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Health Insurance

Health insurance, also called medical insurance, is a policy that helps cover the cost of medical treatment and protects you from high healthcare expenses. It covers various expenses such as hospital stays, surgeries, day-care procedures, modern treatments, and pre- and post-hospitalisation care. But not all health insurance plans are the same. Explore ACKO's health insurance plans, designed for individuals, families, senior citizens, and people with different healthcare needs. Find the right health plan for yourself and your loved ones with ACKO today.

How Does Health Insurance Work in India?

Health insurance is a contract made between you and your insurance company. Here is how it works:

1. Selecting a health insurance plan

Choose your health insurance policy depending on your healthcare requirements and select the right sum insured. In exchange for paying your premium and keeping your policy active, the insurer will take care of your medical bills as per your health insurance policy terms. Based on the insurer, you can pay premiums monthly, quarterly, semi-annually, or annually.

2. Getting medical treatment when needed

In case of your diagnosis of any illness, accident injury, or even for getting medical treatment, you can make use of your health insurance policy.

3. Filing a claim

You have two methods for filing your health insurance claim:

  • Cashless claim: In case you are treated in a network hospital, the insurer settles your medical bills directly with the hospital.
  • Reimbursement claim: In case you get treated in a non-network hospital, you pay the bill first, and then you can file your claim by submitting the documents to your insurer.

Here’s a simple example:

Geeta buys a health insurance policy with a ₹10 lakh sum insured and pays the premium every year. A few months later, she is hospitalised for dengue at a network hospital. Since the treatment is covered under her policy, the insurer settles the hospital bill directly with the hospital through the cashless claim process. Geeta only pays for expenses that aren't covered under her policy, if any.

Types of Health Insurance Plans in India

Health insurance plans are designed to meet different needs and life situations. So, depending on who you are, why you are buying the policy, and what kind of coverage you need, you can choose the best health insurance plan in India that fits your needs.

Here are some of the common types of health insurance plans and how they work.

Individual Health Insurance

An individual health insurance policy provides coverage for the medical expenses of one person. It covers hospitalisation, treatments, prescribed medicines, and other medical costs based on the sum insured chosen by the buyer. It is one of the best choices when you are buying health insurance exclusively for yourself.

Family Floater Health Insurance

A family floater health insurance policy covers various members of your family. You will be covered along with your spouse, children, and, in some cases, dependent parents. Here, you need to note that the sum insured that you opt for will be shared amongst all the insured members of the family.

Senior Citizen Health Insurance

Health insurance policies formulated for senior citizens are developed considering the health requirements of individuals in their old age. They help cover age-related health issues, regular doctor visits, hospital stays, and longer recovery periods. Moreover, most senior citizen health insurance policies offer reduced waiting periods for particular illnesses. This is done to ensure that elderly people are able to get the necessary treatment promptly.

Top-Up and Super Top-Up Plans

Top-up and super top-up plans offer additional coverage over and above your existing health insurance policy. This could be an individual plan or health insurance provided by your employer. Top-up and super top-up plans give you extra health cover when your existing sum insured may not be enough for larger medical expenses.

Critical Illness Insurance

In case of a serious illness, like cancer, heart attack, or stroke, a critical illness insurance plan offers a lump sum amount. You can utilise the lump sum amount for covering treatment costs, everyday expenses, or handling income loss during recovery.

Disease-Specific Plans

People who want coverage for a specific illness, like diabetes, cancer, or heart issues, can purchase disease-specific health insurance plans. For example, if you have diabetes, a disease-specific plan can make managing diabetes a little easier by assisting with routine testing, doctor visits, and continuing treatment.

What are the Key Benefits of buying a Health Insurance Plan?

Let's explore some of the main advantages of health insurance and understand why it is important in your everyday life:

Makes Rising Healthcare Costs Easier to Manage

Healthcare costs are increasing every year, and even basic treatments can be expensive. A health insurance plan or medical insurance policy helps you manage these costs by covering a large part of your treatment expenses, so you don’t have to pay everything on your own.

Protects Your Savings During Medical Emergencies

A sudden illness or accident can lead to last-minute hospital bills. A medical health insurance plan makes sure that your hard-earned savings for important life goals like your child’s education, a home, or future plans are not affected by medical emergencies.

Cashless Treatment at Network Hospitals

Health insurance gives you access to cashless treatment at network hospitals. It means eligible medical expenses will be settled directly by the insurer. This helps reduce stress and allows you to concentrate on recovery without worrying about arranging funds for treatment.

Covers More Than Just Hospital Stays

Health insurance is not limited to hospitalisation alone. It also helps cover expenses like day care procedures, pre- and post-hospitalisation treatment, ambulance charges, and other medical costs. However, it depends on your policy, so choose the right health insurance plans for family that feel right for you and your loved ones.

Get Better Medical Care

With the best health insurance plan in India, you can choose better hospitals and doctors without worrying about the cost of treatment. This ensures timely and quality medical care when the medical care is needed. 

Supports Treatment for Serious and Long-Term Illnesses

Many health insurance policies or medical insurance plans also support the treatment of serious illnesses that need care over a longer period. This makes it easier for you and your family to continue treatment without constantly worrying about the cost.

Offers Tax Benefits on Premium Paid

When you buy health insurance, the premium you pay qualifies for tax benefits under Section 80D of the Income Tax Act, 1961. This helps you save on taxes. 

What is Covered in a Health Insurance Policy?

The list below provides you with details of what's normally covered under a health insurance plan.

