Health Insurance Plans
Safeguard Your Well-being with ACKO's Extensive Medical Insurance Plans, starting from just ₹20/Day*
✅ 100% Room Rent Covered* ✅ Zero deductions at claims ✅ 7100+ Cashless Hospitals
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Buy/Renew Health Insurance Online in India
What is Health Insurance?
Health insurance, also known as medical insurance, is a vital financial tool that provides coverage for the cost of medical treatment for injuries, illnesses, and more. There are a variety of health insurance plans available, from basic in-patient hospitalization coverage to more comprehensive policies that offer additional benefits such as preventive healthcare, death benefits, and more.
Choosing the right health insurance policy or medical insurance plan can ensure you and your family are financially protected in the event of an unexpected illness or injury. Click here to read more about what is health insurance
Enhance your current sum insured by opting for our super top-up plans that provide several amazing benefits like no waiting period, coverage from day one, and many built-in add-ons. Super top-up plans offer all the benefits and coverage of a health plan, with an additional sum insured amount, for that extra cushioning during medical emergencies. Click here to find the right plan.
Discover the Outstanding Features of ACKO Health Insurance
Looking for comprehensive health insurance that meets all your medical needs? Look no further than ACKO. Our Platinum Health Insurance policy offers a wide range of sum insured amounts, from Rs. 10 lakhs to Rs. 1 crore, and even an unlimited option! With ACKO, you won't need to purchase multiple policies as we provide a one-stop solution for all your medical insurance requirements.
At ACKO, we understand that your health is a top priority, which is why we offer the best-in-class health policy. Our Platinum health policy come with a range of benefits such as :
Free health check-ups,
Quick claim settlements, and
Tax benefits under section 80D of the Income Tax Act.
ACKO HEALTH INSURANCE CATEGORIES | ACKO SPECIFICATIONS |
|---|---|
Sum Insured | 10L, 25L, 50L, 1Cr, Unlimited |
Network Hospitals | 7100+ PAN India |
Add-ons | Included in the plan |
Deductions on claims | No deductions |
Middleman commission | None |
Pre-Hospitalisation | 60 days |
Post-Hospitalisation | 120 days |
Why is Medical Insurance Policy important for you and your family?
In today's world, medical insurance policy has become a necessity rather than a luxury. With healthcare costs constantly on the rise, having a health insurance is crucial for safeguarding yourself and your family from unforeseen medical expenses. In this article, we'll discuss why medical policy is essential and why you should consider purchasing one.
Protection Against Rising Medical Costs: Advancements in medical technology have made it possible to treat diseases that were once incurable. However, the cost of these treatments can be exorbitant, making it difficult to afford them out-of-pocket. This is where health insurance comes in, providing a solution to the rising medical costs and inflation. With a health insurance, you can be assured that your medical expenses will be covered.
Access to Quality Medical Facilities: Without health insurance, you may have to compromise on the quality of healthcare you receive. However, with medical insurance, you can access top-notch medical facilities without worrying about the costs. Timely access to quality treatment can also speed up the recovery process, thanks to coverages like pre and post-hospitalisation.
By purchasing a medical insurance policy, you can secure the financial future of yourself and your loved ones. Don't delay; explore your options today!
Why ACKO Health Insurance Policy is India's Top-Ranked Health Insurance Company
At ACKO Health Insurance Policy, we take great pride in providing our customers with unparalleled service and coverage. Our dedication to excellence has been acknowledged by Livemint, who has ranked us as India's top-ranked health insurance company. Read more about our award-winning services and coverage. Source : Livemint
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Top Medical Insurance Plans/Policy in India for Comprehensive Coverage by Acko
Discover your ideal medical insurance policy with ACKO's Platinum and Super Top-up Plans, which offer multiple sum insured options for complete coverage. Our plans are designed to provide comprehensive protection to suit your unique medical insurance needs
10L ACKO Platinum Plan
At ACKO, we offer the 10L Platinum Health Insurance Policy, which offers a sum insured of Rs. 10 lakhs. In the event that you (or a covered family member) need medical care, this 10L Medical insurance policy with a sum insured of Rs. 10 lakhs can provide enough financial support.
10L ACKO Platinum Super Top-up Health Insurance
ACKO Platinum 10L Super Top-up Health Insurance Plans are specialised health policy that can be purchased with or without primary medical insurance coverage. These insurance policies provide coverage above the selected deductible.
25L ACKO Platinum Plan
The days of opting for an additional policy to supplement your health insurance coverage are over! You don’t need to ever worry about buying a separate policy. ACKO’s 25L Health Insurance Plan, covers all your medically necessary hospitalisation, and includes a lot of other benefits.
25L ACKO Platinum Super Top-up Health Insurance
Planning to Switch? Our Super Top-up Health Plan will continue to provide insurance coverage even if you change jobs, and don’t get Group Medical Coverage from the new employer.
50L ACKO Platinum Plan
Even your non-medical expenses are covered under this plan. Plus, you have access to multiple teleconsultations with our Rs. 50 lakhs health plan whenever you need to speak with a doctor.
50L ACKO Platinum Super Top-up Health Insurance
Sweeten the deal by increasing your total sum insured by Rs. 50 lakhs Super Top-up plan, and get access to multiple additional benefits like Zero deductions at claim; and Zero Waiting period.
1 Cr. ACKO Platinum Plan
1 crore health insurance plan is designed to cover you from day one without any waiting period. We want to keep you stress-free about insurance so that you can focus on your health.
1 Cr. ACKO Platinum Super Top-up Health Insurance
We all love a bit more for our money. Under this 1 Cr. Super Top-up Health Insurance plan, you get built-in add-ons like Non-Medical Expenses Waiver, Waiting Period Waiver, Room Rent Waiver, etc. They are a part of the policy, and you don't need to add them separately.
Unlimited ACKO Platinum Plan
Expect limitless coverage with truly unlimited health insurance benefits without any caps on the sum insured amount. We will cover an approved claim no matter how large the expenses are.
Unlimited ACKO Platinum Super Top-up Plan
This Unlimited Super Top-up Health Insurance covers your medical expenses without any upper limit on the sum insured. We will cover the costs under an approved claim, no matter how expensive the treatment is.
What are the Benefits of a Medical Insurance Policy in India?
According to a study conducted by the Public Health Foundation of India, approximately 55 million individuals (4% of India's population) were pushed towards poverty due to high out-of-pocket expenses in 2017. We don't intend to scare you, but not having the right health plan in place can lead to both financial and emotional stress. Even though medical insurance is not mandatory in India like motor insurance, it's advisable to purchase a comprehensive health plan that covers all your medical needs. This way, you can save on hospitalization costs, reduce out-of-pocket expenses, and stay worry-free in case of medical emergencies. Read more about health insurance benefits.
Best-in-class healthcare for loved ones
Being healthy is of utmost importance for you and your family. But sometimes unpredictable medical emergencies or illnesses can come up. Here's where medical insurance is beneficial to cover such healthcare costs. Buying the best health insurance cover in India can help meet personal medical emergency requirements. And with the right health policy, you can get best-in-class healthcare without worrying about further expenses.
Safeguard your finances
A comprehensive medical insurance plan has become a necessity due to the ever-increasing costs of medical care. Without a medical insurance plan, the out-of-pocket expenses will be too high, and your financial planning can go for a toss. You may even have to borrow funds for the unexpected hospitalisation. A good medical policy ensures that your savings and finances are not heavily affected.
Cashless treatment keeps your stress at bay
Hospitalisation can be an emotionally and financially disturbing experience. If your medical bill is significantly high and there is a need to arrange funds, it can further amplify the stress. Cashless treatments help you access quality treatment and reduce the worry of arranging funds for quality healthcare. In cashless treatment, the entire hospitalisation expenses are borne by the insurer.
Holistic plans offer benefits beyond hospitalisation
Comprehensive health plans help cover hospitalisation costs and even other costs related to it — think medicines, diagnostic tests, doctor’s consultation fees, pre & post hospitalisation expenses, etc. Such benefits help you cover medical expenses in case of health issues.
Axe tax payouts
In the recent past, the Insurance Regulatory and Development Authority of India (IRDAI) has taken many measures to simplify health plans to make them accessible and affordable for all. Considering its importance, the government offers tax benefits (under Section 80D of the Income Tax Act, 1961) on the premium paid to encourage everyone to purchase it.
Additional health coverage over and above your employer’s cover
Several organisations provide a Group Health Insurance Plan to their employees. However, this type of insurance is usually not customised according to your requirements. Having additional medical insurance is helpful in case you lose your job or move to a different organisation.
