{"uin":"SBIHLIP23173V012223","name":"Health Edge Insurance","url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited","url":"https://indiainsurances.com/insurer/sbi-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Health Edge Insurance is a health indemnity policy available on individual or family floater basis with sum insured options from 3L to 25Lacs. It has a 30-day initial waiting period, 24-month pre-existing disease and specific disease waiting periods, and optional covers including Unlimited Refill, OPD, Women Care and Global Treatment.","analysis":{"state":"machine","analysed_at":"2026-10-19 22:04:23.89338+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":"quote-verified","value":["Single Comprehensive Plan variant"],"display":"Single Comprehensive Plan variant","note":null,"quote":"Single Comprehensive Plan variant with 9 Basic indemnity Covers and 18 Optional covers to stand in need of medical exigency.","sources":[{"clause":null,"heading":"Health Edge Insurance","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14915#c-health-edge-insurance"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"1/2/3 Years","display":"1/2/3 Years","note":"From the prospectus eligibility table.","quote":"Policy Term | 1/2/3 Years","sources":[{"clause":null,"heading":"Health Edge Insurance","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14915#c-health-edge-insurance"}],"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":"For cashless hospitalisation, intimate within 24 hours of emergency hospitalisation or at least 72 hours before planned hospitalisation. For reimbursement claims, intimate within 48 hours of admission or before discharge from the hospital, whichever is earlier.","display":"Cashless: within 24 hours for emergency and 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 discharge from the Hospital, whichever is earlier","sources":[{"clause":"B(II)(b)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-b-ii-b-2"}],"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":"quote-verified","value":["Duly filled and signed claim form","Certified copy of Hospital discharge Summary","Certified copy of final hospital bill, pharmacy bills, Investigation labs bills","All original reports of Investigations done","Self-attested Copy of PAN card & Aadhar card, photo id & address Proof of the nominee / beneficiary","Beneficiary bank account / NEFT details","Certified copy of Death certificate issued by municipal authority (in case of death of insured)","KYC details and Documents"],"display":"Claim form, discharge summary, final bills, investigation reports, PAN/Aadhaar/photo ID/address proof, bank/NEFT details, death certificate if applicable, and KYC documents","note":"Case-specific and optional-cover claim documents may also be requested.","quote":"Duly filled and signed claim form ... Certified copy of Hospital discharge Summary ... Certified copy of final hospital bill, pharmacy bills,\nParticulars to be provided to us for Claim notification | 1. Policy Number 2. Name of the Insured Person(s) named in the Policy schedule availing treatment, 3. Nature of disease/illness/injury, 4. Name and address of the attending Medical Practitioner Hospital 5. Date and time of event if applicable 6. Date of admission\nInvestigation labs bills ... All original reports of Investigations done ... Self-attested Copy of PAN card & Aadhar card, photo id &\naddress Proof of the nominee / beneficiary (Driving license / Passport / Election Card, etc) for address mentioned in claim form with KYC Form ... Beneficiary bank account / NEFT details: Cancelled cheque or\ncopy of first page of bank passbook showing account holder’s name, Account number, IFSC code, Branch name etc. ... Certified copy of Death certificate issued by municipal\nauthority (in case of death of insured) ... 8 KYC details and Documents","sources":[{"clause":"1","heading":"Duly filled and signed claim form","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-1-4"},{"clause":"2","heading":"Certified copy of Hospital discharge Summary","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-5"},{"clause":"3","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-3-4"},{"clause":"4","heading":"All original reports of Investigations done","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-4-5"},{"clause":"5","heading":"Self-attested Copy of PAN card & Aadhar card, photo id &","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-5-4"},{"clause":"6","heading":"Beneficiary bank account / NEFT details: Cancelled cheque or","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-6-4"},{"clause":"7","heading":"Certified copy of Death certificate issued by municipal","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-7-3"},{"clause":"8","heading":"KYC details and Documents","page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-3"}],"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 at 2% above the bank rate from the date of receipt of claim submission to the date of payment.","display":"Within 15 days from receipt of claim submission; delay interest at 2% above bank rate","note":null,"quote":"The Company shall settle or reject a claim within 15 days from the date of receipt of claim submission.\nii. