{"uin":"ACKHLIP27042V022627","name":"Acko Health II","url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627","insurer":{"slug":"acko-general-insurance","name":"Acko General Insurance Limited","url":"https://indiainsurances.com/insurer/acko-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Acko Health II is an indemnity health policy with in-patient hospitalization, day care treatment, pre and post hospitalization expenses, domiciliary treatment, organ donor expenses, AYUSH and modern treatment. It can be bought for 1, 2 or 3 years with sum insured options from 3 Lakhs to Unlimited and optional covers such as worldwide hospitalization, restore sum insured, co-pay, super top-up, OPD services and daily hospital cash.","analysis":{"state":"machine","analysed_at":"2026-10-19 17:53:57.001798+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"quote-verified","value":["Plan 1","Plan 2","Plan 3","Plan 4","Plan 5"],"display":"Plan 1, Plan 2, Plan 3, Plan 4, Plan 5","note":null,"quote":"Particulars | Plan 1 | Plan 2 | Plan 3 | Plan 4 | Plan 5 | Additional\nconditions","sources":[{"clause":"Annexure 3","heading":"Plans Offered","page":35,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-annexure-3"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"This policy can be purchased for 1 year, 2 years or 3 years.","display":"1 year / 2 years / 3 years","note":null,"quote":"This policy can be purchased for a period of 1 year / 2 years / 3 years.","sources":[{"clause":"2.2","heading":"Policy Period","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-2-2"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For a planned hospitalization, inform ACKO about 3 days in advance. For emergency hospitalization, inform ACKO within 48 hours of admission, before discharge.","display":"Planned: ~3 days in advance; emergency: within 48 hours of being admitted, before discharge","note":null,"quote":"If you are planning a hospitalization, as an ACKO customer, you agree to inform us about the hospitalization ~3 days in advance of the planned hospitalization. If you have to undergo an emergency hospitalization, as an ACKO customer, you agree to inform us about your hospitalization within 48 hours of being admitted, before discharge.","sources":[{"clause":"6.1.2","heading":"Claim Registration","page":36,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1-2"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Claim form duly filled and signed by the insured","Original Discharge/Day Care/Transfer summary","Original hospital bill with detailed break-up of charges applied by hospital","Original payment receipts with receipt numbers & stamp/ seal of the provider","Original Pharmacy/ medicine receipts with receipt numbers & stamp / seal of the provider","Copy of Invoice/Stickers/barcode in case of implants","Copy of all Laboratory and test reports along with prescription by Medical Practitioner and invoice / bill with receipt from diagnostic center","First consultation paper from doctor stating the origin duration and progress of illness","Copy of FIR/ MLC certificate (Accident claims)","Duly filled NEFT Mandate form"],"display":"Claim form, discharge/day care/transfer summary, hospital bills and receipts, pharmacy receipts, implant invoices, lab reports and prescriptions, first consultation paper, FIR/MLC for accident claims and NEFT mandate","note":"The insurer may ask for other documents required to determine claim admissibility.","quote":"The list of necessary claim documents to be submitted for reimbursement in case of hospitalization are as following: ... • Claim form duly filled and signed by the insured\n• Original Discharge/Day Care/Transfer summary ... • Original hospital bill with detailed break-up of charges applied by hospital\n• Original payment receipts with receipt numbers & stamp/ seal of the provider\n• Original Pharmacy/ medicine receipts with receipt numbers & stamp / seal of the provider\n• Copy of Invoice/Stickers/barcode in case of implants\n• Copy of all Laboratory and test reports along with prescription by Medical Practitioner and invoice / bill with receipt from diagnostic center\n• First consultation paper from doctor stating the origin duration and progress of illness ... • Copy of FIR/ MLC certificate (Accident claims) ... • Duly filled NEFT Mandate form","sources":[{"clause":"6.1.4","heading":"Claim Reimbursement Process","page":38,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"ACKO will pay an admissible claim or communicate rejection/non-admissibility within 15 days of submission of all necessary documents and information. If a claim needs investigation, it will initiate and complete the investigation not later than 15 days and then settle or reject the claim within 15 days.","display":"Within 15 days of submission of all necessary documents and information","note":"Delay in claim payment carries interest from intimation to payment at 2% above the bank rate.","quote":"We shall make the payment of admissible claim (as per terms and conditions of the Policy) OR communicate Our rejection/non admissibility of claim under the Policy within 15 days of submission of all necessary documents and information and any other additional information required for the settlement of the claim.","sources":[{"clause":"6.1.7","heading":"Claims Investigation","page":40,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1-7"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"First contact ACKO for grievance resolution on 1800 210 4990 or grievance@acko.com. If