SBI General Group Health Insurance Plan

Backed by reputed names in the industry, SBI General has a good reputation in the general insurance segment. The company offers a range of retail and corporate insurance solutions, SBI Group Health Insurance being one of them.
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Key Statistics of SBI General Insurance Company
GHI Premiums
ā‚¹905 crores
FY 2021
GHI lives insured
14.12 lakh
FY 2020
Health lives insured
40.39 lakh
FY 2020
Health claims Processed
95,204
FY 2020
Health claims Settlement Ratio
66.08%
FY 2020
Claims Settled within 3 months
65.13%
FY 2020
*Source - IRDAI and IBAI annual reportsĀ Ā **GMC - Group Medical Cover
***Claims Settlement Ratio (CSR) is the percentage of claims settled by the insurance company against the no. of claims obtained in a financial year. A high claim settlement ratio indicates the good financial health of the insurance group.
GHI Premiums
ā‚¹1,009 crores
FY 2021
GHI lives insured
53 lakhs
FY 2020
Health lives insured
1.72 crores
FY 2020
Claims Processed
1,67,673
FY 2020
Claims Settlement Ratio
86.52%
FY 2020
Claims Settled within 3 months
86.42%
FY 2020

What is Group Health Insurance?

Before delving into the features and benefits of the SBI Group Health Insurance policy, let's understand the meaning of a group health insurance policy in the first place to know how it all works. A group health plan is a plan which covers the members of a registered group under its scope. The group can be an employer-employee group, trade unions, associations, trusts, banks, account holders, clubs, etc.
A single master policy is issued, which covers all the named members. Each member has an independent sum insured. The policy is usually issued for a year. During the year, any insured member can make a claim and the insurance company would pay the claim. Coverage for other members, however, would run unaffected throughout the tenure. The sum insured is fixed on a mutual understanding between the insurer and the group. The premium can be paid by the group itself, its members or by both.
Highlights Ā of SBIĀ General Group Health Insurance
Dedicated health assistance services
21,000 employees and 8,000 agents
23,000 branches across State Bank group and 5,500 regional rural bank branches
More than 6,000 hospitals
125 locations pan India
More than 6.8 crore existing customers

Standard Benefits Offered by SBIĀ General Group Health Insurance

SBI Group Health Insurance Plan can be taken by different groups for their members. Any registered group with a minimum of 25 members can buy this policy.
Feature
Type of cover
Who/What is included?
Room rent, boarding expenses, and nursing charges
Fee payable to medical practitioners and specialistsĀ 
Cost of medicine, oxygen, blood, etc.
Coverage for HIV or AIDS
Genetic and congenital illnesses
Domiciliary hospitalisation, if it exceeds 3 continuous days
Pre and post hospitalization expenses
60 days and 90 days, respectively
Day care treatment
Day care treatments are covered
Mental health
Yes, coverage for mental illnesses that require inpatient hospitalisationĀ 
General list of exclusions
Pre-existing illnesses would not be covered in the first 48 months of buying the plan
Specific illnesses and treatments would have a waiting period of 90 days or 24 months as specified in the policy
Illnesses within the first 30 days of the plan are not covered
International treatments
Illnesses or injuries due to war or nuclear perils
Cosmetic treatments
Experimental treatments
Dental treatments
Self-inflicted injuries or breach of law
Optional coverage benefits
Annual medical check-ups
Insured members can undergo preventive health check-ups every year, free of cost
Critical illness cover
A list of critical illnesses would be covered under this add-on. If the insured member suffers from any listed illness, a lump sum benefit would be paid
Coverage for outpatient expenses
Under this add-on, the costs incurred on an outpatient basis, i.e., without being hospitalized, are also covered.
Family floater cover
This add-on extends the group insurance cover to the family members of the insured members.
Maternity
Insured members can avail of maternity coverage with or without a waiting period of 9 months. This coverage would cover the cost of childbirth.
Eligibility and other conditions
Minimum number of members
25
Entry age for members
3 months to 65 years
Maximum coverage age
Adults - lifelong
Dependent children - 23 years
Sum insured
Rs.50,000 to Rs.7.5 lakhs per insured member
Term of coverage
1 year
Copayment
10% if admitted to a non-network hospital
Please note that Plum has collated and presented this data for informational purposes only and at a particular point in time. Plum does not endorse, rate, or recommend any particular insurer or insurance product offered by an insurer. The final terms, conditions, and premiums may vary depending upon factors including group size, age, location, and applicable taxes.