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the Insured Person 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":"8(I)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-i-2"}],"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":"quote-verified","value":["Expenses related to the treatment of any Illness within 30 days from the first Policy Commencement Date","Expenses related to the treatment of listed Conditions; Surgeries/treatments until the expiry of 24 months","Expenses related to the treatment of a Pre-Existing Diseases (PED) and its direct complications until the expiry of 24 months","Investigation and Evaluation","Rest Cure, rehabilitation, and respite care","Change of Gender Treatments","Cosmetic or Plastic Surgery","Hazardous or Adventure Sports","Breach of Law","Excluded Providers","Treatment for alcoholism, drug or substance abuse or any addictive condition and consequences thereof","Unproven Treatments","Sterility and Infertility","Maternity","Treatment taken outside India"],"display":"Main exclusions include 30-day illness waiting period, 24-month listed disease/procedure waiting period, 24-month PED waiting period, Investigation and Evaluation, Rest Cure, Change of Gender, Cosmetic or Plastic Surgery, Hazardous or Adventure Sports, Breach of Law, Excluded Providers, alcoholism/drug abuse, Unproven Treatments, Sterility and Infertility, Maternity, and treatment outside India","note":null,"quote":"Expenses related to the treatment of any Illness within 30 days\nSurgery on prostate | Cholecystectomy\nfrom the first Policy Commencement Date shall be excluded excepts claims arising due to an accident, provided the same\nHernia | Hydrocele/Rectocele\nare covered. ... Expenses related to the treatment of listed Conditions; Surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with Us. ... Expenses related to the treatment of a Pre-Existing Diseases (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with Us. ... Investigation and Evaluation (Code-Excl 04): ... Rest Cure, rehabilitation, and respite care (Code- Excl 05) ... Change of Gender Treatments (Code- Excl 07) ... Cosmetic or Plastic Surgery (Code- Excl 08) ... Hazardous or Adventure Sports (Code- Excl 09) ... Breach of Law (Code- Excl 10) ... Excluded Providers (Code-Excl 11) ... Treatment for alcoholism, drug or substance abuse or any addictive condition and consequences thereof (Code- Excl 12) ... Unproven Treatments (Code- Excl 16) ... Sterility and Infertility (Code-Excl 17) ... Maternity (Code-Excl 18) ... Treatment taken outside India (Not applicable for variants wherein D.14 – Global Treatment is applicable.","sources":[{"clause":"2(I)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-a"},{"clause":"2(I)(c)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-c"},{"clause":null,"heading":"1. Illnesses","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-1-illnesses"},{"clause":"A","heading":"STANDARD EXCLUSIONS","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-a-2"},{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-b-ii-c"}],"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 policy gives Bima Bharosa and the insurer's Head – Customer Care as grievance routes, then escalation to the Grievance Redressal Officer if not satisfied or no response within 5 days, before Ombudsman escalation.","display":"Bima Bharosa or Head – Customer Care, then Grievance Redressal Officer (GRO)","note":null,"quote":"You can register your grievances with the regulator using the following link: https://bimabharosa.irdai.gov.in/Home/Home ... Alternatively, if you wish to register your grievances directly with us, you may write to the Head – Customer Care. We aim to respond to all Grievances within 7 days. ... 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)","sources":[{"clause":null,"heading":"D. Grievances Redressal Procedure Stage 1: Bima Bharosa","page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-grievances-redressal-procedure-stage-1-bima-bh"},{"clause":null,"heading":"Stage 2: Head – Customer Care","page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#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/health-edge-insurance-sbihlip23173v012223/document/14917#c-stage-3-grievance-redressal-officer-gro"}],"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":"quote-verified","value":"3L, 5L,7L,10L, 15L,20L and 25Lacs","display":"3L, 5L,7L,10L, 15L,20L and 25Lacs","note":null,"quote":"Sum Insured (SI) | 3L, 5L,7L,10L, 15L,20L and 25Lacs","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"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 policy wording says illness expenses within 30 days are excluded except covered accident claims.","quote":"Initial Waiting Period (Excluding Accidental Hospitalization) | 30 Days","sources":[{"clause":null,"heading":"Waiting Period","page":33,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-waiting-period"}],"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":"quote-verified","value":{"unit":"months","amount":24},"display":"24 months","note":null,"quote":"Expenses related to the treatment of a Pre-Existing Diseases (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with Us.","sources":[{"clause":null,"heading":"1. Illnesses","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-1-illnesses"}],"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":"quote-verified","value":{"unit":"months","amount":24},"display":"24 months","note":"The waiting period is not applicable for claims arising due to an accident.","quote":"Expenses related to the treatment of