Hospitalisation Expenses (Room Rent, ICU, Surgery)

If you have to get admitted to a hospital for treatment, health insurance/medical insurance takes care of the expenses of room rent, ICU charges, surgery, doctors fee, nursing, etc. This makes hospital stays easier to manage, especially during medical emergencies.

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Pre and Post-Hospitalisation Expenses

Not all of the medical expenses happen during hospitalisation. Health Insurance takes care of the expenses incurred before and after hospitalisation, within the defined time period. This can include doctor consultations, medical tests, follow-up visits, and medicines related to the treatment.

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Day Care Procedures

Some treatments do not require an overnight stay in the hospital. Health Insurance covers several such day care procedures (treatments/surgeries requiring less than 24 hours of hospitalisation).

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Charges For Ambulances

It is crucial to reach the hospital in times of an emergency. The ambulance charges are included in the health insurance plans, too. This would help prevent extra costs in such cases.

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Treatment Under AYUSH Systems

Many health Insurance plans also cover Ayush treatments (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy). This gives you the flexibility to choose treatment methods you are comfortable with.

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Costs Associated With Organ Donors

In case of any organ transplant, medical expenses related to the organ donor can also be covered as per the policy terms. It helps remove the financial stress that comes with complex medical procedures.

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Coverage For Mental Health Conditions

Mental health conditions are treated just like physical illnesses. Health Insurance plans provide treatment and hospitalisation facilities for mental health conditions, in line with applicable guidelines.

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Home Healthcare

Some treatments can be safely taken at home under medical supervision. Health Insurance covers eligible home healthcare services when hospitalisation is not necessary, but medical care is still required.

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Coronavirus Treatment

Many health insurance policies cover the treatment for COVID-19, which includes hospitalisation as well as other medical expenses as per the terms and conditions of the policy.

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What is Not Covered in a Health Insurance Policy? 

There are a few situations where your health policy won’t apply, which is fairly common across most health insurance plans. Some of the common exclusions include:

Pre-existing Illnesses and the Waiting Period

Medical expenses related to pre-existing conditions are not covered during the waiting period mentioned in the policy. Once this period is completed, coverage for these conditions begins.

Cosmetic and Aesthetic Treatments

Any form of treatment that is solely for aesthetic purposes will not be covered by medical health insurance. However, in case a cosmetic surgery becomes necessary as a result of an accident or disease, then coverage may apply as per policy terms.

Injuries Caused by Self-Harm

Any medical cost related to injury or ailment caused by self-harm is not covered under the health insurance policy.

War and Related Risks

Events like war, invasion, and other such situations are not covered under the health insurance policy.

Injury During Participation in Adventure Sports

Injuries during participation in adventure sports will not be covered by the health insurance policy.

Medical Care Outside the Country

Most health insurance plans don't cover treatment outside India. You'll need to add international coverage if you want this benefit.

Health Insurance Riders and Add-ons

Health insurance riders or add-ons let you customise your base health insurance plan. They help cover certain costs or situations that may not be fully covered by the standard health policy. 

CoverWhat it does
  
Critical illnessLump sum on diagnosis of a listed illness (cancer, heart attack)
Maternity & newbornCovers delivery expenses and newborn care after the applicable waiting period
Room-rent waiverRemoves the cap on hospital room rent
Personal accident insuranceDeath or disability from an accident
Hospital cashFixed daily amount while admitted 
OPD coverDoctor visits, tests and chemist bills outside the hospital

Note: Riders are optional features you can add to your health insurance plan. So, you don’t have to choose all of them; instead, add only the ones that you need. 

What is a Waiting Period in Health Insurance?

If you purchase a health insurance plan, not every benefit is available from day one. There are certain illnesses that will have a waiting period during which you cannot make claims. This waiting period is called a waiting period, and it depends on your plan and illness. 

TypeUsual length
  
Accidental hospitalisationNo waiting period. Coverage starts from day one
Initial (ordinary illness)Generally 30 days from the policy's start date. 
Specific listed illnesses (cataract, hernia, knee)Up to 24 months
Pre-existing diseases (PED)Up to 36 months
MaternityGenerally 2-4 years

Common Health Insurance Terms (Glossary)

TermSimple Meaning
  
PremiumMoney you pay for your insurance.
Sum InsuredMaximum amount your policy covers.
ClaimRequest for insurance payment.
CoverageWhat your policy pays for.
Network HospitalHospital approved by your insurer.
Cashless ClaimInsurer pays the hospital directly.
Reimbursement ClaimYou pay first, insurer refunds later.
Waiting PeriodTime before some benefits start.
Pre-existing DiseaseIllness you had before buying insurance.
DeductibleAmount you pay before insurance pays.
Co-payYour share of the medical bill.
Room Rent LimitMaximum room cost covered per day.
No Claim Bonus (NCB)Reward for not making claims.
Family FloaterOne policy for the whole family.
ExclusionsThings your policy doesn't cover.
Policy TermHow long your policy lasts.
Grace PeriodExtra time to renew your policy.
Add-ons / RidersExtra coverage you can buy.
PortabilitySwitch insurers without losing benefits.
Claim SettlementApproval and payment of your claim.

Mediclaim vs Health Insurance: What's the Difference?

Many people think mediclaim and health insurance are the same, but they have some important differences.

