{"uin":"SBIPAGP20150V011920","name":"Kutumb Swasthya Bima-Group","url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited","url":"https://indiainsurances.com/insurer/sbi-general-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Kutumb Swasthya Bima-Group is a benefit group health policy with tele-consultation, hospital daily cash, conveyance allowance and personal accident benefits. The policy term is 1 year, with Base, Medium and Top variants.","analysis":{"state":"machine","analysed_at":"2026-10-19 23:02:11.537875+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":["Base","Medium","Top"],"display":"Base, Medium, Top","note":null,"quote":"Sr No | Cover Name | Cover Description | Base | Medium | Top","sources":[{"clause":null,"heading":"Scope of Cover","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-scope-of-cover"}],"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 a tenure of 1 Year only.","display":"1 Year only","note":null,"quote":"The policy can be issued for a tenure of 1 Year only.","sources":[{"clause":null,"heading":"Period of Insurance","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-period-of-insurance"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For hospitalisation, notify the insurer within 48 hours of hospitalisation but not later than discharge. Written notice of claim must be given within seven (7) days after an actual or potential loss begins or as soon as reasonably possible, and in any event no later than (30) Days after an actual or potential loss begins.","display":"Hospitalisation: within 48 hours but not later than discharge; written notice: within seven (7) days and no later than (30) Days","note":"The policy also says the insurer may relax the 30-day intimation limit depending on the merits of the case.","quote":"In case of Hospitalisation, notify Us either at Our call centre or in writing within 48 hours of the Hospitalization but not later than discharge from the Hospital. ... Intimation about an event or occurrence that may give rise to a claim under this Policy must be given within 30 days of it’s happening. ... written notice of claim must be given by You Us within seven (7) days after an actual or potential loss begins or as soon as reasonably possible and in any event no later than (30) Days after an actual or potential loss begins.","sources":[{"clause":null,"heading":"Claim Intimation","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-claim-intimation"},{"clause":null,"heading":"Claim NotiĤcation","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-claim-notihcation"}],"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 Ĥlled and signed claim form","CertiĤed copy of Hospital discharge Summary with pre & post hospitalization consultation details (if any)","CertiĤed copy of Diagnostic report conĤrming diagnosis.","CertiĤed copy of Ĥnal hospital bill with detailed break up","BeneĤciary (Primary Insured) bank account / NEFT details","CertiĤed copy of Death certiĤcate issued by municipal authority","CertiĤed copy of FIR, MLC Copy, Spot Panchnama.","CertiĤed copy of Postmortem examination report, if done.","Duly Ĥlled and signed Central KYC Registry form","Self-attested Copy of PAN card & Aadhar card, photo id & address Proof of the nominee / beneĤciary","CertiĤed copy of Disability certiĤcate issued by Appropriate Govt/Medical authority","CertiĤed copies of hospital treatment records and diagnostic reports","Photograph of insured showing disability"],"display":"Claim form, hospital and diagnostic records, bills, bank/NEFT details, and PA death or disability documents as applicable","note":"Case specific additional documents may be requested if required for justified claim decision and processing.","quote":"In case of Hospital Daily Cash claim, following is the document list for claim submission:\n• Duly Ĥlled and signed claim form\n• CertiĤed copy of Hospital discharge Summary with pre & post hospitalization consultation details (if any)\n• CertiĤed copy of Diagnostic report conĤrming diagnosis.\n• CertiĤed copy of Ĥnal hospital bill with detailed break up Nominee / BeneĤciary details\n• BeneĤciary (Primary Insured) bank account / NEFT details: ... Personal Accident – Death\n• Duly Ĥlled and signed claim form\n• CertiĤed copy of Death certiĤcate issued by municipal authority\n• CertiĤed copy of FIR, MLC Copy, Spot Panchnama.\n• CertiĤed copy of Postmortem examination report, if done. ... • Duly Ĥlled and signed Central KYC Registry form\n• Self-attested Copy of PAN card & Aadhar card, photo id & address Proof of the nominee / beneĤciary ... Personal Accident – Permanent Total Disability\n• Duly Ĥlled and signed claim form\n• CertiĤed copy of Disability certiĤcate issued by Appropriate Govt/Medical authority\n• CertiĤed copies of hospital treatment records and diagnostic reports\n• CertiĤed copy of FIR, MLC Copy, Spot Panchnama.