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Reviewed by Finzony Finance TeamLast updated:
Arogya Sanjeevani is an IRDAI standard health policy offered by SBI General. It pays hospital expenses for you and your family on simple terms at a low premium. You can choose a sum insured from ₹50,000 to ₹10 lakh, on an individual or family floater basis, for a one-year policy that renews for life. Premium can be paid yearly, half-yearly, quarterly or monthly. The cover pays in-patient treatment, with room rent up to 2% of the sum insured (maximum ₹5,000 a day) and ICU up to 5% (maximum ₹10,000 a day), 30 days of pre-hospitalisation and 60 days of post-hospitalisation, all day care procedures, AYUSH treatment, cataract up to ₹40,000 per eye, dental and plastic surgery needed because of disease or injury, road ambulance up to ₹2,000, and 12 modern treatments up to 50% of the sum insured. Every admissible claim carries a 5% co-payment. A cumulative bonus adds 5% of the sum insured for each claim-free year, up to 50%. Adults can join from 18 to 65 years and children from 3 months to 25 years, and there is no exit age. Pre-existing diseases wait 48 months. Maternity, home treatment and OPD are not covered.
IRDAI standard hospital cover with room rent up to 2% of sum insured, a 5% yearly bonus and a 5% co-pay on every claim.
Finzony reads this plan as a basic, low-price hospital cover for people who want something simple, or a first policy for parents and in-laws. Its strengths are the price (from about ₹1,000 a year for a 19 to 35 year old at ₹50,000, before GST), a cumulative bonus that grows to 50%, no exit age, and extras that some basic plans skip, such as AYUSH, dental and plastic surgery after disease or injury, all day care procedures and 12 modern treatments. Know the limits. A 5% co-payment applies to every admissible claim, at every age and sum insured. Room rent is capped at 2% of the sum insured and ICU at 5%, and if you take a costlier room, the rest of the hospital bill is cut in the same proportion, apart from medicines. Pre-existing diseases wait 48 months, the listed conditions wait 24 months, and joint replacement and osteoarthritis wait 48 months. The policy does not pay for maternity, home treatment or OPD, and a top sum insured of ₹10 lakh can fall short for a long stay in a metro hospital. Premium rises steeply with age, and a medical loading of up to 100% can apply. Use this plan when budget is the main concern. If you want no co-payment or no room rent cap, compare it with a comprehensive plan before you decide. SBI General does not publish a single starting premium, so check the quote for your age and sum insured.
SBI General Health Insurance
Key Insights
Founded
2009
SBI General Health Insurance was established 17 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
96.14% CSR, calculated as a 3-year average
SBI General Health Insurance settles 96.14% of all claims it receives, demonstrating strong credibility.
Network Hospitals
16,600+
SBI General Health Insurance has a network of 16,600+ hospitals, ensuring wide accessibility and convenience for policyholders.
Arogya Sanjeevani is the standard hospital cover that IRDAI asked every insurer to offer, so the core terms are the same across insurers. It pays medical expenses for admissions of 24 hours or more, up to the sum insured plus any cumulative bonus.
SBI General's version has a 5% co-pay on every claim and room rent and ICU limits tied to the sum insured.
Choose a sum insured from ₹50,000 to ₹10 lakh. On an individual policy the sum insured applies to each member. On a floater policy one sum insured is shared by the whole family. The policy runs for one year and renews for life.
The sum insured can be changed at renewal, subject to underwriting. A higher amount carries fresh waiting periods for the added portion only. Floater plans in the rate chart go up to 4 adults and 3 children.
Pays treatment expenses while you are in hospital for at least 24 hours: room, boarding and nursing, surgeon, anaesthetist and doctor fees, anaesthesia, blood, oxygen, operation theatre, surgical appliances, medicines and drugs, and diagnostics and imaging.
Room rent and ICU are paid only up to the limits shown below.
Pays expenses for 30 days before admission and for 60 days after discharge, for the same condition, when the hospitalisation claim is accepted.
Post-hospitalisation reimbursement claims must be sent within 15 days of finishing that treatment.
Pays for all day care treatments, meaning procedures that need less than 24 hours in hospital because of medical advances.
The 24-hour minimum stay does not apply to day care.
A 30-day wait applies to any illness except accidents, and it does not apply if you have more than 12 months of continuous cover. Twenty listed conditions and procedures wait 24 months, and joint replacement and age-related osteoarthritis and osteoporosis wait 48 months. Pre-existing diseases wait 48 months. Waits are reduced to the extent of prior cover if you port or migrate without a break, and they start again for any increase in sum insured.
Initial waiting period
Expenses for any illness in the first 30 days of the first policy are excluded, except for accidents. This does not apply if you have more than 12 months of continuous cover. It applies again to any added sum insured.
Specified diseases and procedures
Twenty listed conditions and procedures, such as hernia, piles, cataract, gall bladder stones, tonsillectomy, hysterectomy and internal congenital anomalies, wait 24 months, unless an accident caused them.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 48 months of continuous cover. If a listed disease is also pre-existing, the longer wait applies.
Conditions or treatments that the policy clearly says it will not cover.
The first 20 conditions and procedures are excluded for the first 24 months of continuous cover, even if they begin after the policy starts and even if you declared them. The last two, joint replacement and age-related osteoarthritis and osteoporosis, wait 48 months. The wait does not apply to claims arising from an accident, and if one of them is also a pre-existing disease, the longer wait applies.
