{"uin":"SBIHLIP27036V022627","name":"Arogya Supreme","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627","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":"Individual","kind":"product","status":"active","approved_on":"2021-06-04","withdrawn_on":null,"summary":"Arogya Supreme is a health indemnity policy with Pro, Plus and Premium plans and individual, individual family and family floater options. It has a 30 days initial waiting period, 36 months pre-existing disease waiting period, 100% sum insured refill once in a policy year, and optional co-payment and deductible covers.","analysis":{"state":"machine","analysed_at":"2026-10-19 21:47:24.369854+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":["Pro","Plus","Premium"],"display":"Pro, Plus, Premium","note":null,"quote":"• Plan You have option to choose any plan from below as per Your requirement.\n• Pro\n• Plus\n• Premium","sources":[{"clause":"9","heading":null,"page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-9"}],"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":"The policy can be issued for 1, 2 or 3 years.","display":"1 / 2/ 3 Years","note":null,"quote":"• Period of Insurance The policy can be issued for a tenure of 1 / 2/ 3 Years.","sources":[{"clause":"Excl14(c)","heading":"Biological attack or weapons","page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-excl14-c"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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 (Driving license / Passport / Election Card, etc) for address mentioned in claim form with cKYC Form","Beneficiary bank account / NEFT details: Cancelled cheque or copy 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 authority (in case of death of insured)","KYC details and Documents"],"display":"Claim form, discharge summary, final bills, investigation reports, KYC/ID/address proof, NEFT details, death certificate where applicable, and KYC documents","note":"The policy also lists separate documents for Major Illness Benefit and Hospital Daily Cash claims, and says case-specific additional documents may be requested.","quote":"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 (Driving license / Passport / Election Card, etc) for address mentioned in claim form with cKYC Form ... Beneficiary bank account / NEFT details: Cancelled cheque or copy 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 authority (in case of death of insured) ... • List of Documents for Major Illness Benefit Cover\n1. Duly filled and signed claim form","sources":[{"clause":"1","heading":"Duly filled and signed claim form","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-1-7"},{"clause":"2","heading":"Certified copy of Hospital discharge Summary","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-2-7"},{"clause":"3","heading":null,"page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-3-7"},{"clause":"4","heading":"All original reports of Investigations done","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-4-7"},{"clause":"5","heading":"Self-attested Copy of PAN card & Aadhar card, photo id &","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-5-5"},{"clause":"6","heading":"Beneficiary bank account / NEFT details: Cancelled cheque","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-6-5"},{"clause":"7","heading":"Certified copy of Death certificate issued by municipal","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-7-5"},{"clause":"8","heading":"KYC details and Documents","page":20,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-8-5"}],"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 receipt of claim submission. If payment is delayed, it must pay interest from receipt of claim submission to payment at 2% above the bank rate.","display":"Within 15 days from receipt of claim submission; delay interest at 2% above bank rate","note":null,"quote":"i. The Company shall settle or reject a claim 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(v)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-8-v"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"First complain directly to SBI General by email at head.customercare@sbigeneral.in or gro@sbigeneral.in, or by calling 1800 102 1111. Senior citizens have dedicated email Seniorcitizengrievances@SBIGeneral.in and the same toll-free number before escalation to the Insurance Ombudsman.","display":"Write to head.customercare@sbigeneral.in or gro@sbigeneral.in, or call 1800 102 1111; senior citizens: Seniorcitizengrievances@SBIGeneral.in","note":null,"quote":"Stage 1:\nIf you wish to register your grievances directly with us, you may write to us at head.customercare@sbigeneral.in or gro@sbigeneral.in or call our toll free number- 1800 102 1111. ... Email: Seniorcitizengrievances@SBIGeneral.in Toll-Free Number: 1800 102 1111 (Available 24/7)","sources":[{"clause":null,"heading":"GRIEVANCE REDRESSAL PROCEDURE","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-grievance-redressal-procedure"}],"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":"Multiple sum insured options range from 1 Lac to 5 Cr. The prospectus table gives plan-wise options for Pro, Plus and Premium.","display":"Rs. 1 Lac to Rs. 5 Cr, with plan-wise options for Pro, Plus and Premium","note":"The policy wording says limits are as specified in the Policy Schedule; the plan-wise option table is from the prospectus.","quote":"Multiple Sum Insured range from 1Lac to 5Cr available under the Policy. ... Sum Insured options available:\nPlan | Pro | Plus | Premium\nSum Insured Limit | 1,00,000 | 6,00,000 | 25,00,000\n2,00,000 | 7,50,000 | 30,00,000\n3,00,000 | 10,00,000 | 35,00,000\n4,00,000 | 12,50,000 | 40,00,000\n5,00,000 | 15,00,000 | 