\n• Photograph of insured showing disability","sources":[{"clause":null,"heading":"Claim Documents","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-claim-documents"},{"clause":null,"heading":"Case speciĤc additional documents may be requested if","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-case-specihc-additional-documents-may-be-request"},{"clause":null,"heading":"Nominee / BeneĤciary details","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-nominee-benehciary-details"}],"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 insurer shall settle a claim, including rejection, within 15 days of receipt of the Claim. For suspected frauds, Claim means receipt of the verification or investigation report; delayed payment carries interest at 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed.","display":"Within 15 days of receipt of the Claim; suspected fraud counted from verification/investigation report","note":null,"quote":"We shall settle a claim including its rejection within 15 days of the receipt of the Claim. In case of suspected frauds, the Claim shall mean the receipt of veriĤcation/ investigation report to determine the validity of the claim. In the cases of delay in the payment, We shall be liable to pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the Ĥnancial year in which the claim is reviewed by Us.","sources":[{"clause":null,"heading":"Settlement & Repudiation of a Claim","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-settlement-repudiation-of-a-claim"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Pre-existing Disease Exclusion 001","30-day waiting period exclusion 03","SpeciĤed disease/procedure waiting period Exclusion 02","Investigation & Evaluation 04","Rest Cure, rehabilitation and respite care- Code- ExcI05","Obesity/ Weight Control: Code- ExcI06","Change of Gender Treatments (Code- Excl 07)","Cosmetic or plastic Surgery: Code- ExcI08","Breach of law: Code- ExcI10","Excluded Providers: Code- Excl 11","Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- ExcI12","Sterility and Infertility: Code- ExcI17","Maternity: Code Excl18","Any medical treatment outside India.","War, invasion, acts of foreign enemies, hostilities","Expenses related to any treatment necessitated due to participation as a professional in hazardous adventure sports"],"display":"Waiting-period exclusions plus investigation, rest cure, obesity, change of gender, cosmetic surgery, breach of law, excluded providers, substance abuse, infertility, maternity, outside India, war and hazardous sports exclusions","note":null,"quote":"Pre-existing Disease Exclusion 001 ... 2. 30-day waiting period exclusion 03 ... SpeciĤed disease/procedure waiting period Exclusion 02 ... Investigation & Evaluation 04 ... Rest Cure, rehabilitation and respite care- Code- ExcI05 ... Obesity/ Weight Control: Code- ExcI06 ... Change of Gender Treatments (Code- Excl 07) ... Cosmetic or plastic Surgery: Code- ExcI08 ... Breach of law: Code- ExcI10 ... Excluded Providers: Code- Excl 11 ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code- ExcI12 ... Sterility and Infertility: Code- ExcI17 ... Maternity: Code Excl18 ... Any medical treatment outside India. ... War, invasion, acts of foreign enemies, hostilities ... Expenses related to any treatment necessitated due to participation as a professional in hazardous adventure sports","sources":[{"clause":"1","heading":"SpeciĤed disease/procedure waiting period Exclusion 02","page":3,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-1-2"},{"clause":"1","heading":"Pre-existing Disease Exclusion 001","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-1-3"},{"clause":null,"heading":"2. 30-day waiting period exclusion 03","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-2-30-day-waiting-period-exclusion-03"},{"clause":"3","heading":"Investigation & Evaluation 04","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-3-2"},{"clause":"4","heading":"Rest Cure, rehabilitation and respite care- Code- ExcI05","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-4-2"},{"clause":"5","heading":"Obesity/ Weight Control: Code- ExcI06","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-5-2"},{"clause":"6","heading":"Change of Gender Treatments (Code- Excl 07)","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-6-2"},{"clause":"7","heading":"Cosmetic or plastic Surgery: Code- ExcI08","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-7-2"},{"clause":"8","heading":"Breach of law: Code- ExcI10","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-8-2"},{"clause":"9","heading":"Excluded Providers: Code- Excl 11","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-2"},{"clause":"10","heading":"Treatment for, alcoholism, drug or substance abuse or any","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-10-2"},{"clause":"15","heading":"Sterility and Infertility: Code- ExcI17","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-15-2"},{"clause":"16","heading":"Maternity: Code Excl18","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-16-2"},{"clause":"17","heading":null,"page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-17-2"},{"clause":"18","heading":"War, invasion, acts of foreign enemies, hostilities (whether war","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-18-2"},{"clause":"27","heading":"Expenses related to any treatment necessitated due to","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-27-2"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"The policy lists Bima Bharosa as Stage 1. If registering directly with the insurer, write to Head – Customer Care first, then escalate to the Grievance Redressal OĦcer (GRO) if not satisfied or if no response is received within 5 days, before going to the Insurance Ombudsman.","display":"Bima