Compare Health Insurance Policies
When it comes to health insurance policy, coverage, benefits, and costs can differ considerably. It's crucial to compare various plans to identify the one that best suits your specific healthcare requirements and budget. Read more about how to compare health Insurance policy
ACKO Health Platinium super Top-up | Other Health Insurance Plans |
|---|---|
ZERO - Initial waiting period | 30 DAYS - Initial waiting period |
ZERO - Diseases-specific waiting period | 1-2 YEARS - Diseases-specific waiting period |
ZERO - Copay | FIXED - Copay |
100% - Of all your bills covered | YOU PAY~15% - Of your non-medical expenses |
ALWAYS STAY COVERED - After switching jobs | CAN’T CHANGE COVERAGE - After switching jobs |
NO - Room rent limit | PAY EXTRA - For room upgrades |
Inclusions
Exclusions
Inclusions: What is Covered in Mediclaim Policy for Individuals
Inclusions are among the most important aspects of a health insurance policy. They help you understand the scenarios when you can raise a claim against your policy. Here are the typical inclusions or coverages of an Individual Health insurance policy. However, this may vary for different health policy.
✅ In-patient Treatment: This covers the cost of hospitalisation for the policyholder. In-patient treatment includes expenses such as room rent, nursing charges, ICU charges, doctor visits, and more.
✅ Daycare Procedures: Minor surgeries like cataract removal, tonsil removal, or similar procedures that require less than 24 hours of hospitalisation are covered under daycare procedures.
✅ Pre-hospitalisation: Some surgeries or medical issues necessitate treatment before hospitalisation. The cost of such treatments can be claimed under health insurance as per the policy's terms and conditions.
✅ Post-hospitalisation: The cost of follow-up treatment is covered under individual health insurance policies as per the policy's terms and conditions.
✅ Domiciliary Treatment: The cost of receiving treatment at home can be covered under specific circumstances for a predetermined number of days.
✅ Organ Donation: The cost of medical treatment related to donating an organ is covered as per the policy's terms.
✅ Ambulance: The cost of hiring an ambulance for transportation to the hospital will be borne as per the policy's terms and conditions.
✅ AYUSH Benefits: The cost of availing Ayurveda, Unani, Siddha or Homeopathy (AYUSH) treatment can be claimed as per the policy document.
✅ Newborn Baby Coverage: Insurance coverage for the newborn baby as per the policy's terms.
✅ Daily Cash Benefit: This is generally an add-on cover. This amount can be used to buy medicines or other essentials required by you.
Exclusions: What is Not Covered in Personal Medical Insurance
Every insurance company has a set of scenarios where the policyholder cannot raise a claim. These scenarios are called exclusions. Here is a list of exclusions of an individual medical insurance policy that you should be aware of.
❌ Intentional Injuries: The cost of treating intentional injuries, including attempted suicide, is excluded from the policy.
❌ Adventure Sports: Injuries arising from participating in adventure sports are not covered.
❌ Criminal Activities: Medical attention required due to participating in criminal activity is not covered.
❌ Cosmetic/Dental Surgeries: The cost of cosmetic and dental surgeries, unless required due to an accident, is excluded.
❌ Infertility Treatment: Health insurance generally does not cover the cost of infertility treatment.
❌ Not Mentioned in Policy: Any other medical treatments/surgeries that are not mentioned in the policy document will not be covered.
Note: Please find the full list of inclusions and exclusions in the policy wordings of the ACKO health plan.
What are the eligibility criteria to buy ACKO Health Policy?
ACKO Health Insurance Policy is a comprehensive solution for your medical insurance needs, allowing you to avoid creating a separate portfolio for your family. You can save money by purchasing a single plan that covers all your family members, including your parents-in-law.
Members aged 45 or above must undergo medical screening, i.e., per-policy medical checkup (PPMC), before the policy begins. The ACKO Health Insurance Policy does not have an exit age, allowing you to receive insurance coverage for senior citizens without worrying about the exit age.
How many dependents can we add to ACKO Health Policy?
You can add up to six members to your ACKO Platinum Health Insurance Plan, including two adults and up to four children. The policy is available to individuals above 18 years of age, with dependent children aged between three months to 25 years being eligible.
Eligibility Criteria | For Acko |
|---|---|
Insured members | 6 Members |
Policyholder’s age | 18 years and older |
Dependent spouse’s age | 18 years and older |
Dependent children’s age | 3 months - 25 years |
Why should you buy health insurance at an early age?
Buying health insurance at an early age has several advantages, such as:
Lower Premiums: Health insurance companies often customize quotes based on the applicant's age, among other factors. When you buy health insurance early, you have a lower risk profile, and the premiums are likely to be less than those for someone purchasing the policy at a later stage of their life.
Fewer Health Issues: Generally, people have fewer health issues in their 20s than those over thirty years of age. Thus, your chances of receiving comprehensive insurance increase when you have fewer or no pre-existing conditions.
Easy Completion of Waiting Period: Health insurance policies have waiting periods, which vary according to the policy. You cannot raise a claim when a waiting period is active on your policy. When you buy health insurance early, the likelihood of you raising a claim is lower than when you buy later in life. It becomes easier to complete the waiting period.
Lower Chances of Policy Rejection: An insurer may reject your health insurance application if you have a significant pre-existing disease. The chances of this happening are lower when you are younger.
Better Coverage: When you buy health insurance early, your insurer may offer more coverage options than if you purchase the policy in your 50s. For example, your insurer may include common health issues like diabetes, high blood pressure, or cataracts in the policy because you might be less risky to insure than others.
What are the included add-ons with our health insurance policy?
Add-ons provide additional benefits to a basic health insurance plan. Here is a list of additional coverages included with our medical insurance policy.
Coverage for non-medical expenses
These expenses are usually not covered under a basic health insurance policy - for example, expenses for admission charges, surgical kits, syringes, etc., are not covered. But with our health plan, such non-medical expenses are also covered.
Room rent waiver
With the room rent waiver add-on, you can stay in any hospital room without worrying about how the additional charge will affect the claim amount. It won’t! Our health insurance plan covers the full cost of room rent irrespective of its type.
Waiting period waiver
Generally, insurance companies don’t cover the cost of hospitalisation for pre-existing diseases up to a predefined time limit. This time limit is referred to as a waiting period, and it can range from a few months to a few years. However, this clause does not apply to ACKO Health Insurance Policy. Under our health plan, we will cover the cost of hospitalisation due to a pre-existing disease** from day 1.
Doctor on call
Teleconsultations have gained prominence during the COVID-19 pandemic. It's easier to contact a doctor via phone call or a video call and get a remote consultation instead of personally visiting the clinic. Under this plan, we have added the doctor on call add-on where you can easily call a doctor and we will cover the cost.
How to claim your ACKO health insurance?
You can settle your claims through two approaches — "cashless" and "reimbursement"
Cashless claim
When you get admitted to any of our network hospitals, only pay the amount that ACKO does not cover at the time of discharge. If the expenses are covered as per policy, We will pay the amount directly to the hospital. Cashless claims allow you to stay worry-free as there is no need to arrange funds for the hospitalisation.
Reimbursement claim
In case of a reimbursement claim, you pay the entire medical bill on discharge when you get admitted to any hospital (not necessarily a network hospital). Post-discharge, you can request reimbursement from ACKO by registering a claim and sharing the required hospitalisation-related documents. If the claim is approved, we will compensate as per policy terms.
Health insurance with an example
Here's an example to illustrate how health insurance works in India.
Priya, a 27-year-old teacher, bought the Rs. 10 Lakh ACKO Platinum Health Insurance Plan. During the policy period, she fell ill and was diagnosed with a serious condition that required hospitalisation and medical treatment.
Thanks to her health insurance coverage, Priya could receive the medical treatment she needed without paying any additional cost out-of-pocket. Since her claim was approved, ACKO covered the entire cost of her medical treatment.
In this scenario, Priya was able to receive timely medical treatment without paying the full cost of treatment, as she received treatment under the Cashless Claim facility in a Network Hospital.
Thus, ACKO Platinum Health Insurance Plans help people like Priya get the necessary medical care and reduce their financial burden during emergencies.
Other health insurance plans available at ACKO
ACKO offers various health plans that cover hospitalisation costs as well as coronavirus expenses.
Arogya Sanjeevani by ACKO
Arogya Sanjeevani Policy by ACKO is a basic and straightforward health plan. Get it if you wish to secure yourself and the loved ones from unforeseen medical costs at an affordable premium. It is perfect for someone looking for a plan that fits their budget and meets insurance requirements.
Corona Kavach by ACKO
The Corona Kavach Policy by ACKO is designed to secure your family against soaring COVID-19 medical costs. If you wish to buy an indemnity-based health policy to cover medical expenses due to COVID-19 treatment, ACKO's Corona Kavach policy is an option.
Why choose ACKO for all-in-one health insurance?
ACKO offers a dependable all-in-one health insurance plan with the following benefits:
7100+ network hospitals
Network hospitals let you avail of cashless claims. We have a tie-up with more than 7100+ top-rated hospitals. Fortis, Apollo Hospitals, and Multi Super Speciality hospital Medanta are a few of them. See the network hospital list →
Highly-rated app with easy access
Being a digital-first insurer, our primary focus is to provide an exceptional online experience via the ACKO app. You have access to features like claim registrations, teleconsultations, 24x7x365 customer support, discounts on lab tests, medicine delivery, tracking claim status, and more. Download the app →
7.7 crore+ people covered
ACKO is catering to the insurance needs of over 7.7 crore customers and this number continues to increase. Not only medical insurance but ACKO successfully provides for your car and bike insurance needs as well.
