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Reviewed by Finzony Finance TeamLast updated:
Arogya Top-Up is a top-up health plan from SBI General. It does not replace your main policy. It pays hospital expenses above a deductible that you choose, from ₹1 lakh to ₹10 lakh in steps of ₹1 lakh, up to a sum insured of ₹1 lakh to ₹50 lakh. The deductible applies to each claim, so a claim is paid only when it crosses that amount. It is meant to sit above an existing personal or employer policy at a low premium. The cover pays in-patient treatment, pre-hospitalisation for 60 days and post-hospitalisation for 90 days, day care procedures, domiciliary treatment, organ donor expenses, alternative treatment, maternity expenses and road ambulance up to ₹5,000 per claim. It also covers HIV/AIDS, mental illness up to ₹1 lakh, genetic disorders up to ₹1 lakh, and 12 modern treatments up to 50% of the sum insured. Anyone from 3 months to 65 years can join, and up to 70 years if you pick a deductible of ₹5 lakh or more. There is no exit age, and renewal cannot be refused because you claimed. Individuals can buy for 1, 2 or 3 years. There is no cumulative bonus, and the sum insured reduces after a claim unless you choose to reinstate it.
Top-up cover of ₹1L to ₹50L that pays when a single claim crosses your deductible (₹1L to ₹10L).
Finzony reads this plan as a low-cost way to add large cover above your base or employer policy, as long as you can meet the deductible from that cover or from your own pocket. Its strengths are the range (up to ₹50 lakh above a deductible from ₹1 lakh), maternity cover that many top-ups leave out, short waits of 90 days for hypertension, heart disease and diabetes and 12 months for the listed conditions, and no exit age. The cover also reaches mental illness, HIV/AIDS, genetic disorders and 12 modern treatments such as robotic surgery and immunotherapy. Know the limits. The deductible applies to each claim, so two smaller claims in a year are not added up the way they are on a super top-up. Nothing is paid below the deductible, and there is no OPD cover. The sum insured reduces after every claim, and putting it back costs extra premium. There is no cumulative bonus. Pre-existing diseases wait 36 months, and mental illness, genetic disorders and road ambulance have fixed limits. Anyone over 55 faces a pre-acceptance medical examination, and entry stops at 65, or at 70 only with a deductible of ₹5 lakh or more. Match the deductible to the sum insured on the policy you already hold, and compare it with the SBI General Health Super Top-Up, which adds up claims across the year, before you decide. SBI General does not publish a single starting premium, so get a quote.
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.
Pays medical expenses above the deductible you choose, up to your sum insured. It is meant to sit on top of an existing personal or employer policy, so the base policy takes the first part of a big bill and this plan takes the rest.
The deductible applies to each claim, so a claim below the deductible is not paid at all. Settlement is on an indemnity basis.
Choose a sum insured from ₹1 lakh to ₹50 lakh and a deductible from ₹1 lakh to ₹10 lakh in steps of ₹1 lakh. The prospectus premium table shows the sum insured in steps of ₹1 lakh for every deductible.
On a family policy, the sum insured of a dependent cannot be more than that of the proposer. It cannot be raised or lowered in the middle of the term, only at renewal after underwriting.
Pays treatment expenses above the deductible while you are in hospital, including room rent and boarding, doctor fees including teleconsultation, ICU, nursing, anaesthesia, blood, oxygen, operation theatre, medicines and consumables, diagnostics, dialysis, chemotherapy, radiotherapy, pacemakers and implants, and inpatient physiotherapy.
No room rent cap is stated in the prospectus or wording, but charges must be reasonable and customary. Items in the policy's non-payable list are not paid.
Pays expenses for 60 days before admission and for 90 days after discharge, for each admitted hospitalisation and domiciliary claim.
Paid only for the same condition, and only when the hospitalisation claim is accepted.
Covers day care procedures that need less than 24 hours in hospital because of medical advances, up to the sum insured above the deductible. The policy lists 141 such procedures in Annexure C, including cataract, lithotripsy, coronary angiography, haemodialysis, radiotherapy and cancer chemotherapy.
Puts your sum insured back to its original amount after a claim has reduced it, for the rest of the policy period.
Optional. Charged at pro rata premium from the date of the loss to the expiry of the policy.
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. Hypertension, heart disease and diabetes wait 90 days. The listed conditions and procedures wait 12 months. Pre-existing diseases wait 36 months. Maternity waits 9 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.
Hypertension, heart disease and diabetes
Claims for hypertension, heart disease and diabetes, and their related complications, wait 90 days from the start of the policy. If the condition is pre-existing, the longer wait applies.
