SBI Group Health Insurance
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
GHI lives insured
Health lives insured
Health claims Processed
Health claims settlement ratio***
Health claims Settled within 3 months
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, and more.
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 of Group Care 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 SBI group health insurance
Feature
Type of Cover
What is covered?
Room rent, boarding expenses, and nursing charges
Fees payable to medical practitioners and specialists
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 hospitalisation cover
60 days and 90 days, respectively
Day care treatment
Covered
Mental health
Yes, coverage for mental illnesses that require in-patient hospitalisation
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 benefits
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 SBI 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, here’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’s admin dashboard
Get access to corporate wellness programmes for your employees.
Track your claims
Know how your team is utilizing their employee benefits and medical coverage.
SBI General claims process
To claim SBI General group health insurance plan, insured members should follow the claims process mentioned below:
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 doctor’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.
Frequently Asked Questions
Can I add or remove members after the initial setup?
Super top-up is additional coverage of 20 lakhs added to your existing policy. You can avail the additional cover for yourself, and/or for your entire family (self+spouse+2 kids), and/or your parents.
This policy, however, comes with waiting periods on certain critical illnesses and applicable deductibles.
How are premiums calculated for additions?
Yes, you can add new employees, add new dependents (at the time of marriage or childbirth), and remove employees who exit the company. Additions and deletions can be done using the Plum dashboard.
Do I get refunded for deletions?
Deductible refers to the amount paid by the policyholder (via out-of-pocket or other medical insurance policy) before the super top-up kicks in. Read all about how a deductible works here.
How do I pay for additions and deletions?
No, the policy doesn’t cover same-sex or unmarried couples.
Can an employee convert the group plan to an individual plan if they leave the company?
No, the policy doesn’t cover same-sex or unmarried couples.