SBI Health Edge Plan
SBI Health Insurance recently unveiled the Health Edge policy, a dedicated and flexible health insurance plan that is available to insurance holders based on their needs. The plan offers 9 mandatory and 18 optional indemnity covers. SBI Health Edge is a simple, hassle-free health insurance option that is only available online. The sum insured for the health insurance plan ranges from INR 3 to 25 Lacs and can be purchased for a long time of 3 years.
The Health Edge insurance plan from SBI offers both floater and individual policies with global treatment cover, which covers medical costs for inpatient care outside of India, and OPD cover, which covers allopathic outpatient department (OPD) costs, including diagnostics and pharmacy.
Read on to learn more about the Health Edge insurance policy by SBI in detail!
Here are the eligibility criteria for the SBI Health Edge Insurance Plan.
|Entry Age of Insured Adult||Min – 18 years and Max -65 years|
|Entry Age (Child)||91 days to 30 years|
|Sum Insured (SI)||3L, 5L,7L,10L, 15L,20L and 25Lacs|
Here are the coverage details for the Health Edge insurance policy by SBI.
|Pre-hospitalization Medical Expenses (up to Sum Insured)||30 days|
|Post-hospitalization Medical Expenses (up to Sum Insured)||60 days|
|Day Care Treatment (up to Sum Insured)||All day care covered|
|Emergency Road Ambulance Cover (per hospitalization)||INR 3000|
|Stay Fit Health Check-Up||Up to INR 5,000|
|Out Patient (OPD) Cover||INR 5000/member|
50% of the Base Sum Insured
up to 200% of Base Sum
Up to INR 25,000 for
Normal Delivery and INR
50,000 for C-section.
|Accidental Death Cover (Primary Insured only)||INR 10 Lacs/20Lacs|
|Vector Borne Fixed Benefit||INR 50K/1Lac|
|Critical Illness Cover||INR 300000/-|
|No. of Days of Hospitalization covered||5 days, 10 days, and Unlimited|
|Bariatric Surgery Cover||up to 50,000|
|Hospital Daily Cash|
INR 1000 for 10 days or
INR 2000 for 10 days
|Assisted Reproduction Treatment||INR 1 Lacs|
Features and Benefits of Choosing the SBI Health Edge Policy
The following are the key features and benefits of considering the SBI Health Edge insurance policy.
- In-Patient Hospitalization Treatment
The plan will pay You the medical expenses up to the Sum Insured and the Number of days of hospitalisation (opted) if You are Hospitalised for a Minimum of 24 Hours on the Advice of a Medical Practitioner as defined under the Policy Due to Illness or Accidental Bodily Injury, Sustained or contracted during the Policy Period.
- Pre-hospitalization Medical Expenses
For a period of 30 days, the SBI Health Edge policy will cover the insured person’s pre-hospitalization medical costs related to an illness or injury on a reimbursement-only basis.
- Post-Hospitalization Expenses
The plan will cover the insured person’s post-hospitalization medical costs incurred as a result of an illness or injury for a period of 60 days only on a reimbursement basis.
- Daycare Treatment
If the insured person is admitted for a period longer than two hours, the daycare treatment will also be covered, along with any angiography, dialysis, radiotherapy, or chemotherapy for cancer-related treatments. The plan will cover any medical costs the insured person incurs while receiving daycare services during the policy period.
- Ayush Treatment
In each Policy Year, up to the Sub-limit set forth against this Cover in the Policy Schedule, the Company shall reimburse the Insured Person for Medical Expenses incurred for Inpatient Care under the Ayurvedic, Yoga and Naturopathic, Unani, Siddha, and Homoeopathic systems of medicine in any AYUSH Hospital.
- Hospital Daily Cash
A significant benefit of the SBI Health Edge insurance policy is that, if a medically necessary hospitalisation lasts longer than 24 hours, the plan will pay the daily sum insured up to the maximum number of days and in the manner described in the policy schedule.
- Healing Benefit
If you choose this option and your medically necessary hospitalisation lasts longer than 5 consecutive and continuous days, the plan will pay you a lump sum in the amount specified in the policy schedule.
- Accidental Death Cover for Primary Insured
If the Primary Insured Person sustains an Injury solely and directly as a result of an Accident that occurs during the Policy Period and which solely and directly results in the Primary Insured Person’s death within three hundred and sixty-five (365) days from the date of Accident, the plan will pay the Primary Insured Person a lump sum amount as specified in the Policy Schedule.
- Domestic Help/Staff Indemnity
The plan will cover the Reasonable and Customary Charges for Medically Necessary Treatment received by the Insured Person, in this case, Domestic Help, for an Illness, Injury, or Condition during the Policy Period.
- Maternity Expenses
When you choose the SBI Health Edge insurance policy, the major highlight is that it will cover, after a 48-month waiting period, the Medical Expenses incurred up to the amount listed against this Benefit in the Policy Schedule for the Hospitalisation of the female Insured Person for the delivery of the child during the Policy Period.
