Health Insurance

All hospital expenses, 100% covered

✅ Zero waiting period ✅ Zero deductions at claim

Health Insurance

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What is health insurance?

Health or medical insurance is the financial assistance you can get for medical expenses arising from an unfortunate accident, sudden illness, or planned/emergency hospitalisation. Some health insurance policies provide basic coverage for hospitalisation, while some offer broader coverage, including wellness benefits, preventive healthcare, etc. 

There are different types of health insurance policies, such as Individual Policy, Employer-offered Policy, Critical Illness Policy, etc. For example, a Family Floater Policy for your family insures your loved ones against various medical conditions.

Considering rising medical inflation and expensive medical care, it’s best to insure yourself and your family with a suitable health insurance policy for timely financial support in case of a health emergency.

At ACKO, we offer 1 crore sum insured health insurance plan — a one-stop solution to all your medical insurance needs without buying multiple policies.

Unique Features of ACKO Health Insurance Policy

Our health insurance policy is straightforward and easy to understand when you buy health insurance. Here are the two major 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 end up getting disappointed when their claim is rejected because of a waiting period. This is about to change with ACKO. With ACKO Health Insurance Policy, we will cover the cost of hospitalisation due to a pre-existing disease* from day 1.

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 Health 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
Co-pay 0%
Room rent Covered up to ₹1Cr
Choose any hospital room Allowed, without deductions
Network hospitals 7000+ Hospitals
COVID-19 treatment Covered up to ₹1Cr
AYUSH treatment Covered up to ₹1Cr
Teleconsultations Covered up to ₹1Cr
Preventive health checkup Annually (for insured members above the age of 18 years)
Inflation protect Annual sum insured increases by 10%
Pre-hospitalisation 60 days
Post-hospitalisation 120 days
ICU fees Covered up to ₹1Cr
Ambulance charges Covered up to ₹1Cr
Day-care treatment All treatments covered up to ₹1Cr

Understanding coverages of our best health insurance policy

Inclusions

Exclusions

Inclusions: What’s covered in the ACKO Health Plan

We have curated the ACKO Health Insurance policy to include a host of benefits that include add-ons, unique features like no deductions and coverage from day 1, and an option to add up to four dependent children. Here are the coverages of our 1 Cr. plan.

✅ All types of medically necessary hospitalisation: Sometimes, a health insurance policy covers hospitalisation only for certain ailments covered under the plan. But with our medical insurance policy, you can claim for any type of hospitalisation expenses that are medically necessary (just ensure that you share your past and current medical history while buying the plan). 

✅ Emergency transport for the insured: In case of an emergency, if there are not enough medical facilities available, we will cover the cost of transporting you to a well-equipped hospital. This includes the cost of medically-equipped speciality aircraft, commercial airline, train, or road ambulance.

✅ Wider coverage for pre and post-hospitalisation: We cover the expenses related to treatment for up to 60 days before hospitalisation and 120 days for recovery after hospitalisation. Usually, these costs are covered for a lesser duration in many other health insurance plans. However, we offer a wider coverage on pre and post-hospitalisation expenses.

✅ Cost of road ambulance trips: Many medical insurance policies do not cover ambulance trips made between home and the medical centre. Our policy does. Don’t worry about the cost of a road ambulance while transporting the insured to and from the hospital and the place of residence. These costs are covered up to the sum insured limit.

✅ Day-care treatments: Comparatively smaller medical procedures don’t require prolonged hospitalisation (for example: cataract surgery). These expenses may not be covered for all procedures under your basic health plan. However, you will be covered for related expenses under your ACKO Health Plan.

Exclusions: What’s not covered in the ACKO Health Plan

Below are the exclusions of ACKO Health Insurance Policy.

❌ Undisclosed medical conditions: No coverage for undisclosed medical conditions.

❌ Eyesight correction: The cost of treatment and surgery for correcting eyesight less than 7.5 dioptres is not covered.

❌ Maternity expenses: Medical expenses related to delivery and childbirth are not covered.

❌ Sterility and infertility treatment: Treatment or hospitalisation costs related to sterility and infertility are not covered.

❌ Change-of-gender treatments: Costs related to gender correction surgeries are not covered.

❌ Weight control surgery: A weight control surgery is not covered unless medically necessary.

❌ Cosmetic surgery and dental treatment: Unless medically advised as a result of an accident, the cost of cosmetic surgery and dental treatment is not covered.

❌ Attempted suicide: The cost of treatment as a result of a suicide attempt is not covered.

❌ Prosthetics and other devices: Expenses related to prosthetics and other devices, investigation and evaluation, etc. are not covered.

❌ Supplements and hormonal therapy: This plan does not cover the cost of hormonal therapy or supplements.

Note: Please find the full list of inclusions and exclusions in the policy wordings of the ACKO health plan.

Included add-ons with our health insurance policy

Add-ons increase the benefits of a basic health insurance plan. Here is a list of additional coverages you get with our medical insurance policy.