listed Conditions; Surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with Us.","sources":[{"clause":"2(I)(c)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-c"}],"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":["Internal Congenital diseases","Non infective Arthritis","Diseases of gall bladder including cholecystitis","Urogenital system e.g. Kidney stone, Urinary Bladder Stone","Pancreatitis","Ulcer and erosion of stomach and duodenum","All forms of Cirrhosis","Gastro Esophageal Reflux Disorder (GERD)","Perineal Abscesses","Perianal Abscesses","Cataract","Fissure/Fistula in anus, Hemorrhoids including Pilonidal sinus","Gout and Rheumatism","Benign tumors, Cysts, Nodules, Polyps including breast lumps","Osteoarthritis and Osteoporosis","Polycystic ovarian diseases","Fibroids (Fibromyoma)","Sinusitis, Rhinitis","Tonsillitis","Skin tumors","Benign Hyperplasia of Prostate","Genetic Disorder","Adenoidectomy, tonsillectomy","Tympanoplasty, Mastoidectomy","Dilatation and curettage (D&C)","Nasal concha resection","Myomectomy for fibroids","Surgery of Genito urinary system","Surgery on prostate","Cholecystectomy","Hernia","Hydrocele/Rectocele","Surgery for prolapsed inter vertebral disc","Joint replacement surgeries","Surgery for varicose veins and varicose ulcers","Surgery for Nasal septum deviation","Surgery for Perianal Abscesses","Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries"],"display":"Listed illnesses and procedures include cataract, hernia, joint replacement surgeries, gall bladder disease, kidney/urinary bladder stones, sinusitis/rhinitis, tonsillitis, benign tumors/cysts/nodules/polyps, fibroids, and listed ENT/genito-urinary/prostate/varicose vein surgeries","note":null,"quote":"Internal Congenital diseases | Non infective Arthritis\nVI) Global Treatment: Expenses related to the treatment taken abroad for any listed Illness under this benefit within 36 months\nDiseases of gall bladder including cholecystitis | Urogenital system e.g. Kidney stone, Urinary Bladder Stone\nfrom the first Policy Commencement Date shall be excluded VII) Women Care Benefit: A waiting Period of shall apply for all claims under the Women Care Benefit as Maternity Expenses: 48\nPancreatitis | Ulcer and erosion of stomach and duodenum\nmonths, Assisted Reproduction Treatment: 48 months\nAll forms of Cirrhosis | Gastro Esophageal Reflux Disorder (GERD) ... Cataract | Fissure/Fistula in anus, Hemorrhoids including\nOn availing this option, 10% or 20% Co-Payment as specified in the Policy Schedule, shall be applied on each and every admissible claim wherever applicable under this Policy, once the Co-Payment option\nPilonidal sinus | Gout and Rheumatism\nis availed by the Insured Person, it cannot be opted out of at subsequent Renewal\nBenign tumors, Cysts, Nodules, Polyps including breast lumps | Osteoarthritis and Osteoporosis\nNote 1: This co-payment will be additive to any other co-payment in the Policy, if applicable.\nPolycystic ovarian diseases | Fibroids (Fibromyoma)\nNote 2: Co-payment will be applicable under any admissible claim under Section C.1 (In-patient Hospitalization Treatment) or Section\nSinusitis, Rhinitis | Tonsillitis\nC.4 (Day Care Treatment) or Section C.6 (Bariatric Surgery Cover) or\nSkin tumors | Benign Hyperplasia of Prostate\nSection C.7 (Modern Treatment/Advanced Procedures) or Section C.8 (AYUSH Treatment) Genetic Disorder ... Adenoidectomy, tonsillectomy | Tympanoplasty, Mastoidectomy\nwith or in respect of following expenses till the expiry of waiting period mentioned below:\nDilatation and curettage (D&C) | Nasal concha resection\nI) First Thirty Days Waiting Period (Code-Excl 03):\nMyomectomy for fibroids | Surgery of Genito urinary system ... Surgery on prostate | Cholecystectomy ... Hernia | Hydrocele/Rectocele ... Surgery for prolapsed inter vertebral disc | Joint replacement surgeries ... Surgery for varicose veins and varicose ulcers | Surgery for Nasal septum deviation ... Surgery for Perianal Abscesses | Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries","sources":[{"clause":null,"heading":"1. Illnesses","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-1-illnesses"},{"clause":"D.15","heading":"Co-payment","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-15"},{"clause":"2","heading":"Surgical Procedures","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-3"},{"clause":"2(I)(a)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-a"},{"clause":"2(I)(b)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-b"},{"clause":"2(I)(c)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-i-c"}],"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":"G(b)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-g-b-2"}],"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 policy renewal date. Credits for sum insured, no claim bonus, specific waiting periods, PED waiting period and moratorium period can be transferred if continuously covered without lapses.","display":"Yes, by applying at least 30 days before but not earlier than 60 days from renewal; waiting-period and other credits 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. If such person is presently covered and has been continuously covered without any lapses under any health insurance Policy with an Indian General/Health Insurer, 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. from the existing Insurer to the acquiring Insurer