- Assisted Reproduction Treatment
Another major reason to consider the SBI Health Edge plan is that it will pay for medical costs up to INR 1 lakh incurred for assisted reproductive treatment for infertility, but only after a 48-month waiting period from the insured person’s first day of coverage with the Company.
- Booster Benefit
If this option is chosen, the Base Sum Insured under the current Policy Year’s Base Sum Insured is increased by 50% (as specified in the Policy Schedule) for each claim-free Policy Year (where no claims are reported), provided the Policy is renewed with the Company without a break, up to a maximum cap of 200% (as specified in the Policy Schedule) of the Base Sum Insured.
- Out Patient Cover
Regardless of the type of Policy (floater or individual basis cover), the plan will reimburse the Medical Expenses per member incurred up to the amount specified against this Benefit in the Policy Schedule for the allopathic OPD expenses, including Diagnostics and Pharmacy.
- New Born Baby Cover
When you choose the plan, the Mother is also covered by the policy and the company will reimburse the Medical Expenses for a Newborn Baby up to the Sum Insured specified against this Benefit in the Policy Schedule.
- Global Treatment
If an insured person needs inpatient care outside of India during the policy period due to an illness or one of the below-listed procedures that develops or manifests itself during the policy period, the plan will cover the medical expenses.
Key Exclusions Under the SBI Health Edge Plan
Though there are many exclusions under the Health Edge insurance policy by SBI, the following is a partial list of the policy exclusions. Let’s discuss them in detail!
- War or any act of war, the use of nuclear, chemical, or biological weapons, radiation of any kind, breaking the law with malicious intent, attempting to commit suicide, engaging in risky or adventure sports like skydiving, hand gliding, deep-sea diving, motor racing, horse racing, or scuba diving, as well as receiving treatment for addiction to alcohol, drugs, or other substances, are all prohibited.
- Expenses associated with a doctor’s home visit, breaking the law attempting to do so with criminal intent, intentionally hurting oneself, or making an attempt at suicide while sane or insane.
- Any permanent exclusion that is mentioned in the Policy Schedule that applies to a policyholder’s medical or physical condition or treatment.
- Subfertility treatments that are considered to be experimental, unproven, or under investigation.
- Services that, at the time they are to be provided, are not uniformly recognised and professionally endorsed by the general medical community as being by standards of good medical practice.
- Except when the child from the first delivery or previous deliveries is/are not alive at the time of treatment, treatment received for a second or subsequent pregnancy.
- Services rendered at an unrecognised facility tubal occlusion, bariatric surgery, diagnostic laparoscopy with ovarian drilling, and other similar fertility-enhancing surgeries and procedures.
- Expenses associated with any form of treatment, including surgical intervention, to change a person’s physical characteristics to those of the other sex.
- Treatment costs that are directly related to or result from any insured person breaking the law with criminal intent or attempting to do so.
- Unless prescribed by a medical professional as part of a hospitalisation claim or daycare procedures, dietary supplements and substances can be bought without a prescription, such as but not limited to vitamins, minerals, and organic substances.
- An insured person who breaks the law with the intent to do so causes intentional harm to themselves or attempts suicide while both sane and insane.
Premium Illustration Of Health Edge Insurance Policy By SBI
Let’s take the example of Mr Lankesh Meena, a 30-year-old man from New Delhi who is employed as a product manager by a reputable MNC. A specific health plan that would shield him from high medical costs and save him time and money was what he was looking to buy. After doing a lot of research, he ultimately decided on the SBI Health Edge Insurance plan.
|Age||Sum Insured||Policy Tenure||Premium Before Tax||Total Premium|
|30 Years||Rs. 10 Lakhs||1 Year||Rs. 10,628/yr||Rs. 12,541 (Including GST & Other Taxes)|
|30 Years||Rs. 20 Lakhs||1 Year||Rs. 12,841/yr||Rs. 15,152 (Including GST & Other Taxes)|
How to Avail the SBI Health Edge Insurance Policy?
One will almost certainly need to undergo an expensive medical procedure at least once in their lifetime due to rising healthcare costs. Therefore, buying health insurance like the SBI Health Edge Plan is a sensible way to lessen high medical costs. Including a health insurance policy in your financial strategy can help you avoid a lot of headaches in the future. One of the truly remarkable benefits of having health insurance is the assurance of protection against steadily rising healthcare costs. If you are looking to buy the Health Edge insurance policy by SBI, listed below are the steps to follow.
- Visit the official website of SBI General Insurance.
- On the top, you will see the “Our products” section. After that, hover your mouse over it and then on Retail. When you put your cursor on Retail and health insurance, you will see “Health Edge” on the right. Click on it to open the plan page.
- The moment you click on it, the plan page will be opened. Scroll down a bit and you will see a box asking you to select the members you want to insure, their date of birth, mobile number, Email ID, and more.
