{"uin":"SBIHLGP24031V012324","name":"Group Mediclaim Policy","url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited","url":"https://indiainsurances.com/insurer/sbi-general-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Group Mediclaim Policy is a group health product with indemnity and benefit covers for hospitalisation, optional outpatient, super top-up, hospital daily cash and critical illness sections. It has a 30-day initial waiting period, a 60-month moratorium, portability, no renewal loading based on individual claims experience, and a 15-day claim settlement promise.","analysis":{"state":"machine","analysed_at":"2026-10-19 23:02:06.441138+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents describe covers and optional sections, but do not name plan variants.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"not-stated","value":null,"display":null,"note":"The policy wording points to the Policy Schedule/Certificate of Insurance for the Policy Period and does not state a fixed term.","quote":null,"sources":[],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"Cashless claims must be intimated within 24 hours of emergency hospitalisation or at least 72 hours before planned hospitalisation. Reimbursement claims must be intimated within 48 hours of admission or before discharge, whichever is earlier.","display":"Cashless: within 24 hours for emergency or at least 72 hours before planned hospitalisation; reimbursement: within 48 hours of admission or before discharge, whichever is earlier","note":null,"quote":"Claim Intimation timelines | Within 24 hours of the Emergency Hospitalization At least 72 hours prior to the planned Hospitalization | Within 48 hours of admission or before discharg from the Hospital, whichever is earlier","sources":[{"clause":"17(III)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-17-iii"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The Company shall settle or reject a claim within 15 days from the date of receipt of claim submission. Delay in claim payment carries interest from receipt of claim submission to payment at 2% above the bank rate.","display":"15 days from receipt of claim submission; delay interest at 2% above bank rate","note":null,"quote":"i) The Company shall settle or reject a claim as the case may be, 15 days from the date of receipt of claim submission. ... ii) ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of claim submission. to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"3(i)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-3-i"},{"clause":"3(ii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-3-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"The grievance route stated is Bima Bharosa, or directly to Head – Customer Care at SBI General, then escalation to the Grievance Redressal Officer before the Insurance Ombudsman.","display":"Bima Bharosa or Head – Customer Care, then GRO, then Insurance Ombudsman","note":null,"quote":"Stage 1: Bima Bharosa ... Alternatively, if you wish to register your grievances directly with us, you may write to the Head – Customer Care. ... In case, you are still not satisfied with the decision/resolution communicated by the above officer or have not received any response within 5 days, you may escalate the matter to the Grievance Redressal Officer (GRO) ... you may escalate the matter to the Insurance Ombudsman.","sources":[{"clause":"16","heading":"Redressal of Grievance Stage 1: Bima Bharosa","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-16-3"},{"clause":null,"heading":"Stage 2: Head – Customer Care","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-stage-2-head-customer-care"},{"clause":null,"heading":"Stage 3: Grievance Redressal Officer (GRO)","page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-stage-3-grievance-redressal-officer-gro"},{"clause":null,"heading":"Stage 4: Escalation to Insurance Ombudsman","page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-stage-4-escalation-to-insurance-ombudsman"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"not-stated","value":null,"display":null,"note":"The documents point to the Policy Schedule/Certificate of Insurance for the Sum Insured but do not list selectable amounts.","quote":null,"sources":[],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"The waiting period can be modified if the optional Modification of Initial Waiting Period is availed, as specified in the Policy Schedule/Certificate of Insurance.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... If you avail this option the waiting period stands modified as specified in the Policy Schedule/Certificate of insurance.","sources":[{"clause":"3","heading":"Initial waiting period- Code- Excl03","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-3-3"},{"clause":"B.42","heading":"Modification of Initial Waiting Period","page":13,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-42"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"not-stated","value":null,"display":null,"note":"The documents say PED treatment is excluded until expiry of the number of months specified in the Policy Schedule/Certificate of Insurance, but do not state the number.