in the previous Policy.","sources":[{"clause":null,"heading":"3. Portability","page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-3-portability"}],"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":"quote-verified","value":true,"display":"Lifelong","note":"From the prospectus eligibility table.","quote":"Renewability | Lifelong","sources":[{"clause":null,"heading":"Health Edge Insurance","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14915#c-health-edge-insurance"}],"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":"No loading applies on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"No loading shall apply on Renewals based on individual Claims experience.","sources":[{"clause":"8(I)(d)(ii)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-i-d-ii"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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 any time during the term by giving 7 days' written notice. For policies up to one year, the insurer refunds proportionate premium for the unexpired policy period if no claim was made; for policies longer than one year, it refunds premium for unexpired policy years whose risk coverage has not commenced.","display":"7 days' notice; proportionate refund for unexpired period if term up to 1 year and no claim; for term over 1 year, refund for unexpired policy years whose risk has not commenced","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":"1(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-1-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":"Treatment taken outside India is excluded under the base policy. The optional Global Treatment cover pays inpatient care outside India for listed illnesses or procedures.","display":"Base policy excludes treatment outside India; optional Global Treatment covers listed inpatient care outside India","note":"Global Treatment is an optional cover for listed illnesses or procedures.","quote":"Treatment taken outside India (Not applicable for variants wherein D.14 – Global Treatment is applicable. ... We will pay the Medical Expenses incurred towards the Insured Person’s Inpatient Care outside India during the Policy Period caused solely and directly due to any of the below listed Illness or for below listed procedures","sources":[{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-b-ii-c"},{"clause":null,"heading":"D. 13 Global Treatment","page":18,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-13-global-treatment"}],"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":null,"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, whether received electronically or otherwise, to review the terms and conditions of such Policy.","sources":[{"clause":"2(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-2-a"}],"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":15},"display":"15 days for monthly; 30 days in all other cases","note":null,"quote":"The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"18","heading":"Grace Period Grace period","page":2,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-18"}],"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":"quote-verified","value":"Adult entry age is 18 years to 65 years. Child entry age is 91 days to 30 years.","display":"Adults: Min – 18 years and Max -65 years; children: 91 days to 30 years","note":null,"quote":"Entry Age of Insured Adult | Min – 18 years and Max -65 years\nEntry Age (Child) | 91 days to 30 years","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"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":["Half yearly","Quarterly","Monthly","Annual","Single"],"display":"Half yearly, Quarterly, Monthly, Annual, Single","note":null,"quote":"Option | Instalment Premium Option\nall relevant medical records and shall allow the Company or its representatives to inspect such records. The Insured Person\nOption 1 | Half yearly\nshall furnish such information as the Company may require for settlement of any claim under the Policy, within reasonable\nOption 2 | Quarterly\ntime limit and within the time limit specified in the Policy.\nOption 3 | Monthly ... Option 4 | Annual ... Option 5 | Single","sources":[{"clause":"5(III)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-5-iii"},{"clause":"5(i)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-5-i-2"}],"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":["Domestic Help/Staff Indemnity","Hospital Daily Cash","Accidental Death Cover (Primary Insured only)","Healing Benefit (>5 days of Hospitalization)","Unlimited Refill (Related and Unrelated Illness both)","Vector Borne Fixed Benefit","Critical Illness Cover","Claims Safeguard","Out Patient (OPD) Cover","Booster Benefit","E-opinion","Maternity Expenses","New Born Baby Cover","Assisted Reproduction Treatment","Co-payment","Global Treatment","Health Assistance (A.I. Personal Fitness coaching)","Dietician and Nutrition E-consultation","Unlimited Gym Membership","Walk Healthy Benefit"],"display":"Domestic Help/Staff Indemnity, Hospital Daily Cash, Accidental Death Cover, Healing Benefit, Unlimited Refill, Vector Borne Fixed Benefit, Critical Illness Cover, Claims Safeguard, OPD, Booster Benefit, E-opinion, Women Care, Co-payment, Global Treatment and Wellness options","note":null,"quote":"Domestic Help/Staff Indemnity ... Hospital Daily Cash ... Accidental Death Cover (Primary Insured only) ... Healing Benefit (>5 days of