Overview
SBI General Arogya Premier is a high-value health insurance plan created for customers who want wider protection and premium healthcare access. It offers sum insured options from ten lakh to thirty lakh and covers hospitalisation, day care procedures, domiciliary treatment, organ donor surgery, maternity after nine months, air ambulance and free health check ups after four consecutive claim free years. Benefits include auto reinstatement of the base sum insured, tax deductions under Section 80D and no pre-policy medical tests up to age 55 for customers without medical history. The plan supports individuals and families with long term security.
Experts' Review
Written by Nikhil Nair
Senior Writer
Arogya Premier is designed for customers who want extensive protection and access to quality hospitals. The high sum insured range of ₹10 lakhs to ₹30 lakhs suits urban families and individuals who want a stronger financial cushion against rising medical costs. Coverage includes in patient hospitalisation, day care procedures, air ambulance, organ donor expenses, maternity cover after 9 months, domiciliary hospitalisation and reinstatement of the sum insured at no extra charge if the base cover is fully used during the year.
The plan also provides a 10% cumulative bonus for every claim free year, up to 50%, and health check ups up to ₹5,000 after four claim free years. Entry age begins at three months and goes up to 65 years, with the advantage of no pre-policy medical tests required for customers up to 55 years with no medical history. Long term policy terms of one, two or three years allow customers to lock in premiums.
While the coverage is strong, customers should note that it follows standard waiting periods for pre-existing diseases and specific conditions. It also excludes non medical expenses, cosmetic treatments and certain advanced procedures unless medically necessary.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Doctor consultations are not covered, which is a notable gap.
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 diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
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.
STDs other than HIV
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.
Any types of gastric or duodenal ulcers
Tonsillectomy
Adenoidectomy
Mastoidectomy
Tympanoplasty
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
Doctor consultations are not covered.
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Frequently Asked Questions
Does Arogya Premier 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.
- Maternity and Newborn Waiting Period: There’s a 9-month waiting period before you can make claims related to pregnancy and childbirth.
Does Arogya Premier have room rent restrictions?
Does Arogya Premier offer a restoration benefit?
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