Here's how SBIĀ General is better with Plum

Plum is an insurance platform that offers tailor-made employee healthcare solutions for your organization. Looking for a reason to choose us? Well, hereā€™s 6.
Seamless digital process
Suffered a claim? Inform us over WhatsApp and get digitised claim settlement services.
Customized plans for all
Get a choice of group insurance plans offering comprehensive benefits at affordable rates.
Scales as you expand your team
Add or remove employees and medical benefits as you scale.
Consult a doctor
We offer free teleconsultations through our Teledoc service for our insured members. Now a doctor is just a call away!
Plum Wellness program
Coverage enhancement through health and wellness benefits, only at Plum.
Chat on WhatsApp
With our WhatsApp interface, your members can access their policies any time, anywhere.
Plumā€™s admin dashboard
Automate and manage your day-to-day employee benefits on a single platform.
Track your claims
Know how your team is utilizing their employee benefits and medical coverage.
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How Does Plum Work?

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Open
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to access your insurance
Click on use
my insurance button
on the dashboard
Select
Open WhatsApp
and continue to chat

SBIĀ General Claims Process

To claim SBI General Group Health Insurance Plan, insured members should follow the claims process mentioned below:
Reimbursement Claims
Cashless Claims
In the case of a non-networked hospital, you would have to pay your medical bills during treatments. When you recover, you can seek reimbursement for your claim.
Post treatment and discharge, submit the filled and signed claim form
Submit the doctorā€™s prescription wherein hospitalization is recommended along with any police FIR or medico-legal certificate in the case of accidental hospitalization
Also submit the KYC documents of the insured member
Pre and post hospitalization bills for medicine and consultation
Bank details of the employee - NEFT and cancelled cheque
Inform SBI General Insurance about the treatment. This helps you to register your claim and also to know the nearest networked hospital.
Get admitted at a network hospital.
A pre-authorization claim form should be filled out detailing the claim.
Submit the form 3-4 days before a planned hospitalization or within 24 hours of an emergency admission.
If cashless approval is allowed, you can get treatments on a cashless basis. SBI General would pay your medical bills to the hospital.
After recovery, submit the claim form and the relevant documents to close the claim.
Reimbursement claim
Cashless claim
In the case of a non-networked hospital, you would have to pay your medical bills during treatments. When you recover, you can seek reimbursement for your claim.
Post treatment and discharge, submit the filled and signed claim form
Submit the doctorā€™s prescription wherein hospitalization is recommended along with any police FIR or medico-legal certificate in the case of accidental hospitalization
Also submit the KYC documents of the insured member
Pre and post hospitalization bills for medicine and consultation
Bank details of the employee - NEFT and cancelled cheque
Inform SBI General Insurance about the treatment. This helps you to register your claim and also to know the nearest networked hospital.
Get admitted at a network hospital.
A pre-authorization claim form should be filled out detailing the claim.
Submit the form 3-4 days before a planned hospitalization or within 24 hours of an emergency admission.
If cashless approval is allowed, you can get treatments on a cashless basis. SBI General would pay your medical bills to the hospital.
After recovery, submit the claim form and the relevant documents to close the claim.

Hereā€™s why you will love Plum

With Plum, get complete access to your insurance plan on WhatsApp
Check your healthcare benefits
Intimate your claim
Read whatā€™s covered and not covered
Select other health benefits
Download your Digital health ID Card
See daycare treatment list

Frequently askedĀ 
questions

Is there a premium loading applicable to SBI Group Health Insurance Plan?

Yes, depending on the Incurred Claims Ratio (ICR) of SBI General, a premium loading ranging from 20% to 160% of the premium might be levied.Ā 

How many family members can be covered under the policy?

SBI Group Health Insurance Plan allows coverage for a memberā€™s spouse, dependent children, siblings, dependent parents, and dependent parents-in-law. A maximum of 6 members can be covered.Ā 

What is the coverage limit for room rent or boarding expenses?

The room rent sub-limit is 1% of the sum insured up to a maximum of Rs.1,500/day. In the case of ICU admission, the limit is increased to 2% of the sum insured, up to a maximum of Rs.2,500/day.

What is domiciliary hospitalization?

Domiciliary hospitalization means getting hospitalized at your home. This type of hospitalization is covered if your condition is too critical to be moved to a hospital or if there is no vacancy at a hospital. SBI Group Health Insurance Plan covers such domiciliary hospitalizations, up to 20% of the sum insured, subject to a maximum coverage limit of Rs.20,000.

Is coverage available for Ayurveda or homeopathy treatments?

SBI Group Health Insurance Plan does not have inbuilt coverage for Ayurvedic or homeopathic treatments. However, there is an add-on that allows such coverage. You can avail of the coverage by choosing the add-on and paying an additional premium for the same.Ā