dissatisfied or no response within 14 working days, escalate to the Grievance Redressal Officer at gro@acko.com before approaching IRDAI or the Insurance Ombudsman.","display":"ACKO grievance helpline/email first; then Grievance Redressal Officer at gro@acko.com","note":"The wording calls the escalation officer Chief Grievance Officer; the prospectus/CIS call the officer Grievance Redressal Officer.","quote":"For resolution of grievance, insured may contact the company on our toll-free helpline number 1800 210 4990 (Operating hours: 10 AM – 7 PM, all days of the week). ... you can also write to grievance@acko.com. ... If in case you are dissatisfied with the decision/resolution provided through details indicated above on your Complaint or have not received any response within 14 working days, you may write or email to Chief Grievance Officer:\nEmail: gro@acko.com","sources":[{"clause":"Section 7","heading":"Grievance Redressal","page":41,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-section-7"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"Base Sum Insured options are 3Lakhs, 5Lakhs, 10Lakhs, 15Lakhs, 20Lakhs, 25Lakhs, 50Lakhs, 1cr, 1.5cr, 2.5cr, 5cr, 10cr and Unlimited.","display":"3Lakhs / 5Lakhs / 10Lakhs / 15Lakhs / 20Lakhs / 25Lakhs / 50Lakhs / 1cr / 1.5cr / 2.5cr / 5cr / 10cr / Unlimited","note":"The Policy Information section lists the same options but omits 20 Lakhs.","quote":"Base Sum Insured | 3Lakhs / 5Lakhs / 10Lakhs / 15Lakhs / 20Lakhs /\n25Lakhs / 50Lakhs / 1cr / 1.5cr / 2.5cr / 5cr / 10cr / Unlimited Unlimited","sources":[{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"The optional Initial 30 days waiting period waiver can waive this if in force.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"4.1.3","heading":"30-day waiting period- Code- Excl03","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-3"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"not-stated","value":null,"display":null,"note":"The wording says the PED waiting period is the number of months specified in the Policy Schedule, but no number is printed in the provided product documents.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-stated","value":null,"display":null,"note":"The wording says the specific disease/procedure waiting period is the number of months specified in the Policy Schedule. The schedule of benefits only gives reduction options, not the base waiting period.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Eyes: Cataract, Glaucoma and other disorders of lens, disorders of Retina","Stone: Pancreatitis and Stones in Biliary and Urinary System","Genitourinary","Cysts, Tumor","Prostate","Rectal","Hernia of all sites","Arthritis","Kidney: Chronic kidney disease and failure","Varicose veins of lower extremities","Ear, Nose, Throat","Internal Congenital Anomaly","Gastro","Ligament, Tendon & Meniscal Tear","Neurodegenerative disorders"],"display":"Cataract and other eye disorders, stones, genitourinary conditions, cysts/tumors, prostate, rectal disease, hernia, arthritis and joint replacement, kidney disease, varicose veins, ENT, internal congenital anomaly, gastro conditions, ligament/tendon/meniscal tear and neurodegenerative disorders","note":"The schedule may add any other condition or treatment under this head.","quote":"List of specific diseases/procedures:\n1. Eyes: Cataract, Glaucoma and other disorders of lens, disorders of Retina\n2. Stone: Pancreatitis and Stones in Biliary and Urinary System\n3. Genitourinary: | Abnormal | Utero-vaginal | bleeding, | female | genital | Prolapse,\nEndometriosis/Adenomyosis, Fibroids, PCOD, or any condition requiring dilation and curettage or Hysterectomy, Any Surgery of the genitourinary system unless necessitated by malignancy.\n4. Cysts, Tumor: All internal or external benign or In Situ Neoplasms/Tumors, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump,\n5. Prostate: Hyperplasia of Prostate, Hydrocele, Varicocele and spermatocele\n6. Rectal: Hemorrhoids, Fissure or Fistula or Abscess of anal and rectal region, Pilonidal Sinus & Rectal Prolapse under Rectal disease.\n7. Hernia: Hernia of all sites\n8. Arthritis: Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthritis, Arthrosis such as Rheumatoid Arthritis, Gout, Intervertebral Disc disorders, Joint Replacement Surgeries (other than caused by Accident)\n9. Kidney: Chronic kidney disease and failure\n10. Varicose veins: Varicose veins of lower extremities\n11. Ear, Nose, Throat: Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane, Tonsils and Adenoids, Nasal Septum and Nasal Sinuses/Polyp\n12. Internal Congenital: Internal Congenital Anomaly\n13. Gastro: Gastritis, Gastroesophageal Reflux Disorder, Ulcer, Erosion and Varices of Upper Gastrointestinal Tract\n14. Ligament, Tendon & Meniscal Tear\n15. Neurodegenerative disorders: Conditions affecting the brain and nervous system like Parkinson's, Alzheimer's disease, Dementia etc.","sources":[{"clause":"4.1.2(h)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-2-h"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"years","amount":5},"display":"five continuous years","note":"For enhanced sum insured, five continuous years applies from the date of enhancement only on the enhanced limits.","quote":"After completion of five continuous years of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This continuous period of five years is called as moratorium period.","sources":[{"clause":"5.2.16","heading":"Moratorium