Insurer
SBI General Health Insurance plans and claim process
It is SBI General's version of the IRDAI standard health policy. It pays hospital expenses for you and your family, with a sum insured from ₹50,000 to ₹10 lakh, on an individual or family floater basis, for a one-year policy that renews for life.
You can choose from ₹50,000 up to ₹10 lakh. On an individual policy the sum insured applies to each member. On a floater policy one sum insured is shared by the whole family. The sum insured can be changed at renewal, subject to underwriting.
SBI General does not publish a single starting price. In the prospectus chart, a person aged 19 to 35 pays ₹1,000 a year for a ₹50,000 sum insured, ₹4,501 for ₹5 lakh and ₹5,799 for ₹10 lakh, before GST. At age 56 to 60, ₹5 lakh costs ₹11,924. Floater premiums depend on how many adults and children you cover, and a medical loading of up to 100% can apply.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Claim settlement ratios are from IRDAI Annual Reports. Finzony is not an insurance broker or agent. Verify all details on the official SBI General Health Insurance website before purchasing.
Contact Details
1800 102 1111
Headquarters: 9th Floor, A & B Wing, Fulcrum Building, Sahar Road, Andheri (East), Mumbai – 400099, Maharashtra, India.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Joint replacement, osteoarthritis and osteoporosis
Joint replacement, and age-related osteoarthritis and osteoporosis, wait 48 months. Joint replacement is covered earlier only if an accident caused the need for it.
Higher sum insured
If you raise your sum insured, the waits start again only for the added amount. Waits are reduced to the extent of prior cover if you port or migrate without a break.
Grace period for renewal
A policy paid yearly has a 30-day grace period, and the other payment modes have 15 days. Renew within it to keep your waiting period credit and cumulative bonus. No cover is available during the grace period.
Every admissible claim is subject to a 5% co-payment, so you pay 5% of the payable claim amount and SBI General pays the rest. It applies at all ages and sum insureds, and it does not reduce your sum insured.
Room rent is paid up to 2% of the sum insured, with a maximum of ₹5,000 a day. ICU is paid up to 5%, with a maximum of ₹10,000 a day. For a ₹1 lakh sum insured that is ₹2,000 a day for a room and ₹5,000 for ICU. For ₹5 lakh it is ₹5,000 and ₹10,000. If your room costs more than the limit, all other hospital charges except medicines are paid in the same proportion. For example, a room of ₹10,000 a day against a ₹5,000 limit means those charges are paid at 50%.
At the end of each claim-free policy year, your sum insured grows by 5%, up to 50%, if you renew without a break. If you claim, the bonus you have earned is reduced at the same rate at which it was added, and the sum insured itself is not reduced. On a floater, a claim by any member reduces the bonus.
Any illness waits 30 days at the start, except accidents, and this does not apply if you have more than 12 months of continuous cover. Twenty listed conditions and procedures wait 24 months. Joint replacement and age-related osteoarthritis and osteoporosis wait 48 months. Pre-existing diseases wait 48 months.
No. Childbirth, caesarean section, miscarriage unless caused by an accident, and lawful termination of pregnancy are excluded. Ectopic pregnancy is not excluded. Home treatment and OPD are also not covered.
Yes, with limits. AYUSH inpatient treatment in an AYUSH hospital is covered up to the sum insured. Cataract is covered up to 25% of the sum insured or ₹40,000, whichever is lower, per eye in a policy year, after a 24-month wait. Dental treatment and plastic surgery are covered only when disease or injury makes them necessary.
The proposer must be 18 to 65 years. You can cover yourself, your spouse, parents and parents-in-law, and dependent children from 3 months to 25 years. There is no exit age. A child above 18 who becomes financially independent is not covered under a floater at the next renewal.
Tests apply if the person to be insured is above 45 or has an existing medical condition. The set can include a medical examination, ECG, blood count, ESR, HbA1c, SGPT, serum creatinine, urine routine and total lipids. If your proposal is accepted, SBI General reimburses 50% of the test cost.
Yes. You can pay yearly, half-yearly, quarterly or monthly. The grace period is 30 days for yearly payment and 15 days for the other modes, and no cover is available during the grace period. If an instalment is not paid within the grace period, the policy is cancelled.
For cashless treatment, ask for pre-authorisation at least 48 hours before a planned admission at a network hospital, or within 24 hours of an emergency admission. For reimbursement, send your documents within 30 days of discharge, and within 15 days of finishing post-hospitalisation treatment. SBI General must settle or reject a claim within 30 days of the last document, or 45 days if an investigation is needed.
Yes. The policy renews for life, and renewal cannot be refused because you claimed. A new policy has a 15-day free look period. Under the policy wording, after 8 continuous years no claim can be contested except for proven fraud, but SBI General's customer information sheet states 60 continuous months. Check your policy document for the period that applies to you.
You can cancel with 15 days' written notice. The refund is 75% of the premium if cancelled within 30 days, 50% for 31 to 90 days, 25% for 3 to 6 months, and nothing after 6 months. No refund is paid if any claim has been made or lodged. Within the 15-day free look period of a new policy, you get a refund less medical examination costs, stamp duty and a proportionate risk premium.