FeatureMediclaimHealth Insurance
   
CoverageCovers hospitalisation expenses.Covers hospitalisation along with a wider range of medical expenses and benefits.
Sum insuredUsually offers lower coverage amounts.Offers a wider range of sum insured options, including high-value coverage.
Pre- and post-hospitalisationLimited or available as per the policy.Usually covered, subject to policy terms.
Day-care proceduresMay be covered depending on the policy.Commonly covered under most comprehensive plans.
Add-on coversLimited options.Offers add-ons such as critical illness, maternity, personal accident, and more.
Wellness benefitsGenerally not available.May include preventive health check-ups, wellness programmes, and other benefits.

Health Insurance Tax Benefits Under Section 80D

Health insurance or medical insurance doesn’t just help with medical expenses. It also helps you save tax. The amount you pay towards your health insurance premium can be claimed as a deduction under Section 80D of the Income Tax Act,1961.

Up to ₹25,000 Deduction for Self and Family

If you pay health insurance premiums for yourself, your spouse, or your children, you can claim a tax deduction of up to ₹25,000 in a financial year. This applies to premiums paid for regular health insurance plans, as long as the payment is made through accepted modes.

Up to ₹50,000 Deduction for Senior Citizen Parents

If you pay health insurance premiums for your parents who are senior citizens, you can claim a higher deduction of up to ₹50,000. This benefit is available even if you are already claiming deductions for yourself and your family. 

Additional ₹5,000 for Preventive Health Check-ups

You can also claim up to ₹5,000 in a financial year for preventive health check-ups under Section 80D. This sum is not an additional benefit; rather, it is a component of the total Section 80D limit. In simple terms, it falls under the ₹50,000 cap for older persons or the ₹25,000 cap for those under 60.

Zero GST on Health Insurance Premiums in India

From 22 September 2025, 0% GST applies to health insurance premiums. This means policyholders no longer have to pay the earlier 18% GST. Here’s how 0% GST on health insurance premiums benefits policyholders.

Lower Premiums

With GST removed, you'll pay only the base premium. For example, a health insurance policy with a premium of ₹25,000 that previously cost ₹29,500 (including 18% GST) now costs ₹25,000.

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Better Access to Health Insurance

Lower premiums make health insurance more affordable. This means you can purchase higher health coverage to protect yourself and your family against medical emergencies. 

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How to Calculate Your Health Insurance Premium

health insurance premium calculator is an online tool that helps you estimate how much premium you may have to pay for a health insurance policy. You can easily calculate your premium using ACKO's Health Insurance Premium Calculator below. All you have to do is enter your age, the sum insured you want, and a few basic details.

Factors That Affect Your Health Insurance Premium

Health insurance premiums aren't the same for everyone. It depends on several factors, such as your age, the coverage you choose, and your health profile.

FactorHow it affects your premium
  
AgeThe older you are, the higher your premium is likely to be. Buying health insurance at a younger age is usually more affordable.
Sum insuredChoosing a higher sum insured generally increases your premium.
Individual or family floaterFor family floater plans, the premium is usually based on the age of the oldest insured member.
City of residencePremiums may vary depending on where you live, as treatment costs differ across cities.
Smoking habits and medical historySmokers and people with certain medical conditions may have to pay a higher premium.
Plan type and add-onsComprehensive plans and optional add-ons can increase the premium.

“In your 20s and early 30s, healthcare often feels simple. But treatments have advanced and costs have risen. Buying health insurance early isn’t about fear, it’s about being prepared for today’s healthcare reality. ACKO health plans grow with you.”

Dr Nitin Kumar Gupta

SVP – Health Underwriting & Claims at Acko General Insurance

How to Reduce Your Health Insurance Premium

Health insurance premiums don’t have to feel expensive. Here are a few simple ways to reduce your health insurance premiums. 

  1. Buy Health Insurance Early

    Buying health insurance when you’re young and healthy usually costs less. This is because at this stage, medical risks are lower, which reflects in lower premiums.

  2. Opt for Higher Deductibles

    A deductible is the part of the medical bill you agree to pay yourself before your health insurance starts covering the rest. For example, if your deductible is 25,000, you pay the first 25,000 of the medical bill. After that, your health insurance starts paying.

    When you choose a higher deductible, your monthly premium usually becomes lower. This option makes sense if you’re generally healthy and mainly want insurance for big medical expenses, not small doctor visits.

  3. Choose Family Floater Over Individual Plans

    When covering multiple family members, a family floater plan is often more cost-effective than buying separate policies for everyone. Since the sum insured is shared, you usually end up paying a lower overall premium while covering the whole family.

  4. Maintain a Healthy Lifestyle

    Lifestyle habits can influence long-term health costs. Smoking, lack of exercise, or lifestyle-related conditions may increase medical risks over time. So, staying active, eating well, and going for regular health check-ups can help keep both health risks and future premiums in check.

  5. Use No Claim Bonus

    If you don’t make any claims during a policy year, you may receive a no-claim bonus. This usually increases your coverage or reduces your premium over time.

  6. Compare Plans and Choose the Right Sum Insured

    Comparing plans and selecting a coverage amount that matches your needs helps keep premiums balanced. It avoids choosing a sum insured that is too low or coverage that is much higher than needed.

How Much Health Insurance Coverage Do You Need?

Here’s a simple way to think about the right level of health insurance coverage based on your situation.

Health Insurance by Age Group

Age GroupTypical Monthly Premium Range*What This Usually Means
   
18–30 years300–700+Most people are healthy at this age, so health insurance usually costs less.
30–50 years900–2,000+Health needs start increasing, which is why premiums are higher than before.
50+ years2,500–5,000+Medical care becomes more frequent, so premiums are higher, and some waiting periods may apply.

