SBI Life Smart Health Insurance Plan
This plan has been withdrawn by the insurance company and is no longer available for sale.
SBI Life Smart Health Insurance Plan
SBI Life Smart Health Insurance Plan is a Fixed Benefit Comprehensive Health Plan. It is a Traditional Plan without Bonus facility.
Health Benefits
Family Benefits
No Claim Bonus
Compare this plan with other Health Plans
Key Features
Family Benefits
- This policy can be extended for the entire family as well for self, spouse, parents, children as well as parents-in-law.
- This plan covers till 70 years of age and the premium is fixed for the entire tenure of 5 years, irrespective of claim.
- There is a family discount of maximum 10% for 4 members in the plan
Health Benefits
- It is a Hospitalization cum Surgical Benefit Plan
- In this plan,
- Provides a fixed payout based on per day of Hospitalization
- Offers lump sum payout on all surgical procedures including non-listed surgeries
- Helps to cover post-hospitalization expenses through Recuperation Benefit
- There are 136 Day Care Procedures coverage in this plan as well
- Pre-existing illnesses are covered after 2 years of con tenuous renewal
No Claim Bonus
Benefits
Death Benefit
Being a pure health plan, there is no Death Benefit payable in this plan
Maturity Benefit
Being a pure health plan, there is no Maturity Benefit payable in this plan
Income Tax Benefit
Health Insurance premiums paid up to Rs. 15,000 are allowed as a deduction from the taxable income each year under section 80D.
Riders
There are no additional riders in this plan
Variants
The below illustration is for a healthy male of age 30, 40 and 50 years opting for Annual Basic Sum Assured of Rs 4 lakhs and 5 lakhs respectively.
How it works
In this plan, premium needs to be paid for the entire period of 5 years, during which the premium remains constant irrespective of the claim. This policy can be extended for the entire family as well for self, spouse, parents, children as well as parents-in-law.
There are 5 plans of Rs 1 lakh of Annual Basic Sum Assured, Rs 2 lakhs of Annual Basic Sum Assured, Rs 3 lakhs of Annual Basic Sum Assured, Rs 4 lakhs of Annual Basic Sum Assured and Rs 5 lakhs of Annual Basic Sum Assured. Other Benefits are mapped to Annual Basic Sum Assured.
The Basic Health Benefits in this plan are as follows:
- Daily Hospitalization Cash Benefit
- Daily ICU Benefit
- Lumpsum Surgical Benefit
- Recuperation Benefit for hospitalization of more than 10 days
- Day Care Treatment
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Type
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Amount of Benefit
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Daily Hospital Cash Benefit
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1% of Annual Basic Sum Assured
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Daily ICU Benefit
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2% of Annual Basic Sum Assured
|
|
Listed Surgical Benefit
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There are 4 Grades:
Grade I Surgery- 25% of Annual Basic Sum Assured
Grade II Surgery- 50% of Annual Basic Sum Assured
Grade III Surgery- 75% of Annual Basic Sum Assured
Grade IV Surgery-100% of Annual Basic Sum Assured
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Non Listed Surgical Benefit
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7.5% of Annual Basic Sum Assured
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136 Listed Day Care Treatment
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10% of Annual Basic Sum Assured
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Now, there are certain limits of the Benefits payable as well.
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Type
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Amount of Benefit
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Lifetime Limit
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Daily Hospital Cash Benefit and ICU Benefit
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1.3% of Annual Basic Sum Assured in Year 1
100% of Annual Basic Sum Assured from Year 2 onwards
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3.6 times the Annual Basic Sum Assured
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|
Listed Surgical Benefit and Day Car e Benefit
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100% of Annual Basic Sum Assured
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300% of Annual Basic Sum Assured
|
|
Non Listed Surgical Benefit
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Payable for only 2 procedures
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Payable for only 10 procedures
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136 Listed Day Care Treatment
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Payable for only 1 time
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Payable for only 4 times
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This is a Benefit Plan and not a Reimbursement Plan and hence it can be used over and above other Health Insurance Reimbursement Mediclaim Plans. This Plan has fixed Lumpsum Benefits, irrespective of the actual hospitalization amount.
Eligibility
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Minimum
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Maximum
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|
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Sum Assured (in Rs.)
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1 lakh
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5 lakhs
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Policy Term (in years)
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5
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|
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Premium Payment Term (in years)
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Equal to Policy Tenure of 5 years
|
|
|
Entry Age of Life Insured (in years)
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18
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65
|
|
Entry Age of Dependent Children (in years)
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3 months
|
22
|
|
Age at Maturity (in years)
|
-
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70
|
|
Age at Maturity for Dependent Children (in years)
|
-
|
27
|
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Age at Maturity for Renewal (in years)
|
-
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65
|
|
Relationship Covered
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Self / Spouse / Dependent Children / Parents & Parents-in-law
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|
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Payment modes
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Yearly, Half-Yearly, Quarterly and Monthly
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|
Exclusions
The Permanent Exclusions of this policy are:
- Self afflicted injuries or conditions (including attempted suicide) and/or conditions/ailments arising out of the use or misuse of any drugs or alcohol or intoxicants of any kind or banned substance.
