortly”.
  • The expert will guide you through the entire buying process.

Complete Claim Process of SBI Divyanga Suraksha Insurance Plan

If you want to file a claim for the SBI Divyanga Suraksha Insurance Plan, listed below are the steps to follow.

Cashless Claim Process:

  • Preapproval by the Company or its designated TPA is required before receiving treatment from a network provider.
  • Fill out the cashless request form provided by the network provider and TPA, then send it to the company or TPA for approval.
  • After receiving the insured person’s or the network provider’s cashless request form and any pertinent medical information, the company or TPA will issue a pre-authorization letter to the hospital for verification.
  • The insured person must verify the discharge paperwork, verify and sign it, and pay for all non-medical and non-admissible costs at the time of discharge.
  • If the insured person is unable to provide the necessary medical information, the Company/TPA reserves the right to deny pre-authorization.
  • If the insured person’s request for cashless access is denied, they may still receive treatment as directed by their doctor and submit their claim paperwork to the company or TPA for reimbursement.

Reimbursement Process:

The insured person may provide the necessary documentation to the company within the time frame required by this agreement to be reimbursed for claims;

  • Reimbursement of hospitalization, daycare, and pre-hospitalization expenses

Within 30 days of the hospital discharge date.

  • Reimbursement of post-hospitalization expenses

Fifteen days after the end of the post-hospitalization care.

Documents to Be Submitted:

The following documents must be attached to the reimbursement claim, which must also be submitted within the allotted time frame.

  • Duly Completed claim form.
  • Medical practitioner’s prescription advising admission.
  • KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines.
  • Original bills with itemized break-up
  • Payment receipts
  • Investigation/ Diagnostic test reports etc. supported by the prescription from the attending medical practitioner
  • OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases).
  • Photo Identity proof of the patient.
  • Discharge summary including complete medical history of the patient along with other details.
  • Sticker/invoices of the Implants, wherever applicable.
  • MLR (Medico-Legal Report copy if carried out and FIR (First information report) if registered, wherever applicable.
  • NEFT Details (to enable direct credit of claim amount in a bank account) and cancelled cheque.
  • Legal heir/succession certificate, wherever applicable.
  • Any other relevant document required by the Company/TPA for assessment of the claim.

How To Renew the SBI Divyanga Suraksha Insurance Plan?

Your SBI Divyanga Suraksha health insurance policy’s coverage benefits end the moment it expires. It is well known that there is a risk of exposure as a result. Accidents and hospitalisations for unrelated conditions can occur at any time; if the insurance is not in effect, a financial crisis (on top of a medical emergency) is a double blow.

Listed below are the steps to renew the SBI Divyanga Suraksha Insurance Plan.

  • Go to SBI General Insurance’s official website.
  • You’ll find the “Renew” button at the top. Just click it.
  • After clicking it, you must choose “Health Policy” from the list of options under “Renew Your SBI General Insurance Policy Within Minutes” to proceed with renewing your SBI Divyanga Suraksha Insurance Plan. Select “Continue” from the list of health policy buttons.
  • Enter your policy number after choosing your policy type. Click “Get Quote” after that.
  • The specifics of your SBI Divyanga Suraksha plan will then be visible to you.
  • After that, paying to have your insurance renewed is required. After that, you can renew your insurance using a credit or debit card.
  • After you pay, a message containing details about your policy will be sent to the email and phone number you have on record.

Frequently Asked Questions

No, all HIV claims are subject to a 30-day waiting period.

The two-year waiting period for disabilities only applies to hospitalisation or treatment related to an already-existing disability. After 30 days, additional hospitalisation will be covered as long as the terms and conditions of the product are met.

Under this product, the insured is only permitted to purchase one policy from each insurer. The maximum sum insured under this product may not be exceeded by the aggregate maximum liability of all policies from all insurers.

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