*Premiums vary based on plan, sum insured, health condition, and policy terms.

Health Insurance by Family Size

Family SizeRecommended Sum Insured
  
Couple10 lakh to 25 lakh
Couple + 1 Child25 lakh to 50 lakh
Couple + 2 Children50 lakh to 1 crore
Family with Senior Parents1 crore or more, or consider separate plans for senior parents

The right cover can vary based on age, health conditions, and city of residence. This table is meant as a general reference. Learn more about health insurance for parents

Recommended Sum Insured by City Tier

Types of PlansTier 1 Cities (Metro)Tier 2 Cities (Emerging)Tier 3 / Rest of India
    
Individual Plans₹8k – ₹15k₹7k – ₹13.5k₹6.5k – ₹12k
Family Floater Plans₹15k – ₹30k₹13.5k – ₹27k₹12k – ₹25k
Senior Citizen Plans₹12k – ₹20k₹10k – ₹18k₹9k – ₹15k

Note: Premium calculation is based on a sum insured of ₹10L for each plan.

How to Choose the Right Health Insurance Plan: A Buying Checklist

Choosing a health insurance or medical insurance policy is not just about looking at the premium. A few small details can make a big difference later, especially when you actually need to use the health policy. Here’s a simple checklist to help you make a more informed decision before buying the best health insurance in India for your needs.

  1. 1. Choose the Right Sum Insured

    Make sure the sum insured is enough to cover major medical expenses. Your age, city, lifestyle, and family health history can all affect how much coverage you may need.

    Choosing a very low sum insured might save money now, but it can leave you underprepared during a medical emergency.

  2. 2. Check Waiting Periods Carefully

    Most health insurance plans have waiting periods for certain conditions, especially pre-existing illnesses. Shorter waiting periods mean earlier access to coverage.

    For example, some plans may offer coverage from day one if all health conditions are disclosed upfront.

  3. 3. Understand Coverage Limits and Exclusions

    Some plans have limits on specific expenses like room rent or certain treatments. These limits can reduce how much you finally receive during a claim. It’s important to understand these details before buying a medical insurance policy, so there are no surprises later.

  4. 4. Look at Premiums, Copays, and Deductibles Together

    A lower premium can sometimes come with conditions like copays or deductibles. This means you may need to pay a part of the bill yourself during a claim. Always look at the overall cost, not just the medical insurance premium amount.

  5. 5. Check the Network of Hospitals

    Make sure hospitals you trust or visit often are part of the insurer’s network. This makes cashless treatment easier during emergencies.

  6. 6. See If the Plan Offers Sum Insured Restoration

    Some health insurance plans restore the sum insured if it gets fully or partially used during the policy year. This means that after a claim, the insurer refills the coverage amount for future medical expenses in the same year. However, this is subject to the policy’s terms and conditions.

  7. 7. Check Lifetime Renewability

    Health needs often increase with age. A plan that offers lifetime renewability ensures you can continue your coverage without disruption later in life.

  8. 8. Look at Claim Support and Service Quality

    Good claim support matters when you’re already dealing with stress. Check how easy it is to raise and track claims, and whether customer support is easily available.

  9. 9. Review Add-ons and Extra Benefits

    Some plans offer optional add-ons or wellness benefits. Choose only those that are useful for you and your family, instead of adding features you may never use.

Eligibility Criteria to Buy Health Insurance in India

Eligibility factorDetails
  
Minimum entry ageAdults can usually buy an individual health insurance policy from 18 years of age.
Child entry ageDependent children can generally be covered from 90 days of age and remain covered as dependents up to 25 years, depending on the insurer.
Senior citizensSenior citizens can buy health insurance, although premiums, waiting periods, and medical underwriting may vary by insurer.
Medical check-upSome insurers may ask you to undergo a pre-policy medical check-up, especially if you're older or opting for a high sum insured.
NRI eligibilityNRIs can buy health insurance in India. Most plans cover treatment in India, while international coverage is available only if the policy includes that benefit.

Why Health Insurance is Important in India

The top reasons to buy a health insurance plan are medical inflation, instant and better healthcare, medical emergencies, protection against using saved money for treatment, tax benefits, and more. Let’s deep dive into each one of these reasons.

Tackle medical inflation: The cost of healthcare is rising rapidly in India. Surgeries and medical procedures that cost a few thousand rupees in the past now require lakhs of rupees. In such situations, you need a reliable health plan to protect your finances. According to multiple sources, the medical inflation rate in India is around 14%.

Get better healthcare: With health insurance, you can access medical facilities with better equipment or more experienced staff. India has a stark urban-rural healthcare divide. According to NITI Aayog, there is only 1 government doctor per 11,000 people in rural areas. With health insurance, you can get access to better facilities and a multi-speciality setup at top government and private hospitals.

Deal with sudden medical emergencies: Medical emergencies like accidents or diseases can occur suddenly, and you may not always have enough money to take care of them. A medical insurance plan can be very helpful in such situations. According to the National Crime Records Bureau (NCRB), over 4.6 lakh road accidents were reported in India in 2022. The average cost of emergency hospitalisation in a private facility can range from ₹50,000 to ₹3 lakhs, even for basic trauma treatment.