Hospitalization) ... Unlimited Refill (Related and Unrelated Illness both) ... Vector Borne Fixed Benefit ... Critical Illness Cover ... Claims Safeguard ... OPD | Out Patient (OPD) Cover ... Booster Benefit ... E-opinion ... Maternity Expenses ... New Born Baby Cover ... Assisted Reproduction Treatment ... Co-Pay | Co-payment ... Global Cover | Global Treatment ... Wellness | Health Assistance (A.I. Personal Fitness coaching) Dietician and Nutrition E-consultation Unlimited Gym Membership ... Walk Healthy Benefit","sources":[{"clause":null,"heading":"Optional","page":33,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-optional"}],"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":"quote-verified","value":"Coverage is not available during the grace period from the due date of instalment premium until the company receives the premium; renewal grace period also states coverage is not available.","display":"Coverage is not available during the grace period","note":"The definition clause also says insurers shall offer coverage during the grace period if premium is paid in instalments during the policy period.","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. ... Coverage is not available during the Grace Period.","sources":[{"clause":"5(I)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-5-i"},{"clause":"8(I)(d)(ii)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-i-d-ii"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room rent is payable at actuals up to the sum insured.","display":"Actuals up to Sum Insured","note":null,"quote":"Room Rent | Actuals up to Sum Insured | Basis of Payment - Indemnity","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"The policy states room rent as actuals up to sum insured, not as a room category.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU charges are payable at actuals up to the sum insured.","display":"Actuals up to Sum Insured","note":null,"quote":"ICU Charges | Actuals up to Sum Insured | Basis of Payment - Indemnity","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"There is no stated compulsory base co-payment. If the optional co-payment is availed, 10% or 20% co-payment applies to each admissible claim where applicable; optional OPD has 50% co-payment on professional fees and 30% on diagnostics and pharmacy.","display":"None unless opted; optional co-payment 10% or 20%, and OPD co-pay 50% on Professional Fees and 30% on Diagnostics and Pharmacy","note":"Optional co-payment, once availed, cannot be opted out at subsequent renewal.","quote":"On availing this option, 10% or 20% Co-Payment as specified in the Policy Schedule, shall be applied on each and every admissible claim wherever applicable under this Policy ... 50% co-payment will be applicable on Professional Fees\nii) 30% co-payment will be applicable on Diagnostics and Pharmacy Expenses to be borne by the Insured","sources":[{"clause":"D.15","heading":"Co-payment","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-15"},{"clause":"D.9","heading":"Out Patient (OPD) Cover","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-9"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"quote-verified","value":["Bariatric Surgery Cover: up to 50,000"],"display":"Bariatric Surgery Cover: up to 50,000","note":null,"quote":"Bariatric Surgery Cover | up to 50,000 | Basis of Payment - Indemnity","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Payable only if the related inpatient/day care/modern treatment/AYUSH claim is accepted.","quote":"We will indemnify on Reimbursement basis only, the Insured Person’s Pre-hospitalization Medical Expenses incurred in respect of an Illness or Injury for duration of 30 days.","sources":[{"clause":"C.2","heading":"Pre-hospitalization Medical Expenses","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-2"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"60 days","note":"Payable only if the related inpatient/day care/modern treatment/AYUSH claim is accepted.","quote":"We will indemnify on Reimbursement basis only, the Insured Person’s Post-Hospitalization Medical Expenses incurred following an Illness or Injury for duration of 60 days.","sources":[{"clause":"C.3","heading":"Post-hospitalization Medical Expenses","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-3"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"Day Care Treatment is covered for any day care treatment during the policy period following illness or injury, if advised as medically necessary; admission must be more than 2 hours and angiography, dialysis, radiotherapy or chemotherapy for cancer are also covered.","display":"Any Day Care Treatment; admission more than 2 hours, including Angiography, Dialysis, Radiotherapy or Chemotherapy for cancer","note":"OPD Treatment and Diagnostic Services costs are not covered under the day care benefit.","quote":"We will indemnify the Medical Expenses incurred by the Insured Person’s under any Day Care Treatment during the Policy Period following an Illness or Injury. Conditions:\nThe above coverage is subject to fulfilment of following conditions:\ni) The Day Care Treatment is advised in writing by a Medical Practitioner as Medically Necessary Treatment.