Overview
The SBI Arogya Supreme Premium plan is an enhanced variant of the Arogya Supreme Plus policy, offering enhanced health insurance coverage. It includes extended post-hospitalization coverage from 60to 180 days, comprehensive in-patient hospitalization, and optional benefits like hospital cash, enhanced cumulative bonus (50% up to a maximum of 200% of the base SI, in case of no claims) and no claim bonus protector (if claim is less than 50,000).. The plan provides sum insured options from ₹25 lakhs and above, with lifelong renewability and a network of over 16,600 hospitals.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Arogya Supreme Premium plan by SBI is a comprehensive health insurance solution with notable updates, such as extended post-hospitalization coverage to 180 days, which enhances financial support during recovery. However, the plan has limitations, including extensive disease-wise sub-limits on cataracts and modern treatments, which may restrict coverage for high-cost procedures. The No-Claim Bonus is modest at 15% (up to 100%) with clawbacks, which may not incentivize claim-free years as much as other plans.
While SBI General has a competitive average claim settlement ratio of 97% (across 2021-24), the plan's operational efficiency and credibility concerns may impact policyholders' experiences. For comprehensive coverage without sub-limits, buyers might find better options in the market.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
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.
Customisable
Choose a co-payment between 10% and 20% to reduce premiums.
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 cataracts, 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 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Enhanced Cumulative Bonus
Recommended
Additional bonus of 50% up to a maximum of 200%, with a clawback of 50% if claimed in the previous year. Remember, you cannot opt out of this rider at renewal once you opt for this rider.
No Claim Bonus Protector
Recommended
Your bonus amount will not be affected if the claim is less than Rs. 50,000 in the entire year.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a payout between ₹500 to ₹5000 for defined number of days.
Major Illness
Paid out as 100% of the sum insured for 30 illnesses.
Voluntary Co-Payment
Choose a co-payment between 10% and 20% to reduce premiums.
Per Claim Deductible
Choose deductible between ₹10,000 and ₹25,000 and get a discount on premiums.
Accidental Hospitalization Additional Cover
Additional 1.5x or 2x of base sum insured applicable for emergency-caused directly due to an accident.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
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.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs 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 2 years.
Internal Congenital diseases
Diseases of gall bladder including cholecystitis
Urogenital system diseases (e.g., kidney stone, urinary bladder stone)
Pancreatitis
Ulcer and erosion of stomach and duodenum
Waiting Period
30 days Initial waiting period
2 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.
What's missing in the policy
Maternity benefits not offered.
Doctor consultations are not covered.
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does Arogya Supreme Premium 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 2-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.
- 90-Day Waiting Period: Hospitalizations won’t be covered for Diabetes, Hypertension and Cardiac conditions if these are not diagnosed as PEDs at the time of purchase.
Does Arogya Supreme Premium have room rent restrictions?
Does Arogya Supreme Premium offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.