Period","page":36,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-2-16"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured person can port the policy to other insurers under portability guidelines and carry accrued continuity benefits in waiting periods. The application should be received at least 30 days before, but not earlier than 60 days from, the renewal due date.","display":"Can port to other insurers with accrued continuity benefits in waiting periods","note":null,"quote":"The Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. ... the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under:\n1. The waiting periods specified in Section 4.1.1, 4.1.2 & 4.1.3 shall be reduced by the number of continuous preceding years of coverage of the Insured Person under the previous health insurance Policy. ... The application of Portability should have been received by Us at least 30 days before, but not earlier than 60 days from the due date for renewal.","sources":[{"clause":"5.2.13","heading":"Portability","page":35,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-2-13"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"Yes, no maximum cover ceasing age","note":"Renewal can still be refused on stated grounds such as established fraud, non-disclosure or misrepresentation, and if the policy is withdrawn.","quote":"There is no maximum cover ceasing age.","sources":[{"clause":"2.1","heading":"Eligibility Criteria","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-2-1"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading applies on renewals based on individual claims experience.","display":"No loading based on individual claims experience","note":null,"quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"5.1.13","heading":"Renewal of Policy","page":31,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-1-13"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["Investigation & Evaluation- Code- Excl04","Rest Cure, rehabilitation and respite care- Code- Excl05","Obesity/ Weight Control: Code- Excl06","Change-of-Gender treatments: Code- Excl07","Cosmetic or plastic Surgery: Code- Excl08","Breach of law: Code- Excl10","Excluded Providers: Code- Excl11","Code- Excl13","Code- Excl14","Refractive Error: Code- Excl15","Unproven Treatments: Code- Excl16","Sterility and Infertility: Code- Excl17","Maternity: Code Excl18","Other sexually transmitted diseases","Hazardous or Adventure Sports: Code-Excl09","Treatment taken outside India","External Congenital Anomaly or defects","OPD Treatment","Suicide","Dental","War and Exposure to Hazardous Substances","Substance abuse and addictions"],"display":"Excl04 to Excl18 permanent exclusions plus product-specific exclusions including STDs other than HIV, professional hazardous/adventure sports, treatment outside India unless covered, external congenital anomaly, OPD unless covered, suicide/self-harm, dental, war/hazardous substances and substance abuse/addictions","note":"Permanent Exclusions Set 1 can be waived if the relevant option is opted; Set 2 cannot be waived.","quote":"Investigation & Evaluation- Code- Excl04 ... Rest Cure, rehabilitation and respite care- Code- Excl05 ... Obesity/ Weight Control: Code- Excl06 ... Change-of-Gender treatments: Code- Excl07 ... Cosmetic or plastic Surgery: Code- Excl08 ... Breach of law: Code- Excl10 ... Excluded Providers: Code- Excl11 ... Code- Excl13 ... Code- Excl14 ... Refractive Error: Code- Excl15 ... Unproven Treatments: Code- Excl16 ... Sterility and Infertility: Code- Excl17 ... Maternity: Code Excl18 ... Other sexually transmitted diseases: Expenses for venereal disease or any sexually transmitted disease except HIV. ... Hazardous or Adventure Sports: Code-Excl09 ... Treatment taken outside India: Any treatment outside of India is not covered unless specifically covered under Basic Benefit Option 3.3.1 ... External Congenital Anomaly or defects ... OPD Treatment: OPD consultations, diagnostics tests, pharmacy costs shall not be payable unless covered as an Add-on Benefit (3.4.3) ... Suicide: Treatment for condition arising out of any insured Person committing or attempting to commit self harm or attempted suicide. ... Dental: Treatment, procedures and preventive, diagnostic, restorative, cosmetic services related to disease, disorder and conditions related to natural teeth and Gingiva unless necessitated under inpatient or pre/post hospitalization care due to an Accident. ... War and Exposure to Hazardous Substances ... Substance abuse and addictions","sources":[{"clause":"4.1.4","heading":"Investigation & Evaluation- Code- Excl04","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-4"},{"clause":"4.1.5","heading":"Rest Cure, rehabilitation and respite care- Code- Excl05","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-5"},{"clause":"4.1.6","heading":"Obesity/ Weight Control: Code- Excl06","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-6"},{"clause":"4.1.7","heading":"Change-of-Gender treatments: Code- Excl07","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-7"},{"clause":"4.1.8","heading":"Cosmetic or plastic Surgery: Code- Excl08","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-8"},{"clause":"4.1.9","heading":"Breach of law: Code- Excl10","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-9"},{"clause":"4.1.10","heading":"Excluded Providers: Code- Excl11","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-10"},{"clause":"4.1.11","heading":"Code- Excl13","page":26,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-11"},{"clause":"4.1.12","heading":"Code- Excl14","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-12"},{"clause":"4.1.13","heading":"Refractive