Policy explained · SBI General
SBI General Super Health: what your policy covers
SBI General Super Health has no room rent limit (conditions apply). It has a 24-month wait for knee & hip replacement and a 24-month wait for pre-existing conditions. Optional add-ons can add a co-pay. On a typical ₹4,50,000 knee & hip replacement bill, the insurer pays about ₹4,41,000 to ₹4,50,000 and you pay about ₹0 to ₹9,000 (estimate).
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At a glance
- 🛏️No capRoom rentNo limit; conditions apply, see the termsPolicy wordings, page 30, read 28 Sep 2026
- 🧾10% to 20%Co-payIf you chose an optional co-pay or add-onNot in the worked examplePolicy wordings, page 18, read 28 Sep 2026
- ⏳24 monthsKnee & hip replacement waitOver by month 30Conditions apply, see the termsPolicy wordings, page 31, read 28 Sep 2026
- ⏳24 monthsPre-existing conditions waitOver by month 30Conditions apply, see the termsPolicy wordings, page 20, read 28 Sep 2026
- 🩹CoveredConsumablesConditions apply, see the termsPolicy wordings, page 13, read 28 Sep 2026
Waiting periods, month by month
- Pre-existing conditions24 monthsOver by month 30Conditions apply, see the terms
- Knee & hip replacement24 monthsOver by month 30Conditions apply, see the terms
- Elective cardiac surgery3 monthsOver by month 30Conditions apply, see the terms
- Spine surgery24 monthsOver by month 30Conditions apply, see the terms
- Prostate surgery24 monthsOver by month 30Conditions apply, see the terms
- Hysterectomy24 monthsOver by month 30Conditions apply, see the terms
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
A ₹5 lakh sum insured is sold only on the Prime, Elite and Premier plans (Platinum starts at ₹10 lakh and Platinum Infinite at ₹50 lakh), so this example uses their terms (policy wordings, page 30).
Not in these numbers: a 10% to 20% co-pay applies if you chose an optional co-pay or add-on.
₹0 to ₹9,000 could go either way: non-payable items, 0% to 2% of the bill because consumables are covered (estimate)
| Step | Amount (estimate) |
|---|---|
| Bill total | ₹4,50,000 |
| Insurer's share before non-payable items and co-pay | ₹4,50,000 |
| Non-payable items, 0% to 2% of the bill because consumables are covered | minus ₹0 to ₹9,000 |
| Insurer pays | ₹4,41,000 to ₹4,50,000 |
| You pay | ₹0 to ₹9,000 |
The terms, with the policy text
14 terms read from the SBI General Super Health documents (UIN SBIHLIP24141V022324). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | No limit (No limit) | Policy wordings, page 30Condition: The same on all 5 plans: room rent is paid at actual cost up to the sum insured. Room Rent Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured |
| ICU limit | No limit (No limit) | Policy wordings, page 30Condition: The same on all 5 plans. ICU Charges Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured Actuals up to Sum Insured |
| Co-pay | No general co-pay in the wording. With an add-on: 10% to 20% if you chose an optional co-pay or add-onOnly in some cases | Policy wordings, page 18On availing this option, 10% or 20% Co-Payment |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, page 6Condition: Room rent is paid at actual cost on all 5 plans, so this matters only if your policy schedule sets a room limit. It does not apply at hospitals that charge the same for every room. In case of admission to a room at rates exceeding the limits as mentioned under 1.a and 1.b of Policy Schedule, 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. |
| Consumables (gloves, masks and other non-medical items) | Covered (Covered) | Policy wordings, page 13Condition: Claims Shield is built into all 5 plans. It pays these items when the insurer accepts your hospital claim. C. 17. Claims Shield If We have accepted a Hospitalization claim under Section C, then the items which are not payable as per List I - ‘Expenses not covered’ under Annexure II related to that particular claim will become payable |