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-stated","value":null,"display":null,"note":"The documents say specified disease/procedure treatment is excluded until expiry of the number of months specified in the Policy Schedule/Certificate of Insurance, but do not state the number.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Cataract","Benign Prostatic Hypertrophy","Hysterectomy / myomectomy for menorrhagia or fibromyoma or prolapse of uterus","Non-infective Arthritis, Treatment of Spondylosis / Spondylitis, Gout & Rheumatism","Surgery of Genitourinary tract","Calculus Diseases of any etiology","Sinusitis and related disorders","Surgery for prolapsed intervertebral disc unless arising from accident","Surgery of varicose veins and varicose ulcer","Chronic Renal failure including dialysis","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Treatment for joint replacement unless arising from accident","Age-related Osteoarthritis & Osteoporosis"],"display":"Cataract, BPH, hysterectomy/myomectomy, non-infective arthritis/spondylosis/spondylitis/gout/rheumatism, genitourinary surgery, calculus diseases, sinusitis, prolapsed intervertebral disc surgery, varicose veins/ulcer surgery, chronic renal failure including dialysis, gastric/duodenal ulcer, joint replacement, age-related osteoarthritis and osteoporosis","note":null,"quote":"f) List of specific diseases/procedures\n• Cataract\n• Benign Prostatic Hypertrophy\n• Hysterectomy / myomectomy for menorrhagia or fibromyoma or prolapse of uterus\n• Non-infective Arthritis, Treatment of Spondylosis / Spondylitis, Gout & Rheumatism\n• Surgery of Genitourinary tract\n• Calculus Diseases of any etiology\n• Sinusitis and related disorders\n• Surgery for prolapsed intervertebral disc unless arising from accident\n• Surgery of varicose veins and varicose ulcer\n• Chronic Renal failure including dialysis\n• Gastric/ Duodenal Ulcer\n• Gout and Rheumatism\n• Treatment for joint replacement unless arising from accident\n• Age-related Osteoarthritis & Osteoporosis","sources":[{"clause":"2(f)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-2-f"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced Sum Insured, sixty continuous months applies from the date of enhancement on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance Policy, no Policy and claim shall be contestable by the Insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":"12","heading":"Moratorium Period","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-12-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The Insured Person can port the policy to other insurers by applying at least 30 days before, but not earlier than 60 days from, the renewal date. Waiting-period and moratorium credits can transfer if the person has continuous cover without lapses under an Indian General/Health Insurer.","display":"Yes, apply 30 to 60 days before renewal; credits for Sum Insured, no claim bonus, specific waiting periods, PED waiting period and moratorium can transfer","note":null,"quote":"The Insured Person will have the option to port the Policy to other Insurers by applying to such Insurer to port the entire Policy along with all the members of the Family, if any, at least 30 days before, but not earlier than 60 days from the Policy Renewal date as per lRDAl guidelines related to Portability. ... the proposed Insured Person is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, Specific Waiting Periods, Waiting Period for Pre-existing Diseases, Moratorium Period, etc.","sources":[{"clause":"9","heading":"Portability","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-9-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"not-stated","value":null,"display":null,"note":"The documents say the policy shall ordinarily be renewable, but do not state lifelong renewal or absence of a maximum renewal age.