ACKO Medical Inflation Protect vs NCB
India's medical inflation has been on the rise. According to the Ministry of Statistics and Programme Implementation (MOSPI) report, medical inflation in 2021 was at 14%, and PwC's Health Research Institute (HRI) report predicts a 6.5% increase in medical costs in 2022.
Health insurance can help reduce the impact of medical inflation on your finances and out-of-pocket expenses, especially with features like Inflation Protect and Zero Deductions at Claim.
| Parameter | ACKO Inflation Protect | No Claim Bonus |
|---|---|---|
| Sum Insured | Every year irrespective of claim in previous year | Only if you did not claim in previous year |
| Upper limit on Sum insured | Capped at 100% | Capped at 50-100% |
| Increment % | 10% fixed increment every year | Resets to zero if you claim and then starts again |
Unique Features of ACKO Medical Policy:
Our Medical policy is designed to be easy to understand and offers comprehensive coverage and valuable services. Here are two significant features of the ACKO health plan.
Zero waiting period
✅ ACKO will cover your hospitalisation costs from day 1.
A waiting period on medical insurance has always put people in a soup. Anyone would naturally expect their insurer to cover the cost of treating a pre-existing disease** and get disappointed when their claim is rejected because of a waiting period. This is about to change. With ACKO Health Insurance Policy, we will cover the cost of hospitalisation due to a pre-existing disease** from day 1.
Learn more about the waiting period for health insurance.
Zero deductions at claim
✅ ACKO will pay your entire hospital bill.
There are many factors at play when you make a claim. Things like co-pay, room rent capping, deductibles, non-payable expenses, etc. are a few of the many things that increase your out-of-pocket expenses by a great deal. When you are covered under ACKO medical insurance policy, your out-of-pocket expenses are reduced. We don’t have a cap on room rent, and you can choose any hospital room you wish. Neither do we consider things like co-pay, deductibles, etc. while calculating the claim amount. So practically, zero deductions.
Additional Key features of ACKO Health Insurance Policy
Yes, there are more! With ACKO health plan, you get the following additional benefits.
| KEY FEATURES | ACKO ADVANTAGE | What It Is? |
|---|---|---|
| Co-pay | 0% | You get a “0% co-pay” benefit. Usually, other plans have a co-pay clause, which means you will need to pay a certain percentage of every hospital bill out of your pocket. |
| Room rent | Up to your Sum Insured | There are no room rent limits; you can choose a suitable hospital room for the insured members, and we will cover the expenses up to your sum insured. Other plans have room rent limits, which means part of your bill will not be covered if you go for an expensive room; it's not just the additional cost of the room, but many other costs will not be covered too. |
| Network hospitals | 7100+ Hospitals | Receive cashless treatments at over 7100+ network hospitals with best-in-country processing time (60 mins on average). |
| COVID-19 treatment | Up to your Sum Insured | All COVID-19-related (any variant) hospitalisations are covered. |
| AYUSH treatment | Up to your Sum Insured | AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatments that require overnight hospitalisation are covered. |
| Teleconsultations (Through ACKO app) | Up to your Sum Insured | Teleconsults with General physicians or Specialists are covered, as long as you initiate the teleconsult from the ACKO app. |
| Preventive health checkup | Annually (for insured members above the age of 18 years) | 1 annual health check-up for all insured members above 18 years is covered. You can visit a lab of your choice and get a preventive health checkup done. |
| Inflation protect | Annual sum insured increases by 10% | With this feature, you get something better than NCB (No Claim Bonus). Here, your sum insured will be increased by 10% every year, regardless of whether you raise a claim or not. |
| Pre-hospitalisation | (upto 60 days before) | All costs associated with your medical condition (e.g., doctor's visit, lab tests, medicines) in the days leading up to your hospitalisation are covered. Most insurers will only cover a few days before hospitalisation. |
| Post-hospitalisation | (up to 120 days after) | All costs associated with your medical condition (e.g., doctor's visit, lab tests, medicines) after discharge from the hospital are covered. Most insurers will only cover a few days after hospitalisation. |
| ICU fees | Up to your Sum Insured | All ICU fees are covered. |
| Ambulance charges | Up to your Sum Insured | All charges to transport the insured members to the hospital (via roadways) are covered. |
| Day-care treatment | All treatments covered up to your Sum Insured | All hospitalisations that last less than 24 hours (as long as they are medically necessary) are covered, for example, Cataract, Coronary angiography, Haemodialysis, Chemotherapy, Ligament tear/meniscus tear surgery, and Radiotherapy (for cancer). |
Understanding coverages of our best health insurance policy
Can I buy health insurance online?
Yes, buying health insurance online is more convenient and cost-effective compared to purchasing a similar policy offline, mainly due to the digital infrastructure of online medical insurance companies.
How do I apply for a health insurance plan?
There are two ways to buy health insurance plans in India: offline and online. The offline method involves extensive paperwork and visiting an agent's or insurer's office. It can be time-consuming and cumbersome.
In contrast, the online method is easy, quick, and seamless. Visit the insurer's website, such as ACKO, choose the policy, and make the payment. Online platforms also allow for easy policy renewal and digital claims processing.
Steps to buy health insurance plan online from ACKO
You and the family members can get insured under the best health insurance plan in India by following the below-mentioned steps.
Step 1 - Visit the platform: Visit www.acko.com or download the mobile app.
Step 2 - Share details: Enter a few details such as your age, dependent’s details, and some other personal information to get a health insurance quote.
Step 3 - Get policy: Pay the premium and receive the policy document instantly at the registered email address.
Here’s how you can renew health insurance on ACKO.
Documents required to buy medical insurance plans in India
To avail of a medical insurance policy, below is the list of documents required.
Proof of age | This can include a Driving Licence, Voter's ID, Passport, Birth Certificate, etc. |
Identity proof | You will need to provide a PAN card, Passport, Driving Licence, Voter's ID, or other similar identification documents. |
Proof of address | You may need to submit documents such as a Ration card, Passport, Voter's ID, Aadhaar card, bank statement, telephone/electricity bill, etc. to prove your address |
Medical test report | In some cases, you may be asked to undergo a medical check-up and submit the report to the insurer. |
Note: The exact set of documents may vary depending upon the nature of claim.
Documents required while registering a claim
Below is the list of documents required while raising a claim with your medical insurance provider.
Duly filled health insurance claim form
Discharge summary
Prescription and cash invoice
Copy of your insurance card
Medico-Legal Certificate (MLC) or FIR in case of an accident
Investigation report (X-Ray/ECG/Scan/Laboratory)
Original medical bills and receipts
Cancelled cheque in case of reimbursement
Any other document as requested by your insurer
Can I get tax benefits from health insurance?
Mediclaim insurance is essential. Thus, the Government of India encourages everyone to buy the best health insurance plan by offering tax benefits on the premium paid under Section 80D of the Income Tax Act, 1961.
How to save tax with a health/medical insurance policy?
Apart from receiving all the health insurance benefits provided by the policy, you can also save a significant amount of tax on the premium. To save tax on health policies, produce an insurance certificate while filing tax for the current assessment year. Then, you will receive tax benefits (as per the prevailing tax regulations) depending upon the number of insured members under the health plan.
Additional tax savings with preventive health check-up (Deduction under section 80D)
You can save additional tax by opting for a preventive health check-up during the corresponding assessment year. By doing so, you receive a dual benefit — the latest status update of your health and an additional tax benefit. The tax deduction will be under Section 80D of the Income Tax Act.
Checklist to buy the best health insurance plan online
There are a plethora of health plans in India. Here are some tips for choosing the best health insurance policy that caters to your healthcare needs and fits the budget.
Select the right sum insured amount
It is essential to select the correct sum insured amount. Hence, buy a plan depending on your age, medical conditions, location and healthcare needs. An insurance plan with a low sum insured may not support you adequately during a medical emergency.
Assess your requirements
Individual plans are suitable for individuals who prefer health insurance only for themselves. However, if you want medical insurance covering loved ones, choose the Family Floater plan. It offers maximum benefits at a competitive price. Again, it is crucial to assess personal requirements and budget before deciding on the right plan.
Benefits and services
Yes, it is vital to ensure that a health insurance plan doesn’t burn a hole in your pocket. However, it is more important to look beyond the premium amount and check for benefits and services that an insurer offers. For example, look for insurers that embrace the digital approach to help you save time, have positive customer reviews, and offer you comprehensive coverage.