Error: Code- Excl15","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-13"},{"clause":"4.1.14","heading":"Unproven Treatments: Code- Excl16","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-14"},{"clause":"4.1.15","heading":"Sterility and Infertility: Code- Excl17","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-15"},{"clause":"4.1.16","heading":"Maternity: Code Excl18","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-16"},{"clause":"4.2.2","heading":"Permanent Exclusions Set 1 (Can be Waived if opted)","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-2-2"},{"clause":"4.2.2(b)","heading":"Muscle stimulation by any","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-2-2-b"},{"clause":"4.2.3","heading":"Permanent Exclusions Set 2 (Cannot be Waived)","page":28,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-2-3"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"You may cancel by giving 7 days’ written notice and receive proportionate premium for the unexpired policy period. No refund is made if any claim has been admitted or lodged or any benefit has been availed.","display":"Proportionate premium for unexpired policy period after 7 days’ written notice; no refund if claim admitted/lodged or benefit availed","note":null,"quote":"The Insured may cancel this Policy by giving 7 days’ written notice, and in such an event, the Company shall refund to the Insured a proportionate premium for the unexpired policy period. Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.","sources":[{"clause":"5.1.9","heading":"Cancellation","page":30,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-1-9"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Medical treatment is covered in India only unless a specific policy benefit says otherwise. The optional Worldwide in-patient hospitalization benefit can cover hospitalization outside India if it is in force.","display":"India only, unless specified otherwise; optional worldwide in-patient hospitalization","note":"All admitted or payable claims are settled in India.","quote":"All medical treatment for the purpose of this Insurance will have to be taken in India only. ... The geographical scope of this Policy applies to events limited to India unless specified otherwise under this Policy. ... If this benefit is in force and if anyone insured under the policy undergoes hospitalization anywhere outside India, we will cover the in-patient medical expenses of such hospitalization.","sources":[{"clause":"5.1.6","heading":"Territorial Limit","page":30,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-1-6"},{"clause":"5.2.3","heading":"Geography","page":33,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-2-3"},{"clause":"3.3.1","heading":"Worldwide in-patient hospitalization","page":14,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3-1"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applies at policy inception, not on renewals or at the time of porting.","quote":"The insured shall be allowed a period of thirty days (30 days) from date of receipt of the Policy to review the terms and conditions of the Policy, and to return the same if not acceptable.","sources":[{"clause":"5.1.16","heading":"Free look period","page":32,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-1-16"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"For instalment premiums, the grace period is 15 days for monthly instalments and 30 days for quarterly/half-yearly instalments.","quote":"At the end of the Policy Period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain continuity of benefits.","sources":[{"clause":"5.1.13","heading":"Renewal of Policy","page":31,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-1-13"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Entry age is 91 days onwards with no maximum entry age restriction. PA add-on benefits have a minimum age of 18 years and maximum entry age of 75 years.","display":"91 days onwards; no maximum entry age restriction","note":"The maximum entry age for a dependent child is 24 years.","quote":"This Policy covers persons in the age group of 91 days onwards (*18 years for PA add-on benefits).\n2. There is no maximum entry age restriction (*75 years for PA add-on benefits).","sources":[{"clause":"2.1","heading":"Eligibility Criteria","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-2-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["monthly","quarterly","half yearly","yearly"],"display":"monthly/quarterly/half yearly or yearly","note":"The prospectus says 2-year and 3-year policies are single payment.","quote":"Payment of premium instalments under this Policy will be allowed on a monthly/quarterly/half yearly or yearly basis.","sources":[{"clause":"5.2.4","heading":"Premium","page":33,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-5-2-4"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Worldwide in-patient hospitalization","Restore Sum Insured","Cumulative Bonus","No Claim Bonus Sum Insured","No Claim Discount","First Notification of Claim","Preferred Providers Network","Co-pay","Super Top-up","Waiver of non-payable expenses","All medically necessary hospitalization","Reduction in Specific Illness Waiting Period - Comprehensive","Reduction in Specific Illness Waiting Period - Essential","Preventive Health Check-up","Inflation Protect Sum Insured","Initial 30 days waiting period