Overview
The SBI Arogya Top-up plan offers an affordable way to extend health coverage, with sum insured options ranging from ₹1 lakh to ₹50 lakhs. The plan features no co-payment, no room rent restrictions, and covers pre- and post-hospitalization expenses (60 and 90 days, respectively). It is suitable for those seeking to bolster their existing health cover at a low premium, with options for 1, 2, or 3-year policies.
Experts' Review
Written by Nikhil Nair
Senior Writer
The SBI Arogya Top-up plan is a decent option for those looking to significantly increase their health coverage, especially since it offers a maximum sum insured of up to ₹50 lakhs. Its key USP is the no co-payment and no room rent restriction clause, meaning the insurer covers the entire treatment cost up to the sum insured, which is a major advantage for policyholders.
However, the plan’s main limitation is its high deductible, which varies from ₹1 lakh to ₹10 lakhs, meaning policyholders must pay this amount out-of-pocket or from a base plan before the insurer kicks in. While premiums are generally affordable—about 10-15% lower than comparable plans—the disease-wise limit on modern treatments, Mental illness & Internal Congenital Diseases can be a concern for those anticipating frequent or costly medical needs.
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.
Your insurer doesn’t provide free health check-ups, which could be a drawback for some.
Doctor consultations are not covered, 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 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.
STS 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
Surgery on internal or external tumour, cysts, nodules, polyps (of any kind including breast lumps)
All types of Hernia and Hydrocele
Anal Fissures, Fistula and 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.
Your insurer doesn’t provide free health check-ups.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Arogya Top-up 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 90 days to 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 Top-up have room rent restrictions?
Does Arogya Top-up offer a restoration benefit?
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