Look for the nearest network hospital in the insurer's list
Start by going through the list of the insurer's network of hospitals. Locate the nearest one beforehand so that you don't have to bear the hassle of finding one during an emergency. If a good hospital in your vicinity is listed as a network hospital, it will help you access cashless treatment and reduce stress. See ACKO network hospitals →
Minimum waiting period
Many health plans come with a waiting period for different types of ailments. It is advisable to select a health policy with a lower waiting period for pre-existing conditions and diseases. Note: There is no waiting period under ACKO Health Insurance Policy. So you get coverage from day 1 if you disclose all pre-existing conditions you are suffering from.
No sub-limits
Many health plans come with a sub-limit on diseases, treatment and room rent. These sub-limits sometimes can turn out to be a significant amount. Hence, buying a plan that does not have sub-limits is recommended to help you reduce out-of-pocket expenses. ACKO Health Insurance Policy does not have any unhappy surprises like sublimits. Check full list of features here →
High Claim Settlement Ratio (CSR)
High claim settlement ratios mean a higher probability that your claim may be settled. Select an insurer with a high CSR, as it reflects that it will not reject a claim without a valid reason.
Lifetime renewability
It is imperative to understand the time for which your medical plan is active. As health complications increase with age, there are high chances that you may require health insurance during old age. Hence, it is recommended to opt for a plan with lifetime renewability that reduces hassles and unforeseen medical expenses during such time.
What are the top reasons to buy medical insurance plans?
Here are the top reasons to buy health insurance plans.
Financial protection against medical issues
A health insurance plan can provide substantial financial protection to cover the costs of treatment. It usually offers coverage for hospitalisation costs, tests, ambulance charges, and medication expenses.
Tax benefit
Section 80D exempts up to Rs. 25,000 in tax (subject to changes) for paying the health insurance premium. Thus, buying a health plan can decrease your overall tax obligation.
Cost-effective policies
The payable premium for a health cover keeps rising as you become older. It would be wise to purchase health insurance as soon as possible because the longer you wait, the more expensive the premiums become.
Changing lifestyles
These days, chronic illnesses like diabetes, heart disease, and renal ailments are becoming increasingly common. As a result, it is crucial to buy comprehensive health insurance coverage.
How to get a physical copy of your health insurance policy
Here are the steps to follow if you wish to download the physical copy of your health insurance policy.
Step 1: Scroll up to the top and log in to your ACKO account. Use the registered mobile number to generate the one-time password.
Step 2: Click on your health insurance policy to open it.
Step 3: Click on download and take a printout.
You can print multiple copies of your health policy if required.
How to download your health insurance policy copy?
Gone are the days when you had to keep the hard copy of your health insurance policy handy. Now, you can access it anytime by simply downloading it from your ACKO account. Here is how.
Steps to download your ACKO Health Insurance Policy.
Step 1: Scroll up and click on the Login button to access your ACKO account.
Step 2: Open your health insurance policy and click on download.
Alternatively, check the inbox of your registered email address for the policy and download the attachment.
Three popular myths about medical insurance
Here is a list of the three most popular medical insurance myths that some people believe are true. But in reality, they are just myths and should not be considered to be true.
Myth 1: Online health insurance is a scam - Some people prefer buying medical insurance using the traditional method—through intermediaries or by visiting an insurance company, as they might distrust online insurers. However, each insurance company (whether online or offline) must be registered with the Insurance Regulatory and Development Authority of India (IRDAI). You must cross check their registration number on the IRDAI website before purchasing insurance. By the way, ACKO’s IRDAI registration number is 157!
Myth 2: I need to pay the hospital bill for treating a pre-existing disease - Usually, insurance companies cover pre-existing diseases after a certain waiting period. However, under ACKO Health Insurance Policy, we cover pre-existing conditions from day 01. We bear the treatment costs with zero deductions on an approved claim. All you have to do is tell us about your medical history and disclose any pre-existing disease (if applicable) while buying the plan.
Myth 3: I can only claim if I was hospitalised - Under ACKO Health Insurance Policy, you get coverage for daycare procedures, emergency transport, and also pre and post-hospitalisation. These coverages are not limited to hospitalisation and extend to other medical treatments as well. So under our health plan, you can make a claim against an inclusion even if it is not related to hospitalisation.
Health Insurance Portability
Portability in health insurance refers to switching a health insurance plan from one insurer to another. As per this feature, you can port your existing health insurance plan to ACKO.
Note that porting your current health insurance plan to ACKO can only happen if the plan is due for renewal. So, if your plan is expiring soon, you can consider porting it to us. Here are some tips if you want to port your health plan to ACKO.
Reconsider your health insurance needs before porting the policy.
Check if the new sum insured amount is sufficient for you and your family.
Extend the coverage with a Super Top-up Plan if required.
Check the features and benefits of ACKO Platinum Health Insurance Plans.
Buying an ACKO Platinum Health Insurance Plan is possible only after a Pre-Policy Medical Check-up (PPMC). We will call you to confirm the scheduling of the PPMC once you apply for portability. Read more about Health Insurance Portability.
Types of Health Insurance Plans
Here is a list of different types of health insurance plans.
Individual Health Insurance Plans
This plan offers coverage to one individual/person. However, some insurers also allow the policyholder's spouse to be added to the policy and avail of medical insurance coverage.
Family-floater Health Insurance Plan
Immediate family members (spouse, parents, children) can be insured under the Family-floater Health Insurance Plan. Here, insured members share the total sum insured of the policy.
Senior Citizen Health Insurance Plan
This plan covers senior citizens, i.e., people above the age of 65 years. You can buy a dedicated Senior Citizen Health Insurance Plan for your elderly family members for adequate coverage.
Critical Illness Insurance Plan
Critical illnesses like cancer, stroke, kidney failure, major organ transplantation, heart attack, etc., are life-threatening diseases, and their medical treatment is quite expensive. You can get health insurance coverage for such specific diseases through the Critical Illness Insurance Plan. These plans are also called Fixed Benefit Health Insurance Plans, as you get a fixed lump sum amount in the case of an approved claim.
Group Health Insurance Plan
A group of people, for instance, a bunch of employees of the same company, can be covered under a Group Health Insurance Plan. Each member of this group has access to a fixed (separate/specific) sum insured. In some cases, the insured member can add their family members to the plan and share the allotted sum insured.
Top-up Health Insurance Plan
People who are already covered under a health plan or those who can bear the medical expenses up to a certain threshold can opt for a Top-up Health Insurance Plan. It provides coverage beyond a fixed threshold known as a 'deductible' in insurance parlance.
How does health insurance in India work?
The Indian health insurance industry has gone through a paradigm shift over the last few years. Today, additional features like teleconsultations, health tracking, nudging the customer to make better changes in lifestyle, etc., are an essential part of a health policy. The end-to-end process is divided into the following stages:
Stage 1 - Research
At this stage, it is important to know your needs. Look for suitable coverage and a good health insurance company. The research stage is crucial as it will decide what and from whom you will be buying.
Stage 2 - Purchase
The results of your research in Stage 1 will help you find a suitable health insurance policy from a good insurer. You can make the purchase either online or offline. However, buying it online is much faster and convenient.
Stage 3 - Claims
You need to raise a claim against a health insurance plan to get financial support from the insurance company. Some insurers need extensive paperwork for submitting claims. At ACKO, we eliminate paperwork by leveraging our digital infrastructure. This allows us to handle claims more efficiently, ensure accuracy, and achieve a faster settlement. Raise a claim through ACKO’s website or app by logging into the ACKO account. All you need to do is upload a few documents - and you’re all set!
Stage 4 - Renewal
It is necessary to renew your health insurance plan if you are looking for continued medical coverage. Renewal is also a great opportunity to review coverage and make the required changes in the policy. For example, shift your parents to a Senior Citizen Plan if they crossed the age of 65 years during the policy period. Increase the sum insured of the policy if more members are added to the family.
Why compare health insurance plans online?
You should compare health insurance plans online to ensure that you buy a plan that meets your requirements without compromising the features, benefits, and services. Thus, comparing plans can ensure value for money.
Does your health insurance policy cover coronavirus treatment?
Yes, most health policies cover coronavirus treatment; however, please check the applicable policy wordings to confirm the same. IRDAI has directed all general insurers to offer coverage for coronavirus treatment through health plans.
How to calculate health insurance premiums?
You can use a health insurance premium calculator to know the approximate cost of the policy. It is a free-to-use digital tool available on a health insurer's website. It uses factors like the type of plan, add-on covers, health conditions, age, etc., to determine your payable premium.
Here are the steps to calculate health insurance premium using a calculator.
Step 1: Visit www.acko.com, navigate to the health insurance section and enter information like your age, gender, etc.
Step 2: Decide how many individuals you wish to insure, how much coverage you need, and which add-ons you want to buy.
Step 3: Select the coverage and click "calculate" to view the payable premium for the chosen cover.
How to renew health insurance online
You must renew your health insurance policy if you want uninterrupted medical coverage. The renewal process offers you a chance to assess the existing coverage and update the policy as well.
The contactless online method appears to be the ideal choice for renewing health insurance coverage in light of the recent pandemic. Here are steps to renew a medical plan online.