45,00,000","sources":[{"clause":"2","heading":null,"page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-2"},{"clause":"9(i)(v)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-9-i-v"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":36},"display":"36 months","note":null,"quote":"a) Expenses related to the treatment of a Pre-Existing Diseases (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first Policy with Us.","sources":[{"clause":null,"heading":"A. Illnesses","page":15,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-a-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 policy separately states 90 days for Hypertension, Diabetes, Cardiac Condition and Major Illness Benefit, and 15 days for COVID 19.","quote":"a) 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":"F(I)(c)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-f-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. Kidneystone, Urinary Bladder Stone","Pancreatitis","Ulcer and erosion of stomach and duodenum","All forms of Cirrhosis","Gastro Esophageal Reĥux Disorder (GERD)","Perineal Abscesses","Perianal Abscesses","Cataract","Fissure/Ĥstula in anus, Hemorrhoids including","Pilonidal sinus","Gout and rheumatism","Benign tumors, cysts, nodules, polyps including breast lumps","Osteoarthritis and osteoporosis","Polycystic ovarian diseases","Fibroids (Ĥbromyoma)","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 Ĥbroids","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 include cataract, hernia, gall bladder disease, kidney/urinary stones, arthritis, GERD, cirrhosis, benign tumours, fibroids, sinusitis/rhinitis, tonsillitis, BPH and listed surgeries such as adenoidectomy/tonsillectomy, D&C, prostate surgery, cholecystectomy, hydrocele/rectocele, joint replacement, varicose vein surgery and ENT surgeries","note":"The clean list is quoted from the prospectus; the same list appears in the policy wording but is split across adjacent clauses.","quote":"Internal Congenital diseases | Non infective Arthritis\nDiseases of gall bladder including cholecystitis | Urogenital system e.g. Kidneystone, Urinary Bladder Stone\nPancreatitis | Ulcer and erosion of stomach and duodenum\nAll forms of Cirrhosis | Gastro Esophageal Reĥux Disorder (GERD)\nPerineal Abscesses | Perianal Abscesses\nCataract | Fissure/Ĥstula in anus, Hemorrhoids including\nPilonidal sinus | Gout and rheumatism\nBenign tumors, cysts, nodules, polyps including breast lumps | Osteoarthritis and osteoporosis\nPolycystic ovarian diseases | Fibroids (Ĥbromyoma)\nSinusitis, Rhinitis | Tonsillitis\nSkin tumors | Benign Hyperplasia of Prostate\nGenetic Disorder ... Adenoidectomy, tonsillectomy | Tympanoplasty, Mastoidectomy\nDilatation and curettage (D&C) | Nasal concha resection\nMyomectomy for Ĥbroids | Surgery of Genito urinary system\nSurgery on prostate | Cholecystectomy\nHernia | Hydrocele/Rectocele\nSurgery for prolapsed inter vertebral disc | Joint replacement surgeries\nSurgery for varicose veins and varicose ulcers | Surgery for Nasal septum deviation\nSurgery for Perianal Abscesses | Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries","sources":[{"clause":null,"heading":"A. Illnesses","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-a-illnesses"},{"clause":null,"heading":"B. Surgical Procedures","page":15,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-b-surgical-procedures"}],"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, the sixty continuous months apply from the date of enhancement only 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":"A(I)(b)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-a-i-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 another insurer by applying at least 30 days before, but not earlier than 60 days from, the renewal date, and transfer credits for sum insured, no claim bonus, specific waiting periods, PED waiting period and moratorium period.","display":"Porting allowed to other insurers with waiting-period and other credits; apply at least 30 days before but not earlier than 60 days from renewal date","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.","sources":[{"clause":"3","heading":"Portability","page":22,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-3-8"}],"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":"Yes, renewal age is lifelong","note":null,"quote":"• Renewal age is lifelong.","sources":[{"clause":"9","heading":null,"page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-9"}],"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, and renewal shall not be denied because the insured made claims in preceding policy years.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"iii) Renewal shall not be denied on the ground that the Insured Person had made a Claim or Claims in the preceding Policy years. ... vi) No loading shall apply on Renewals based on individual Claims experience.","sources":[{"clause":"1","heading":"Renewal Conditions","page":21,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-1-8"}],"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 at any time by giving 7 days' written notice. For terms up to one year, the insurer refunds proportionate premium for the unexpired period if no claim was made; for terms over one year, it refunds premium for unexpired policy years whose risk coverage has not commenced.","display":"7 days' notice; proportionate unexpired premium if term up to one year and no claims; unexpired policy-year premium if term over 1 year and 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":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#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 outside India is excluded, so the health treatment cover is India-only. Domestic emergency