waiver","Doctor-on-call","Family physician","Out-Patient Department (OPD) Medical Services","Access to our Out-Patient Medical Services Network","Monthly No Claim Bonus OPD Sum Insured","Daily Hospital Cash","Accidental Death or Disability Cover","Accidental Disability Cover","Value Added Services"],"display":"Worldwide hospitalization, restore, cumulative/NCB benefits, claim notification and preferred provider discounts, co-pay, super top-up, waiver of non-payable expenses, all medically necessary hospitalization, waiting-period reductions, preventive check-up, inflation protect, initial waiting waiver, doctor/family physician/OPD services, daily cash, accident covers and value added services","note":"These apply only if opted and specified in the policy schedule.","quote":"The benefits listed in this section are available as optional add-ons with the basic benefits. Only those benefits under this section that are opted for by the insured and specifically mentioned in the policy schedule will be applicable. ... 3.3.1 Worldwide in-patient hospitalization ... 3.3.2 Restore Sum Insured ... 3.3.3 Cumulative Bonus ... 3.3.4 No Claim Bonus Sum Insured ... 3.3.5 No Claim Discount ... 3.3.6 First Notification of Claim ... 3.3.7 Preferred Providers Network ... 3.3.8 Co-pay ... 3.3.9 Super Top-up ... 3.3.10 Waiver of non-payable expenses ... 3.3.11 All medically necessary hospitalization ... 3.3.12 Reduction in Specific Illness Waiting Period - Comprehensive ... 3.3.13 Reduction in Specific Illness Waiting Period - Essential ... 3.3.14 Preventive Health Check-up ... 3.3.15 Inflation Protect Sum Insured ... 3.3.16 Initial 30 days waiting period waiver ... The benefits listed in this section are available as add-ons with the basic benefits. Only those benefits under this section that are opted for by the insured and specifically mentioned in the policy schedule will be applicable. ... 3.4.1 Doctor-on-call ... 3.4.2 Family physician ... 3.4.3 Out-Patient Department (OPD) Medical Services ... 3.4.4 Access to our Out-Patient Medical Services Network ... 3.4.5 Monthly No Claim Bonus OPD Sum Insured ... 3.4.6 Daily Hospital Cash ... 3.4.7 Accidental Death or Disability Cover ... 3.4.8 Accidental Disability Cover ... 3.4.9 Value Added Services","sources":[{"clause":"3.3","heading":"Basic benefit options","page":14,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3"},{"clause":"3.4","heading":"Add-on benefits","page":18,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-4"},{"clause":null,"heading":"Table of Contents","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-table-of-contents"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"For instalment premiums, coverage is available during the grace period. For renewal grace period, continuity credits are protected if renewed within 30 days, but the insurer will not pay for any claim arising out of an Injury or Accident that occurred during the Grace Period.","display":"Instalment grace: coverage available; renewal grace: no claim for Injury or Accident during grace period","note":null,"quote":"If the premium is paid in instalments during the policy period, coverage will be available for the grace period also. In case of Renewal: If the policy is renewed during grace period of 30 days, all the credits (sum insured, No Claim Bonus, Specific Waiting periods, waiting periods for pre-existing diseases, Moratorium period etc.) accrued under the policy shall be protected. However, We will not be liable to pay for any claim arising out of an Injury or Accident that occurred during the Grace Period.","sources":[{"clause":"19(b)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-19-b"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room rent is covered for the room category specified in the policy schedule. Schedule options show General Ward, Shared Room, Single AC Room or Up to Sum Insured.","display":"Room Category: General Ward / Shared Room / Single AC Room / Up to SI","note":"The actual room category or rent limit is as specified in the policy schedule.","quote":"If anyone insured under the policy is hospitalized, we will cover the room rent charges for the room category and ICU charges during hospitalization stay as specified in the policy schedule. ... Room Rent/ ICU | Room Category: General Ward / Shared Room /\nSingle AC Room / Up to SI","sources":[{"clause":"3.2.2","heading":"Room Rent /ICU","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-2"},{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"quote-verified","value":"The schedule options for room category are General Ward, Shared Room, Single AC Room or Up to Sum Insured.","display":"General Ward / Shared Room / Single AC Room / Up to SI","note":"The selected category is as specified in the policy schedule.","quote":"Room Rent/ ICU | Room Category: General Ward / Shared Room /\nSingle AC Room / Up to SI","sources":[{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU charges are covered during hospitalization as specified in the policy schedule, with schedule options showing Up to Sum Insured.","display":"ICU charges during hospitalization stay as specified in the policy schedule; Up to SI","note":"The actual ICU limit is as specified in the policy schedule.","quote":"If anyone insured under the policy is hospitalized, we will cover the room rent charges for the room category and ICU charges during hospitalization stay as specified in the policy schedule. ... Room Rent/ ICU | Room Category: General Ward / Shared Room /\nSingle AC Room / Up to SI","sources":[{"clause":"3.2.2","heading":"Room Rent /ICU","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-2"},{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"quote-verified","value":"If you use a room category, room rent or ICU charges higher than the policy schedule limit, you bear a proportional part of the total admissible in-patient medical expenses. Proportional deduction does not apply for medicines and other items billed at MRP.","display":"Yes, proportional reduction applies if room category / room rent / ICU charges are higher than the schedule limit","note":null,"quote":"If you avail a room with room category / room rent / ICU charges higher than those mentioned in the policy schedule, then you will have to bear a part of the total admissible in-patient medical expenses (including surcharges, taxes, etc.). The expenses that you will have to bear in such a case would be proportional to the difference between the room rent actually availed and the room rent limit specified in the policy schedule. ... However, the proportional deduction will not be applicable for medicines and other items that are billed at MRP.","sources":[{"clause":"3.2.2","heading":"Room Rent /ICU","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-2"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"not-stated","value":null,"display":null,"note":"The documents refer to sub-limits as specified in the policy schedule, but do not print disease or procedure sub-limit amounts for named treatments.","quote":null,"sources":[],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"Pre: 30, 60, 90 Days","note":"Plans Offered table shows 60 days pre-hospitalization for Plans 1 to 5.","quote":"Pre or Post | Hospitalization | Pre: 30, 60, 90 Days\nMedical Expenses | Post: 60, 90, 120, 180 Days","sources":[{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"Post: 60, 90, 120, 180 Days","note":"Plans Offered table shows 180 days for Plans 1, 2 and 5, and 120 days for Plans 3 and 4.","quote":"Pre or Post | Hospitalization | Pre: 30, 60, 90 Days\nMedical Expenses | Post: 60, 90, 120, 180 Days","sources":[{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"Day Care Treatment is covered for procedures in the linked day care list. OPD treatment is not covered under this benefit unless the OPD add-on is in force.","display":"Covered for listed day care procedures","note":null,"quote":"If anyone insured under the policy undertakes Day Care Treatment in a hospital / nursing home / day care center, we will cover the expenses of the day care treatment. Please find the list of day care procedures covered here - https://acko-cms.ackoassets.com/Acko_Day_Care_List_2d5b412dbf.pdf.\nNote: Any treatment undertaken as an Out-Patient or in an out-patient department is not covered unless section 3.4.3 is in force.","sources":[{"clause":"3.2.3","heading":"Day Care Treatment","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-3"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalization is covered when treatment at home is medically necessary, but only if it continues for at least 3 consecutive days and on reimbursement basis.","display":"Covered if domiciliary hospitalization continues for at least 3 consecutive days","note":"The treating Medical Practitioner must confirm in writing that domiciliary hospitalization was medically necessary.","quote":"If anyone insured under the policy undergoes Domiciliary Hospitalization i.e. medical treatments or procedures taken at home, we will cover the cost of such domiciliary hospitalization.\nNote:\n• We will cover such costs only if the domiciliary hospitalization continues for at least 3 consecutive days. In such a case, we will cover the medical expenses incurred from the first day.","sources":[{"clause":"3.2.7","heading":"Domiciliary Treatment","page":13,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-7"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"AYUSH treatment is covered for medically necessary in-patient medical care at AYUSH hospitals or health care facilities for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. Medical expenses other than in-patient AYUSH treatment expenses are not covered.","display":"Covered for in-patient Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy treatment","note":null,"quote":"If anyone insured under the policy undergoes medically necessary treatment at any AYUSH Hospitals or health care facilities for any of the listed AYUSH treatments namely Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, we will indemnify the medical expenses incurred towards in-patient Medical care towards the medical treatment. Any medical expense other than in-patient care AYUSH treatment expenses are not covered under this policy.","sources":[{"clause":"3.2.10","heading":"AYUSH Treatment","page":13,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-10"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Modern treatments are covered when performed as in-patient or day care treatment, including uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy monoclonal antibody IV injection, intravitreal injections, robotic surgeries, stereotactic radiosurgeries, bronchial thermoplasty, prostate vaporisation, IONM and hematopoietic stem cell therapy for bone marrow transplant for hematological conditions.","display":"Covered for listed modern treatments including robotic surgeries, oral chemotherapy and stem cell therapy for specified bone marrow transplant","note":null,"quote":"If anyone