Overview
The SBI Arogya Plus Plan is a health insurance policy that covers hospitalization and outpatient expenses up to ₹3 lakhs. It includes benefits like pre- and post-hospitalization coverage, AYUSH treatments, domiciliary hospitalization, and 141 daycare procedures. With no co-payment or room rent restrictions, it provides financial protection against rising medical costs for individuals and families at an affordable premium.
Experts' Review
Written by Nikhil Nair
Senior Writer
The SBI Arogya Plus plan is designed to be a budget-friendly option for those seeking basic health insurance coverage. The absence of co-payment and room rent restrictions is a definite plus as it allows you to pick any room without worrying about additional charges, which is rare in this price range.
The inclusion of outpatient expenses is a standout feature, as most basic health plans don’t cover consultations or treatments outside of hospitalization. Coverage for AYUSH treatments and 141 daycare procedures also adds value, catering to both traditional and modern healthcare needs.
However, the sum insured cap at ₹3 lakhs is significantly limiting, especially for those living in Tier-1 cities where medical costs can be considerably higher.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
SBI
Key Insights
Founded
2009
SBI was established 16 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
96% claims settled in 30 Days
SBI settles 96% of all claims it receives demonstrating strong credibility.
Network Hospitals
16,600+
SBI has a strong network with over 16,600 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
21 complaints per 10,000 claims registered
SBI experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with certain illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years but it will cover Hypertension, Heart Disease & diabetes after just 90 days.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Surgery to correct deviated septum and hypertrophied turbinate
unless necessitated by an accidental body injury.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 1 years.
Gastric or Duodenal Ulcers (any type)
Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty
Surgery on all internal or external tumors/cysts/nodules/polyps (including breast lumps)
All types of Hernia and Hydrocele
Anal Fissures, Fistula in anus, Hemorrhoids/Piles
Waiting Period
30 days Initial waiting period
1 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard overall. However, specific illness waiting period is better than usual.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
Customer Reviews
A
Alisha Mehra
inpatient, for treatment costs and hospitalization expenses covered, is great for doctor visits and tests!
B
Bharat Negi
No co-payment means I don't have to worry about paying a percentage of the bill.
C
Chhavi Pant
No room rent restrictions is a big relief, can choose a good room without extra cost.
J
Jatin Rana
Wish it had a higher sum insured option for more comprehensive protection.
H
Harsh Rawat
Sum insured of ₹3 lakhs might be low for major surgeries in big cities.
F
Farooq Ahmed
Pre and post hospitalization expenses are also taken care of. Good overall coverage.
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Frequently Asked Questions
Does Arogya Plus have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Arogya Plus have room rent restrictions?
Does Arogya Plus offer a restoration benefit?
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