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SBI Life Smart Health Insurance Plan

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This plan has been withdrawn by the insurance company and is no longer available for sale.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.
 
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

 

Type
Amount of Benefit
Daily Hospital Cash Benefit
1% of Annual Basic Sum Assured
Daily ICU Benefit
2% of Annual Basic Sum Assured
Listed Surgical Benefit
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
Non Listed Surgical Benefit
7.5% of Annual Basic Sum Assured
136 Listed Day Care Treatment
10% of Annual Basic Sum Assured
 
Now, there are certain limits of the Benefits payable as well.

 

Type
Amount of Benefit
Lifetime Limit
Daily Hospital Cash Benefit and ICU Benefit
1.3% of Annual Basic Sum Assured in Year 1
100% of Annual Basic Sum Assured from Year 2 onwards
3.6 times the Annual Basic Sum Assured
Listed Surgical Benefit and Day Car e Benefit
100% of Annual Basic Sum Assured
300% of Annual Basic Sum Assured
Non Listed Surgical Benefit
Payable for only 2 procedures
Payable for only 10 procedures
136 Listed Day Care Treatment
Payable for only 1 time
Payable for only 4 times
 
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.
 
 
Key Features of SBI Life Smart Health Insurance Policy
 
  • It is a Hospitalization cum Surgical Benefit Plan
  • This plan covers till 70 years of age and the premium is fixed for the entire tenure of 5 years, irrespective of claim
  • This policy can be extended for the entire family as well for self, spouse, parents, children as well as parents-in-law
  • 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
  • 'No Claim Bonus' available, if there is no claim during the previous Policy Year
  • Pre-existing illnesses are covered after 2 years of con tenuous renewal
  • There is a family discount of maximum 10% for 4 members in the plan
 
 
Benefits you get from SBI Life Smart Health Insurance Policy
 
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.
 
 
Eligibility conditions & other restrictions in SBI Life Smart Health Policy
 

 

 
Minimum
Maximum
Sum Assured (in Rs.)
1 lakh
5 lakhs
Policy Term (in years)
5
Premium Payment Term (in years)
Equal to Policy Tenure of 5 years
Entry Age of Life Insured (in years)
18
65
Entry Age of Dependent Children (in years)
3 months
22
Age at Maturity (in years)
-
70
Age at Maturity for Dependent Children (in years)
-
27
Age at Maturity for Renewal (in years)
-
65
Relationship Covered
Self / Spouse / Dependent Children / Parents & Parents-in-law
Payment modes
Yearly, Half-Yearly, Quarterly and Monthly
 
 
Sample illustration of Premium for SBI Life Smart Health Insurance Plan
 

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.

 

Sample Premiums in SBI Life Smart Health Plan

 

Additional Features and Benefits of SBI Life Smart Health Insurance Plan
 
Riders – There are no additional riders in this plan
 
 
Policy Exclusions of SBI Life Smart Health Insurance Plan
 
The Permanent Exclusions of this policy are:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Treatment for injury or illness caused while engaged in criminal or unlawful activities or while resisting arrest.
  7. 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.
  8. Non-allopathic methods of surgery and treatment.
  9. 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.
  10. 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.
  11. Hospitalization for the sole purpose of physiotherapy or any ailment for which hospitalization is not warranted due to advancement in medical technology.
  12. 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.
  13. 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.
  14. 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.
  15. Hospitalization where Life Assured is admitted as a donor for organ transplant.
  16. Hospitalization / Surgery for correction of birth defects or congenital anomalies.
  17. Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
  18. Hospitalization for treatments for smoking cessation programs and treatment of nicotine addiction.
  19. Hospitalization for refractive surgery on eye (laser surgery for correction of sight) / LASIK (laser-assisted in situ keratomileusis).
  20. Hospitalization for removal of implants done prior to date of commencement of policy.
  21. Hospitalization for rest-cure and Rehabilitation.
  22. 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.
  23. Admission to a hospital outside the geographical limits of India.
 
How to Make a Claim?
 
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
 
 
Frequently Asked Questions about SBI Life Smart Health Insurance Plan
 
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.
 
 
 
What happens if?
 
You stop paying the premium - If 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 policy – Being a pure health plan, there are no Surrender Benefits under this plan.
 
You want a loan against your policy – Loan facility is not available in this plan.

 
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