Protect your savings: According to the Reserve Bank of India, on average, Indian household savings are around ₹10–12 lakhs, but a critical illness could wipe out 30–50% of it in one year. In fact, World Bank data indicates that 17% of Indian families fall below the poverty line after paying for medical treatment. Without health insurance, you might need to use your savings or borrow a loan to pay for medical expenses. Thus, a health plan can protect your savings and your overall finances.

Avail cashless claims: If you get treated in the insurer's network hospital, you can raise a cashless claim. This reduces your expenses drastically, and you can focus on recovery. Now you can even get cashless claims at non-network hospitals thanks to the 'Cashless Everywhere' initiative introduced by the General Insurance Council (GIC).

Reduce your tax burden: If you opt for the old tax regime, you can claim a tax deduction of up to ₹75,000 under Section 80D for the health insurance premiums you pay.

Peace of mind: You can relax and focus on your recovery knowing that your medical insurance will take care of the finances.

Common Health Insurance Myths

Many consumers delay purchasing health insurance due to assumptions or things they have heard over time. Let’s learn some of the common myths: 

“I do not need health insurance because I am young and healthy”

The problem is, health issues don’t always give you notice. Accidents, infections, or sudden treatments can happen even when you’re young.

“I do not have to disclose any pre-existing conditions”

Some people are reluctant to discuss past health problems. Leaving things unsaid feels safer. But later on, that frequently leads to problems. When you genuinely need assistance, being honest from the beginning frequently reduces tension.

“My Corporate Health Insurance is Enough”

Getting health insurance from your employer feels like a big relief. And it does help. At the same time, that cover is tied to your job. It may change when your role changes, or stop altogether. A personal plan stays with you through all of that.

“Claim Filing is Too Difficult to Understand”

Stories about complicated claims have been around for a long time.

Today, the majority of claims, particularly cashless ones, are processed online and are considerably easier than most consumers realise.

“Health Insurance Costs Too Much”

The health insurance cost can seem expensive just by looking at the premium. However, medical expenses have the power of changing that perspective very quickly. At that point, insurance begins to feel like a help rather than an additional cost.

“When I need health insurance, I can purchase it”

This is a very common idea that many people have. When a problem arises, many think they will get health insurance, but insurance functions best when it is already in place. Purchasing it in advance provides protection when you need it and gives you enough time to choose the best health insurance policy in India based on your needs.

Health Insurance Portability: How to Port Your Health Insurance Policy

Portability is your right to move an existing policy to a new insurer at renewal while keeping the benefits you have earned. Here's what you should know:

    • Apply to the new insurer 45 to 60 days before your policy renewal date.
    • Make sure there's no break in your coverage while switching.
    • The credit you've earned for waiting periods, your No Claim Bonus (NCB), and your 5-year moratorium period continue with the new policy, subject to IRDAI rules.
    • The new insurer may review your application before approving it. If you choose a higher sum insured, the additional coverage may have fresh waiting periods or different terms.
    • There is no portability fee. You'll only pay the premium for your new policy

How to Buy Health Insurance Plans Online from ACKO

You can buy health insurance from ACKO through the website or the mobile app. Below are the steps to buy health insurance plans online.

StepWhat You Do
  
Step 1: Get a QuoteEnter basic details: your age, dependents, and personal information to get your personalised quote instantly
Step 2: Choose Your PlanPick from ACKO Platinum Health Plan or ACKO Platinum Lite Health Plan based on your needs and budget
Step 3: CustomiseAdjust your coverage based on what works best for you and your family
Step 4: Review and PayReview your plan details and complete payment securely online
Step 5: Get CoveredPolicy is issued as soon as processing is complete. Your coverage begins from the date of purchase.

Find Cashless Hospitals Near You

11,500+ hospitals across India. Search by city, area, or pincode to find the nearest cashless hospital in your network. A list of the top hospitals in your city includes: 

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Max healthcare

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Manipal hospitals

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Fortis hospital

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Apollo hospitals

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Narayana hospital

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Aster Hospitals

How to File a Health Insurance Claim with ACKO

At ACKO, you get two easy ways to file your claim, and you can pick whichever works best for your situation. Go cashless if you want the hospital bills sorted directly, or choose reimbursement if you've already paid and want the money back
 

  1. Cashless Claim

    Step 1: Initiate claim through the ACKO app in minutes

    Step 2: Cashless pre-authorisation processed in as little as 1 hour

    Step 3: Get treated, zero paperwork, zero upfront payment

    Step 4: Bill settled directly with hospital, typically within 3 hours of discharge

    Step 5: Track claim status in real time on the ACKO app

  2. Reimbursement Claim

    Step 1: Initiate claim through the ACKO app in minutes

    Step 2: Upload hospital bills, discharge summary, medical reports

    Step 3: Documents processed on centralised digital platform

    Step 4: Settlement processed in as little as 1 day

    Step 5: Track claim status in real time on the ACKO app

Common Reasons Health Insurance Claims Get Rejected 

Most health insurance claims are settled successfully. However, a claim may be rejected if it doesn't meet the policy terms and conditions. 

ReasonWhat it means
  
Waiting period not completedThe treatment is for a condition that's still under the waiting period.
Pre-existing disease not disclosedA medical condition wasn't disclosed when the policy was purchased.
Treatment isn't coveredThe claim is for a treatment or expense that's excluded under the policy.
Policy has lapsedThe premium wasn't paid on time, so the policy wasn't active when the claim was made.
Incorrect or incomplete documentsMissing or inaccurate documents can delay or lead to claim rejection.
Fraud or misrepresentationProviding false information or submitting fake documents can result in claim rejection.
Hospitalisation not medically necessaryThe insurer may reject claims if the treatment or hospital admission isn't medically justified as per the policy.