Bharosa; Head – Customer Care; then Grievance Redressal OĦcer (GRO) before Insurance Ombudsman","note":"Head – Customer Care email is head.customercare@sbigeneral.in; GRO email is gro@sbigeneral.in.","quote":"Stage 1: Bima Bharosa ... Alternatively, if you wish to register your grievances directly with us, you may write to the Head – Customer Care. We aim to respond to all Grievances within 7 days. ... Stage 3: Grievance Redressal OĦcer (GRO) In case, you are still not satisĤed with the decision/resolution communicated by the above oĦcer or have not received any response within 5 days, you may escalate the matter to the Grievance Redressal OĦcer (GRO) ... Stage 4: Escalation to Insurance Ombudsman","sources":[{"clause":null,"heading":"Stage 1: Bima Bharosa","page":10,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-stage-1-bima-bharosa"},{"clause":null,"heading":"Limitation of Liability","page":9,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-limitation-of-liability"}],"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":"conflicting","value":"The product has Base, Medium and Top variants. Hospital Daily Cash is not covered in Base, `250 per day for maximum 30 days in Medium, and `250 per day for maximum 60 days in Top; Conveyance Allowance is not covered in Base and `400 in Medium and Top; Permanent Total Disablement amounts are `1,00,000, `3,00,000 and `5,00,000 for Base, Medium and Top.","display":"Base, Medium, Top; Hospital Daily Cash `250/day for 30 or 60 days; PA PTD `1,00,000/`3,00,000/`5,00,000","note":"The prospectus says Top Hospital Daily Cash is `250 per day for maximum 60 days, while the CIS says: \"Hospital Daily Cash- `250 per day for maximum 30 days for Medium plan and `250 per day for maximum 30 days for Top plan.\" The prospectus answer is shown because it gives the product option table.","quote":"Hospitalization BeneĤt (per life) | a) Hospital Daily Cash | Not Covered | `250 per day for maximum 30 days | `250 per day for maximum 60 days\nb) Conveyance Allowance BeneĤt (lumpsum per paid claim) | Not Covered | `400 | `400 ... Personal Accident (For Primary Insured Only) | a) Accidental Death | Not Covered | `250 per day for maximum 30 days | `250 per day for maximum 60 days\nb) Permanent Total Disablement | `1,00,000 | `3,00,000 | `5,00,000 ... Sub-Limits: • Hospital Daily Cash- `250 per day for maximum 30 days for Medium plan and `250 per day for maximum 30 days for Top plan.","sources":[{"clause":"Row 2","heading":"Hospitalization BeneĤt (per life)","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-row-2"},{"clause":"Row 3","heading":"Personal Accident (For Primary Insured Only)","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-row-3"},{"clause":"Row 5(b)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15091#c-row-5-b"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applies to illness; accident claims are excepted if covered.","quote":"Expenses related to the treatment of any illness within 30 days from the Ĥrst policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":null,"heading":"2. 30-day waiting period exclusion 03","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-2-30-day-waiting-period-exclusion-03"}],"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":"Coverage after 36 months for any PED is subject to the same being declared at the time of application and accepted by insurer.","quote":"Expenses related to the treatment of a Pre-existing disease and its direct complication shall be excluded until the expiry of 36 months of continuous coverage after the inception of the Ĥrst policy with the insurer.","sources":[{"clause":"1","heading":"Pre-existing Disease Exclusion 001","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-1-3"}],"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":"days","amount":90},"display":"90 Days","note":"Other specific waiting periods printed are 1, 2 and 3 Years, as per plan opted; accident is excepted.","quote":"SpeciĤc Waiting Period means a period up to 90 Days/ 1/ 2/ 3 Years (as per plan opted) from the commencement of a health insurance policy during which period speciĤed diseases/treatments (except due to an accident) are not covered.","sources":[{"clause":"42","heading":"SpeciĤc Waiting Period","page":3,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-42"}],"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":["Hypertension","Cardiac condition","Diabetes","Any types of gastric or duodenal ulcers","Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty","All internal or external tumor /cysts/nodules/polyps of any kind including breast lumps","All types of Hernia and Hydrocele","Anal Fissures, Fistula and Piles","Cataract","Benign Prostatic Hypertrophy","Hysterectomy/ myomectomy for menorrhagia or Ĥbromyoma or prolapse of uterus","Non infective Arthritis, Treatment of Spondylosis / Spondilytis, Gout & Rheumatism","Surgery of Genitourinary tract","Calculus Diseases","Sinusitis, nasal disorders and related disorders","Surgery for prolapsed intervertebral disc unless arising from accident","Vertebro-spinal disorders (including disc) and knee conditions","Surgery of varicose veins and varicose ulcers","Chronic Renal failure","Joint replacement surgery due to degenerative condition, age related osteoarthritis and osteoporosis unless such joint replacement surgery