assistance is for travel within India.","display":"India only; treatment taken outside India is excluded","note":null,"quote":"III) Treatment taken outside India. ... We will provide the Emergency medical assistance as below when You are travelling within India 150 kilometers or more away from Your residential address as mentioned in the Policy Schedule for domestic services.","sources":[{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-b-ii-c"},{"clause":"17","heading":"Domestic Emergency Assistance Services (including Air","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-17-3"}],"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":"Applies to new individual health insurance policies except those with tenure of less than a year.","quote":"i) 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(i)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-2-i"}],"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 premium; 30 days in all other cases","note":"For sorting, the shorter monthly-premium grace period is used.","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":null,"heading":"23 Grace period","page":2,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-23-grace-period"}],"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":"Adults can enter from 18 years to 65 years. Children can enter from 91 days to 25 years.","display":"Adults: 18 yrs. to 65 yrs.; Child: 91 days to 25 yrs.","note":null,"quote":"Minimum | Maximum\nAdult | 18 yrs. | 65 yrs.\nChild | 91 days | 25 yrs.","sources":[{"clause":"9","heading":null,"page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-9"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Single","Half Yearly","Quarterly","Monthly"],"display":"Single, Half Yearly, Quarterly or Monthly","note":null,"quote":"If the Insured Person has opted for Payment of Premium on an instalment basis i.e. Single, Half Yearly, Quarterly or Monthly, as mentioned in the Policy Schedule/Certificate of Insurance","sources":[{"clause":"4","heading":"Premium Payment in Installment","page":18,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-4-6"}],"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":["Hospital Cash Benefit","Major Illness Benefit","Additional Sum Insured for Accidental Hospitalization","Enhanced Cumulative Bonus","No Claim Bonus Protector","Co-Payment","Any Room Upgrade","Deductible"],"display":"Hospital Cash Benefit; Major Illness Benefit; Additional Sum Insured for Accidental Hospitalization; Enhanced Cumulative Bonus; No Claim Bonus Protector; Co-Payment; Any Room Upgrade; Deductible","note":"These optional covers apply only if opted and up to the limits in the Policy Schedule.","quote":"Optional Covers 1. Hospital Cash Benefit: We will pay per day Sum Insured up to maximum number of days as specified in the Policy Schedule, if the Hospitalization exceeds 24 hours. 2. Major Illness Benefit: We will pay 100% of Sum Insured or maximum up to Rs. 25,00,000/- whichever is less if the Insured Person suffers from listed major illnesses. 3. Additional Sum Insured for Accidental Hospitalization: We will provide an additional 1.5 times, or 2 times of base Sum Insured towards Medical Expenses incurred for In- Patient Hospitalization Treatment in case the Insured Person is hospitalised due to an accident causing Injury. 4. Enhanced Cumulative Bonus: On each renewal of the policy, we will increase the Sum Insured by 25% or 50% maximum up to 200% of basic Sum Insured as specified in Policy Schedule. 5. No Claim Bonus Protector: On availing of this option, we will protect the percentage of Cumulative Bonus and Enhanced Cumulative Bonus as specified in the Policy schedule. 6. Co-Payment: 10% or 20% Co-Payment as specified in the Policy Schedule, shall be applied on each and every admissible claim after Deductible wherever applicable under this Policy. 7. Any Room Upgrade: Insured person shall be eligible to upgrade the room type category, eligibility to any room in a hospital excluding suite and above. 8. Deductible: On availing of this option, Insured person shall bear on his/her own account an amount equal to the opted deductible specified in the Policy Schedule for any admissible claim amount.","sources":[{"clause":"Row 5","heading":"Policy Coverage (What the Policy Covers)","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923#c-row-5"}],"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":"For instalment premiums, coverage is available during the grace period from the due date until the company receives premium. For renewal after the policy period, coverage is not available during the grace period.","display":"Instalment premiums: coverage available during grace; renewal grace: coverage not available","note":"The two statements apply to different contexts: instalment premium due during the policy period, and renewal after policy period expiry.","quote":"ii. During such Grace Period, coverage will be available from the due date of instalment premium till the date of receipt of premium by Company. ... v) At the end of the Policy Period, the Policy shall terminate and can be renewed within the Grace Period of 30 days to maintain continuity of benefits without Break in Policy. Coverage is not available during the Grace Period.","sources":[{"clause":"4(I)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-4-i-3"},{"clause":"1","heading":"Renewal Conditions","page":21,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-1-8"}],"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 plan and sum-insured dependent: Pro for Rs.3 Lakhs and Rs.4 Lakhs allows Single Private AC Room with a 1% restriction as an option, and for Rs.5 Lakhs Single pvt AC Room with upgrade option; Plus allows Single Private AC