Step 1: You will get a renewal-related email reminder (from [email protected]) before policy expiry.
Step 2: The payment link for policy renewal will be included in the email. To make the payment, just click the link.
Step 3: After making your payment, you will receive your renewed insurance plan shortly.
What are the factors that influence health insurance premium calculation?
Here are the factors that influence health insurance premium calculation.
Age: The higher the age, the higher the premium. For instance, the age of the oldest member insured under the ACKO Platinum Health Insurance Plan plays a prominent role in premium calculation.
Sum insured: At ACKO, we offer health insurance plans with different sum insured amounts ranging from Rs. 25 lakhs to an unlimited amount. The premium of your health plan will depend on the sum insured amount you choose. For example, the premium for the 25 L ACKO Platinum Plan will be less than the Unlimited ACKO Platinum Plan.
Location: The location of your residence is considered while calculating the premium. One reason for this is the difference in the cost of medical treatment across India. For example, people living in rural areas are usually charged less premium as compared to people living in urban areas.
Number of insured members: More members results in a higher policy premium. For instance, ACKO Platinum Plans are Family-floater Health Plans. You can insure yourself, your spouse, and up to four children under our medical insurance plans. If the number of insured members is more, then you may have to pay more premium.
Medical status: Your current medical status is determined with the help of a Pre-Policy Medical Check-up (PPMC) while buying an ACKO Platinum Plan. You must also disclose your medical history when you purchase the policy. The premium will depend upon your current and past medical history.
News related to health insurance
Rajasthan Right to Health Bill 2022: Citizens get access to free emergency treatment
Date: 23rd March 2023
Rajasthan has become the first state in India to recognize healthcare as a fundamental right for its citizens. On Tuesday, the Assembly passed the Rajasthan Right to Health Bill 2022, granting every resident the right to receive free medical at government or appointed private hospitals in case of an emergency.
The bill ensures that every resident can get treatment without prepayment at any "public health institution, health care establishment, and designated health care centres." The government will reimburse the healthcare provider if a patient cannot pay the charges after receiving emergency care, stabilisation, and referral.
Under the bill's provisions, no healthcare provider can deny or delay treatment based on pending police clearance. Additionally, fines of up to Rs 10,000 for first-time offenders and up to Rs 25,000 for subsequent violation of any rule, will be imposed. Ref URL: From IndiaTimes
Hospitalization is not necessary to be covered by medical insurance, the consumer court rules
-March 16, 2023
Hospitalization is not necessary for medical insurance payout, according to the Vadodara Consumer Disputes Redressal Commission. According to the consumer court, modern technologies enable speedy, effective treatment for patients—and without the need for hospitalisation.
Several health insurance companies have likely increased their premium
-March 06, 2023
As per a leading news agency’s sources, various general insurance companies have likely increased their health insurance premium by at least 15 to 18%. There could be several reasons that influenced this hike in premium, including the COVID-19 pandemic, inflation, claim frequency rate, etc. The health insurance sector is instrumental in accounting for thirty-five per cent of the premium associated with the general insurance industry, and this increase can have a direct impact on the said percentage.
Irdai directs insurers to cover PWDs and AIDS
1st March 2023
In October 2022, the IRDAI directed insurance companies to include mental illness coverage in health insurance policies by October 31, 2022. However, insurers have made no progress in launching such a scheme, necessitating the regulator issuing another directive.
The Insurance Regulatory and Development Authority (IRDAI) has ordered insurance companies to "immediately" launch an appropriate product offering health insurance cover for certain vulnerable sections of society — persons with disabilities (PWD), people living with HIV/AIDS, and those suffering from mental illness.
Health insurance policies must offer Mental Illness Cover—IRDAI directive
-October 25, 2022
The Insurance Regulatory and Development Authority of India has made it compulsory for all Indian insurance companies to offer coverage for mental illness under health insurance. Insurers must comply and adhere strictly to the requirements of the MHC Act, 2017 before October 31, 2022.
The significance of mental health has been brought to light by the COVID-19 pandemic. As more people seek medical help, the stigma associated with mental health is reducing. This is reflected in the latest orders from IRDAI.
Insurers can now file less number of returns to IRDAI
-September 14, 2022
The insurance regulator is implementing a range of changes in the Indian insurance sector to make it easier for stakeholders to conduct their business. One such change is that general and health insurers would have to file eight returns while life insurers would have to file three returns instead of the present 17 returns. Filing returns (meaning submitting the necessary paperwork) is an integral part of being compliant with IRDAI norms. However, the practice is stringent and time-consuming.
Insurers are required to provide different returns to the regulator, including actuarial reports, asset and liability valuations, solvency margin, and yearly financial statements. By reducing the number of returns, the insurers can now focus on doing better business in the insurance sector. Note that these changes in reporting standards will take effect immediately.
IRDAI to introduce BIMA SUGAM, an all-in-one insurance platform
-September 02, 2022
The Insurance Regulatory and Development Authority of India has advocated for universal access to affordable health insurance via lowering costs. Before India celebrates its 100th year of independence in 2047, universal health insurance should be the goal for all stakeholders, according to IRDAI Chairman Debasish Panda.
Speaking on Tuesday at the Health Insurance Summit 2022, Panda suggested that high operating and distribution costs and hospital expenditures (indirect costs) may influence insurance premiums.
The Chairman added, "We have to look at ways of cutting the expenses to make insurance inexpensive," which should not be overly cumbersome for insurers either. Pricing is likely very high, making insurance coverage unaffordable for certain parts of society.
He added that BIMA SUGAM, a new all-in-one insurance platform, is being developed by the regulator to support this expansion. The site will serve as a one-stop shop where customers can access all insurance products.
Source URL: From TimesNowNews
IRDAI Preparing All-information Health Insurance Portal
-August 19, 2022
The Insurance Regulatory and Development Authority of India (IRDAI) is working on a health insurance portal that is expected to hold all information about health insurance policies and claims, as reported by Zee News. The portal shall have information such as cost of treatment, treatment facility, cost of claims, etc., related to IRDAI-promoted Insurance Information Bureau (IIB) registered 35,000 hospitals across the country.
Claims reported by the hospitals to the insurer and Third Party Administrator (TPA) shall be available through this portal. It is also expected to find fraudulent claims and lend visibility about the cost of treatment.
Non-ICU hospital room rent to attract GST
-July 26, 2022
The 47th meeting of the Goods and Services Tax (GST) Council took place on June 28 and 29, 2022. During this meeting, it was decided that a 5% GST will be imposed on non-ICU hospital room rent. However, applicability was defined only for room rent exceeding Rs. 5,000 per day. This decision was made as part of a larger tax rate rationalisation effort and came into effect on July 18, 2022.
The repercussion of this move will be an increase in the cost of healthcare in India. For example, if a person is charged Rs. 21,000 as room rent for three days, he/she will have to additionally pay Rs. 1,050 as GST. Considering that patients are likely to be admitted for long durations, their hospitalisation costs may also mount up.
The regulator extends the deadline for remote health insurance services to March 2022
-September 15, 2021
The Insurance Regulatory and Development Authority of India (IRDAI) has again pushed the deadline for allowing health insurance companies to offer remote services to 31st March 2022. Earlier, a signed, hard copy was one of the most essential documents in the process of buying/renewing a health insurance policy or for raising a claim.
However, due to the COVID-19 lockdown and social distancing, meeting the insurance agent or sending these documents via post is still not possible in many parts of the country. Thus, to avoid any obstacles in the continued health and general insurance coverage, the regulator has decided to permit the use of digital methods for issuing policies. Such a method of buying/renewing health insurance seems more convenient for isolated policyholders or those living in a situation of complete lockdown.
As per the IRDAI guidelines, insurance companies must send the health insurance policy and the proposal form to the policyholders' registered email addresses and inform them via multiple touchpoints like SMS or mobile numbers. The policyholder must then confirm the acceptance via One Time Password (OTP) or a dedicated hyperlink. Even though the effects of the COVID-19 pandemic seem to have reduced in some parts of India, the risk of infection continues.
IRDAI Issues New Use-and-File Norms for Health Insurance
– February 09, 2021
As per an update on February 8, 2021, the Insurance Regulatory and Development Authority of India (IRDAI) has made changes concerning the Use-and-File norms for health insurance products. The insurance regulator has allowed insurers more freedom for products belonging to certain categories under the Use-and-File norms. As per these norms, insurers can offer policies to potential policyholders without seeking IRDAI approval. The new categories under health insurance are Personal Accident Insurance, Benefit-based Health Insurance and under travel insurance are Overseas and Domestic Travel Insurance.
The Corona Rakshak Policy that was launched in 2020 is an example of a Use-and-File product. The benefits of including more products under the Use-and-File category are increased innovation, better personalisation, and quick-to-market policies. Products filed post-April 1, 2021 will follow the new norms. The IRDAI circular issued on Monday has more details about their recent update.