What are No Claim Bonus and Loyalty Benefits in Health Insurance? 

No Claim Bonus in health insurance is a reward you receive for not making any claims during a policy year. Instead of losing this benefit, you can carry it forward when you renew your policy, subject to the policy terms.

Some insurers also offer loyalty benefits to customers who renew their policy regularly. These benefits vary from one insurer to another and may include additional coverage, wellness rewards, premium discounts, or other policy benefits.

How to Renew Your Health Insurance Online

Renewing your medical insurance online is simple and takes only a few minutes. As your health policy expiry date gets closer, you’ll receive a reminder from us so you don’t miss it.

  1. Step 1.svg

    The reminder email includes a payment link. You can open the link, review your health policy details, and complete the payment online.

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    Once the payment goes through, your policy is renewed and shared with you shortly. There’s no paperwork and no extra steps to follow.

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Documents Required to Buy Health Insurance

Buying health insurance doesn’t require a long list of documents. In most cases, you only need to share a few basic details to get started when applying for the best health insurance policy in India.

Identity Proof

You’ll need to share a valid identity proof to confirm who you are. This can include documents such as a PAN card, Aadhaar card, Passport, Driving Licence, or Voter ID.

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Age Proof

Age proof helps confirm your eligibility for the plan and decide the premium. Documents like a Passport, Aadhaar card, Birth Certificate, Driving Licence, or Voter ID are commonly accepted.

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Address Proof

Address proof is required to verify your current place of residence. This can include Aadhaar card, passport, voter ID, utility bills, bank statements, or other valid address documents.

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Income Proof (If Applicable)

Income proof is not always required. In certain cases, it may be asked for specific plans or higher coverage amounts, depending on the policy terms.

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Medical Reports (If Required)

Based on age or health details shared, a medical check-up may be needed. If required, the medical reports help assess health conditions accurately before issuing the policy.

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Documents Required to Claim Health Insurance

To process your health insurance claim, you'll need to submit a few documents. The exact list may vary depending on your insurer and the type of claim (cashless or reimbursement).

DocumentWhy it's required
  
Duly filled claim formTo initiate your claim request.
Health insurance policy detailsTo verify your policy and coverage.
Hospital discharge summaryConfirms your diagnosis, treatment, and discharge details.
Original hospital bills and payment receiptsRequired to verify the treatment expenses (mainly for reimbursement claims).
Doctor's prescriptionsSupports the treatment and medicines prescribed.
Diagnostic test reportsHelps verify the medical condition and treatment.
Pharmacy billsRequired if medicines are covered under your policy.
Identity proofTo verify the insured person's identity, if requested.
Cancelled cheque or bank account detailsRequired for reimbursement claims so the approved amount can be credited to your bank account.

Why Choose ACKO Health Insurance?

Millions of people choose ACKO, and it's easy to see why. The plans are simple to understand, claims get settled quickly, and the whole experience is digital. You get wide coverage at an affordable price.

₹400 Crore+
Claims Settled
ACKO has settled ₹400+ crores in claims. Fast, hassle-free payouts, that's our promise to every policyholder.
Claims Settled
11,500+
Cashless Hospitals
Cashless treatment at 11,500+ hospitals nationwide. No upfront payment, no paperwork, no hassle.
Cashless Hospitals
Zero
Room Rent Limits
No room rent caps or sub-limits. Choose any hospital room and get fully covered, no hidden deductions.
Room Rent Limits

Choose your ACKO Health Plan

ACKO offers two types of health insurance plans: the ACKO Platinum Lite Health Plan and the ACKO Platinum Health Plan. Both plans are 100% digital, so you can buy, manage, and make claims without any lengthy paperwork or multiple steps.

ACKO Platinum Lite Health Plan

The ACKO Platinum Lite Health Plan (also known as the ACKO Standard Plan) is a great value option that covers all the essentials you actually need. Here’s what you get:

FeatureDetails
  
Sum Insured₹10 Lakh, ₹25 Lakh, ₹50 Lakh, ₹1 Crore
Waiting Period30-day initial waiting period (except accidents); 2-year waiting period for specific illnesses; 3-year waiting period for pre-existing conditions
Pre-hospitalisation Expenses60 days
Post-hospitalisation Expenses180 days
Insurance Inflation ProtectionSum Insured increased by 10% every year, up to 100% of Base Sum Insured
Co-payZero co-pay as a standard feature 
Room RentNo limits; any room of choice; no ICU day/charge limits
Hospital Bill Payment100% covered, including consumables and surgical needs
Day-care Treatment500+ Daycare treatments covered (procedures that don’t require 24-hour hospitalisation)
Domiciliary TreatmentCovered (home treatment due to medical condition or unavailability of hospital beds)
Ambulance TripsMultiple road ambulance trips covered
COVID-19 TreatmentAll variants covered
AYUSH TreatmentsCovered (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy)
Vision Care TreatmentCovers eye-related surgeries that require at least 24 hours of hospitalisation, such as cataract surgery
Accident-Related Dental TreatmentCovered
Organ Donor ExpensesAll surgery & hospitalisation expenses of donor covered
Free Yearly Health Check-upsFor all insured members aged above 18
Free Unlimited TeleconsultationsUnlimited consultations with GPs and specialists via ACKO app
Second Opinion ConsultationsConsultation costs covered
Tax BenefitsA tax deduction of up to Rs. 75,000 under Section 80D
Free Look Period30 days. Full premium refund if cancelled

ACKO Platinum Health Plan

Most health insurance plans make you wait. ACKO Platinum Health Plan doesn't. You get everything that comes with ACKO Platinum Lite, plus more benefits. 

