Acko Platinum Health Insurance

Acko Platinum Health Insurance is a health insurance policy offered by Acko General Insurance Company Limited.

This plan perfectly balances affordability, unique features, and benefits. One of its standout features is the zero waiting period, meaning you won't have to wait for coverage on any disease or illness. In addition to hospitalisation-related costs, the plan also covers various expenses such as consumables and OPD expenses. Based on our research, Acko Platinum Health Insurance plan has received a higher number of complaints regarding claim settlements and policy purchases. This suggests that their track record in both purchasing and handling claims is poor.

What are the benefits offered by Acko Platinum Health Insurance Plan?

• Inpatient hospitalisation coverage: When you choose the Acko Platinum Health Insurance plan, you can be assured that it provides comprehensive coverage for your inpatient hospitalisation expenses. In simple terms, this means that it takes care of all the costs that arise when you are admitted to a hospital for more than 24 hours. From your hospital room and nursing care to consultations, prescription medications, ICU charges, and any other relevant expenses - this plan has got you covered.
• Pre-hospitalisation coverage: Before you go to the hospital, you might have to pay for certain medical expenses. These costs, known as pre-hospitalisation charges, cover things like consultations, lab tests, checkups, and medical reports. It's important to remember that your insurance will only cover these expenses if they are directly connected to the medical condition that requires you to be admitted and if your claim is approved as part of your inpatient hospitalisation expenses. With the Acko Platinum Health Insurance plan, you can rest assured that all your pre-hospitalisation expenses will be taken care of for a duration of 60 days prior to your hospitalisation, up to the sum insured.
• Post-hospitalisation coverage: Once you are discharged from the hospital, you may come across certain medical expenses known as post-hospitalisation expenses. These expenses encompass consultation fees, check-up costs, medical test charges, and more. In order for these expenses to be covered, they must be directly associated with your hospital stay and approved as part of your inpatient hospitalisation coverage.With Acko Platinum Health Insurance plan, you receive extensive coverage for post-hospitalization expenses up to the sum insured for a duration of 120 days following your hospitalisation
• Daycare treatment coverage: With the Acko Platinum Health Insurance plan, you can now benefit from comprehensive coverage for all your daycare treatments, without any limit up to the sum insured. This means that medical procedures or surgeries that used to require an extended hospital stay can now be completed within 24 hours, thanks to advancements in medical technology. 
• Domiciliary treatment coverage: With the Acko Platinum Health Insurance plan, you'll have peace of mind knowing that all expenses associated with domiciliary treatments are completely covered up to the sum insured. Domiciliary treatments are medical treatments for illnesses or injuries that require immediate attention in a hospital but can be safely administered at home due to the patient's severe illness or injury, or the unavailability of hospital beds nearby.
• Organ donor coverage: The Acko Platinum Health Insurance plan has got you covered when it comes to organ donor expenses. If you find yourself in the position of being an organ recipient, this plan will take care of the inpatient costs up to the sum insured.
• Modern treatment coverage: With the continuous progress of medical technology, you have the incredible opportunity to benefit from groundbreaking treatments that were once unimaginable. Treatments such as stem cell therapy and radio surgeries are now available to address conditions that were previously considered untreatable. The Acko Platinum Health Insurance plan is specifically designed to keep pace with these advancements, ensuring that you are covered for the expenses associated with these cutting-edge treatments up to the sum insured, without any limitations.
• Non-medical expenses coverage: Acko Platinum Health Insurance plan also provides coverage for non-medical expenses without any limit. These non-medical expenses include the cost of consumables like gloves, nebulization kits, oxygen masks, and other essential items required for treatment.
• No claim bonus: If you don't make any claims during the policy period, the insurance company rewards you with a no claim bonus. With the Acko Platinum Health Insurance plan, you can receive 10% of your sum insured as a bonus, up to a maximum of 100%. If you make a claim during a policy period yet the bonus will remain intact.
• Super no claim bonus: The super no claim bonus is like a supercharged version of the no claim bonus, and it works in a similar way. The Acko Platinum Health Insurance plan does not offer this benefit.
• Restoration benefit: The restoration benefit is designed to smartly restore your sum insured after it has been used up during a policy year. With the Acko Platinum Health Insurance plan, you can take advantage of this benefit for related illnesses. This helpful feature kicks in once both your sum insured and no claim bonus have been partially utilised. You can enjoy this benefit an unlimited number of times within a policy year, starting from the subsequent claims you make.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

Acko Platinum Health Insurance: Financial Limits

• Room rent limit: The room rent limit is the highest amount that your insurance provider will cover for your hospital room expenses. When you opt for a room within this limit, you won't incur any additional charges. However, if you opt for a more expensive room, you will be accountable for a proportionate share of the overall hospital bill, not just the difference in room rent. With the Acko Platinum Health Insurance plan, you enjoy the flexibility to choose any room without any limitations.
• ICU rent limit: In the Acko Platinum Health Insurance plan, you won't have to worry about any limits on the ICU rent. This means that your plan will cover the entire cost of your stay in the intensive care unit at the hospital, up to the maximum sum insured.
• Copayment: In the Acko Platinum Health Insurance plan, you won't have to worry about any copayment. A copayment, also known as a copay, is the portion of the approved claim amount that you would typically need to pay out of pocket. However, with this plan, once your payment is made, the insurer will cover the rest of your expenses.
• Deductible: In the Acko Platinum Health Insurance plan, you won't have to worry about deductibles. Unlike other insurance plans, where you have to pay a specific amount out of pocket before your coverage starts, this plan covers your costs without any deductibles. So you can enjoy the benefits without any additional expenses.
• Limits on surgeries/treatments: This covers the maximum coverage provided by your health insurance policy for specific medical procedures or treatments. Certain plans have predetermined limits on the amount they will cover for certain procedures, while others do not. With the Acko Platinum Health Insurance plan, you can enjoy coverage for cataract treatment and joint replacement surgeries up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual opting for a sum insured of Rs. 10 Lakhs.