- Any sexually transmitted diseases or any condition directly or indirectly caused to or associated with Human Immuno Deficiency (HIV) Virus or any Syndrome or condition of a similar kind commonly referred to as AIDS.
- War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection military or usurped power of civil commotion or loot or pillage in connection herewith.
- Police personnel, Naval or military operations(including duties of peace time) of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like.
- Injury directly or indirectly arising from high risk activities or sports including but not limited to engaging in or taking part in: mountaineering, rock climbing, hunting potholing, parachuting, parasailing, bungee jumping, canyoning, hang-gliding, hot balloon aviation, daring feats or stunts, driving or riding in any kind of race, scuba diving, skiing, tobogganing, sledging and ice skating.
- Treatment for injury or illness caused while engaged in criminal or unlawful activities or while resisting arrest.
- Hospitalization arising out of nuclear disaster, radioactive contamination or chemical radiation and/or release of nuclear or atomic energy; and diseases/injuries arising out of or in connection with the same.
- Non-allopathic methods of surgery and treatment.
- Hospitalisation arising from any psycho-geriatric or psychiatric condition, insanity, mental or nervous breakdown, study and treatment of sleep apnoea, speech therapy, nutritional counselling, hospitalisation due to any condition where no active management of the condition is involved or rest cures.
- Any diagnosis or treatment arising from or traceable to pregnancy (whether uterine or extra uterine), childbirth including caesarean section, medical termination of pregnancy and/or any treatment related to pre and post natal care of the mother or the new born / Birth control procedures, hospitalization in case of maternity / pregnancy / childbirth / infertility / sterility / erectile dysfunction / impotency/ miscarriage / abortion / contraception / circumcision and any complications of these events. However, this exclusion will not apply to Ectopic Pregnancy.
- Hospitalization for the sole purpose of physiotherapy or any ailment for which hospitalization is not warranted due to advancement in medical technology.
- Any treatment not performed by a Physician / Surgeon, registered with the Medical Council of India / State medical council or any treatment of a purely experimental nature.
- Hospitalisation primarily for investigatory purpose, diagnosis, X-ray examination, general physical or routine medical examination, OPD procedures and treatments, vaccinations, diagnosis, screening and investigation, preventive medical check-up, / medicines, treatments / examinations specifically for weight reduction or gain or private nursing.
- Circumcision, vaccination, cosmetic or aesthetic treatments of any description, change of gender surgery, plastic surgery (unless such plastic surgery is necessary for the treatment of Illness or Accidental Bodily Injury as a direct result of the insured event), treatment directly or indirectly related to sterility.
- Hospitalization where Life Assured is admitted as a donor for organ transplant.
- Hospitalization / Surgery for correction of birth defects or congenital anomalies.
- Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
- Hospitalization for treatments for smoking cessation programs and treatment of nicotine addiction.
- Hospitalization for refractive surgery on eye (laser surgery for correction of sight) / LASIK (laser-assisted in situ keratomileusis).
- Hospitalization for removal of implants done prior to date of commencement of policy.
- Hospitalization for rest-cure and Rehabilitation.
- Sex change or treatment related to sex change, which results from, or is in any way associated with or any complications arising from sex change procedures.
- Admission to a hospital outside the geographical limits of India.How to Make a Claim?
FAQs
Does SBI Life Smart Health Insurance Plan cover Pre-existing Diseases?As mentioned earlier, SBI Life Smart Health Insurance Plan does cover Pre-existing Diseases and hospitalization from the same after a continuous renewal of 24 months and not before that. Thus, there is a waiting period for Pre-Existing Diseases for a period of 2 years.
Is Maternity Benefit provided under SBI Life Smart Health Insurance Plan?SBI Life Smart Health Insurance Plan does not cover Maternity Benefit and hospitalization from the same. It is not even after continuous renewals as in other plans.
Is Day Care Procedures covered from Day 1 in SBI Life Smart Health Insurance Plan?SBI Life Smart Health Insurance Plan covers 136 Day Care Procedures but after a waiting period of 30 days from policy inception.
You stop paying the premiumIf the policy holder stops paying the premium within 30 days of the due date, the policy lapses and all benefits cease. If the lapsed policy is not revived within 90 days of the due date of the first unpaid premium then the policy will be terminated.
You want to surrender the policyBeing a pure health plan, there are no Surrender Benefits under this plan.
You want a loan against your policyLoan facility is not available in this plan.
Claim Process
You can make a cashless claim at the time of hospitalization through a network of 4000+ hospitals or at any time of the day in their 24 hour Customer Service desk at the TPA (Third Party Administrator) approved by the IRDA.
Documents required to file a claim are:
- Copy of Policy Document
- Claim Form
- Treating Doctor’s Certificate
- Discharge Card and copy of all medical documents related to hospitalizations
- Any other document as the TPA/Company may require depending on type/cause of claim
- Identity Proof of the Policyholder
- Age Proof of the Life Assured
- PAN card copy of the Policyholder (for online policies)
- Direct Credit Mandate of the Policyholder