What You Get Extra with ACKO Platinum Health PlanDetails
  
Sum Insured₹1 Crore and Unlimited, never worry about exhausting your coverage
Zero Waiting PeriodCovered from Day 1 (No waiting period)
Zero Disease-Specific Waiting PeriodNo waiting period for specific illnesses
Pre-existing Disease Waiting Period0 to 3 years based on your health
Unlimited RestorationCoverage gets restored unlimited times in a year

 

Note:  Those looking for health insurance plans for family can confidently choose the ACKO Platinum Health Plan. It is highly suitable for families seeking comprehensive, digital-first, and affordable coverage.

ACKO Platinum Super Top-up Health Plan

Along with the plans above, ACKO also offers the Platinum Super Top-up Health Plan. It is a smart way to increase your coverage without paying for a whole new health insurance policy.

What is a Super Top-up Plan?

A Super Top-up plan is like a backup cover for very large medical bills. It starts paying only after your hospital bills exceed a certain amount, called a deductible. The deductible is the amount you pay first (either from your pocket or through your existing health insurance plan). After that, the Super Top-up plan pays the remaining bill amount. 

This is how the plan works: 

  • If your hospital bill is ₹8 lakh and your deductible is ₹5 lakh:
  • You (or your existing health insurance policy) pay the first ₹5 lakh
  • The Super Top-up plan covers the remaining ₹3 lakh

Since it only steps in for the bigger expenses, a Super Top-up plan costs a lot less than a regular health insurance policy. 

ACKO Platinum Super Top-up Health Plan Sum Insured Options:

The coverage options you can choose from include ₹10 lakh, ₹25 lakh, ₹50 lakh, ₹1 crore, and unlimited coverage.

Built-in Benefits in ACKO Health Insurance Plans (No Add-ons Needed)

ACKO plans already include most of the important benefits by default, so you don't have to rely on multiple add-ons or pay extra premiums. This keeps your coverage simpler, more transparent, and often more affordable.

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Unlimited Restoration of Sum Insured

Your cover restores once it gets used up.

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No Room Rent Capping

Pick any room you’re comfortable with. Single to deluxe, there are no room rent limits.

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ACKO Inflation Protect

The sum insured goes up by 10% every year, regardless of past claims. The maximum increase is up to 100% of the original cover.

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Zero Waiting Period

Many treatments are covered from day one.

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100% Hospital Bills Covered

From surgeries to syringes, hospital bills are covered as per your policy.

Real claims, Real people

Don't take our word for it. Here's what our customers say about their claims experience with ACKO.

ACKO Health Insurance Reviews by Malya

We are happy to be associated with Acko Insurance. The discharge process was really seamless, and there was not much waiting time. I feel you are already up to the mark and doing great.

I would suggest considering all social media negative reviews carefully, as one strong review gives more impact. Initially, when I found a review on LinkedIn, I thought you were also another boat to sink, but due to word-of-mouth recommendations, which is powerful, my opinion changed, and I associated with you.

Heartfelt Gratitude for Your Prompt Approval by Navoneel

I am writing to express my sincere gratitude for the prompt approval during my wife's hospitalisation. Your efficiency played a crucial role in my early discharge, allowing me to recover comfortably at home with my family.

The speed at which you processed my request not only reduced my stress but also reassured me that choosing Acko for my health insurance was indeed the right decision. In times of medical need, having a reliable and supportive insurance provider makes a world of difference, and your seamless service has truly exceeded my expectations.

My family and I are deeply appreciative of the seamless experience and the peace of mind it has given us. Thank you once again for your dedication and commitment to ensuring a smooth and timely process. I will certainly recommend Acko to my friends and family for the exceptional service you provide. 

“When you buy from ACKO, you get support that’s ready for real-life medical needs. With 8+ crore customers and over 400 crore in claims settled across 11,500+ cashless hospitals, ACKO has handled many real cases that shape how it works in practice today.”

Kunal Kapur

Senior VP, ACKO Health Insurance

Frequently Asked Questions on Health Insurance in India

Before buying health insurance, it’s completely normal to have questions. To make things easier, here are answers to some common questions people usually have while considering the best health insurance in India.

Health insurance is a type of insurance that helps pay for medical expenses when you get sick, are injured, or need hospital treatment.

Hospital treatment in India is expensive. Even a few days in a hospital can cost a lot of money. Medical insurance covers these hospital costs. You won't have to end up spending all your savings or take loans if you need medical attention. So, health insurance is crucial today.

Mediclaim policy usually covers the cost of hospitalisation due to illness or accidents. Health insurance gives coverage of hospitalisation, day care procedure, pre and post-hospitalisation, along with wellness and preventive healthcare services, subject to the policy.

The sum insured is the amount up to which your insurance company will cover your expenses in a year. The right coverage depends on your city, age and place of residence.

A family floater plan covers many family members under one shared amount.

You pay a specific percentage while the insurance company pays the rest. The plan with co-payment tends to be cheaper.

Deductible refers to the initial sum which an individual must pay for medical costs before the insurance kicks in to help cover the remaining cost.

