Overview
The SBI Arogya Supreme Pro plan is a basic health insurance policy offering essential coverage with a sum insured range of ₹3 lakhs and 5 lakhs. The plan includes optional benefits like hospital cash and enhanced cumulative bonus (25% increase up to a maximum of 200% of the base cover, in case of no claims). However, it has disease-wise sub-limits on cataracts and modern treatments and room rent restrictions, limiting its comprehensive appeal.
Experts' Review
Written by Nikhil Nair
Senior Writer
The SBI Arogya Supreme Pro plan is a straightforward health insurance solution with some notable limitations. Its lack of co-payment is a positive aspect, ensuring that policyholders do not have to bear additional costs during hospitalization.
However, the plan has 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% of the base cover) with clawbacks, and pre- and post-hospitalization coverage is limited to 30 and 60 days, respectively.
While SBI's claim settlement ratio is competitive at a 3-year average (2021-24) of 97%, operational efficiency concerns persist due to limited grievance redressal metrics. For comprehensive health insurance, buyers might find better options that offer broader coverage without sub-limits and more robust operational support.
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
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Customisable
Change Single Private Room to Any Room except for suite & above.
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 - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Enhanced Cumulative Bonus
Recommended
Additional bonus of 25% up to a maximum of 200%, with a clawback of 25% if claimed in the previous year. Remember, you cannot opt out of this rider at renewal once you opt for this rider.
Room Rent Modifier
Recommended
Change Single Private Room to Any Room except for suite & above.
Hospital Cash
Hospital cash benefit paid out if hospitalisation 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.
No Claim Bonus Protector
Your bonus amount will not be affected if the claim is less than Rs. 50,000 in the entire year.
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.
Customer Reviews
A
Aarav S.
Basic health insurance policy offering essential coverage. Good for starters.
A
Aanya V.
Sum insured options up to ₹5 lakhs, suitable for those with limited budget.
A
Aditya G.
Focuses on affordability while providing necessary protection.
A
Arjun J (new)
Operational efficiency of PSU insurers can be a concern for quick claim processing.
A
Anirudh K.
Sum insured is quite low (up to ₹5L), may not be sufficient for major illnesses or city treatments.
A
Akhil P.
A good entry-level plan from a trusted public sector insurer.
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Frequently Asked Questions
Does Arogya Supreme Pro 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 Pro have room rent restrictions?
Does Arogya Supreme Pro offer a restoration benefit?
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