\nii) The Day Care Treatment would be covered if the Insured Person is admitted for more than 2 hours and would also cover treatment taken for Angiography, Dialysis, Radiotherapy or Chemotherapy for cancer.","sources":[{"clause":"C.4","heading":"Day Care Treatment","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-4"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalization is not covered.","display":"Not covered","note":null,"quote":"Expenses related to Domiciliary hospitalization shall not be covered.","sources":[{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-b-ii-c"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"AYUSH inpatient care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems is covered in any AYUSH Hospital up to the sub-limit specified in the policy schedule; the benefit table states covered up to sum insured.","display":"Covered up to SI","note":null,"quote":"The Company shall indemnify the Medical Expenses incurred by the Insured Person for Inpatient Care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the Sub-limit specified against this Cover in the Policy Schedule, in any AYUSH Hospital. ... AYUSH | Covered up to SI | Basis of Payment - Indemnity","sources":[{"clause":"C.8","heading":"AYUSH Treatment","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-8"},{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Modern Treatments/Advanced Procedures are covered either as inpatient care or day care and include uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchical thermoplasty, vaporisation of the prostrate, IONM and hematopoietic stem cell therapy for bone marrow transplant.","display":"Covered up to SI for listed and not limited modern treatments including robotic surgeries, oral chemotherapy, immunotherapy and stem cell therapy","note":null,"quote":"The following procedures / treatments will be covered either as Inpatient Care or as part of Day Care Treatment as per Sections C.1 and C.4 respectively, in a Hospital of modern treatments and not limited to the following:\ni) Uterine Artery Embolization and HIFU (High intensity focused ultrasound)\nii) Balloon Sinuplasty\niii) Deep Brain stimulation\niv) Oral chemotherapy\nv) Immunotherapy- Monoclonal Antibody to be given as injection\nvi) Intra vitreal injections\nvii) Robotic surgeries\nviii) Stereotactic radio surgeries\nix) Bronchical Thermoplasty\nx) Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)\nxi) IONM - (Intra Operative Neuro Monitoring)\nxii) Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered. ... Modern Treatments/Advanced Procedures | Covered up to SI | Basis of Payment - Indemnity","sources":[{"clause":"C.7","heading":"Modern Treatments/Advanced Procedures","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-7"},{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Emergency road ambulance expenses are covered up to the limit in the policy schedule; the benefit table states INR 3000 per hospitalisation. It covers transfer to the nearest hospital in an emergency, from one hospital to another, or from hospital to home when the related claim is admissible.","display":"Emergency Road Ambulance: INR 3000 per hospitalisation","note":null,"quote":"We will pay for expenses incurred up to the limit as specified in the Policy Schedule, on Road Ambulance Services if You required;\ni) To be transferred to the nearest Hospital in an emergency\nii) Or from one Hospital to another Hospital\niii) Or from Hospital to Home Provided that claim under Section C.1 (Inpatient Hospitalization Treatment) or Section C.4 (Day Care Treatment) or Section C.7 (Modern Treatments) C.8 (AYUSH Treatments) is admissible under the Policy. ... Emergency Road Ambulance Cover (per hospitalization) | INR 3000 | Basis of Payment - Indemnity","sources":[{"clause":"C.5","heading":"Emergency Road Ambulance Cover (per hospitalization)","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-5"},{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"There is no stated base restoration. If the Unlimited Refill option is availed, each single claim under that benefit is payable up to 100% of the Base Sum Insured and it applies from the first claim in a policy year, including related and unrelated illness.","display":"None unless Unlimited Refill is opted; optional refill up to 100% of Base Sum Insured for each single claim","note":"This is an optional cover; for family floater policies the amount is available on a floater basis.","quote":"On availing this option, this benefit is triggered and becomes payable for each and every claim from the first claim itself in a policy year. ... Single claim under this benefit will be payable up to 100% of Base Sum Insured as specified in the Policy Schedule ... Unlimited Refill (Related and Unrelated Illness both) | Unlimited Refill up to 100% of BSI | Basis of Payment - Indemnity","sources":[{"clause":"D.5","heading":"Unlimited Refill (Related and Unrelated Illness both)","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-5"},{"clause":null,"heading":"Optional","page":33,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-optional"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"Booster Benefit is optional. If availed, the sum insured increases by 50% of the Base Sum Insured of the immediately preceding policy year for each claim-free policy year, up to a maximum cap of 200%; if a claim is made, the accrued booster reduces at the same rate.","display":"Optional Booster Benefit: 50% of Base Sum Insured per claim-free year, up to 200%; reduced at same rate after a claim","note":"This is an optional cover.","quote":"On availing