Room with upgrade option; Premium pays actuals up to Sum Insured.","display":"Pro: Single Private AC Room for Rs.3 Lakhs/Rs.4 Lakhs and Rs.5 Lakhs, with 1% restriction as an option for Rs.3 Lakhs/Rs.4 Lakhs; Plus: Single Private AC Room; Premium: actuals up to Sum Insured","note":"Any Room Upgrade is an optional cover, not the base room-rent answer.","quote":"Room Rent | For Rs.3 Lakhs & Rs. 4 Lakhs - Single Private AC Room (1% restriction as an option available) For Rs. 5 Lakhs - Single pvt AC Room (upgrade option available) | Single Private AC Room (upgrade option available) | Actuals up to Sum Insured","sources":[{"clause":"Row 8(I)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923#c-row-8-i"}],"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":"quote-verified","value":"Pro and Plus base room category is Single Private AC Room, with plan-specific upgrade options; Premium is actuals up to Sum Insured rather than a room category.","display":"Pro and Plus: Single Private AC Room; Premium: Actuals up to Sum Insured","note":"For Pro Rs.3 Lakhs and Rs.4 Lakhs, the CIS also mentions a 1% restriction as an option available.","quote":"Room Rent | For Rs.3 Lakhs & Rs. 4 Lakhs - Single Private AC Room (1% restriction as an option available) For Rs. 5 Lakhs - Single pvt AC Room (upgrade option available) | Single Private AC Room (upgrade option available) | Actuals up to Sum Insured","sources":[{"clause":"Row 8(I)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923#c-row-8-i"}],"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/ICCU limit is plan and sum-insured dependent: Pro Rs.3 Lakhs and Rs.4 Lakhs pay actual ICU/ICCU expenses with a 2% restriction as an option, and Pro Rs.5 Lakhs pays actual ICU/ICCU expenses; Plus pays actual ICU/ICCU expenses; Premium pays actuals up to Sum Insured.","display":"Pro: actual ICU/ICCU expenses, with 2% restriction option for Rs.3 Lakhs/Rs.4 Lakhs; Plus: actual ICU/ICCU expenses; Premium: actuals up to Sum Insured","note":null,"quote":"ICU / ICCU | For Rs. 3 Lakhs & Rs. 4 Lakhs - as per actual ICU/ICCU expenses provided by Hospital (2% restriction as an option available) For Rs. 5 Lakhs - as per actual ICU/ICCU expenses provided by Hospital | As per actual ICU/ ICCU expenses provided by Hospital | Actuals up to Sum Insured","sources":[{"clause":"Row 8(I)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923#c-row-8-i"}],"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":"quote-verified","value":"If admitted to a room at rates exceeding the room rent or ICU limits, reimbursement of associated medical expenses is reduced in the same proportion. The deduction does not apply to hospitals that do not follow differential billing or expenses where differential billing is not based on room category.","display":"Yes, associated medical expenses are reduced in the same proportion if room rates exceed limits","note":null,"quote":"iii. In case of admission to a room at rates exceeding the limits as mentioned under 1.a and 1.b, the reimbursement of all other Associated Medical Expenses incurred at the Hospital, shall be payable in the same proportion as the admissible rate per day bears to the actual rate per day of room rent charges.\niv. Proportionate deductions shall not apply in respect of the Hospitals which do not follow differential billings or for those expenses in respect of which differential billing is not adopted based on the room category.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-1-4"}],"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 base co-payment stated unless the optional co-payment is chosen. If chosen, 10% or 20% co-payment applies on each and every admissible claim after deductible where applicable, and cannot be opted out at subsequent renewal.","display":"None unless optional co-payment is opted; then 10% or 20% on each and every admissible claim after deductible","note":"Co-payment is listed as an optional cover.","quote":"6. Co-Payment On availing this option, 10% or 20% Co-Payment as specified in the Policy Schedule, shall be applied on each and every admissible claim after Deductible wherever applicable under this Policy, once the Co-Payment option is availed by the Insured Person, it cannot be opted out of at subsequent Renewal.","sources":[{"clause":null,"heading":"3. Additional Sum Insured for Accidental Hospitalization","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-3-additional-sum-insured-for-accidental-hospital"}],"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":"quote-verified","value":"There is no base deductible stated unless the optional deductible is chosen. If chosen, the insured bears the opted deductible amount for any admissible claim; CIS states Rs. 10000 or Rs. 25000 applies on a per-claim basis if opted and specified.","display":"None unless optional deductible is opted; Rs. 10000/ Rs. 25000 per claim if opted","note":"Deductible is an optional cover and does not reduce the Sum Insured.","quote":"The Insured Person shall bear on his/her own account an amount equal to the opted deductible specified in the Policy Schedule for any admissible claim amount. ... Rs. 10000/ Rs. 25000 shall apply on admissible claim amount\n(Applicable on per claim basis - only if opted and specified in the Policy Schedule)","sources":[{"clause":null,"heading":"8. Deductible","page":14,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-8-deductible"},{"clause":"1","heading":"Rs. 10000/ Rs. 25000 shall apply on admissible claim amount","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923#c-1"}],"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":["Genetic Disorder: maximum up to Rs. 1,00,000/-","Internal Congenital Anomaly: 25% of Sum Insured","Advance Procedures: up to 25% of Sum Insured","Cataract Treatment: Rs 50,000/- or Rs 1,00,000/- per eye as specified in the Policy Schedule"],"display":"Genetic Disorder Rs. 1,00,000; Internal Congenital Anomaly 25% of Sum Insured; Advance Procedures 25% of Sum Insured; Cataract Rs 50,000 or Rs 1,00,000 per eye","note":"Cataract amount depends on the Policy Schedule and plan; prospectus states Pro Rs.50,000 per eye and Plus/Premium Rs.1,00,000 per eye.","quote":"If You are hospitalized due to any genetic disorder illness, We will pay Medical Expenses as listed in Section C.1 maximum up to Rs. 1,00,000/- ... If You are hospitalized due to any Internal Congenital diseases, We will pay Medical Expenses of 25% of Sum Insured ... We will pay Medically necessary Expenses either as In-Patient Hospitalization or as part of Day Care Treatment up to 25% of Sum Insured ... We will pay Medical Expenses of Rs 50,000/- or Rs 1,00,000/- incurred for treatment of Cataract as specified in the Policy Schedule, per eye","sources":[{"clause":"4","heading":"Genetic Disorder","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-4-4"},{"clause":"5","heading":"Internal Congenital Anomaly","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-5-4"},{"clause":"7","heading":"Advance Procedures","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-7-4"},{"clause":"8","heading":"Cataract Treatment","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-8-4"}],"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 for Pro; 60 days for Plus / Premium","note":"The policy wording says 30 days or 60 days as specified in Policy Schedule. The prospectus table shows Pro 30 days and Plus / Premium 60 days.","quote":"No of Days | 30 days | 60 days","sources":[{"clause":"A.1","heading":null,"page":4,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-a-1"}],"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 for Pro; 90 days for Plus; 180 days for Premium","note":"The policy wording says up to 60 days, 90 days or 180 days as specified in Policy Schedule.","quote":"Plan | Pro | Plus | Premium\nNo of Days | 60 days | 90 days | 180 days","sources":[{"clause":"10","heading":"Post-Hospitalization Cover","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-10"}],"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 in a Hospital or Day Care center, but not in the outpatient department. The policy says the indicative Day Care Procedures list is in Annexure-II.","display":"Covered in Hospital or Day Care center, not in the Outpatient department; indicative list in Annexure-II","note":null,"quote":"We will pay for the Medical Expenses under Section C.1 on hospitalization of Insured Person in Hospital or Day Care center for Day Care Treatment but not in the Outpatient department. ... Indicative Day Care Procedures list is given in Annexure-II of this Policy Document.","sources":[{"clause":"12","heading":"Day Care Treatment","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-12-3"}],"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 covered up to the Sum Insured when prescribed by the treating medical practitioner and the insured cannot be moved to a hospital, no room is available, or the medical practitioner advises home treatment with daily monitoring.","display":"Covered up to Sum Insured when prescribed and hospitalisation at home is necessary due to inability to move, non-availability of room, or medical advice with daily monitoring","note":"The clause lists exclusions for domiciliary treatment including asthma/bronchitis/tonsillitis/URTI, arthritis/gout/rheumatism, chronic nephritis/nephritic syndrome, diarrhoea/dysentery/gastroenteritis, diabetes, epilepsy, hypertension, psychiatric or psychosomatic disorders and pyrexia of unknown origin.","quote":"We will pay the Medical Expenses up to the Sum Insured as specified in the Policy Schedule, incurred on Domiciliary Hospitalization. Condition\ni) It has been prescribed by the treating Medical Practitioner and\nii) the condition the Insured Person is such that he/she could not be removed to a Hospital or\niii) the Medical Necessary Treatment is taken at Home on account of non-availability of room in Hospital or\niv) The Medical Practitioner advices the Insured Person to undergo treatment at home and continuous active line of treatment with monitoring of the health status by a Medical Practitioner for each day during treatment of Insured Person.","sources":[{"clause":"11","heading":"Domiciliary Hospitalization","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-11-3"}],"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 or alternative treatment is covered up to the Sum Insured when hospitalised in a Hospital, AYUSH Hospital or AYUSH Day Care Centre for Ayurvedic, Yoga and Naturopathy, Unani, Siddha or Homeopathy treatment, subject to the listed conditions.","display":"Covered up to Sum Insured for Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy hospitalisation in Hospital/AYUSH Hospital/AYUSH Day Care Centre","note":"The treatment cannot be taken on outpatient basis and must be within India.","quote":"We will pay Medical Expenses up to the Sum Insured as specified in the Policy Schedule, as listed under Section C.1 on Your Hospitalization in Hospital or AYUSH Hospital or AYUSH Day Care Centre for following Alternative Treatments prescribed by Medical Practitioner o Ayurvedic o Yoga and Naturopathy o Unani o Siddha o Homeopathy","sources":[{"clause":"15","heading":"Alternative Treatment / AYUSH","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-15-3"}],"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":"Advance Procedures are covered as in-patient hospitalisation or day care treatment up to 25% of Sum Insured, including uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra-vitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, prostate vaporisation, IONM and specified stem cell therapy.","display":"Covered up to 25% of Sum Insured for listed Advance Procedures including oral chemotherapy, immunotherapy, robotic surgeries, stereotactic radio surgeries and stem cell therapy","note":null,"quote":"We will pay Medically necessary Expenses either as In-Patient Hospitalization or as part of Day Care Treatment up to 25% of Sum Insured as specified in the Policy Schedule, incurred on Advance Procedures as below but not limited to the following:\ni) Uterine Artery Emobalization and HIFU\nii) Balloon Sinuplast\niii) Deep Brain Stimulation\niv) Oral Chemotherapy (covered as OPD also)\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)","sources":[{"clause":"7","heading":"Advance Procedures","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-7-4"}],"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":"quote-verified","value":"Organ donor hospitalisation expenses for harvesting the donated organ are covered up to the Sum Insured where the insured person is the recipient and the inpatient hospitalisation claim for the insured person is accepted. Donor pre- and post-hospitalisation expenses and other expenses consequent to harvesting are excluded.","display":"Covered up to Sum Insured for organ donor’s Hospitalization for harvesting; donor pre/post-hospitalisation expenses excluded","note":null,"quote":"We will pay Medical Expenses up to the Sum Insured as specified in the Policy Schedule, towards organ donor’s Hospitalization for harvesting of the donated organ where an Insured Person is the recipient ... The Organ Donor’s Pre-Hospitalization and Post-Hospitalization expenses are excluded under the Policy\niv) Any other Medical Expenses or Hospitalization consequent to the harvesting is excluded under the Policy","sources":[{"clause":"14","heading":"Organ Donor Expenses","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-14-3"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance is covered up to Rs. 3,000, Rs. 5,000 or Rs. 7,000 as specified in the Policy Schedule for emergency transfer to the nearest hospital, transfer between hospitals, or hospital to home. Domestic emergency assistance including air ambulance is provided when travelling within India 150 kilometers or more away from the residential address, with plan-wise limits in the schedule.","display":"Road ambulance Rs. 3,000 / Rs. 5,000 / Rs. 7,000; domestic emergency assistance including air ambulance within India when 150 kilometers or more away from residence","note":"Prospectus states road ambulance limits are Pro Rs.3,000, Plus Rs.5,000 and Premium Rs.7,000 per hospitalisation; domestic emergency assistance is not available under Pro, up to 5 Lacs under Plus and up to 10 Lacs under Premium.","quote":"We will pay for expenses incurred up to Rs. 3,000/- or Rs. 5,000/- or Rs. 7,000/- as specified in Policy Schedule, on Road Ambulance Services if You required;. ... We will provide the Emergency medical assistance as below when You are travelling within India 150 kilometers or more away from Your residential address as mentioned in the Policy Schedule for domestic services.","sources":[{"clause":"13","heading":"Road Ambulance","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-13-3"},{"clause":"17","heading":"Domestic Emergency Assistance Services (including Air","page":11,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-17-3"}],"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":"Sum Insured Refill refills 100% Basic Sum Insured on complete or partial utilisation of the existing Policy Sum Insured including Cumulative Bonus or Enhanced Cumulative Bonus during the policy year. It is available only once during the policy year, unused refill expires, and a single claim cannot exceed the sum of Basic Sum Insured and earned bonus.","display":"100% Basic Sum Insured refill once in a Policy Year on complete or partial utilisation","note":"The clause does not state a same-illness restriction.","quote":"We will refill 100% Basic Sum Insured on complete or partial utilization of Your existing Policy Sum Insured including Cumulative Bonus or Enhanced Cumulative Bonus (if applicable) during the Policy Year. ... ii. Sum Insured Refill is available only once during Policy Year. ... iv. If the Refilled Sum Insured is not utilized in a Policy Year, it will expire.","sources":[{"clause":"18","heading":"Sum Insured Refill","page":12,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-18-3"}],"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":"On each renewal, if there has been no claim in the expiring policy year under Section C, the policy pays 15% of Basic Sum Insured as Cumulative Bonus, accumulable up to 100% of Basic Sum Insured. It reduces at the same rate in the event of an admissible claim; instead, the insured may opt for No Claim Discount.","display":"15% of Basic Sum Insured per claim-free renewal, up to 100%; reduced at the same rate after an admissible claim","note":"The insured can either opt Cumulative Bonus or No Claim Discount if no claim has been made under the expiring policy.","quote":"On each Renewal of the Policy with Us, We will pay 15% of Basic Sum Insured under expiring Policy as Cumulative Bonus in the Policy provided that;\ni. There has no claim under the Policy in expiring Policy Year under Section C\nii. Cumulative Bonus will be reduced at the same rate as accrued in the event of admissible claim under Section C of the Policy.