- After that, you will see three options, namely Plan A, Plan B, & and Plan C. Click one as per your needs and then click on “Buy Now” in the blue-colored button.
- Then, you will see the premium amount on your right side along with other policy details on the page. After that, click on the “Continue” button. Once you click on it, you will need to enter your occupation and PAN number. Then, calculate your BMI. Also, in the below section, go through two of the checkboxes and select if have ever suffered from any injury or not. Then, click on the “Next” button.
- After checking all the details if you are satisfied with the policy details, click on the “Buy Now” button.
- After clicking on it, you’ll have to choose the document proof and enter your birthdate. Click “Proceed” after providing your ID proof information and birthdate.
- You can make the payment using your credit/debit card, Net Banking, EMI, or UPI on the payment page that opens after you click it. Pick the strategy that works best for you. After that, click “Proceed to Pay”.
- The final step will involve sending you a message and the policy documents via email and your registered mobile number.
How to File a Claim for the SBI Health Edge Policy?
A health insurance claim is the process by which the policyholder informs the insurer of the medical costs incurred to make a compensation claim. The insurer is accountable for covering the medical expenses following the terms and conditions of the policy. Under their health policy, the insured may submit a cashless or reimbursement medical insurance claim. The insured must work with the Third-Party Administrator or TPA and submit the necessary paperwork for cashless claims. However, the policyholder must contact the health insurance provider within the predetermined time frame for reimbursement claims.
Claim Process for Planned Hospitalisation:
- Inform your insurance company, SBI General Insurance, in advance, ideally 4-5 days before the hospitalisation, about the planned treatment.
- Locate the closest cashless hospital where you can get treatment.
- While in the hospital, present your cashless card, insurance policy number, and other pertinent paperwork.
- Download the pre-authorization form from your insurer’s website or pick one up at the hospital insurance desk. Complete it completely and send it to the insurer. You might also need to submit the pre-authorization form in advance, depending on the insurance provider.
- The insurance company, in this case, SBI General Insurance, will confirm the information and inform the hospital.
- The hospital will send the insurer the medical bills and receipts, and the costs will be paid out by the terms of the plan.
You are free to receive medical care at the hospital of your choice and then submit a claim for reimbursement. The procedures for filing a reimbursement health insurance claim are as follows:
- As soon as possible, notify the insurance company, SBI General Insurance, about the claim. You must notify the insurer of any planned treatment or urgent hospitalisation within the specified time frame.
- Cover the costs of the medical care received and keep the original receipts on hand.
- Send the insurance company the original bills, the insurance claim form, and any additional supporting paperwork.
- The insurance company, SBI General Insurance, is responsible for verifying the invoices and claim information. The insurer may ask for additional documents if more information is needed.
- The claim will be approved or denied following the terms of your insurance policy and the claim.
- If your health insurance claim has been approved, the claimed amount will be reimbursed shortly.
Documents Required to File Health Insurance Claims
Whether you are filing a cashless or reimbursement health insurance claim, you are required to submit the following documents.
- Documents detailing doctor’s consultation
- Health insurance Identity Card
- Duly filled health insurance claim form
- Copy of insurance policy document
- Medical bills and reports, including hospital admission and discharge slips, in case of hospitalisation
- Copy of your prescription and pharmacy bills
- Investigative and diagnostic reports, such as X-rays, MRIs, etc.
- Copy of the First Information Report (FIR) filed with the police or Medico-Legal Certificate (MLC), in case of an accident
- Discharge summary
- Cancelled cheque, in case of reimbursement claim
- Other relevant documents
Renewal Process of the SBI Health Edge Plan
Your health insurance policy expires if you fail to renew it on time and pay the premium within the grace period. Any claims submitted between the time of expiration and the time of renewal will be denied. Additionally, you will need to purchase new health insurance after your current policy expires.
During this time, you won’t have coverage for any medical emergencies or hospital stays, so you’ll have to pay for all of your medical expenses. The following are the steps to follow to renew your SBI Health Edge insurance policy.
- Go to the official website of SBI General Insurance.
- On the top, you will see the “Renew” button. Click on it.
- Once you click on it, you will need to select “Health Policy” to continue renewing your SBI Health Edge Plan. Click on the “Continue” button under health policy.
- After that, select your policy type and then enter your policy number. Then, click on “Get Quote”.
- Then, you will see the details of your SBI Health Edge plan.
- After that, you must pay to have your insurance renewed. After that, you can use a credit or debit card to renew your insurance.
- The email address and phone number you have on file will receive a message with information about your policy after you make your payment.
Frequently Asked Questions
No, under Family Floater, a parent and parent-in-law combination is not permitted.
No pre-policy check-up till 55 years of age.
The planned treatment under this cover shall be claimed on a Reimbursement basis in Indian currency only.
The Family Floater can accommodate a maximum of 4 adults. Self, a spouse, a group of dependent parents, or parents-in-law are considered to be 4 adults.