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"Renewal shall not be denied because of claims in earlier policy years, and no loading applies on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"Renewal shall not be denied on the ground that the Insured Person had made a Claim or Claims in the preceding Policy years. ... No loading shall apply on Renewals based on individual Claims experience.","sources":[{"clause":"10","heading":"Renewal of Policy","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-10-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["Excl04 Investigation & Evaluation- Code- Excl04","Excl05 Rest Cure, rehabilitation and respite care- Code- Excl05","Excl06 Obesity/ Weight Control: Code- Excl06","Change of Gender Treatments (Code- Excl 07)","Cosmetic or plastic Surgery: Code- Excl08","Hazardous or Adventure sports: Code- Excl09","Breach of law: Code- Excl10","Excluded Providers: Code- Excl11","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- Excl12","Treatments received in heath hydros, nature cure clinics, spas or similar establishments","Dietary supplements and substances that can be purchased without prescription","Refractive Error: Code- Excl15","Unproven Treatments: Code- Excl16","Sterility and Infertility: Code- Excl17","Maternity: Code Excl18","Any medical treatment taken outside India, unless otherwise agreed by Us as Specified in the Policy Schedule/Certificate of Insurance.","War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war","Dental treatment or Surgery of any kind unless requiring Hospitalisation as a result of accidental Bodily Injury"],"display":"Standard permanent exclusions Excl04 to Excl18 and product exclusions including outside-India treatment unless agreed, war/nuclear risks, external aids unless agreed, alternative medicines, intentional self-injury, vaccination except post-bite, outpatient procedures unless agreed, dental treatment unless accidental hospitalisation, STD other than HIV/AIDS, stem cell storage unless agreed, service charges and non-medically necessary treatment","note":"Several exclusions say they do not apply where the relevant optional benefit is agreed and specified in the Policy Schedule/Certificate of Insurance.","quote":"Excl04 Investigation & Evaluation- Code- Excl04 ... Excl05 Rest Cure, rehabilitation and respite care- Code- Excl05 ... Excl06 Obesity/ Weight Control: Code- Excl06 ... Change of Gender Treatments (Code- Excl 07) ... Cosmetic or plastic Surgery: Code- Excl08 ... Hazardous or Adventure sports: Code- Excl09 ... Breach of law: Code- Excl10 ... Excluded Providers: Code- Excl11 ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- Excl12 ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... Dietary supplements and substances that can be purchased without prescription ... Refractive Error: Code- Excl15 ... Unproven Treatments: Code- Excl16 ... Sterility and Infertility: Code- Excl17 ... Maternity: Code Excl18 ... Any medical treatment taken outside India, unless otherwise agreed by Us as Specified in the Policy Schedule/Certificate of Insurance. ... War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war ... Dental treatment or Surgery of any kind unless requiring Hospitalisation as a result of accidental Bodily Injury","sources":[{"clause":"Excl04","heading":"Investigation & Evaluation- Code- Excl04","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-excl04"},{"clause":"Excl05","heading":"Rest Cure, rehabilitation and respite care- Code- Excl05","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-excl05"},{"clause":"Excl06","heading":"Obesity/ Weight Control: Code- Excl06","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-excl06"},{"clause":"4","heading":"Change of Gender Treatments (Code- Excl 07)","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-4-4"},{"clause":"5","heading":"Cosmetic or plastic Surgery: Code- Excl08","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-5-4"},{"clause":"6","heading":"Hazardous or Adventure sports: Code- Excl09","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-6-4"},{"clause":"7","heading":"Breach of law: Code- Excl10","page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-7-4"},{"clause":"8","heading":"Excluded Providers: Code- Excl11","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-8-4"},{"clause":"9","heading":"Treatment for, Alcoholism, drug or substance abuse or any","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-9-4"},{"clause":"10","heading":"Treatments received in heath hydros, nature cure clinics, spas or","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-10-4"},{"clause":"11","heading":"Dietary supplements and substances that can be purchased","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-11-4"},{"clause":"12","heading":"Refractive Error: Code- Excl15","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-12-3"},{"clause":"13","heading":"Unproven Treatments: Code- Excl16","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-13-2"},{"clause":"14","heading":"Sterility and Infertility: Code- Excl17","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-14-2"},{"clause":"15","heading":"Maternity: Code Excl18","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-15-2"},{"clause":null,"heading":"C. