Overview
SBI General’s Retail Health Insurance Policy is a basic, entry level medical insurance plan designed for individuals and families seeking affordable hospitalisation coverage. It offers sum insured options from ₹50,000 to ₹5 lakh and covers room rent, ICU charges, surgery costs, consultation fees, and pre and post hospitalisation. The plan includes benefits like domiciliary hospitalisation, 12 advanced treatments, cataract cover, parental and child attendant care, day care procedures and free health check-ups every four claim-free years. With flexible city-based plan options, no pre-policy medical tests up to age 45 and lifelong renewability, it delivers broad yet cost-efficient protection.
Experts' Review
Written by Nikhil Nair
Senior Writer
SBI General’s Retail Health Insurance Policy is a versatile and budget-friendly option for families, young earners and first-time buyers who want essential but dependable health cover. The plan offers wide hospitalisation benefits, including room rent up to 1% of the sum insured per day and ICU up to 2%, up to 25% of sum insured. It also covers anaesthesia, blood, oxygen, OT charges, and surgical appliances, capped at 40% per illness. Pre and post hospitalisation are covered for 30 and 60 days, and ambulance cover is available up to 1% percent of the sum insured, capped at ₹1,500.
The policy also includes value-adds such as domiciliary hospitalisation, parental attendant care for senior insured members, child escort care, convalescence benefit, cataract cover, HIV or AIDS treatment up to ₹50,000, mental illness cover and recognised alternative treatments. Coverage varies slightly by geography, with Plan A, Plan B and Plan C determining claim payouts based on the insured’s city tier. The plan’s cumulative bonus offers 5% for every claim-free year, up to 25%, and pre-acceptance medical tests are not required for those below forty-five with no medical history.
While the sum insured maxes out at ₹5 lakh and room rent sub-limits apply unless add-ons are purchased, the policy remains competitive for families seeking structured cover without complex features. Waiting periods include thirty days for illnesses, forty-eight months for pre-existing conditions and staged waiting for specific diseases.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
Maternity benefits not offered, 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
On most occasions the insurer will pay your medical bills in full up to the sum insured — no questions asked. However, if you were forced to be treated in a hospital that’s not a part of their network, then they’ll make you co-pay 10% of the final bill.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Customisable
Removes room rent restriction from 1% of the sum insured to any room.
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 upto 10% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Removal of Room Rent limits
Recommended
Removes room rent restriction from 1% of the sum insured to any room.
Removal of Operation and Consultancy charges limit
Removes the limits on Operation and Consultancy charges.
Removal of Ayush treatment limit
Removes the limits on Ayush coverage.
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 and proved to our satisfaction that the condition is a result of an accidental 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 3 years.
Any types of gastric or duodenal ulcers
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 and Piles
Waiting Period
30 days Initial waiting period
3 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
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Retail Health Policy 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 3-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 Retail Health Policy have room rent restrictions?
Does Retail Health Policy offer a restoration benefit?
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