Acko Platinum Health Insurance Plan: Waiting Periods & Exclusions

👉Waiting period

You may come across a waiting period when you purchase the health insurance policy. This is a specific time frame when certain illnesses and medical conditions are not immediately covered. It's important to note that claims for specific conditions can only be made once the waiting period has passed. Let's take a look at some of the types of waiting periods you may encounter.

• Initial waiting period: There is a mandatory waiting period of 30 days for all medical conditions, except for accidents. Please note that during this period, you will not be able to make a claim for any hospitalisation, unless it is due to an accident.
• Waiting period for pre-existing conditions: A pre-existing condition is defined as any medical condition or illness that you have had in the 36 months preceding the purchase of your health insurance policy. In the Acko Platinum Health Insurance plan, there is a waiting period of 0-36 months as per the health evaluation for pre-existing conditions. During this waiting period, you will not be able to make any claims for costs related to your pre-existing disease.
• Waiting period for specific diseases: In addition to any pre-existing conditions, insurers also have a list of specific medical conditions or illnesses that require waiting periods. These waiting periods apply regardless of whether you have previously experienced those diseases or not. It's important to note that the waiting period is determined by the insurer and is not based on your current health status. With the Acko Platinum Health Insurance plan, there is no waiting period for specified diseases.

👉Exclusions

Health insurance policies do not offer coverage for certain medical conditions or situations, which are known as exclusions. Let's see what are some of these exclusions:

• Standard Permanent Exclusions: All insurance providers are required to adhere to the ‘standard permanent exclusions’ established by IRDAI. These include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite sex. 
5. Plastic/Cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc. as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to the treatment received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance providers have the ability to impose extra exclusions for specific medical conditions or situations, in addition to the standard permanent exclusions. If you have certain illnesses or severe medical conditions that insurers perceive as high-risk, they may choose to permanently exclude coverage for them from your policy. Please be aware that health insurers are limited to a specific set of illnesses defined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply permanent exclusions. It is important to note that they are not permitted to impose permanent exclusions for illnesses or diseases that are not included in this list.
• Non-standard exclusions (Specific exclusions): These exclusions are additional to the standard permanent exclusions mentioned by the IRDAI. They vary among insurance companies and are based on the terms and conditions of each policy. Below, you will find a few specific exclusions that are included in the Acko Platinum Health Insurance plan-

1. Treatment for self-inflicted injuries.
2. Treatment for HIV and AIDS, regardless of transmission method.
3. Screening, prevention, and treatment for sexually transmitted infections or diseases (excluding HIV/AIDS).
4. Use of radio frequency or other ablation procedures, unless pre-approved in writing.
5. Expenses related to external birth defects.
6. Expenses related to non-allopathic or alternative treatments, except for AYUSH treatment.
7. ulation (excluding fractures).
8. Advanced treatments such as Hyperbaric Oxygen Therapy, KTP Laser Surgeries, cyber knife treatment, and other similar procedures.
9. Specialised treatment options for sleep disorders.
10. Coverage for medical expenses related to illness or injury resulting from withdrawal and addiction.
11. Dental treatments (excluding those required due to an accident).
12. Circumcision procedures are covered only when deemed necessary for treating a disease or injury.
13. Prosthetics and other non-surgically implanted devices are covered only if required due to an accident.
14. Coverage does not extend to injuries or illnesses caused by nuclear, radiological emissions, war, acts of terrorism, etc.
15. Expenses associated with growth hormone therapy, hormone replacement therapy (HRT), and administration of other hormonal medications are not covered.

What to expect in terms of claims experience if you buy from Acko General Insurance Company Limited?

• Speed of claims: Acko General Insurance Company has settled 99.63% of its claims within 30 days. Claim settlement experience can be average based on these numbers.
• Claim-related complaints: As per our research, we found that Acko General Insurance Company has a complaint rate of  0.27% for claims in comparison to other insurance providers. This indicates that their claim settlement process is average.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurer's financial performance. It shows the total claims paid out in relation to the premiums received in a specific fiscal year. Acko General Insurance Company has a claims incurred ratio of 56.90%.
• Claim settlement ratio: Acko General Insurance Company’s claim settlement ratio stands at 93.29%. This figure reflects the proportion of total claims received to those successfully settled by the company in a specific fiscal year.
• Network hospitals: Acko General Insurance Company provides access to an extensive network of 14,300+ hospitals. This broad network allows customers to receive cashless treatment without any financial worry.

How is the customer service of Acko General Insurance Company?

• Policy purchase-related complaints: Based on our research, Acko General Insurance Company has received 0.01% of complaints related to its after-sales service, which is higher than other insurance companies. 
• Response on Toll-Free: Our research suggests that Acko General Insurance Company’s response time on their toll-free is quick, as compared to other insurers. 
• Response on Twitter: As per our research, Acko General Insurance Company has a slow response time on Twitter, as compared to others.

About Acko General Insurance Company

Acko General Insurance Company Limited is an innovative insurance company in India that prioritises digital-first solutions. With a comprehensive range of insurance products, Acko General Insurance Company Limited caters to the diverse needs of its customers. The company's offerings include health insurance, car insurance, bike insurance, travel insurance, and more. Established in 2016 and headquartered in Bengaluru, Acko is led by Mr. Sanjeev Srinivasan, who serves as the CEO and MD.