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-c-specific-exclusions"},{"clause":"15(d)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-15-d"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The Policyholder may cancel the policy at any time during the term by giving 7 days’ written notice. For terms up to one year, proportionate premium for the unexpired policy period is refunded if no claims were made; for terms over one year, premium is refunded for unexpired policy years where risk coverage has not commenced.","display":"7 days’ written notice; proportionate refund for unexpired period if term up to one year and no claim, or refund for unexpired policy years not commenced for terms over 1 year","note":null,"quote":"The Policyholder may cancel his/her Policy at any time during the term, by giving 7 days’ notice in writing. The Insurer shall\ni) refund proportionate premium for unexpired Policy Period, if the term of Policy upto one year and there is no Claim (s) made during the Policy Period.\nii) refund premium for the unexpired Policy Period, in respect of policies with term more than 1 year and risk coverage for such Policy years has not commenced.","sources":[{"clause":"7(a)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-7-a"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Medical treatment outside India is excluded unless the insurer agrees otherwise as specified in the Policy Schedule/Certificate of Insurance. Cover beyond Indian geographical jurisdiction may be available only if specifically agreed and specified.","display":"India only, unless otherwise agreed and specified in the Policy Schedule/Certificate of Insurance","note":null,"quote":"Any medical treatment taken outside India, unless otherwise agreed by Us as Specified in the Policy Schedule/Certificate of Insurance. ... Cover beyond Indian Geographical jurisdiction available in expiring policy, if specifically agreed by us to be covered and Specified in the Policy Schedule/Certificate of Insurance.","sources":[{"clause":null,"heading":"C. Specific Exclusions","page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-c-specific-exclusions"},{"clause":"17(I)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-17-i"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Policy wording states this for new individual health insurance policies except those with tenure of less than a year.","quote":"Every Policyholder of new individual health insurance policies except those with tenure of less than a year, shall be provided a free look period of 30 days beginning from the date of receipt of policy document","sources":[{"clause":"14","heading":"Free Look Period","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-14-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days; 15 days for monthly instalments","note":"The stated 30-day grace period applies to Single, Half Yearly and Quarterly instalment options; monthly instalments have 15 days.","quote":"In case of monthly instalment option, a Grace Period of 15 days is applicable. Whereas, in case of Single, Half Yearly, Quarterly instalment options, a Grace Period of 30 days is applicable.","sources":[{"clause":"15","heading":"Premium payment in instalments (wherever applicable)","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-15-3"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"not-stated","value":null,"display":null,"note":"The documents define some dependents such as children from day 1 up to the age specified in the schedule, but do not state overall minimum and maximum entry ages for buying the policy.","quote":null,"sources":[],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Single","Half Yearly","Quarterly","Monthly"],"display":"Single, Half Yearly, Quarterly or Monthly","note":null,"quote":"If the Insured Person has opted for Payment of Premium on an instalment basis i.e. Single, Half Yearly, Quarterly or Monthly, as mentioned in the Policy Schedule/Certificate of Insurance","sources":[{"clause":"15","heading":"Premium payment in instalments (wherever applicable)","page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-15-3"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Modification of Pre-hospitalization Medical expenses","Modification of Post-hospitalization Medical expenses","Modification of Modern Treatment","Modification of Inpatient care under Alternative Treatment","Modification of Domiciliary Hospitalization","Modification of Bariatric Surgery","Maternity Expenses","New Born Baby Cover","Child Vaccination Cover","Well Baby Cover for New Born","Stem Cell Preservation Cover","Infertility Cover and Surrogacy Cover","Accident Multiplier","Emergency Ground Ambulance","Air Ambulance Cover","Prosthetics Cover","Convalescence Benefit","Funeral and Repatriation Cover","Compassionate visit","Accompanying Person Cover","Health Check-up","Zero deductions in claim in case of death of Insured","Sub-limit on Specified Illness/Conditions","Loyalty Credit","Weekly Benefit","Voluntary Co-payment","E-Opinion","Corporate Floater","Sum Insured Reinstatement","Claim settlement in network only","Claim settlement on Reimbursement only","Physiotherapy