insured under the policy undergoes in-patient or day care medical treatment as warranted for the following medical procedures, we will indemnify the medical expenses related to the medical procedures:\n• Uterine Artery Embolization and HIFU\n• Balloon Sinuplasty\n• Deep Brain stimulation\n• Oral chemotherapy\n• Immunotherapy-Monoclonal Antibody to be given as Intravenous injection\n• Intravitreal injections\n• Robotic surgeries\n• Stereotactic radiosurgeries\n• Bronchial Thermoplasty\n• Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)\n• IONM - (Intra-Operative Neuro Monitoring), if used in association with any surgery which warrants such a procedure\n• Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions","sources":[{"clause":"3.2.11","heading":"Modern Treatment","page":14,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-11"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"quote-verified","value":"Organ donor in-patient hospitalization expenses for harvesting the organ are covered up to the insured’s sum insured if the insured’s in-patient hospitalization claim is admitted and the transplant conditions are met. Donor pre/post hospitalization, screening, acquisition, transportation or preservation costs and experimental or investigational transplants are not covered.","display":"Covered up to the insured’s sum insured for organ harvesting in-patient hospitalization expenses","note":null,"quote":"If anyone insured under the policy requires organ donation, we will cover all the in-patient hospitalization expenses incurred by the person’s organ donor for harvesting of the organ.\nNote:\n• We will cover the in-patient hospitalization expenses for the person’s organ donor only upto the insured’s sum insured ... However, we will not cover the following expenses -\n• Pre-hospitalization and post-hospitalization expenses of the organ donor\n• Costs incurred towards donor screening\n• Costs related to the acquisition of the organ\n• Expenses related to transportation or preservation of the organ\n• Transplant of any organ/tissue where the transplant is experimental or investigational.","sources":[{"clause":"3.2.8","heading":"Organ Donor Expenses","page":13,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-8"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance or public transport costs for emergency care are covered at reasonable cost if medically necessary and a basic benefit claim is accepted. Domestic emergency evacuation is also covered within India and may use medically equipped specialty aircraft, commercial airline, train, Ambulance or air ambulance depending on medical needs.","display":"Road ambulance/public transport reasonable cost; domestic emergency evacuation may include air ambulance within India","note":"Schedule options include road ambulance limits from 1k to 10k or up to Sum Insured, and domestic emergency evacuation limits from 1Lakh to 10 Lakhs or up to Sum Insured.","quote":"If anyone insured under the policy needs to be transported to a hospital or day care center by an ambulance or public transport for emergency care, then we will cover the reasonable cost of such transportation. ... You can avail transportation by medically equipped specialty aircraft, commercial airline, train, Ambulance or air ambulance depending upon the medical needs and available transportation specific to each case, and within the geographical territory of India only.","sources":[{"clause":"3.2.5","heading":"Road Ambulance Limit","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-5"},{"clause":"3.2.6","heading":"Domestic Emergency Evacuation Limit","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-6"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"Restore Sum Insured is optional. If in force, ACKO refills the sum insured as defined in the policy schedule when the base sum insured, inflation protect sum insured and any NCB sum insured used in previous claims is insufficient; it does not trigger for the first claim and unused restored sum insured is not carried forward.","display":"Optional; Once/Unlimited, unrelated or related and unrelated, as per schedule","note":"The schedule of benefits lists Once for unrelated, Once for related and unrelated, Unlimited times for unrelated, and Unlimited times for related and unrelated; Plans Offered show some plan variants.","quote":"We will refill the sum insured of the policy, as defined in the policy schedule, if you use the total of the base sum insured, inflation protect sum insured (if applicable) and any NCB sum insured (if applicable) in previous claims and it is insufficient to pay for any other medical expenses of anyone insured under the policy.\nNote:\n• The Restore Sum Insured will be available for conditions (whether related or related and unrelated both) as mentioned in the policy schedule.