ACKO Health Insurance

Acko Standard Health Insurance

Acko Standard Health Insurance

Let’s Get To Know The Plan Better!

The Acko Standard Health Insurance is a comprehensive health insurance plan by Acko General Insurance Company Limited. It stands out as a comprehensive and robust health insurance option, offering a myriad of benefits and features tailored to address all your and your family’s healthcare requirements. It is designed to ensure you get top-notch medical care without the stress of financial concerns.

Are You Eligible?

  • Minimum Age Of Entry: 18 years
  • Maximum Age Of Entry: 99 years
     

An Overview of Benefits and Limitations

Inpatient hospitalisation expenses are the costs you incur when you stay in a hospital for over 24 hours. These include charges for your room, nursing services, doctor fees, prescribed medicines, drugs, ICU expenses, etc. Acko Standard Health Insurance not only takes care of these expenses but also extends coverage to various other expenses, including –

  • Pre & Post Hospitalisation Expenses
    Expenses you incur before getting admitted to the hospital, such as consultations, tests, lab reports, etc., as well as after discharge from the hospital, such as medical check-ups, rehabilitation sessions, etc., are covered under Acko Standard Health Insurance Plan. These expenses will be covered up to the sum insured for a reasonable time frame - 60 days before you get hospitalised and 120 days after you leave the hospital. It is important to note that these expenses will be covered only if they are related to your hospitalisation and approved as part of your inpatient coverage.

     
  • Daycare Treatment Coverage
    Daycare treatments are those medical procedures or surgeries that used to require a long hospital stay but can now be done within a day due to medical advancements. Acko Standard Health Insurance Plan covers all daycare procedures up to the sum insured without any limit.

     
  • Domiciliary Treatment Coverage
    Domiciliary treatments are medical treatments or procedures that necessitate immediate attention in a hospital but are carried out at home if you are too sick or injured to be transported safely to a hospital or there are no hospital beds available nearby. With Acko Standard Health Insurance, domiciliary treatment expenses are covered up to the sum insured.

     
  • Organ Donor Coverage
    The Acko Standard Health Insurance Plan takes care of the inpatient expenses of the organ donor in case of organ transplantation, up to the sum insured you choose for the policy.

     
  • Modern Treatment Coverage
    The medical field has undergone an amazing transformation in the last few decades, all thanks to incredible technological advancements. The Acko Standard Health Insurance plan keeps up with these changes and covers the costs of modern treatments up to the sum insured.

     
  • Non-Medical Expenses
    Apart from the medical costs, the Acko Standard Health Insurance Plan also takes care of non-medical expenses. These include the expenses related to essential items like gloves, nebulization kits, oxygen masks, etc., that are needed for treatment. These items can be costly and add up quickly. This plan covers these expenses up to the chosen sum insured and eases your financial strain.

     
  • Restoration Benefit
    The Restoration Benefit ensures that your cover amount is replenished when it is exhausted within a policy year. Once you have fully or partially utilised your base sum insured and inflation protect sum insured, the restore benefit will get activated. This benefit can be utilised for subsequent claims unlimited times in a policy year for unrelated illnesses. This ensures that you always have the financial support you need for new treatments incurred within the same policy year.

     
  • Room Rent Limit
    Room rent limit is the highest amount your health insurance policy covers for your hospital room. If you choose a room within this limit, you won't have any extra expenses. But, if you choose a fancier room that costs more than your limit, you'll face a proportionate deduction. This means you'll be responsible for a proportionate share of the total bill, not just the extra room charges. With Acko Standard Health Insurance, you have the freedom to choose any room – shared, single, deluxe, or any available room. This means that the plan will not interfere with your choice as there are no restrictions on room rent.

     

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Some Highlighting Features You Need To Be Aware Of!

  • Inflation Protect Sum Insured
    To tackle the rising healthcare costs, the Acko Standard Health Insurance Plan offers a unique feature – the inflation protect sum insured. This innovative benefit ensures that your sum insured grows by 10% each year, regardless of whether you make a claim or not, subject to a maximum of 100% of the sum insured. Under this benefit, you receive a fixed increment each year to counteract the impact of inflation.

  • Tele-Consultations (Through ACKO App)
    In our fast-paced world, healthcare needs are changing, and so are the solutions. Keeping this in mind, Acko Standard Health Insurance Plan allows you to connect with qualified medical professionals through tele-consultations. Using the Acko App, you can consult with general physicians or specialists without the need to physically visit a clinic or hospital. This ensures that you can receive medical advice conveniently, adapting to the evolving landscape of healthcare.

     
  • No Financial Limits On Treatments/Diseases
    If your insurer has not clearly excluded a particular illness, you can claim the entire amount up to the sum insured, irrespective of the medical condition and diseases you’re facing. This policy does not apply sub-limits for specific treatments like cataract treatments, joint replacement surgeries, etc.

     

Understanding Waiting Periods

Certain illnesses and diseases may not be covered for a specific duration right after buying a health insurance policy. This timeframe is referred to as the waiting period. This means that you cannot make a claim for these conditions until this waiting period is over. Here are the types of waiting periods –

  • Initial Waiting Period: After purchasing your policy, please note that there is a 30-day waiting period before you can make a claim for any condition, except in the case of accidents. During this period, you cannot make a claim for hospitalisation unless it is related to an accident.
     