New Rules For Health Insurance To Be Followed From October 01
– September 30, 2020
Recently the Indian health insurance industry has undergone a lot of changes. New rules have been laid down by the high court and IRDAI. These rules are to be followed from October 01, 2020. Here are the details: New illnesses like genetic diseases, mental illnesses, Neuro disorder, robotic surgery, oral chemotherapy, psychological illness etc. will form a part of a health insurance policy along with coverage for COVID-19.
The pre-existing diseases clause previously had a waiting period imposed on the coverage of the policy, it lasted for years on some policies. Now the pre-existing diseases that are diagnosed 48 months ago can be covered within three months of buying the policy. Coverage for an implant and diagnostics, pharmacy bills, etc to be included in the health insurance policy. A claim cannot be rejected on the basis or misrepresentation or late filing if the policy has been actively renewed for eight consecutive policy periods. According to IRDAI, the insurance company has been given 8 years to investigate the medical history of a policyholder. Telemedicine to become a part of health insurance. Online consultation has gained much popularity during the COVID-19 pandemic.
As per another rule that will be implemented, a policyholder can choose to buy multiple health insurance plans. He/she can apply for a partial payment to the health insurance company of his/her choice if one company cannot pay the full claim amount. All health insurance policies bought on or after October 01, 2020, will be as per the above-mentioned rules.
Health and Auto Insurance Buying Process Becomes Totally Online
– September 14, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has made an important announcement with regard to buying and selling of insurance policies. This announcement has been made keeping in mind the ongoing COVID-19 pandemic. The apex insurance body has allowed insurance companies to sell health and auto policies in a totally online manner.
Thus, the overall process of purchasing these policies has been made completely online. As a result, there will be no requirement of physical documents such as the application form or hard copies of the policy. This new change is applicable in cases where the sum insured does not go beyond INR one crore. This new rule is said to be applicable until March 2021. The IRDAI had issued a circular to all general and health insurance companies regarding this new rule on 10 September 2020.
Now Avail Group Covers for Newly Launched Health Plans
– July 31, 2020
The ongoing COVID-19 pandemic has caused turmoil across industries. To offer some sort of a backup to the public, the Insurance Regulatory and Development Authority of India (IRDAI) had recently launched two policies: Arogya Sanjeevani and Corona Kavach. These were launched as individual policies. However, recent updates suggest that these two policies can be availed as a group cover as well. Group insurance plans are standard plans that cover a group of people under one policy.
Thus, employers can offer these policies to their employees as a part of Employee Health Insurance. It can be offered by both public as well as private-sector employers. In the case of these group plans, most of the terms and conditions remain the same but there can be a change in the premium. The insurers have some flexibility in charging the premium for group policies in accordance with IRDAI guidelines.
Date For Enrollment Under Sarbat Sehat Bima Yojana Extended For Farmers
– July 27, 2020
The date for Sarbat Sehat Bima Yojana that is the Ayushman Bharat Yojana in Punjab, has been extended to include farmers and their families under health insurance. The Ayushman Bharat Yojana is the Indian Government’s flagship program that provides free health insurance for low-income groups in the country. By extending the date of applying to the Sarbat Sehat Bima Yojana, the authorities aim to include 9.5 Lakh farmers under the benefit. Applications from farmers will be accepted until 05 August 2020.
Farmers with ‘J’ form and ‘sugar cane weighment slips’ are expected to apply for the scheme with self-declaration and other documents as published by the authorities. Eligible families can get in touch with the Market Committee office or Commission Agent (Arhtiya) to apply under the Sarbat Sehat Bima Yojana on or before 05 August 2020. Eligible members and their nominees can avail cashless treatment in any of the empanelled hospitals, which include 208 government and 546 private hospitals. The coverage provided under this scheme is Rs. 5 Lakh per family per year that can be availed to get treatment for 1396 diseases.
Punjab: Farmers Can Submit Applications for the Rs. 5 Lakh Health Insurance by 24 July
– July 21, 2020
The state government of Punjab has asked farmers to avail the Rs. 5 lakh health insurance scheme by 24 July 2020 for the cashless treatment under the Ayushman Bharat Sarbat Sehat Bima Yojana Punjab for the current financial year. The premium for the insurance will be borne by the Punjab Mandi Board and the farmers need not pay the same. Both farmers and their families will be covered under the scheme through which they can avail cashless treatment at network hospitals for 1,396 ailments, which includes cancer treatment, heart surgery and accident-related treatments.
Beneficiaries can avail treatment from 546 private hospitals and 208 government hospitals in the state. Farmers need to fill the ‘J’ form to enroll in the scheme. Also, the self-declaration is available with the market committee and commission agent or it can be downloaded from the mandi board website. Eligible beneficiaries will receive a special insurance card to avail the treatment.
COVID-19: Treatment At Makeshift Hospitals to be Covered Under Health Insurance
– July 21, 2020
The insurance regulator said that the treatment of COVID-19 at makeshift hospitals will be covered under health insurance approved by the government. The number of cases has been on the rise, which has prompted state governments to permit makeshift hospitals to treat COVID patients. In a circular, the Insurance Regulatory and Development Authority of India (IRDAI) said that in an effort to make sure that treatment of the novel coronavirus, temporary or makeshift hospital approved by the state or central government should be considered as a hospital and all insurance companies should settle claims from these hospitals.
The circular further specified that if a patient is admitted to a makeshift or temporary hospital, then such hospital will be considered as a network hospital and the claim should be settled accordingly. It also asked third-party administrators to take note of the circular and honour claims raised by COVID-19 patients through these types of hospitals.
IRDAI Directs Insurers to Settle Health Insurance Claim for Hospitalisation in a Makeshift Hospital
– July 17, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) in a circular said insurance companies should settle health insurance claims for hospitalisation in a makeshift hospital. The announcement comes amid rising COVID-19 cases across the country and metro cities are running out of beds, which has prompted state governments to provide makeshift hospitals.
However, there have been several instances of claims being denied, especially if treated at makeshift hospitals. In a circular, the IRDAI said that to ensure that the cost of COVID-19 treatment is covered under the terms and conditions. Hence, temporary or makeshift hospitals approved by the respective state government regarded as a network of hospitals and insurance providers should settle the claims. It asked third-party administrators to adhere to the circular to allow claims to be settled for COVID-19 treatment at a makeshift hospital.
Punjab CM Gives Nod to Cover 9.5 Lakh Farmers Under Health Insurance Scheme
– July 16, 2020
Punjab Chief Minister Amrinder Singh gave nod to bring 9.5 lakh farmers & their families under the health insurance scheme of Ayushman Bharat Sarbat Sehat Yojana (ABSSY). Through the scheme, beneficiaries can avail treatment facilities such as cancer treatment, major surgical treatments such as heart surgery, accident cases and joint replacement.
Treatment facility of up to Rs. 5 lakh can be availed by the beneficiaries at any of the 208 government hospitals and 546 empanelled hospitals. The health insurance scheme in Punjab was launched back in 2019 by the state government. The release said that the health insurance scheme will cover a total of 9.5 lakh farmers with effect from 20 August 2020. Farmers can get cashless treatment facilities and the Mandi board will pay the premium for the health insurance.
Insurance Regulator Allows Insurers to Launch Standard Corona Kavach Health Insurance
– July 14, 2020
India’s insurance regulator Insurance Regulatory Authority of India (IRDAI) has approved health and general insurance companies to launch the standard health insurance for COVID-19, Corona Kavach health insurance in the country. The Corona Kavach is an exclusive health insurance plan which covers treatment for COVID-19, including the cost to procure PPE, oxygen, gloves, masks, etc.
The Sum Insured in this standard coronavirus health insurance is a minimum of Rs. 50,000 and a maximum of Rs. 5,00,000. The policy can be availed by people between the age group of 18 and 65 years. The policy can be purchased as a family floater type which includes spouse, dependent children and parents/parents-in-law. Also, it covers comorbidities and pre-existing conditions and can be bought for 3.5, 6.5 or 9.5 months of tenure. Policyholders can avail home treatment for up to 14 days under this plan.
IRDAI In Favour of Short-term Health Insurance Policies for Coronavirus
– June 25, 2020
Insurance companies can now offer specific short-term health insurance policies to cover the novel Coronavirus thanks to the Insurance Regulatory and Development Authority of India (IRDAI). Here, the short-term is defined as a period that is more than three months but less than twelve months. Now, insurers can offer a 3-to-11-month Coronavirus-related policy to the people. Note that a fixed policy period of 12 months will not be deemed as a short-term cover.
IRDAI issued a circular on 23 June 2020 stating the guidelines to introduce the short-term health insurance plans, which can be offered by Life, General, and Health insurance providers. However, Life insurance providers can only offer benefit-based policies, whereas General and Health insurance providers can offer both benefit-based as well as indemnity-based policies to the people. These short-term health insurance policies can be for an individual and a group.