Coverage for non-medical expenses

These are expenses that are usually not covered under a basic health insurance policy. For example, admission charges, surgical kits, syringes, etc. With our health insurance policy, you get these add-ons included to cover the cost of such non-medical expenses.

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 things like 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 is not applicable to ACKO Health Insurance Policy. With ACKO Health Insurance Policy, 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.

Why choose ACKO for all-in-one health insurance?

Apart from being a dependable insurer, you can get a comprehensive health insurance plan from ACKO for the following reasons.

7000+ network hospitals

Network hospitals let you avail of cashless claims. We have a tie-up with more than 7000+ 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.

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 ACKO’s network hospitals, you only pay the amount that is not covered by ACKO at the time of discharge. If the expenses are covered as per policy, ACKO shall pay the amount directly to the hospital. Cashless claims allow you to stay worry-free as you don’t need to arrange funds for the hospitalisation.

Reimbursement claim

In case of a reimbursement claim, when you get admitted to any hospital (not necessarily a part of ACKO’s network), you pay the entire medical bill to the hospital on discharge. Post-discharge, you can request reimbursement from ACKO by registering a claim and sharing all hospitalisation-related documents. If the claim is approved, ACKO will compensate as per policy terms.

What are the benefits of a medical insurance policy in India?

As per the study by the Public Health Foundation of India, approx. 55 Million (4% of India's population) were pushed towards poverty due to high out-of-pocket expenses in 2017. We don’t mean to scare you but not having the right health plan in place can lead to financial and emotional stress. Even though medical insurance is not mandatory like motor insurance in India, everyone should ideally buy an all-inclusive health plan to save hospitalisation costs, stay worry-free and reduce out-of-pocket expenses.

Best-in-class healthcare for loved ones

Being healthy is of utmost importance for you and your family. And to cover healthcare costs, you need medical insurance. Hence, you should buy the best health insurance in India that meets your requirements. When you have the right health plan by your side, you can give your family best-in-class healthcare without any worry, which otherwise can be difficult.

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, your 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. Medical insurance 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 for you and your family. If your medical bill is significantly high and you have 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.

Holistic plans offer benefits beyond hospitalisation

Comprehensive health plans not only help you cover hospitalisation costs but even other costs related to it — think medicines, diagnostic tests, and even doctor’s consultation fees. Such benefits not only help you cover medical costs but also help you stay healthy.

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 medical insurance policies to their employees with a group insurance plan. However, this type of insurance is not customised according to your requirements. Having additional medical insurance protects you if you lose your job or move to a different organisation.

Why is medical insurance important for you and your family?

Buying health insurance is not mandatory like purchasing motor insurance. No one will issue a challan or impose a penalty on your name if you don't own a family health insurance policy. However, buying health insurance these days is no longer a choice but a necessity.

Considering the burgeoning healthcare costs of quality healthcare facilities, we can't stop emphasising the importance of holistic health plans. Medical insurance is important for those who wish to avail the following.

  1. Protection against rising medical costs: Medical inflation in India has been at an all-time high. According to the PwC's Health Research Institute (HRI) report, there is a projected 6.5% increase in medical costs in 2022. Health insurance can help in reducing the impact of medical inflation on your finances and reduce out-of-pocket expenses, especially with features like zero deductions at claim.

  2. Quality medical facilities: You might have to compromise on the quality of healthcare if you don't have health insurance. But if you do have health insurance, it will be easier to avail treatment in a good quality medical facility without thinking twice about the costs. The quality of treatment and timely availability can help with the faster recovery of the patient thanks to coverages like pre and post hospitalisation.

What’s the eligibility criteria to buy ACKO Health Insurance Policy?

ACKO Health Insurance Policy is practically a one-stop solution for your health insurance needs as you don't have to create a whole portfolio for the people you love. You spend less money on this plan as compared to buying multiple health insurance policies like a Family Floater plan (that usually covers only five members), or a separate Senior Citizen plan for parents. Likewise, since we cover your parents-in-law in the same plan, you don't have to worry about buying another policy for them.

Members above the age of 45 years are required to undergo medical screening i.e. per-policy medical checkup (PPMC) before the policy begins. Note that ACKO Health Insurance Policy does not have any exit age. So, if your policy is approved, you can get insurance for senior citizens without worrying about the exit age (which is usually 65 to 75 years depending on the terms of the insurer). We will continue to insure elder people without an exit age.

How many dependents can we add to ACKO Health Insurance Policy?

You can add up to 10 dependents to the 1 cr. plan apart from yourself. The list would look like this — six adults and up to four children. You can buy or get insured under the plan if you are above 18 years of age. Dependent children between the ages of 03 months to 25 years are eligible.

Can I get tax benefits from health insurance?

Health insurance is super 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.

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How to save tax with a health/medical insurance policy?

Apart from receiving all the health insurance benefits provided by your policy, you can save a significant amount of tax on the premium as well. To save tax on health insurance, you need to produce a health insurance certificate while filing your 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 your health plan.

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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.

Can I buy health insurance online?