\niii. Cumulative Bonus can be accumulated up to 100% of Basic Sum Insured ... If opted, We shall provide a percentage of discount in premium at the Renewal of the Policy, for each completed and continuous Policy Year, provided no claim has been made in the expiring Policy Year.","sources":[{"clause":null,"heading":"2. Cumulative Bonus","page":13,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-2-cumulative-bonus"},{"clause":null,"heading":"3. No Claim Discount","page":13,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-3-no-claim-discount"}],"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 included under in-patient hospitalisation treatment. However, all non-medical expenses as per the policy annexure are excluded.","display":"Medicines, drugs, and consumables covered under in-patient hospitalisation; non-medical expenses excluded","note":null,"quote":"g) Medicines, drugs, and consumables ... XI) All Non-Medical Expenses as per Annexure-2 of the Policy.","sources":[{"clause":"1","heading":"In-patient Hospitalization Treatment","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-1-4"},{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-b-ii-c"}],"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. The exclusion applies to medical treatment expenses traceable to childbirth, including complicated deliveries and caesarean sections incurred during hospitalisation, except ectopic pregnancy, and to miscarriage unless due to an accident and lawful medical termination of pregnancy.","display":"Not covered; maternity excluded except ectopic pregnancy and miscarriage due to accident","note":null,"quote":"XV. Maternity (Code-Excl 18 Medical treatment expenses traceable to child-birth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy; Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy Period.","sources":[{"clause":"4(iv)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-4-iv"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"The documents do not state newborn cover from birth. They state that dependent children can be covered from 91 days and up to 25 years of age.","display":"No newborn-from-birth cover stated; dependent children can be covered from 91 days","note":null,"quote":"Dependent children can be covered from 91 days and up to 25 years of age.","sources":[{"clause":"B(I)(a)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-b-i-a"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"quote-verified","value":"In-patient mental healthcare is covered when hospitalisation is for a mental illness contracted during the policy period, up to the limit specified in the Policy Schedule under Section C.1, and the hospitalisation is prescribed by a medical practitioner and done in a Mental Health Establishment.","display":"Covered for hospitalisation for Mental Illness, up to the Policy Schedule limit under Section C.1","note":null,"quote":"If You are hospitalized for any Mental Illness contracted during the Policy Period, We will pay Medical Expenses -upto the limit as specified in Policy Schedule, under Section C.1 in accordance with The Mental Health Care Act, 2017, subsequent amendments and other applicable laws and Rules provided that;\ni) The Hospitalization is prescribed by a Medical Practitioner for Mental Illness\nii) The Hospitalization is done in Mental Health Establishment","sources":[{"clause":"2","heading":"Mental Healthcare","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-2-4"}],"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":"Preventive health check-up is available every year from the 1st renewal year during which the insured has held the Arogya Supreme Policy, irrespective of claims made. For family floater, it applies only to two eldest family members aged 18 years and above at the start date; for individual, to each insured person aged above 18 years.","display":"Preventive health check-up every year from 1st renewal year, irrespective of claims","note":"The listed health check-ups are arranged only on cashless basis through network providers.","quote":"You will be eligible for a preventive health check-up as listed below at every year from 1st renewal year during which You have held Our Arogya Supreme Policy irrespective of claims made under the Policy. ... ii. For Family Floater, this cover will be applicable only to two (2) eldest members of the Family who are aged 18 years and above on the start date of Policy. For Individual, this cover will be applicable to each Insured Person who are aged above 18 years.","sources":[{"clause":null,"heading":"D .Renewal Benefit","page":12,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-d-renewal-benefit"},{"clause":"20(vii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-20-vii"}],"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":"General outpatient treatment is excluded except specific conditions that can be taken on outpatient basis and are approved by the company. Oral chemotherapy under Advance Procedures is specifically covered as OPD also.","display":"No general OPD cover; OPD excluded except approved specific conditions, with Oral Chemotherapy covered as OPD also","note":null,"quote":"X) Any treatment taken on outpatient basis except specific conditions which can be taken on outpatient basis only and claims are approved by the Company. ... iv) Oral Chemotherapy (covered as OPD also)","sources":[{"clause":"B(II)(c)","heading":"Biological attack or weapons","page":16,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-b-ii-c"},{"clause":"7","heading":"Advance Procedures","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-7-4"}],"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":"Premium is computed based on the city of residence provided in the proposal form. Zone 1 includes listed metros/cities and Zone 2 is the rest of India; insured persons of any zone can avail pan-India treatment without any