Maternity
Maternity expenses are not paid in the first 9 months of the policy. This does not apply on continuous renewal within the grace period, up to the sum insured and limit of the previous policy.
Conditions or treatments that the policy clearly says it will not cover.
These conditions and procedures are excluded for the first 12 months of continuous cover, even if they begin after the policy starts and even if you declared them. Hypertension, heart disease and diabetes, shown at the end, wait 90 days instead. The wait does not apply to claims arising from an accident, and if a listed condition is also pre-existing, the longer wait applies.
Insurer
SBI General Health Insurance plans and claim process
It is a top-up health insurance plan from SBI General. It pays hospital expenses above a deductible you choose, from ₹1 lakh to ₹10 lakh, up to a sum insured of ₹1 lakh to ₹50 lakh, and is meant to sit on top of your existing health policy.
The plan pays only the part of a claim that is above your deductible, up to your sum insured. Suppose you hold a ₹10 lakh sum insured with a ₹3 lakh deductible. A hospital claim of ₹8 lakh is paid ₹5 lakh, the part above the deductible. A claim of ₹2 lakh is not paid at all, because it does not cross ₹3 lakh. This is a simplified illustration. Your policy schedule and wording decide the final amount.
On this plan the deductible applies to each claim, so a claim is paid only when that one claim crosses the deductible. A super top-up adds up your claims across the policy year, so several smaller claims can cross the deductible together. SBI General sells a separate Health Super Top-Up for that.
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)
Specified diseases and procedures
The listed conditions and procedures, such as hernia, piles, gall bladder stones, tonsillectomy, calculus diseases and degenerative joint replacement, wait 12 months, unless an accident caused them.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 36 months of continuous cover. If a listed disease is also pre-existing, the longer wait applies.
Higher sum insured
If you raise your sum insured at renewal, 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.
You can choose a sum insured from ₹1 lakh to ₹50 lakh and a deductible from ₹1 lakh to ₹10 lakh in steps of ₹1 lakh. On a family policy, a dependent's sum insured cannot be more than the proposer's.
SBI General does not publish a single starting price. In the prospectus premium table, a person aged 19 to 35 pays ₹3,009 a year before GST for a ₹10 lakh sum insured above a ₹1 lakh deductible. Premium rises with age and falls as the deductible rises, and the minimum premium is ₹200. SBI General has also published a newer premium table effective 1 February 2025, so your quote may differ.
The prospectus does not tie this plan to an SBI General base policy. Choose a deductible that matches the sum insured on the policy you already hold, so that the two fit together.
Yes. It pays reasonable and customary charges for delivery during hospitalisation, including caesarean sections, and lawful medical termination of pregnancy, above your deductible. A 9-month wait applies from the start of the policy, except on continuous renewal within the grace period. Infertility treatment and IVF are not covered.
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. Hypertension, heart disease and diabetes wait 90 days. The listed conditions and procedures wait 12 months. Pre-existing diseases wait 36 months, and maternity waits 9 months.
No, not automatically. From the day you receive a claim amount, the sum insured for the rest of the policy period goes down by that amount. You can opt to reinstate it to the original amount by paying extra pro rata premium from the date of the loss to the end of the policy.
No. The prospectus says a cumulative bonus is not applicable to this plan.
Any individual can buy it for self and family, meaning spouse, dependent children, dependent parents and parents-in-law. Entry is from 3 months to 65 years, and up to 70 years if you choose a deductible of ₹5 lakh or more. There is no exit age. A group policy needs at least 10 members and runs for one year.
A proposer over 55 faces a pre-acceptance medical examination, and the underwriter decides which tests are needed. If the proposal is accepted, SBI General reimburses 50% of the test cost. The medical report is valid for one month.
A floater gets 10% for 2 members, 15% for 3 and 20% for 4 or more. Non-floater family cover gets 5% for 2 members and 7.5% for more than 2. A 2 year term gets 5% and a 3 year term 7.5%, and direct business gets 15%. Premium is loaded by 5% each for smoking, alcohol and any form of tobacco.
For cashless treatment, ask for pre-authorisation before admission at a network hospital. For reimbursement, intimate within 48 hours of hospitalisation, and send the claim documents within 15 days of discharge. Post-hospitalisation claims must be sent within 15 days of finishing that treatment, and within 105 days of discharge at most. SBI General must settle or reject a claim within 30 days of the last document, or 45 days if an investigation is needed.
Yes. Renewal cannot be refused because you claimed, and there is no loading for your own claims. After 60 continuous months of cover, no policy or claim can be contested except for established fraud. A new policy has a 30-day free look period, with a refund of the premium less a proportionate risk premium, medical examination costs and stamp duty if you have not claimed.