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Reviewed by Finzony Finance TeamLast updated:
SBI General Health Edge is a customisable hospitalisation plan with 9 basic covers and 18 optional covers. There is one plan, with a sum insured of ₹3, 5, 7, 10, 15, 20 or 25 lakh, and you can buy it for yourself, for individuals in a family, or on a family floater with up to 4 adults and any number of children. Terms run for 1, 2 or 3 years. The base cover pays for stays of 24 hours or more, day care procedures of more than 2 hours, pre-hospitalisation for 30 days and post-hospitalisation for 60 days, road ambulance, bariatric surgery for eligible cases, AYUSH treatment, and modern treatments such as robotic surgery and stereotactic radiosurgery. A Stay Fit health check-up is included once every policy year for every adult. The extras are optional. You can add an Unlimited Refill, which restores cover from the first paid claim for related and unrelated illness, and a Booster Benefit that adds 50% of your base sum insured for every claim-free year, up to 200%. Other optional covers include maternity, newborn care, assisted reproduction, OPD, Global Treatment for 16 listed conditions, Critical Illness, Hospital Daily Cash, Claims Safeguard, Healing Benefit, a Vector Borne fixed benefit, Accidental Death, Domestic Help cover and wellness services. Proposers can join from 18 to 65 years, and children from 91 days to 30 years. Renewal is for life.
Higher sum insured options with no room rent sub-limits on premium variants.
Finzony reads Health Edge as a plan for buyers who like to pick their own cover. Its best features are the short waits and the optional extras. Pre-existing diseases and the 39 listed conditions wait 24 months, which is shorter than the 36 months many plans use for pre-existing diseases. Hypertension, diabetes and cardiac conditions that develop after you buy wait only 90 days. The Unlimited Refill pays up to 100% of your base sum insured on each claim for related or unrelated illness, the Booster Benefit can build your cover up to 3 times, and Claims Safeguard makes consumables and other non-payable items payable. Maternity, assisted reproduction, OPD and treatment abroad can all be added, which many plans do not offer at all. The trade-offs matter. The sum insured stops at ₹25 lakh, and the base cover has no refill or bonus, so a large claim can use up your cover unless you add those options. The 30-day initial wait is waived only after more than 24 months of continuous cover. Maternity and assisted reproduction wait 48 months, Global Treatment waits 36 months and covers only 16 listed conditions, and OPD carries a 50% co-payment on doctor fees and 30% on diagnostics and pharmacy. Sub-limits such as room rent and ambulance are set in your policy schedule and do not grow with the Booster. Home treatment is not covered. If you want a plan with a bigger sum insured and a built-in refill, compare it with SBI General's Arogya Supreme and Super Health. SBI General does not publish a starting premium in the prospectus, so get a quote for your age before you decide.
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.
A single plan with 9 basic covers and 18 optional covers. You add only what you need, such as refill, booster, maternity, OPD, Global Treatment, Critical Illness and wellness services.
You pay only for the covers you pick, so your premium depends on your choices.
Choose ₹3, 5, 7, 10, 15, 20 or 25 lakh. A family floater can include up to 4 adults and any number of dependent children.
The sum insured stops at ₹25 lakh.
Pays treatment expenses when you are admitted for 24 hours or more on a doctor's advice, including room rent, ICU or ICCU, nursing, doctor fees, medicines, diagnostics, operation theatre charges and implanted devices.
Room rent is paid up to the limit in your Policy Schedule. Every paid claim reduces your sum insured for that policy year, unless you add a refill.
Pays expenses for 30 days before admission and 60 days after discharge, for the same illness or injury.
Both are paid on a reimbursement basis only.
Covers day care procedures when you are admitted for more than 2 hours, and also covers angiography, dialysis, and radiotherapy or chemotherapy for cancer.
OPD treatment and diagnostic services are not covered under this benefit.
Restores your cover from the first paid claim, for related and unrelated illness. Each claim is payable up to 100% of the base sum insured, for as many claims as occur in the policy year.
Pays for hospitalisation, day care and AYUSH claims. On a floater it is shared by the family. It does not apply to a Global Treatment claim.
Adds 50% of the base sum insured of the previous policy year for each claim-free year, up to 200% of the base sum insured.