Health insurance is important for everyone, regardless of age or health condition. Whether you are a student, working professional, self-employed, married, or retired, having health insurance helps protect you from unexpected medical expenses.

The best health insurance policy in India depends on your age, family size, health needs, budget, and the hospitals you prefer. When you compare plans based on these factors, it becomes easier to find good health insurance that works for you.

Health insurance helps when you need hospital treatment. It covers hospital stays, surgeries, and treatment costs. Many health insurance plans also help with expenses just before and after hospitalisation.

There are some expenses that are not covered. Some of them include cosmetic treatments, self-inflicted injuries and treatments without the advice of a doctor. All policies mention certain expenses that are not covered.

Usually, yes. Expenses like doctor visits, tests, and medicines taken before admission or after discharge from the hospital are covered for certain number of days as mentioned in the policy.

Many treatments today don’t need a full day in the hospital. Procedures like cataract surgery or chemotherapy are usually covered, even if you go home the same day.

A waiting period is simply a time gap. During this period, certain treatments or conditions won’t be covered, even though your policy is active.

Health conditions you already have usually come with a waiting period of a few years. Once that time is over, treatment related to those conditions is covered.

Health insurance does not pay for pregnancy costs immediately. You usually need to have the policy for a few years first. Also, every plan pays a different amount, so it’s better to check this before planning a pregnancy.

Premium is the money you pay every year to keep your health insurance active. So, the amount is mainly calculated based on various factors like how old you are and how much hospital bill you want the insurance to help pay.

The price changes based on simple factors like your age, your health, and how big a hospital bill you want covered. If the insurance may need to pay more, the yearly cost is usually higher.

Often, yes. Instead of buying separate insurance for each person, one plan covers the whole family. This usually costs less than paying for many individual plans.

Buying insurance early, choosing only the cover you really need, and avoiding extra features you won’t use can help keep the medical insurance premium lower.

Yes. Instead of paying all the money together once a year, you can split it into smaller payments, like every month or every few months. This makes paying easier, but the total amount may become a little more.

It can increase. When you become older, insurance usually costs more, just like many other things. So even if you didn’t use the insurance, the price may go up when you renew it.

Yes. The money you pay for health insurance can reduce your tax amount. This benefit is given by the government under income tax rules.

When someone is treated in a hospital, you need to inform the insurer. This can be done at the hospital itself or later online. The insurer then helps pay the hospital bill, either directly through a cashless claim or after treatment through reimbursement. This is how claims usually work under the best insurance policy in India.

Under the cashless claim, you do not make payment for the entire hospitalisation bill; rather, the insurer pays the hospital bill directly. On the other hand, under a reimbursement claim, you pay the bill first before submitting the bills to the insurer, who makes the payment after.

If you go to a hospital that is part of your insurer’s network, you only need to share your healthcare insurance details. The hospital coordinates with the insurance company, and once the claim is approved, most of the bill is settled directly, so you don’t have to pay upfront.

Since you have already made the payment for your hospital bill, you only need to provide evidence of this transaction. This involves providing the hospital bill, the prescription from the doctor, and the proof of payment.

Once all papers are submitted correctly, healthcare insurance claims are usually settled in a few days. If something is missing, it may take longer.

Yes. If the hospital is not part of your insurer’s network, you pay the bill yourself first. After that, you can submit a reimbursement claim to the insurance company to get the money back.

Claims are usually rejected when the treatment is not covered, the required waiting period is not over, or proper papers are not submitted.

First of all, you need to understand the insurer's claim rejection letter to understand the exact reason for the denial. If the claim was rejected due to missing documents, incorrect information, or a clerical error, you can submit the required documents or request the insurer to review the claim again.

Yes. After leaving the hospital, you must apply for the claim within a fixed number of days. If you apply too late, the insurer may refuse to pay.

Health insurance usually works for one year. Before the policy ends, you need to pay the next year’s amount to keep your coverage active. This applies to most of the best health insurance plans in India, and renewal can be done easily online.

If you miss the payment date for your health insurance, the insurer gives you a few extra days to pay. These extra days are called the grace period. If you pay during this time, your policy continues.

If you don’t pay on time and also miss the extra days, the insurance stops working. After that, it will not pay hospital bills until you start it again.

Yes. If your policy lapses, earlier health insurance benefits can be lost. When you start again, you may have to serve waiting periods again before certain treatments are covered, even if you previously had the best insurance policy.

Yes, policy renewal is usually the best time to increase your sum insured. Most insurers allow you to enhance your coverage at renewal, subject to their underwriting guidelines.

Yes, the right time to include family members as additional policyholders is at renewal. They might have waiting periods even if your policy is currently in operation.

Portability allows you to switch insurers without losing benefits like waiting period credits for pre-existing diseases. 

A No-Claim Bonus (NCB), also known as a Cumulative Bonus, is a reward offered by your health insurance company for not making any claims during a policy year. Depending on the policy, this bonus may increase your sum insured or provide a discount on your renewal premium, without requiring you to pay an additional premium for the increased coverage.

Disclaimer: The plans, services, features, processes, and other details mentioned on this page are subject to availability and changes. Please check the applicable policy wordings before making any insurance-related decisions. Feel free to reach out to us at 1800 266 2256 or [email protected] for any queries.

Roocha Kanade profile avatar

Written by

Roocha Kanade

Content Architect

Dr Nitin Kumar Gupta profile avatar

Reviewed by

Dr Nitin Kumar Gupta

SVP – Health Underwriting & Claims at ACKO General Insurance