is necessitated by Accidental Bodily Injury","Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or, as may be necessitated due to an accident","Dental treatment or surgery of any kind unless required as a result of Accidental Bodily Injury to natural teeth requiring hospitalization treatment"],"display":"Hypertension, cardiac condition, diabetes, ulcers, ENT procedures, tumours/cysts/polyps, hernia, piles, cataract, BPH, hysterectomy/myomectomy, arthritis/spondylosis/gout/rheumatism, genitourinary surgery, calculus disease, sinusitis, prolapsed disc, vertebro-spinal and knee conditions, varicose veins, chronic renal failure, joint replacement, circumcision and dental treatment","note":null,"quote":"a) Hypertension,\nb) Cardiac condition\nc) Diabetes ... a) Any types of gastric or duodenal ulcers,\nb) Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty\nc) All internal or external tumor /cysts/nodules/polyps of any kind including breast lumps\nd) All types of Hernia and Hydrocele\ne) Anal Fissures, Fistula and Piles ... a) Cataract\nb) Benign Prostatic Hypertrophy\nc) Hysterectomy/ myomectomy for menorrhagia or Ĥbromyoma or prolapse of uterus\nd) Non infective Arthritis, Treatment of Spondylosis / Spondilytis, Gout & Rheumatism\ne) Surgery of Genitourinary tract ... f. Calculus Diseases ... g. Sinusitis, nasal disorders and related disorders ... h. Surgery for prolapsed intervertebral disc unless arising from accident ... i) Vertebro-spinal disorders (including disc) and knee conditions; ... j. Surgery of varicose veins and varicose ulcers ... k. Chronic Renal failure ... a) Joint replacement surgery due to degenerative condition, age related osteoarthritis and osteoporosis unless such joint replacement surgery is necessitated by Accidental Bodily Injury.\nb) Circumcision unless necessary for treatment of a disease, illness or injury not excluded hereunder, or, as may be necessitated due to an accident\nc) Dental treatment or surgery of any kind unless required as a result of Accidental Bodily Injury to natural teeth requiring hospitalization treatment.","sources":[{"clause":null,"heading":"Exclusions applicable to Ninety days of cover from","page":4,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-exclusions-applicable-to-ninety-days-of-cover-fr"},{"clause":null,"heading":"Table of beneĤts","page":4,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-table-of-benehts"},{"clause":"1(b)(i)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-1-b-i"}],"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, completion of sixty continuous months applies from the date of enhancement on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance Policy, no Policy and claim shall be contestable by the Insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":"5","heading":"Moratorium Period: After completion of sixty continuous","page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15091#c-5"}],"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 may port the policy to other insurers by applying at least 30 days before, but not earlier than 60 days from, the policy renewal date. If continuously covered without lapses under an Indian general or health insurer, credits for sum insured, no claim bonus, specific waiting periods, PED waiting period and moratorium period can be transferred.","display":"Allowed; apply at least 30 days before and 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. If such person is presently covered and has been continuously covered without any lapses under any health insurance Policy with an Indian General/Health Insurer, the proposed Insured Person is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, SpeciĤc Waiting Periods, Waiting Period for Pre-existing Diseases, Moratorium Period, etc. from the existing Insurer to the acquiring Insurer in the previous Policy.","sources":[{"clause":null,"heading":"2. Portability and Continuity BeneĤts-","page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-2-portability-and-continuity-benehts"}],"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, no exit age applicable","note":"Renewal is subject to the product not being withdrawn and exceptions for established fraud, non-disclosure or misrepresentation.","quote":"There is no exit age applicable to the policy. ... The Policy shall ordinarily be renewable provided the product is not withdrawn, except on grounds of established fraud or non-disclosure or misrepresentation by the Insured Person.","sources":[{"clause":null,"heading":"Age Criteria & Eligibility","page":1,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-age-criteria-eligibility"},{"clause":"9(vii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-vii"}],"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 shall apply on renewals based on individual claims experience.","display":"No loading based on individual claims experience","note":null,"quote":"No loading shall apply on Renewals based on individual Claims experience.","sources":[{"clause":"9(vii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-vii"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"Personal Accident applies to events or occurrences anywhere in the world, but teleconsultation and hospital daily cash are restricted to India only. All admitted or payable claims are settled in India in Indian