IRDAI Notifies Health Insurance Providers Not to Contest Claims After Eight Years of Premium Payment
– June 16, 2020
In a fresh set of guidelines, the Insurance Regulatory and Development Authority of India (IRDAI) has said health insurance providers cannot contest claims after eight continuous years of premium payment. The notification came after the insurance apex body said that the main aim is to simplify the general terms and clauses in indemnity-based health insurance plans. This does not cover personal accident cover and domestic/international travel.
Also, this was done to ensure uniformity across the insurance industry by simplifying the policy wordings of the terms and conditions. The new guidelines will be applicable to all health insurance policies that are not in compliance with these guidelines. This will be revised when they are due for renewal from 1 April 2021. Also, the guideline says that health insurance companies cannot contest claims after 8 continuous premium payments unless permanent exclusions are specified in the policy or proven for fraud.
New IRDAI Directives Allow Telemedicine Coverage Under COVID-19 Health Insurance
– June 12, 2020
IRDAI has ordered insurance companies to extend coverage for including telemedicine in their health insurance plans. Insurance Regulatory and Development Authority (IRDAI) is a government body that governs the Indian insurance sector. Including Telemedicine under a health insurance coverage will prove to be beneficial especially in the current COVID-19 pandemic where patients are supposed to remain in quarantine. This will ensure patients get access to quality health care services and help in containing the spread of Coronavirus to some extent.
An increasing number of COVID-19 cases among medical staff can also be reduced with telemedicine.Telemedicine is a method through which patients can get a professional medical opinion like treatment and prevention, or diagnosis via telecommunication technology. Medical practitioners are to adhere to the Telemedicine Practice Guidelines dated 25th of March 2020 laid down by the Ministry of Health and Family Welfare (MoHFW). The claim for Telemedicine consultation can be made by a policyholder under the Outpatient Department (OPD) coverage of their health insurance policy.
Maharashtra Announces Rs.50 Lakh Insurance for Journalists
– June 9, 2020
The Maharashtra State Government announced Rs.50 insurance coverage for journalists and media personnel under the State’s accident cover. This announcement was made by the Public Health Minister on Thursday. Previously, the government had included other COVID-19 frontline warriors such as doctors, police, nurses, Anganwadi workers and home guards under the scheme. Journalists and other media personnel who are on active duty will be part of the State’s comprehensive personal accident coverage of Rs.50 lakh. Until the details of the package are worked out and the scheme comes into force, COVID-19 warriors will be covered through ex-gratia assistance of Rs.50 lakh.
Free Health Insurance Policy To All Citizens in Maharashtra
– May 5, 2020
The state government of Maharashtra announced that it will offer a free health insurance scheme to all people in the state. Maharashtra will be the first state to announce such a scheme in the country. This will be extended through the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme. Citizens of Maharashtra can avail free and cashless treatment or hospitalisation.
To apply for the scheme one must provide their domicile certificate and ration card. The state health minister said that the scheme was extended until now to 85% of the population, now the remaining 15% will be covered under the scheme. Employees of state government, white ration cardholders and semi-government will be eligible to apply for the scheme. He added that a Memorandum of Understanding has been signed between the government and General Insurance Public Sector Association for the treatment of the novel coronavirus or COVID-19 cases at private hospitals in Mumbai and Pune.
Health Insurance Scheme for COVID-19 Warriors Announced by West Bengal Government
– May 3, 2020
The state government of West Bengal has announced a health insurance policy for COVID-19 warriors including journalists with a sum insured amount of Rs.10 lakh. On the occasion of Press Freedom Day, Chief Minister Mamata Banerjee said that the press should be respected for their contribution to the society and they are the fourth pillar of democracy and should be able to perform their duties without any fear. The health insurance scheme of Rs.10 lakh will cover frontline coronavirus warriors and journalists so that they can perform their duties fearlessly.
Insurance Regulator Directs Health Insurance Providers to Settle Claim in 2 Hours
– April 23, 2020
Insurance Regulatory and Development Authority of India (IRDAI), the apex body for insurance companies in the country has directed that claims should be settled within two hours by health insurance companies. The circular said that from the time they receive the authorisation request, the hospital should receive authorisation on cashless treatment within two hours.
It also said that the decision of the final discharge should be communicated to the hospital within 2 hours from the time the insurers or the third party administrator receives the final bill or any necessary needs from the network provider or hospital. The IRDA also asked health and general insurance companies that appropriate guidelines are issued to their respective third party administrators during this time of lockdown in an effort to contain the spread of the coronavirus in the country.
COVID-19: Health, Vehicle Insurance Renewal Date Extended
– April 16, 2020
Amidst the ongoing lockdown to contain the spread of the infectious COVID-19 in India, the common man is facing several hardships. The Centre, in an effort to bring some relief to Third-party health and vehicle insurance policyholders, has extended the date to renew their policies without being affected by a lapse of the insurance coverage. Insurance policies which are falling due between 25 March to 3 May 2020 have been extended to be paid by 15 May 2020.
Failure to renew third-party health insurance policies on the due date get an extension of one month; however, there is no coverage during this extended period. As for the third-party motor insurance policies, there is no grace period and a penalty is charged for failure to renew it by the due date. However, with this announcement by the Finance Ministry, policyholders can get some relief to pay the renewal premium of their health or vehicle insurance till 15 May 2020.
Indian Bank Offers Up to Rs.4 Lakh Insurance Cover To Business Correspondents
– April 15, 2020
Indian Bank said it has offered insurance coverage of up to Rs.4 lakh to business correspondents which are instrumental in ensuring the availability of essential banking services especially in the rural and unbanked areas during the ongoing lockdown to contain the spread of the novel Coronavirus.
The public-sector bank is offering the cover under the Pradhan Mantri Suraksha Bima Yojana and Jeevan Jyoti Bima Yojana. Business correspondents of banking services include those providing primary banking services such as cash withdrawals, deposits and other services especially in the remotest regions of the country. The Centre has announced a second lockdown to contain the spread of COVID-19 in the country and only essential goods and basic banking services are available currently.
Health and General Insurers Cleared by IRDAI to Market COVID-19 Health Insurance Policy
– April 3, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has cleared Acko General Insurance and 29 other insurance companies to market COVID-10 health insurance policy in India. The COVID-19 health insurance scheme will cover the hospitalisation expenses airing out of treat for the deadly Novel Coronavirus infections.
The policy will offer coverage of Rs.1 lakh and Rs.5 lakh and the idea behind the new policy is to streamline a policy exclusive for the treatment of the COVID-19 infection and offer a standard insurance policy with common features. The standalone policy will be launched by the selected insurance companies but will be known as ‘Aarogya Sanjeevani Policy’. The price will be decided by those insurance companies.
COVID-19: Health Care Workers to Get Rs.50 lakh Health Insurance for 3 Months
– March 20, 2020
The Indian government has proposed to offer health insurance to health care workers to the tune of Rs.50 lakh per person. This includes paramedics, sanitation employees, doctors and ASHA workers. During a press conference, Finance Minister Nirmala Sitharaman said that health insurance coverage will be provided to health workers for a period of three months. The health insurance comes into effect from 25 March 2020.
The coverage will include ward boys, safai karamcharis, nurses, paramedics, ASHA workers, technicians, specialists, doctors and other health workers. They will be covered under the Special Insurance Scheme. About 22 lakh health workers are expected to benefit from this scheme.
IRDAI Asks Insurance Companies to Conduct Board Meeting Through Video Conference
– March 23, 2020
In the wake of rising Coronavirus infections in the country, the Insurance Regulatory and Authority of India (IRDAI) to conduct board meeting only through video conferencing till the end of June 2020. Also, insurers have been given 30 additional days to submit their third-quarter returns. The apex body of insurance in India has appealed to all insurers, its intermediaries and distribution channels to be more sensitive to requirements of policyholders during this trying times in the country.
It also asked them to operate through telephonic or digital mode. It said that all details such as services, office working hours and the alternative arrangements for payment of premium, renewal or the claim process to be displayed on their respective website.
IRDAI Brings in Changes to the Definition of Pre-Existing Diseases
– February 12, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) has recently changed the definition of pre-existing diseases in health insurance. In a circular, the IRDAI said that it has removed the modified or additional clause from the existing definition in an effort to make it more simple and customer-friendly.
The IRDAI said that if some illnesses were identified within three months of purchasing the health insurance policy, then it would be considered under pre-existing diseases. However, as per the recent circular, these diseases will not be considered as pre-existing diseases.
Health Ministry Says Rs.3,520 crore Have Been Released to States in Two Year Under AM-PMJAY
– February 6, 2020
Under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Health Ministry has released Rs.3,520 crore to states in the last two years. The Ministry also said that the reasons for slow use of funds were because four states were not implementing the scheme. The four states include Delhi, West Bengal, Odisha and Telangana.
Also, states such as Punjab and Rajasthan joined the scheme late 2019 hence the lower utilisation of funds. Also, large states like MP, UP and Bihar are implementing the scheme for the first time and hence, the traction has been slow. AB-PMJAY is India’s flagship health insurance plan, which is also considered the biggest in the world.
