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SBI General Insurance Company

Ltd
Arogya Plus Policy

Arogya Plus Policy- Fixed Premium


Plans
OPD Cover and
Hospitalization
cover

Fixed Premium
Plans

Cover up to 3
years

Key Features- Arogya Plus Policy


Entry Age: 3 Months to 65 years, cover available for
individual and family.

OPD consultation and treatment up to the


specified limits

Key Features- Arogya Plus Policy

Eligible Hospitalization expenses


Room Rent, Boarding expenses
Medical Practitioners Fee
Intensive Care Unit charges
Nursing Expenses
Anaesthesia, blood, oxygen, operation theatre expenses, surgical
appliances, medicines & consumables, diagnostic expenses and xray, dialysis, chemotherapy, radiotherapy, cost of pacemaker,
prosthesis/internal implants and any medical expenses incurred
which is integral part of the operation

Key Features- Arogya Plus Policy

Eligible Hospitalization expenses cont


Physiotherapy as inpatient care and being part of the treatment
Drugs,
medicines
and
hospitalization period

consumables

Diagnostic procedures
Dressing, ordinary splints and plaster casts.

consumed

during

Key Features- Arogya Plus Policy


contd..

Pre and Post Hospitalization of 60 and 90 days respectively

142 Day Care expenses

Ambulance charges up to Rs 1,500/-

Cover for Maternity Expenses up to the OPD limit in the


policy.

No Pre medical test up to 55 years of age.

Key Features- Arogya Plus Policy


contd..

Sum Insured option of Rs 1,00,000 to 3,00,000/-

Policy period up to 3 years.

Portability option available

Grace period of 30 days post lapse of policy for continued


benefits

Income tax relief under Sec 80 D of Income Tax Act can be


taken for the premium paid.

Key Exclusions- Arogya Plus Policy


Key Exclusions:

Time based exclusions for specific treatments for first 48 months

Time based exclusions for specific treatments for first 12 months

First 30 days exclusion for illness/sickness except hospitalization


due to injury

First 9 months exclusion for Maternity expenses.

Treatment taken outside India

Injury/disease directly or indirectly caused or contributed due to


nuclear weapons/materials

Key Exclusions- Arogya Plus Policy


Key Exclusions cont:

War, invasion, acts of foreign enemy, hostilities, etc

Epidemic disease recognized by WHO or Indian Government.

Intentional self injury or violation of any law.

Cosmetic or aesthetic treatments of any description, lasik


treatment for refractive error. Any form of plastic surgery (unless
necessary for the treatment of illness or accidental bodily injury).

Treatment for de-addiction from drug or alcohol or other


substance.

Key Exclusions- Arogya Plus Policy

Any condition directly or indirectly caused by or associated


with human immunodeficiency virus or variant/mutant viruses
and or any syndrome or condition of a similar kind commonly
referred to as AIDS.

Vaccination or inoculation except as part of post-bite


treatment for animal bite

Treatment for any mental illness or psychiatric or


psychological ailment / condition.

Genetic disorders and stem cell implantation /


surgery/storage.

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Key Exclusions- Arogya Plus Policy

Treatments in health hydro, spas, nature care clinics and the


like.

Experimental and unproven treatment.

Disease / illness or injury whilst performing duties as a serving


member of a military or police force.
(Note: the above is a partial listing of the policy exclusions.
Please refer to the policy wordings for the full listing)

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Arogya Plus Policy- Claims process flow

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Arogya Plus Policy Claim processcontd.


Dedicated Centralized Health Claims Team including qualified
doctors to manage all health products including Critical Illness
and Hospital Cash.

Retail Indemnity Claims management and cashless access


through Top performing TPAs in the market servicing >1 Million
Lives.
Paramount TPA
MD India TPA
Medicare TPA

Serviced over 1.3 Million claims in 2011-12

Work allocation to TPAs linked to SBI Circles.

TPA performance monitoring through signed SLAs and


performance linked variable incentives and work allocation.
Focused on Service (TATs), quality of care and claims cost.

Access to 3000+ Hospitals including Leading Multi specialty


Hospitals PAN India
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Arogya Plus Policy Premium


Computation
Basis of Rating

Pricing Criteria
Deductible Opted
Age
Sum Insured
No of family member covered
Family (non floater)/Family
(Floater)
Policy Period

Rank by Priority/Weight
age
1
2
3
4
5
6

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Arogya Plus Policy Premium


Computation
Loading
Basic Premium will be loaded by 5% each for habit of smoking, alcohol
and any other type of tobacco including betel nut in any form for which
prior consent will taken from insured.

Discount

Base on number of family member covered and Policy duration etc


following discount will applied.
1.
Family (non floater) discount
2 member = 5%.
>2 members = 7.5%.
2.
Long term discount
2 year = 5%
3 year = 7.5%

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Thank You

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