rupees.","display":"Personal Accident worldwide; teleconsultation and hospital daily cash India only","note":null,"quote":"Geography In Policy, Personal Accident Section Applies to events or occurrences taking place anywhere in the world. However, teleconsultation and hospital daily cash section are restricted to India only. All admitted or payable claims under this Policy shall be settled in India in Indian rupees.","sources":[{"clause":"9(iv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-iv"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"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":"9(i)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"The insured person must be at least 18 years and must not have completed 65 years on the date of commencement of the policy period, unless it is a renewal. Dependent children can be covered from 91 days to 25 years.","display":"18 to 65 years; dependent children 91 days to 25 years","note":null,"quote":"To be eligible to be covered under the Policy or get any beneĤts under the Policy, the Insured Person should have attained the age of at least 18 years and shall not have completed the age of 65 years on the date of commencement of the Policy Period as applicable to such Insured Person unless it is renewal of Policy. Dependent children can be covered from the age of 91 days to 25 years.","sources":[{"clause":"1","heading":"Age Limit","page":6,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-1-4"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"conflicting","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly, Half Yearly, Quarterly or Monthly","note":"The policy wording mentions Monthly, Half Yearly, Quarterly and Yearly/single payment, while the prospectus says: \"Quarterly, Half yearly & Yearly\".","quote":"For Yearly premium paying mode. ... 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/CertiĤcate of Insurance ... Quarterly, Half yearly & Yearly","sources":[{"clause":"9(i)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-i"},{"clause":"9(iv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-iv"},{"clause":null,"heading":"Premium Paying term","page":4,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-premium-paying-term"}],"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":"not-stated","value":null,"display":null,"note":"The documents refer to Basic or Optional Benefits but do not name any optional cover available for extra premium.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"conflicting","value":"Coverage is not available during the Grace Period.","display":"Not available during the Grace Period","note":"The policy wording says coverage is not available during the grace period. The prospectus says: \"During such Grace Period, coverage will be available from the due date of instalment premium till the date of receipt of premium by Company.\"","quote":"During such Grace Period, coverage will not be available from the due date of instalment premium till the date of receipt of premium by Company. ... Coverage is not available during the Grace Period. ... During such Grace Period, coverage will be available from the due date of instalment premium till the date of receipt of premium by Company.","sources":[{"clause":"9(iv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-iv"},{"clause":"9(vii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119#c-9-vii"},{"clause":"27(vi)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093#c-27-vi"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]}],"documents":[{"kind":"wording","label":"Kutumb Swasthya Bima-Group Policy Wording","pages":11,"fetched_at":"2026-10-17 20:04:36+00","source_url":"https://content.sbigeneral.in/uploads/Kutumb_Swasthya_Bima_Group_Policy_Wording_KEN_c9e4726878.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15119"},{"kind":"prospectus","label":"Kutumb Swasthya Bima-Group Prospectus","pages":9,"fetched_at":"2026-10-17 20:03:52+00","source_url":"https://content.sbigeneral.in/uploads/Kutumb_Swasthya_Bima_Group_Prospectus_KEN_5590b1ce7e.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15093"},{"kind":"cis","label":"Kutumb Swasthya Bima-Group Customer Information Sheet","pages":5,"fetched_at":"2026-10-17 20:03:51+00","source_url":"https://content.sbigeneral.in/uploads/Kutumb_Swasthya_Bima_Group_CIS_KEN_962c2b7dac.pdf","url":"https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920/document/15091"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"SBI General Insurance official website","url":"https://www.sbigeneral.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Health claims","url":"https://www.sbigeneral.in/claim/health","note":null},{"purpose":"claim","kind":"insurer","name":"Home claims","url":"https://www.sbigeneral.in/claim/home","note":null},{"purpose":"claim","kind":"insurer","name":"Motor claims","url":"https://www.sbigeneral.in/claim/motor","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.sbigeneral.in/grievance-redressal","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Policy renewal","url":"https://www.sbigeneral.in/policy-renewal","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Kutumb Swasthya Bima-Group (UIN SBIPAGP20150V011920), IndiaInsurances, https://indiainsurances.com/policy/sbi-general-insurance/kutumb-swasthya-bima-group-sbipagp20150v011920"}