Budget 2020: Ayushman Bharat Scheme, Health Sector Gets a Boost of Rs.69,000 Crore Under
– February 4, 2020
Expanding the Centre’s flagship scheme, Ayushman Bharat, Finance Minister of India allocated Rs.69,000 crore in the current Budget 2020. The scheme is considered as the World’s largest government-funded health insurance plan. Through the expansion, the scheme will witness more hospitals being set up in Tier 1 and Tier 2 cities in the country under the Public-Private Partnership (PPP) model. Tax proceeds from the sale of medical devices will be utilised to fund government hospitals in these regions, while Rs.6,000 crore has been allocated for the PMJAY scheme.
Over 1 Lakh Community Health Officers to be Placed at Health Centres by 2022: Ayushman Bharat Scheme
– December 12, 2019
The Central government’s flagship health scheme, Ayushman Bharat, will employ 1,20,000 community health officers who will be assigned at health and wellness centres by 2022. All sub-centres, primary health centres, and urban primary health centres will be upgraded to Health and Wellness Centres (HWCs) in an effort to offer comprehensive primary health care. The plan is also to create 1,50,000 HWCs by the end of financial year 2022. The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to offer health insurance policy with a coverage of Rs.5 lakh per family per annum. The scheme will cover over 10 crore poor families across the country.
IRDAI Circular Allows Policyholders to Select Their Own Health Insurance TPA
– December 11, 2019
A circular issued by the Insurance Regulatory and Development Authority of India (IRDAI) states that policyholders need not depend on the insurance company to choose a third-party administrator (TPA) while buying health insurance. Now, the policyholder can select a TPA of their choice from the host of TPAs engaged by the insurance company. In case, the TPA is terminated by the insurer, the policyholder has the choice to choose any TPAs listed by the insurer. If the policyholder does not choose any TPAs, the insurer may choose its choice of TPA.
Proposal to Lower Sum Insured Amount on Standard Health Indemnity Insurance
– November 29, 2019
The Insurance Regulatory and Development Authority of India (IRDAI), which is the apex body of the insurance sector in the country, has proposed to lower the sum insured amount from Rs.1 lakh to Rs.5 lakh on individual and family floater policies. Through this proposal, the public is allowed to opt a suitable health insurance cover, offering basic hospitalisation costs. The difference is the premium charged on these types of insurances. Earlier this year, the IRDAI had made it mandatory for all general insurance companies to provide a standard health indemnity insurance with a basic sum insured amount between Rs.50,000 to Rs.10 lakh.
NITI Aayog Report Proposes Mandatory Health Insurance for All
– November 18, 2019
The government think tank, NITI Aayog, in its report has proposed mandatory health insurance for all in India. It said that the current हेल्थ इन्शुरन्स schemes in India are highly fragmented at the level of risk pools and payers. Apart from the Ayushman Bharat as well as the packages offered by the National Health Mission (NHM), the government may explore the mandatory health insurance for future risk pooling options.
FAQ's - Health Insurance - Buying & Renewing
What is the difference between health insurance and Personal Accident Cover?
Below are the differences between the two types of insurance policies.
The health insurance policy offers claims towards injury, illness, and other medical conditions.
Personal Accident Cover provides coverage due to accidental death while the medical insurance policy does not.
Disabilities are not covered under health insurance coverage.
Can I nominate a person for medical insurance?
Yes, you can nominate a person under Section 39 of the Insurance Act, 1938. While the policy is active, during your lifetime, you can nominate any person or persons to whom the insurance company will pay applicable benefits under the health insurance upon your unfortunate death.
Is a medical test mandatory for all?
Medical tests are mandatory for individuals above the age of 45 years to get coverage under ACKO Health Insurance Policy.
If my policy has expired, can I still renew my insurance policy?
Your health insurance policy offers a grace period of 30 days. However, any claims raised during these 30 days will be rejected. Additionally, if you do not renew the policy within the grace period, the policy will lapse.
Can I transfer my health insurance policy from one insurer to another?
Yes, you can transfer your policy from one insurance provider to another as per the circular issued by the IRDAI. This process is known as portability of health insurance plans.
Can a person have more than one health policy?
Yes, you can own more than one health insurance policy. However, it is recommended to opt for another health policy only if you feel that the sum insured of your first policy is not sufficient.
How to calculate the health insurance premium amount?
You can easily calculate the premium for your medical insurance policy by using the health insurance premium calculator. This is a free, online tool that will help you understand the approximate amount you must pay for buying the policy. A premium calculator is usually a part of the process when you set out to buy health insurance.
Health Insurance - Claims & Coverage - FAQ's
Are children covered in health insurance policies?
Yes, dependent children between the age of 3 months and 25 years are eligible to be covered under the policy.
Can I claim a tax exemption for the premium paid for a health insurance plan?
Yes, you can claim tax deductions under Section 80D of the Income Tax Act and the Finance Act, 2018. For example, it offers tax benefits of up to Rs. 25,000 for a Family Floater policy, which includes the primary policyholder, spouse, and dependent children. In case you include your parents aged below 60 years, then you can claim an additional deduction of Rs. 25,000. And, if your parents are above 60 years, the deduction is up to Rs. 50,000. Please note that tax benefits are subject to changes on an annual basis.
What does permanent exclusion mean?
Diseases covered under the permanent exclusions will not be covered under the health insurance policy.
What is the maximum number of claims allowed in a year?
As per the terms and conditions, you can raise several claims during the policy period subject to a maximum of the sum insured.
FAQ's -Terminologies Related
What is copay?
Under the co-pay clause of the policy, the policyholder along with the insurance company must share a part of the claim amount as per the policy. Read more about Copay in Health Insurance
Note: There is no copay clause under ACKO Health Insurance Policy. With our zero-deductions-at-claim feature, you get coverage for the entire hospitalisation bill.
What does pre-existing disease mean?
Any ailment, medical condition, injuries, or related medical conditions for which you have symptoms or signs, and/or diagnosed, and/or received medical treatment or advice within a stipulated time period prior to the first policy by the insurance company is considered as pre-existing diseases.
What is the annual sum insured?
The maximum amount that the insurer will pay in case of hospitalization of the policyholder or the beneficiaries of the policy, which is as per the terms and conditions of the insurance policy, is known as the sum insured amount.
What is the waiting period in a health insurance plan?
The time in which you cannot raise a claim is called a waiting period in health insurance. There are roughly three types of waiting period:
Initial waiting period
Pre-existing diseases waiting period
Specific diseases waiting period
Note: ACKO Health Insurance Policy does NOT have any waiting period. If you are honest about your medical history, we will provide health insurance coverage as soon as your policy is approved.
What does network hospital mean?
A hospital that has an agreement with the insurance company for offering cashless hospitalisation is called a network hospital. If treated at a non-network hospital, you must raise a claim through the reimbursement procedure.
What do you mean by cashless hospitalisation?
Under the cashless treatment, you need not settle the medical bills (only pay for what's not covered). The insurance company will settle the payment for your hospitalisation as per the policy terms.
What do you mean by premium?
To benefit from your health insurance plan, the amount you pay to the insurance company is known as a premium amount.
What is a health check-up facility?
Some insurance companies provide cover for general health check-ups, but it may have a waiting period before you can take advantage of the benefit. However, with ACKO Health Insurance Policy, there is no waiting period applicable.
What does Family Floater policy mean?
A Family Floater health insurance plan covers you and your family members such as your spouse and dependent children. Compared to individual plans, which cater to one individual, the Family Floater is robust, offering wide coverage for the family.
What does Critical Illness insurance mean?
Generally, the critical illness cover is offered through the insurance company’s add-ons. Under this coverage, the insurer covers the policyholder’s family against critical diseases such as stroke, heart attack, and kidney failure, among others.
Do I need to compulsorily buy health insurance at an early stage?
No, it is not mandatory to buy a health plan when you are young. You can buy it even when you cross 50. However, many health insurance companies have minimum and maximum age criteria. Check the maximum age criteria to avoid rejection of the policy.
Buying policy at an early stage helps in many ways. As you grow older, health complications may increase. The probability of suffering from lifestyle diseases such as diabetes, hypertension or thyroid may also increase. Since ageing increases the chances of claims, the health insurance policy bought at a later stage can be costly. Thus, buy a plan as early as possible.
What is the difference between health and mediclaim insurance?
Mediclaim policies are designed to cover basic hospitalisation costs and specific illnesses; however, the coverage or the sum insured will be compromised. Mediclaim cover can be viewed as a low-premium health insurance policy.
On the other hand, a medical insurance policy is designed to cover you comprehensively. Apart from basic hospitalisation costs, it can cover pre and post-hospitalisation costs, critical illnesses, etc. depending upon the selected cover and policy wordings.
If you want a comprehensive health cover, health insurance offers the maximum benefits and features. However, if you want limited health coverage with a low-premium health cover, then a mediclaim policy can be an option.
Where can I learn more about common health insurance terminologies?
Please visit our dedicated health insurance glossary page to learn about common terms related to health insurance.
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