SAMPOORNA AROGYA (for SBI bank)

Sampoorna Arogya is a comprehensive product with wide range of sum insured

Product Description offerings and plans carved keeping the needs of target customer in mind. Available
for SBI Accountholders (Savings & Individual Current Account) only.
Who can buy? Family consists of Self , Spouse, 3 Children, Parents / Parents in law
Cover Types Individual Policy; Family Floater
Scope of Policy 3 Sections - Hospitalization; Critical Illness; Hospital Daily Cash
Plans Available Standard, Classic, Super, Ultra
Plan Limits Refer Table A
Plan Features Refer Table B
Age Criteria Refer Table C
Policy Tenure Annual
Grace Period/ Free Look Up 30 days for Annual Mode; 15 days free look period
• No claim is payable for first 30 days, except for claims due to accident.
• 1 year waiting period for listed Illnesses /disease.
• 90 days for Hypertension, Heart Disease and related complications
• 90 days for Diabetes and related complications
Waiting Period • 90 days for Critical Ilness with survival period of 28 days
• 48 months waiting period for all pre-existing diseases
• 15 days for Covid-19
Note - If any of the specified disease/procedure falls under the waiting period specified for pre-
Existing diseases, then the longer of the two waiting periods shall apply.
Major Exclusions • Cosmetic or plastic Surgery
(Please refer the Policy • Rest Cure, rehabilitation and respite care
wording for the complete list) • Treatment for, Alcoholism, drug or substance abuse or any addictive condition

TABLE - A
PLAN TYPE STANDARD CLASSIC SUPER ULTRA
Sum Insured Rs 1/2/3/4/5 Lakhs Rs 2/3/4/5 Lakhs Rs 2/3/4/5 Lakhs Rs 6/7/8/9/10 Lakhs
1. Hospitalization cover Available for all Plans
2. Hospital Daily Cash** Rs 500 x 30 days Rs 1000 x 30 days Rs 2000 x 30 days
3. CI (30 Critical Illnesses*) Not Available Equal to SI

TABLE- B
COVERAGE NAME STANDARD CLASSIC SUPER ULTRA
1. OPD Cover Not Available 1% of SI, max 10K; Deductible – Rs.500
2. Pre / Post hospitalization Expenses 30/60 days 60/ 90 days
3. Day Care Surgery/Procedures (537) Available for all
4. Room Rent & ICU 2% for Normal Room & 4% for ICU
20% of Sum Insured subject to 20% of Sum Insured subject to max of Rs.
5. Domiciliary Hospitalization
maximum of Rs. 50,000/- 2Lakhs
6. Alternative Treatments Max Rs 50,000/-
1% of Sum Insured subject to 1% of Sum Insured subject to max of Rs.
7. Ambulance charges
maximum of Rs. 5,000/- 10,000/-
8. Organ Donor Expenses Not Applicable Up to 50% of SI
9. Reinstatement Benefit Not Applicable 100% of SI reinstated for other illnesses
10. Mental Healthcare Available for all

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Created by SBIG HR & Learning – Sales Training Team – For Internal Training Purpose Only
11. HIV/AIDS Cover Up to Sum Insured
12. Genetic Disorders Maximum Rs 1 Lakh
13. Internal Congenital Anomaly 25% of Sum Insured
14. 12 Advance procedure (Refer PW) 25% of Sum Insured

TABLE - C
COVER ADULT – MIN/MAX AGE CHILD – MIN/MAX AGE BASIS OF SUM INSURED
1. Hospitalization 18 years & 65 years 91 days & 25 years Individual/Family Floater
2. Hospital Daily Cash 18 years & 65 years 91 days & 25 years Individual basis
3. Critical Illness 18 years & 65 years 18 years & 25 years Individual basis
4. OPD cover 18 years & 65 years 91 days & 25 years Individual/Family Floater

*LIST OF 30 CRITICAL ILLNESSES

1. Cancer of Specified Severity 2. Deafness
3. Open Chest CABG 4. Loss of speech
5. Open heart replacement 6. Kidney failure requiring regular dialysis
7. First heart attack 8. End stage liver failure
9. Pulmonary Hypertension 10. Surgery of Aorta
11. End Stage Lung Failure 12. Parkinson’s disease
13. Stroke with permanent symptoms 14. Brain surgery
15. Permanent paralysis of limb 16. Apallic syndrome
17. Multiple Sclerosis 18. Alzheimer's Disease
19. Benign Brain Tumor 20. Aplastic Anaemia
21. Motor neuron disease 22. Bacterial Meningitis
23. Coma of specified severity 24. Loss of Independent Existence
25. Major head trauma 26. Encephalitis
27. Blindness 28. Fulminant Viral Hepatitis
29. Major organ / bone marrow transplant 30. Third degree burns

**HOSPITAL DAILY CASH LIMITS

1. Sickness Hospital Cash Benefit per day - SI Rs. 500, 1000 and 2000 as per Plan Opted max
no of days – 30
2. Accident Hospital Cash Benefit Twice (2x) the HDC limit
3. ICU Cash Benefit (Max 15 days) Thrice (3x) the HDC limit
4. Convalescence Benefit Lumpsum 5x HDC if hospitalization is more than 10 days
5. Compassionate Benefit Lumpsum 10x HDC if accidental death whilst in hospital
6. Day Care Treatment Benefit (max of 2 Day Care Lumpsum 5x HDC or max INR 10,000
Treatments per Insured Person per Policy Period)
Important Points:
• Policy will be allowed only to SBI Account holder and his / her dependent hence account holder is mandatory.
• Cross combination of Parents & Parents in Laws will not be allowed under Family Floater. For child, one of
the parents needs to be concurrently covered with us.
• Applicable to Individual Current Account/Saving Bank Account holder of SBI Bank. NRIs can take this
policy only if they have Saving Bank account in SBI Bank.

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Created by SBIG HR & Learning – Sales Training Team – For Internal Training Purpose Only