A 30-day wait applies to any illness except accidents, and it is waived only if you have more than 24 months of continuous cover. Hypertension, diabetes and cardiac conditions wait 90 days, and Critical Illness waits 90 days. The 39 listed conditions and procedures wait 24 months, and pre-existing diseases also wait 24 months. Global Treatment waits 36 months, and maternity and assisted reproduction wait 48 months. Waits are reduced to the extent of prior cover if you port or migrate, 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 is waived only if you have more than 24 months of continuous cover, and it does not apply to Critical Illness, hypertension, diabetes and cardiac claims, which have their own waits.
Specified diseases and procedures
39 listed conditions and procedures, such as cataract, hernia, joint replacement and stones, wait 24 months, unless an accident caused them.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 24 months. If a listed disease is also pre-existing, the longer wait applies.
Conditions or treatments that the policy clearly says it will not cover.
These 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 wait does not apply to claims arising from an accident. If one of them is also a pre-existing disease, the longer wait applies, which here is also 24 months.
Insurer
SBI General Health Insurance plans and claim process
Health Edge is a customisable health insurance plan from SBI General with 9 basic covers and 18 optional covers. It comes as one plan with a sum insured from ₹3 lakh to ₹25 lakh and a policy term of 1, 2 or 3 years.
You can choose ₹3, 5, 7, 10, 15, 20 or 25 lakh, on an individual basis or on a family floater with up to 4 adults and any number of dependent children.
Your premium depends on your age, sum insured and the covers you add. As an illustration in the prospectus, with a ₹5 lakh sum insured, before loading and taxes, a 30 or 35-year-old pays ₹6,305 a year and a 10 or 15-year-old pays ₹4,446. A family of four (2 adults and 2 children) pays ₹21,502 when each person is covered separately, and ₹15,051 on a floater after the 30% floater discount.
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)
The bonus reduces at the same rate if you claim, and sub-limits do not rise with it. You must renew within the grace period.
Makes the items in the non-payable List I payable on an accepted hospitalisation claim, such as consumables and other non-medical expenses.
Pays delivery expenses, including pre-natal care from confirmation of pregnancy and post-natal care for up to 8 weeks, up to the amount in your schedule.
A 48-month wait applies, and it is limited to two deliveries or terminations in a lifetime. Voluntary termination in the first 12 weeks is not covered.
Covers the baby's medical expenses from day one up to 90 days of age, if the mother's maternity claim is accepted.
A baby older than 90 days and under 1 year can be added by endorsement or at renewal, with extra premium.
Pays up to ₹1 lakh for assisted reproduction treatment for sub-fertility, one cycle per eligible person in a policy year, and in-patient admission is not needed.
A 48-month wait applies, it is over and above the base sum insured, and it does not cover pre and post treatment expenses, cryopreservation or surrogate services.
Pays in-patient treatment abroad for 16 listed conditions and procedures, such as cancer surgery, heart valve replacement, bone marrow transplant, CABG after a heart attack, and kidney, liver, lung and heart transplants.
A 36-month wait applies. The illness must be diagnosed in India, your doctor must recommend treatment abroad, and it is paid on reimbursement only, in rupees.
Pays allopathic OPD expenses, including doctor fees, diagnostics and pharmacy, up to the amount in your schedule for each member.
You bear 50% of doctor fees and 30% of diagnostics and pharmacy. It excludes dental treatment, spectacles, physiotherapy and preventive tests, and is paid on reimbursement only.
Pays a lump sum on first diagnosis of any of 60 listed illnesses, including cancer, heart attack, CABG, stroke, kidney failure, major organ transplant and Alzheimer's disease.
Only for ages 18 to 45, with a 90-day wait and a 28-day survival period. It is once in a lifetime, over and above the base cover, and must be taken when the policy starts.
Pays a lump sum if you are hospitalised for at least 48 continuous hours with dengue, malaria, filaria, kala-azar, chikungunya, Japanese encephalitis or Zika.
Available once in a lifetime for each insured person, and pre-existing illness is not covered.
Pays a fixed daily amount for each day in hospital, after a 24-hour deductible, and twice the amount for days in an ICU, up to the number of days in your schedule.
Paid on a benefit basis with no cashless, and it does not reduce the sum insured.
Pays a lump sum if you are hospitalised for more than 5 continuous days, per hospitalisation for each insured person.
Paid over and above the sum insured. The amount is in your schedule.
Pays a lump sum to the primary insured person if an accident causes death within 365 days.
Must be taken when the policy starts, and it is over and above the base sum insured.
Covers hospital treatment of your domestic help under hospitalisation, day care, AYUSH, modern treatments, road ambulance and bariatric surgery, with its own sum insured.