co-pay.","display":"Premium based on city of residence: Zone 1 listed cities; Zone 2 rest of India; pan-India treatment without co-pay","note":null,"quote":"Premium Zones For the purpose of Policy issuance, the premium will be computed basis the city of residence provided by the Insured Person in the proposal form. ClassiĤcation of cities would be as under:\nZone 1 – Mumbai & MMR/Pune/Ahmadabad/Delhi & NCR/ Kolkata/ Chennai/ Bangalore / Hyderabad Zone 2 - Rest of India\nNote: Insured Person of any zone can be availed Pan-India Treatment without any Co-Pay.","sources":[{"clause":"Excl14(c)(vii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-excl14-c-vii"}],"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 can be availed only at network providers. The insurer pays the cashless authorised amount directly to the network provider.","display":"Available only at Network Providers; insurer pays authorised amount directly to the Network Provider","note":null,"quote":"i) Cashless Facility can be availed only at Our Network Providers. The complete list of Network Providers and empanelled Service providers are available on Our Website and can be obtained by Contacting Our TPA. ... iv) We will make payment for the Cashless authorized amount directly to the Network Provider.","sources":[{"clause":"8(i)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-8-i"},{"clause":"8(iv)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#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 may be intimated to the insurer or TPA, and the policy defines TPA as the third-party administrator appointed by the insurer from time to time as specified in the Policy Schedule.","display":"Insurer or TPA; TPA appointed from time to time as specified in the Policy Schedule","note":"The specific TPA name is not stated in the extracted documents.","quote":"TPA means the third-party administrator that we appoint from time to time as specified in the Policy Schedule. ... Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the recognized modes of communication.","sources":[{"clause":"19","heading":"TPA","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-19"},{"clause":null,"heading":"41 Notification of Claim","page":3,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926#c-41-notification-of-claim"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, Family Floater Basis is available","note":null,"quote":"• Type of Policy\n• Individual basis\n• Individual Family basis\n• Family Floater Basis","sources":[{"clause":"9","heading":null,"page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924#c-9"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Supreme Arogya Supreme Policy Wordings (w.e.f 10th July 2026)","pages":29,"fetched_at":"2026-10-17 19:57:56+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Policy_Wordings_w_e_f_10th_July_2026_1237d56950.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14926"},{"kind":"wording","label":"Arogya Supreme AROGYA_SUPREME_Policy_Wording","pages":28,"fetched_at":"2026-10-17 19:58:04+00","source_url":"https://content.sbigeneral.in/uploads/AROGYA_SUPREME_Policy_Wording_19e6aaaec0.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14930"},{"kind":"wording","label":"Arogya Supreme (IRDAI copy)","pages":68,"fetched_at":"2026-10-20 02:33:30+00","source_url":"https://irdai.gov.in/documents/37343/931203/SBIHLIP21043V012122_HEALTH2046.pdf/a7ae7064-d08b-718d-e2b0-ed00576693a9?version=1.1&t=1668768148722&download=true","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/28758"},{"kind":"prospectus","label":"Arogya Supreme Arogya Supreme Prospectus (w.e.f 10th July 2026)","pages":25,"fetched_at":"2026-10-17 19:57:54+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Prospectus_w_e_f_10th_July_2026_539dcbb0b6.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14924"},{"kind":"prospectus","label":"Arogya Supreme Arogya_Supreme_Prospectus","pages":53,"fetched_at":"2026-10-17 19:58:02+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Prospectus_4a2f7244f1.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14928"},{"kind":"cis","label":"Arogya Supreme Arogya Supreme CIS (w.e.f 10th July 2026)","pages":8,"fetched_at":"2026-10-17 19:57:53+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_CIS_w_e_f_10th_July_2026_6abd0121a6.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14923"},{"kind":"cis","label":"Arogya Supreme Arogya_Supreme_CIS","pages":8,"fetched_at":"2026-10-17 19:58:01+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_CIS_85ad2d4068.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14925"},{"kind":"brochure","label":"Arogya Supreme Arogya Supreme-Brochure","pages":10,"fetched_at":"2026-10-17 19:56:51+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Brochure_0c4339f5c2.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14899"},{"kind":"brochure","label":"Arogya Supreme Arogya Supreme Plus - Brochure","pages":12,"fetched_at":"2026-10-17 19:56:59+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Plus_Brochure_bff5546498.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14902"},{"kind":"brochure","label":"Arogya Supreme Arogya Supreme Premium - Brochure","pages":12,"fetched_at":"2026-10-17 19:57:08+00","source_url":"https://content.sbigeneral.in/uploads/Arogya_Supreme_Premium_Brochure_4cbd806bee.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627/document/14906"}],"versions":[{"uin":"SBIHLIP21043V012122","version":null,"approved_on":null},{"uin":"SBIHLIP27036V022627","version":null,"approved_on":null}],"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":"Arogya Supreme (UIN SBIHLIP27036V022627), IndiaInsurances, https://indiainsurances.com/policy/sbi-general-insurance/arogya-supreme-sbihlip27036v022627"}