this option, Booster Benefit be applied, Sum Insured is increased by 50% (as specified in the Policy Schedule) of the Base Sum Insured of immediate preceding Policy Year in respect of each claim free Policy Year (where no claims are reported), provided the Policy is renewed with the Company without a break, subject to maximum cap of 200% (as specified in the Policy Schedule) of the Base Sum Insured under the current Policy Year. If a claim is made in any particular Policy Year, the Booster Benefit accrued shall be reduced at the same rate at which it has accrued.","sources":[{"clause":"D.10","heading":"Booster Benefit","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-10"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Medicines, drugs and consumables are covered under inpatient hospitalisation. Non-payable List I items become payable only if the optional Claims Safeguard cover is availed.","display":"Medicines, drugs, and consumables covered; List I non-payable items covered only with optional Claims Safeguard","note":null,"quote":"g) Medicines, drugs, and consumables ... On availing this option, If We have accepted a Hospitalization claim under Section C, then the items which are not payable as per List I – ‘Expenses not covered’ under Annexure II related to that particular claim will become payable","sources":[{"clause":"C.1","heading":"In-patient Hospitalization Treatment","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-1"},{"clause":"D.8","heading":"Claims Safeguard","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-8"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity is excluded under the base policy, except where the Women Care optional cover applies. Under that option, maternity expenses for delivery during hospitalisation are covered up to the policy schedule amount, subject to a 48 months waiting period; the benefit table states up to INR 25,000 for normal delivery and INR 50,000 for C-section.","display":"Excluded unless Women Care optional cover is availed; optional cover up to INR 25,000 normal delivery and INR 50,000 C-section after 48 months","note":"The optional benefit includes pre-natal and post-natal medical expenses and is limited to maximum two deliveries or terminations during the insured person's lifetime.","quote":"Maternity (Code-Excl 18) (Not Applicable for Section D.12 – Women Care Benefit) Medical treatment expenses traceable to child-birth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy; ... On availing this option, We will indemnify the Medical Expenses incurred up to the amount specified against this Benefit in the Policy Schedule for the Maternity Expenses incurred in respect of the Hospitalization of the female Insured Person for the delivery of the child during the Policy Period, subject to a waiting period of 48 months. ... Maternity Expenses | Up to INR 25,000 for Normal Delivery and INR 50,000 for C-section.","sources":[{"clause":"A","heading":"STANDARD EXCLUSIONS","page":23,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-a-2"},{"clause":"D.12.1","heading":"Maternity Expenses","page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-12-1"},{"clause":null,"heading":"Optional","page":33,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-optional"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"New Born Baby Cover is available only if the optional Women Care benefit is availed and the maternity claim is accepted. It covers medical expenses for a new born baby from day one up to 90 days of age, subject to the mother being covered under the policy.","display":"Optional New Born Baby Cover: covered from day one up to 90 days, if maternity claim is accepted","note":"A new born baby older than 90 days and less than 1 year can be added by endorsement or at the next renewal, whichever is earlier, on additional premium.","quote":"On availing this option, the Company will indemnify up to the Sum Insured specified against this Benefit in the Policy Schedule for the Medical Expenses incurred in respect of a New Born Baby subject to Mother being covered under the policy. ... The claim under this benefit shall be payable, if the Company has accepted the claim under Benefit-D.12.1 Maternity Expenses\nii) The coverage will be available in respect of a New Born Baby for 90 days from date of delivery.\niii) The Baby born during the policy period, will be covered from day one up to 90 days of age.","sources":[{"clause":"D.12.2","heading":"New Born Baby Cover","page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-12-2"},{"clause":null,"heading":"Condition","page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-condition-2"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","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 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"quote-verified","value":"Stay Fit Health Check-Up is available once in a policy year for preventive tests, up to the sub-limit in the policy schedule; the benefit table states up to INR 5,000.","display":"Once in a Policy Year, up to INR 5,000","note":"Available to all adult members above 18 years of age on individual basis.","quote":"The Insured Person may avail a health check-up, only for Preventive Test, up to a sub-limit as specified in Your Policy Schedule. ... This benefit is available only once in a Policy Year and all tests must have been done on the same date subject to the conditions mentioned