and Rehabilitation cover","Home Health Care","Non-medical/Consumables Expenses","External Congenital Anomalies","Cancer Care","Attendant Charges Cover","De-addiction Expenses Cover","Modification of Home/Vehicle","Expenses for External Aids and Medical Equipment","Modification of Waiting period for Pre- Existing Diseases","Modification of Initial Waiting Period","Modification of Waiting Period for Diseases Specific Exclusions","Franchise","Vision Correction","Per claim deductible","Gender Reassignment Cover","Wellness Care","OPD Cover","Second Medical Opinion Cover","Common Disease Cover","Super Top Up Cover","Hospital Daily Cash","Critical Illness Cover"],"display":"Optional hospitalization covers, OPD/second opinion, common disease, super top-up, hospital daily cash and critical illness covers, as opted and specified in the schedule","note":"The policy wording contains many optional covers; exact applicability and limits depend on the Policy Schedule/Certificate of Insurance.","quote":"In consideration of payment of additional Premium or reduction in the Premium as applicable, it is hereby declared and agreed that We will pay the expenses under below listed Covers ... These Covers are optional and applicable only if opted for ... B.7 Maternity Expenses ... B.8 New Born Baby Cover ... B.12 Infertility Cover and Surrogacy Cover ... B.26 Voluntary Co-payment ... B.28 Corporate Floater ... B.46 Per claim deductible ... B.47 Gender Reassignment Cover ... B.48- Wellness Care ... We will indemnify the Reasonable and Customary Charges incurred during the Policy Period for OPD Treatment of the Insured Person as per cover / benefit as opted and specified under Policy Schedule/ Certificate of insurance. ... Under Out-Patient Expenses the below optional cover is available ... C.2 Second Medical Opinion Cover ... Section D COMMON DISEASE COVER ... Section E SUPER TOP UP COVER ... Section F HOSPITAL DAILY CASH ... Section G CRITICAL ILLNESS COVER","sources":[{"clause":"Section B","heading":"OPTIONAL COVERS UNDER HOSPITALIZATION COVER","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-section-b"},{"clause":"B.7","heading":"Maternity Expenses","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-7"},{"clause":"B.8","heading":"New Born Baby Cover","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-8"},{"clause":"B.12","heading":"Infertility Cover and Surrogacy Cover","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-12"},{"clause":"B.26","heading":"Voluntary Co-payment","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-26"},{"clause":"B.28","heading":"Corporate Floater","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-28"},{"clause":"B.46","heading":"Per claim deductible","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-46"},{"clause":"B.47","heading":"Gender Reassignment Cover","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-47"},{"clause":null,"heading":"B.48- Wellness Care","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-48-wellness-care"},{"clause":"C.1","heading":"OPD Cover","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-c-1"},{"clause":null,"heading":"Under Out-Patient Expenses the below optional cover is available","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-under-out-patient-expenses-the-below-optional-co"},{"clause":"C.2","heading":"Second Medical Opinion Cover","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-c-2"},{"clause":"Section D","heading":"COMMON DISEASE COVER","page":15,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-section-d"},{"clause":"Section E","heading":"SUPER TOP UP COVER (Annual Aggregate Deductible)","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-section-e"},{"clause":"Section F","heading":"HOSPITAL DAILY CASH","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-section-f"},{"clause":"Section G","heading":"CRITICAL ILLNESS COVER","page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-section-g"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"conflicting","value":"Coverage is not available during the grace period under the policy wording.","display":"Coverage is not available during the grace period","note":"Prospectus says: \"During such Grace Period, coverage will be available from the due date of instalment premium till the date of receipt of premium by Company.