| Costs before and after the hospital stay | 60 days before admission, 90 days after dischargeCovered | Policy wordings, page 30Condition: 60 days before admission on all 5 plans. After discharge: 90 days on Prime, Elite, Premier and Platinum, and 180 days on Platinum Infinite. Post-Hospitalization Medical Expenses 90 Days 90 Days 90 Days 90 Days 180 Days(up to Sum Insured) Pre-Hospitalization Medical Expenses 60 Days 60 Days 60 Days 60 Days 60 Days (up to Sum Insured) |
| Waiting period for pre-existing conditions | 24 months of continuous coverOver by month 30 | Policy wordings, page 20Condition: The same on all 5 plans. A pre-existing condition here means one diagnosed or treated in the 36 months before your policy started, and it must be declared when you buy. Expenses related to the treatment of a Pre-Existing Diseases (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the �rst Policy with Us. |
| Waiting period for knee & hip replacement | 24 months of continuous coverOver by month 30 | Policy wordings, page 31Condition: On the Prime, Elite and Premier plans. On Platinum and Platinum Infinite it is 12 months. Not applicable to claims arising from an accident. 2 years 2 years 2 years 1 year 1 year |
| Waiting period for elective cardiac surgery | 90 days of continuous coverOver by month 30 | Policy wordings, page 20Condition: For hypertension, diabetes and cardiac conditions, unless they were pre-existing and disclosed when you bought the policy. IV) Hypertension, Diabetes, Cardiac Condition: A waiting period of 90 days shall apply for all claims of Hypertension, Diabetes, Cardiac Condition except if these diseases are pre-existing and disclosed at the time of Policy. |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 31Condition: On the Prime, Elite and Premier plans. On Platinum and Platinum Infinite it is 12 months. Not applicable to claims arising from an accident. 2 years 2 years 2 years 1 year 1 year |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 31Condition: On the Prime, Elite and Premier plans. On Platinum and Platinum Infinite it is 12 months. Not applicable to claims arising from an accident. 2 years 2 years 2 years 1 year 1 year |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 31Condition: On the Prime, Elite and Premier plans. On Platinum and Platinum Infinite it is 12 months. Not applicable to claims arising from an accident. The list names fibroids and surgery for fibroids, not hysterectomy by name. 2 years 2 years 2 years 1 year 1 year |
| Sub-limit for bariatric surgery | ₹50,000Limit applies | Policy wordings, page 30Condition: On the Prime, Elite and Premier plans. On Platinum and Platinum Infinite the limit is ₹2,00,000. Up to INR 50,000 Up to INR 50,000 Up to INR 50,000 Up to INR 2 Lacs Up to INR 2 Lacs |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 13Condition: Covered for adults with a BMI of 40 or more, or 35 or more with a serious related condition. Surgery for cosmetic reasons stays excluded, and payment is capped at the plan's sub-limit. C. 13. Bariatric Surgery Cover If You are Hospitalized on the advice of a Medical Practitioner because of conditions mentioned below which required You to undergo Bariatric Surgery during the Policy Period, then We will pay You, Medical Expenses as listed in Section C.1 related to Bariatric Surgery Eligibility |
Questions
What does no room rent capping mean on SBI General Super Health?
There is no limit on the SBI General Super Health plan: the policy wordings set no daily limit on room rent (Policy wordings, page 30, read 28 Sep 2026). The room you choose does not trigger a proportionate cut, but co-pay, waiting periods, sub-limits and non-payable items still apply.
How is proportionate deduction calculated on SBI General Super Health?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Room rent is paid at actual cost on all 5 plans, so this matters only if your policy schedule sets a room limit. It does not apply at hospitals that charge the same for every room. Source: Policy wordings, page 6, read 28 Sep 2026.
Check your own policy
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Sources
- SBI General Super Health: policy wordings (accessed 28 Sep 2026)
- SBI General Super Health: customer information sheet (cis) (accessed 28 Sep 2026)