in the policy schedule. ... Stay Fit Health Check-Up | Up to INR 5,000 | Basis of Payment - Indemnity","sources":[{"clause":"C.9","heading":"Stay Fit Health Check-Up","page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-9"},{"clause":"C.9(i)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-c-9-i"},{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD is an optional cover. It reimburses per member medical expenses up to the amount specified in the policy schedule for OPD expenses including diagnostics and pharmacy; the benefit table states INR 5000/member. It has 50% co-payment on professional fees and 30% on diagnostics and pharmacy.","display":"Optional OPD: INR 5000/member, including Diagnostics and Pharmacy; 50% co-pay on Professional Fees and 30% on Diagnostics and Pharmacy","note":"OPD expenses are claimable on reimbursement basis only.","quote":"On availing this option, We will indemnify the Medical Expenses per member incurred up to the amount specified against this Benefit in the Policy Schedule for the OPD expenses including Diagnostics and Pharmacy ... OPD | Out Patient (OPD) Cover | INR 5000/member | Basis of Payment - Indemnity ... 50% co-payment will be applicable on Professional Fees\nii) 30% co-payment will be applicable on Diagnostics and Pharmacy Expenses to be borne by the Insured","sources":[{"clause":"D.9","heading":"Out Patient (OPD) Cover","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-d-9"},{"clause":null,"heading":"Optional","page":33,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-optional"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"quote-verified","value":"The benefit table describes the premium type as zone agnostic premium.","display":"Zone Agnostic Premium","note":null,"quote":"Premium Type (Zone Agnostic Premium) | Age Banded","sources":[{"clause":"Annexure II","heading":"Non -Medical Expenses","page":30,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-annexure-ii"}],"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":"quote-verified","value":"Cashless facility is available only at the insurer's network providers. The insurer pays the cashless authorised amount directly to the network provider.","display":"Cashless facility only at network providers; authorised amount paid directly to the network provider","note":null,"quote":"Cashless Facility can be availed only at Our Network Providers. The complete list of Network Providers and empaneled Service providers are available on Our Website and can be obtained by Contacting Our TPA. ... We will make payment for the Cashless authorized amount directly to the Network Provider.","sources":[{"clause":"8(i)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-i"},{"clause":"8(iv)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-iv"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims can be intimated to the insurer through available modes including the insurer's or TPA's website, and the network-provider list can be obtained by contacting the TPA.","display":"Insurer/TPA channels","note":null,"quote":"You shall intimate the Claims to us through any available mode of communication as specified in the Policy, Health Card or our Website or Our TPAs Website ... The complete list of Network Providers and empaneled Service providers are available on Our Website and can be obtained by Contacting Our TPA.","sources":[{"clause":"B(II)(b)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-b-ii-b-2"},{"clause":"8(i)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917#c-8-i"}],"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":"Individual/Family Floater basis","note":"The policy covers self, spouse, dependent children, parents and/or parents-in-law under family floater as stated in the prospectus.","quote":"How can You cover Yourself | Individual/Family Floater basis.\nIn a family ĥoater Policy, a maximum of 4 adults and any number of dependent children can be included in a single Policy.","sources":[{"clause":null,"heading":"Health Edge Insurance","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14915#c-health-edge-insurance"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Edge Insurance Policy Wordings","pages":33,"fetched_at":"2026-10-17 19:57:31+00","source_url":"https://content.sbigeneral.in/uploads/Health_Edge_Insurance_Policy_wording_75e1ad1343.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14917"},{"kind":"prospectus","label":"Health Edge Insurance Prospectus","pages":19,"fetched_at":"2026-10-17 19:57:29+00","source_url":"https://content.sbigeneral.in/uploads/Health_Edge_Insurance_Prospectus_40bf485b77.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14915"},{"kind":"cis","label":"Health Edge Insurance Health Edge CIS","pages":7,"fetched_at":"2026-10-17 19:57:28+00","source_url":"https://content.sbigeneral.in/uploads/Health_Edge_Insurance_CIS_3acd82e819.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14913"},{"kind":"brochure","label":"Health Edge Insurance Brochure","pages":17,"fetched_at":"2026-10-17 19:56:34+00","source_url":"https://content.sbigeneral.in/uploads/57c0b8140d1f4b1ab31b64c87c52a236.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223/document/14896"}],"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":"Health Edge Insurance (UIN SBIHLIP23173V012223), IndiaInsurances, https://indiainsurances.com/policy/sbi-general-insurance/health-edge-insurance-sbihlip23173v012223"}