\"","quote":"During such Grace Period, coverage will not be available from the due date of instalment premium till the date of receipt of premium by Company.","sources":[{"clause":"7(c)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-7-c"},{"clause":"21(I)(c)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15066#c-21-i-c-2"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":"The wording says room rent is as specified in the Policy Schedule/Certificate of Insurance, but no daily room rent limit is printed in the provided documents.","quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"quote-verified","value":"Maternity Expenses is an optional cover. It pays medically necessary treatment for normal delivery, routine or elective Caesarean, maternity complications, pre-natal medical expenses, post-natal check-ups and miscarriage during the policy period, if the insured person has been covered since inception for the continuous coverage period specified in the schedule.","display":"Optional maternity cover for normal delivery, Caesarean, maternity complications, pre-natal and post-natal checks and miscarriage; waiting/continuous coverage period as specified in the schedule","note":"Maximum liability per pregnancy and the continuous coverage period are specified in the Policy Schedule/Certificate of Insurance.","quote":"We will indemnify the reasonable and customary charges for Medical Expenses incurred towards Medically Necessary Treatment of the Insured Person in case of normal delivery, routine or elective Caesarean or Maternity related Complications including Pre-natal Medical Expenses and Post-Natal check-ups and miscarriage during the Policy Period. ... The Insured Person in respect of whom a claim for Maternity Expenses is made must have been covered as an Insured Person since the inception of the First Policy with Us for at least the period of continuous coverage as specified in the Policy Schedule/Certificate of Insurance","sources":[{"clause":"B.7","heading":"Maternity Expenses","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-7"},{"clause":"B.7(I)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-7-i"}],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"quote-verified","value":"Pre-existing disease treatment and its direct complications are excluded until the expiry of the number of months specified in the Policy Schedule/Certificate of Insurance, unless modified by an optional cover.","display":"Not day-one by default; PED is excluded until the schedule-specified months expire","note":"The actual PED waiting period is schedule-specific and is not printed in the provided documents.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of number of months (as Specified in Policy Schedule/Certificate of Insurance) of continuous coverage after the date of inception of the first policy with insurer. ... If you avail this option the pre -existing waiting period stands modified as specified in the Policy Schedule/Certificate of insurance.","sources":[{"clause":"1","heading":"Pre-Existing Diseases (Code- Excl01)","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-1-5"},{"clause":"B.41","heading":"Modification of Waiting period for Pre- Existing Diseases","page":13,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094#c-b-41"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, Family Floater Sum Insured","note":null,"quote":"Sum Insured (Basis) | Family Individual Sum Insured Sr. No. Insured Name Base Sum Insured Family Floater Sum Insured Sr. No. Insured Name Base Sum Insured","sources":[{"clause":"Row 4","heading":"Sum Insured (Basis)","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15065#c-row-4"}],"law":[]}],"documents":[{"kind":"wording","label":"Group Mediclaim Policy Policy Wordings","pages":37,"fetched_at":"2026-10-17 20:03:43+00","source_url":"https://content.sbigeneral.in/uploads/Group_Mediclaim_Policy_Policy_wording_1901_8ab1275749.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15094"},{"kind":"prospectus","label":"Group Mediclaim Policy Prospectus","pages":17,"fetched_at":"2026-10-17 20:03:05+00","source_url":"https://content.sbigeneral.in/uploads/Group_Mediclaim_Policy_Propsectus1901_5c24d6b7b7.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15066"},{"kind":"cis","label":"Group Mediclaim Policy Customer Information Sheet","pages":6,"fetched_at":"2026-10-17 20:03:04+00","source_url":"https://content.sbigeneral.in/uploads/Group_Mediclaim_Policy_CIS_73d2779098.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324/document/15065"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"SBI General Insurance official website","url":"https://www.sbigeneral.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Health claims","url":"https://www.sbigeneral.in/claim/health","note":null},{"purpose":"claim","kind":"insurer","name":"Home claims","url":"https://www.sbigeneral.in/claim/home","note":null},{"purpose":"claim","kind":"insurer","name":"Motor claims","url":"https://www.sbigeneral.in/claim/motor","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.sbigeneral.in/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Policy renewal","url":"https://www.sbigeneral.in/policy-renewal","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Group Mediclaim Policy (UIN SBIHLGP24031V012324), IndiaInsurances, https://indiainsurances.com/policy/sbi-general-insurance/group-mediclaim-policy-sbihlgp24031v012324"}