Yes, buying a health insurance policy online is more convenient and cheaper when compared to buying a similar policy offline. This is due to the digital infrastructures offered by online health insurance companies and a low operational cost for carrying out different insurance-related processes.

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 is more cumbersome as it involves exhaustive paperwork and efforts. Plus, it is time-consuming as you need to visit an agent's or insurer's office.

The online method is easy, quick and seamless. All you have to do is visit the insurer's website (for example, ACKO), select the policy, and make the payment. Plus, online platforms also allow you to renew and raise claims digitally. 

Steps to buy medical insurance plan online

You can insure yourself and your family with the best health insurance plan in India at your fingertips by following the below-mentioned steps.

Here’s how you can renew your health insurance on ACKO.

Documents required to buy medical insurance plans in India

To avail of a health insurance policy, below is the list of documents required.

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.

Checklist to buy the best health insurance plan online

There are a plethora of health insurance plans in India. Here are some tips for choosing the best health insurance policy that caters to your healthcare needs and also fits the budget.

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Select the right sum insured amount

It is essential to select the correct sum insured amount. Hence, choose a plan that lets you choose the sum insured amount depending on your age, medical conditions, location and healthcare needs. It doesn’t make sense if your health plan comes with an inadequate sum insured. It may not support you during a medical emergency.

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Assess your requirements

Individual plans are suitable for individuals who prefer health insurance only for themselves. However, if you want medical insurance that covers your family, then choose the Family Floater plan. It offers maximum benefits at a competitive price. Again, it is crucial to assess your requirements and budget before deciding on the right plan.

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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.

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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 →

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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.

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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 →

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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.

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Lifetime renewability

It is extremely important to understand the time period for which your medical plan will cover you. As health complications increase with age, there are high chances that you may require your health insurance plans during your old age. Hence, it is recommended to opt for a plan that comes with lifetime renewability and reduces hassles and unforeseen medical expenses during such time.

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 important part of a health insurance plan, thanks to the insurance regulator IRDAI. The end-to-end process of a health insurance policy is divided into the following stages:

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Stage 1 - Research

In this stage, you need to assess your profile, understand how much coverage you need and from which insurance company you need to buy the health insurance plan. So, this is a crucial stage as it will decide your buying decision. Compare health insurance plans online →

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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.

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Stage 3 - Claims

You need to raise a claim against your 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. You can raise a claim through ACKO’s website or app by logging into your ACKO account. All you need to do is upload a few documents — and you’re all set!

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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.

Other health insurance plans available at ACKO

ACKO offers various health plans that cover hospitalisation costs as well as coronavirus expenses.

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Arogya Sanjeevani by ACKO

Arogya Sanjeevani Policy by ACKO is a basic and straightforward health plan if you wish to secure yourself and your family from unforeseen medical costs at an affordable premium. It is perfect for someone looking for a plan that fits your pocket as well as your health requirements.

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Corona Kavach by ACKO

The Corona Kavach Policy by ACKO is designed to secure you and/or 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, then ACKO's Corona Kavach policy is the right choice for you.

Disclaimer: *In case the pre-existing disease surfaces after a policy is issued. However at the time of claim, if it is found that the policyholder did not disclose any known pre-existing diseases while buying the policy, the claim may get rejected.

Frequently asked questions about health insurance

Buying and renewing related FAQs

What is the difference between health insurance and Personal Accident Cover?

Below are the differences between the two types of insurance policies.

  1. The health insurance policy offers claims towards injury, illness, and other medical conditions.

  2. Personal Accident Cover provides coverage due to accidental death while the health insurance policy does not.

  3. 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.

What are the factors which influence the calculation of a premium?

Below are the factors which influence the calculation of a premium.

  1. Age of the insured

  2. The number of insured members 

  3. Sum insured

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 health 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.

Claims and coverage related FAQs

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.

Terminologies related FAQs

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.

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 hospitalisation 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:

  1. Initial waiting period

  2. Pre-existing diseases waiting period

  3. 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 health 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.

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 Insurance Industry Returning To Normalcy With 25% Growth In August 2020

– September 24, 2020

The IRDA regularly publishes consolidated reports about the performance of various insurance sectors in India. According to a report about the health insurance sector, there is a growth of 25% as compared to reports published in August 2019. It is being observed that these numbers indicate the return of normalcy in the health insurance sector that was affected by the economic downfall. This was caused due to the COVID-19 pandemic. The economy of India suffered massively since the outbreak, however it looks like there is a certain amount of improvement now that the government has eased lockdown restrictions, i.e. unofficially called Unlock 4.0. According to the official date, currently there are 966382 cases of COVID-19. 4674987 people have been discharged or cured and unfortunately 91149 have succumbed to the deadly virus. Considering the growth rate in the health insurance sector, it can be said that slowly the condition is improving.

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 Thier 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 indeminity 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 health insurance 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.

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CIN: U66000KA2016PLC138288

IRDAI Registration No: 157

Category: Non-Life Insurance

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