SBI Life Smart Health Insurance Plan

 

• 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

 

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

• 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

 

	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

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.

 

 

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.

• 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