Individual cover, taken when the policy starts, and you can drop it at a later renewal. Entry age is up to 65.
Gives unlimited second opinions from SBI General's panel doctors on a covered illness.
A second opinion does not replace a visit to your own doctor.
Gives access to AI personal fitness coaching, dietician and nutrition e-consultations, and unlimited gym membership through SBI General's service providers.
Can only be taken when the policy starts. Gym use must be kept active every quarter or every 6 months, and these services are not medical advice.
Walk Healthy gives a discount of up to 30% on your renewal premium for steps recorded on SBI General's app. A voluntary co-payment of 10% or 20% on each claim lowers your premium.
Walk Healthy is part of the Wellness Benefit, and the app must be downloaded within 180 days. A co-payment cannot be removed at a later renewal and adds to any other co-payment.
Hypertension, diabetes and cardiac conditions
A 90-day wait applies to all claims for hypertension, diabetes and cardiac conditions, except where the condition is pre-existing and disclosed when you buy.
Critical Illness
If you add the optional Critical Illness Cover, a 90-day wait applies from the start of the first policy.
Global Treatment
Treatment abroad for the 16 listed conditions is excluded for the first 36 months from the first policy start date.
Maternity and assisted reproduction
Maternity expenses and Assisted Reproduction Treatment under the optional Women Care Benefit each wait 48 months.
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.
The base cover pays hospitalisation, pre and post hospitalisation, day care, road ambulance, bariatric surgery, modern treatments, AYUSH and a Stay Fit health check-up. Refill, booster, maternity, newborn care, assisted reproduction, OPD, Global Treatment, Critical Illness, Hospital Daily Cash, Claims Safeguard and wellness services are optional.
Only if you add the optional Unlimited Refill. It starts with your first paid claim and pays each later claim in the policy year up to 100% of your base sum insured, for related or unrelated illness. On a floater, it is shared by the family.
If you add it, SBI General increases your sum insured by 50% of the previous year's base sum insured for each claim-free year, up to 200% of the base sum insured. It reduces at the same rate if you claim, and sub-limits do not rise with it.
Any illness waits 30 days, except accidents, and this is waived only after more than 24 months of continuous cover. Pre-existing diseases and the 39 specified diseases and procedures wait 24 months. Hypertension, diabetes and cardiac conditions wait 90 days. Global Treatment waits 36 months, and maternity and assisted reproduction wait 48 months.
Yes, as an optional Women Care Benefit. It pays delivery expenses with pre-natal and post-natal care (up to 8 weeks), for up to two deliveries in a lifetime, after a 48-month wait. Newborn Baby Cover protects the baby for 90 days, and Assisted Reproduction Treatment pays up to ₹1 lakh with a 48-month wait.
Yes, with the optional Global Treatment. It pays in-patient treatment abroad for 16 listed conditions, such as cancer surgery, heart valve replacement and organ transplants, after a 36-month wait. The illness must be diagnosed in India, and the claim is paid on reimbursement in rupees.
Only with the optional OPD Cover. It pays allopathic doctor fees, diagnostics and pharmacy up to the amount in your schedule, but you bear 50% of doctor fees and 30% of diagnostics and pharmacy, and claims are paid on reimbursement.
It is an optional cover, taken when the policy starts, that gives you AI personal fitness coaching, dietician and nutrition e-consultations and unlimited gym membership. With Walk Healthy, steps recorded on SBI General's app can earn a discount of up to 30% on your renewal premium.
Proposers can join from 18 to 65 years, and children from 91 days to 30 years. Renewal is for life. A floater covers you, your spouse, dependent children, and parents or parents-in-law. An individual policy can also cover relatives such as siblings, grandparents and in-laws.
A floater gets 20% for 2 members, 25% for 3 members and 30% for more than 3. Individual policies get 5% for 2 or more members. Term discounts are 4% for 2 years and 6% for 3 years, and SBI Group employees get a discount. Long-term discounts do not apply with instalments.
For cashless treatment, intimate SBI General within 24 hours of an emergency admission or at least 72 hours before a planned one, and use a network hospital. For reimbursement, intimate within 48 hours of admission or before discharge, and send the documents within 30 days of discharge. SBI General must settle or reject a claim within 30 days, or 45 days if it needs an investigation. The claims toll-free numbers are 1800 210 3366 and 1800 210 6366.
Yes. Renewal cannot be refused because you claimed, and there is no loading for your own claims. After 60 continuous months, no claim can be contested except for proven 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.