  • Pre-existing Diseases Waiting Period: A pre-existing disease is any medical condition or illness you had in the 48 months before getting a health insurance policy. With the Acko Platinum Health Insurance Plan, there is a 48-month waiting period for pre-existing diseases. During this time, the policy will not cover expenses related to these pre-existing conditions.
     
  • Waiting Period For Specific Diseases: Insurers enforce waiting periods for certain medical conditions or illnesses, regardless of whether you have previously experienced them or not. It's important to note that these waiting periods are determined by the insurer and are not influenced by your current health status. The Acko Standard Health Insurance Plan has a 24-month waiting period for specific diseases.
     

Exclusions

Exclusions refer to specific situations that your health insurance policy does not cover. These include –

  • Standard Permanent Exclusions: The IRDAI has defined a list of 'standard permanent exclusions' that all insurance companies must adhere to. These include –
    • Investigation And Evaluation: Hospital admission only for observation or monitoring purposes.
    • Rest Cure, Rehabilitation, And Respite Care: Admission to a facility for bed rest without active treatment.
    • Obesity/Weight Control: Treatment or surgery for weight control or obesity.
    • Change Of Gender Treatment: Treatment altering the body's characteristics to the opposite sex.
    • Plastic/Cosmetic Surgery: Treatment or surgery to modify body characteristics or appearance.
    • Profession In Hazardous Or Adventure Sports: Treatment expenses while participating professionally in adventure activities such as scuba diving, horse racing, river rafting, mountaineering, etc.
    • Breach Of Law: Expenses for the treatment of a person committing a breach of law with criminal intent.
    • Excluded Providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
    • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
    • Treatments In Establishments For Domestic Purposes: Expenses of treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
    • Dietary Supplements, Substances Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
    • Refractive Error: Expenses for correcting refractive errors up to 7.5 diopters for improved eyesight.
    • Unproven Treatments: Surgeries, medical procedures, or treatments not proven to be effective.
    • Expenses Related To Birth Control, Sterility, Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like ZIFT, IVF, ICSI, GIFT, gestational surrogacy, etc.
    • Maternity Expenses: Costs related to pre/post-natal care, childbirth-related hospitalisation, etc.
       
  • Additional Permanent Exclusions: Apart from the standard permanent exclusions mentioned earlier, insurance companies might apply additional exclusions for specific situations or health conditions. If you have certain illnesses or severe medical conditions that insurers deem too risky to cover, they might permanently exclude them from your policy. It is important to note that insurers can only apply permanent exclusions to a set of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
     
  • Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard permanent exclusions set by the IRDAI. These exclusions can vary among insurance companies and depend on the policy’s terms and conditions. Here are some of the specific exclusions under the plan –
    • Injuries or medical conditions caused by self-inflicted actions.
    • Treatment for HIV and AIDS, whether transmitted sexually or not.
    • Treatment for sexually transmitted diseases (excluding HIV and AIDS), including screening and prevention.
    • External congenital anomalies or defects.
    • Non-Allopathic or AYUSH treatments.
    • Conditions related to disturbances in normal sleep patterns or behaviours, such as sleep apnea, snoring, etc.
    • Circumcisions (unless necessary due to illness or injury as part of treatment) and aesthetic or change-of-life treatments like sex transformation operations.
    • Growth hormone therapy, hormone replacement therapy (HRT), and administration of other hormonal medications.
    • Use of Radio Frequency (RF) probe for ablation or other procedures unless pre-approved in writing.
    • Prosthetics and devices that are not internally implanted through surgery, and the cost of cochlear implants unless required due to an accident or intra-operative necessity.

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Summary

Here’s a snapshot of everything covered in this article -

Product Benefits

Coverage Limits

Pre-Hospitalisation Coverage

Covered up to the sum insured for 60 days before hospitalisation

Post-Hospitalisation Coverage

Covered up to the sum insured for 120 days after hospitalisation

Daycare Treatment Coverage

All  daycare treatments are covered up to the sum insured

Domiciliary Treatment Coverage

Covered up to the sum insured

Organ Donor Coverage

Inpatient expenses of the donor are covered up to the sum insured

Modern Treatment Coverage

Covered up to the sum insured

Non-Medical Expenses

Covered up to the sum insured

Restoration Benefit

Restores 100% of the base sum insured for unrelated illnesses unlimited times for subsequent claims within a policy year, triggered on partial or complete utilisation of the sum insured and inflation-protected sum insured.

Room Rent Limit

No room rent limit

Waiting Period for Pre-existing Diseases

Covered after a 48-month waiting period

Waiting Period for Specific Diseases

Covered after a 24-month waiting period

FAQs

  1. What's the maximum health coverage available with the Acko Standard Health Insurance Plan?
    You can choose health coverage of up to INR 1 Crore under the Acko Standard Health Insurance Plan.
     
  2. Does Acko Standard Health Insurance cover maternity costs?
    Unfortunately, the Acko Standard Health Insurance Plan does not cover expenses related to pregnancy.
     
  3. Does the Acko Standard Health Insurance Plan have a room rent limit?
    No, you have the flexibility to choose any type of room available in the hospital – be it a single private room, shared room, deluxe room,  suite, etc.
     
  4. Does Acko Standard Health Insurance Plan cover AYUSH treatment?
    Yes, AYUSH treatments, including Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy, are all covered under the Acko Standard Health Insurance plan.
     
  5. Does Acko Standard Health Insurance Plan cover consumables?
    Yes, the Acko Standard Health Insurance Plan covers all costs related to consumables and single-use medical supplies, such as gloves, syringes, masks, cotton, etc.