\n• Restoration of Sum Insured will not trigger for the first claim made in the policy year\n• If the restore sum insured is not utilized in a policy year, it will not be carried forward to the next policy year.","sources":[{"clause":"3.3.2","heading":"Restore Sum Insured","page":14,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3-2"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"No Claim Bonus Sum Insured is optional and, if in force, adds a fixed percentage of base sum insured in the subsequent policy year if there is no claim under in-patient hospitalization or day care treatment. Schedule options are 5%, 10%, 15%, 20%, 25% or 50%, and the NCB Sum Insured cannot exceed the Base Sum Insured.","display":"Optional NCB Sum Insured 5% / 10% / 15% / 20% / 25% / 50%; capped at Base Sum Insured","note":"The product also has an optional Cumulative Bonus; the wording says in the event of a claim there is no impact on accrual of Cumulative Bonus.","quote":"If this benefit is in force and if anyone insured under the policy makes no claim in the current policy year under in-patient hospitalization (Basic Benefit 3.2.1) or day care treatment (Basic Benefit 3.2.3), we will provide an additional sum insured in the subsequent policy year. The additional NCB Sum Insured we will provide in the subsequent year, will be a fixed percentage of the base sum insured of the current policy year. ... During any Policy Year, the NCB Sum Insured cannot be more than the Base Sum Insured. ... No Claim Bonus Sum Insured | 5% / 10% / 15% / 20% / 25% / 50%","sources":[{"clause":"3.3.4","heading":"No Claim Bonus Sum Insured","page":15,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3-4"},{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Consumables are included in in-patient hospitalization only if opted. The optional Waiver of non-payable expenses covers items in Annexure 1 if medically necessary and the related in-patient, day care or domiciliary claim is admitted.","display":"Only if opted; waiver of non-payable expenses can cover Annexure 1 items","note":null,"quote":"Associated medical expenditures including Intravenous fluids, blood transfusion, surgical appliances used, consumables (if opted) and/or enteral feedings. ... If this benefit is in force, we will cover all the expenses listed in the Annexure 1 “List of non-payable expenses” ... We will only cover these expenses if -\n• The expenses are medically necessary.\n• We admit the claim for in-patient hospitalization (Basic Benefit 3.2.1) or day care treatment (Basic Benefit 3.2.3) or domiciliary treatment (Basic Benefit 3.2.7).","sources":[{"clause":"3.2.1","heading":"In-patient Hospitalization","page":11,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-1"},{"clause":"3.3.10","heading":"Waiver of non-payable expenses","page":17,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3-10"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity expenses are excluded, including childbirth, complicated deliveries and caesarean sections, except ectopic pregnancy; miscarriage is excluded unless due to an accident.","display":"Excluded, except ectopic pregnancy; miscarriage excluded unless due to an accident","note":null,"quote":"Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization or pre/post-hospitalisation) except ectopic pregnancy;\nii) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"4.1.16","heading":"Maternity: Code Excl18","page":27,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-4-1-16"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"The policy covers persons from 91 days onwards, so cover from birth is not stated as available in the base eligibility.","display":"No cover from birth stated; entry from 91 days onwards","note":"The documents define New Born Baby as up to 90 days, but do not state a newborn baby cover benefit.","quote":"This Policy covers persons in the age group of 91 days onwards (*18 years for PA add-on benefits). ... Child above 91 days will be added in the policy as per underwriting assessment process.","sources":[{"clause":"2.1","heading":"Eligibility Criteria","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-2-1"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"quote-verified","value":"Preventive Health Check-up is optional. If in force, ACKO facilitates listed tests for insured persons above 18 years as mentioned in the policy schedule, with schedule frequency options of once in a year, once in two years or once in three years.","display":"Optional; Once in a year / Once in two years / Once in three years","note":"Plans Offered show once a year for Plans 1 to 4 and can be opted for Plan 5.","quote":"If this Benefit is in force, we will facilitate and provide the following preventive health check-ups, to anyone insured under the policy if they are above 18 years of Age, as mentioned in the policy schedule. ... Preventive Health Check-up | Once in a year/ Once in two years/ Once in three\nyears","sources":[{"clause":"3.3.14","heading":"Preventive Health Check-up","page":17,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-3-14"},{"clause":"Section 8(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-section-8-b"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment is not covered under day care unless the OPD add-on is in force. If the add-on is in force, it covers physical consultation, prescribed diagnostics, prescribed pharmacy and OPD treatment/procedures at the specified network, subject to the policy schedule.","display":"Not covered unless OPD add-on is in force; add-on covers physical consultation, diagnostics, pharmacy and OPD treatment/procedure","note":"The schedule specifies limits and network for the OPD add-on.","quote":"Any treatment undertaken as an Out-Patient or in an out-patient department is not covered unless section 3.4.3 is in force. ... If this benefit is in force, we will cover the following mentioned OPD costs if incurred due to a medically necessary treatment in a hospital or day care center or any service provider of out- patient facility -\n• Physical Consultation ... • Prescribed Diagnostics ... • Prescribed Pharmacy ... • OPD Treatment/procedure","sources":[{"clause":"3.2.3","heading":"Day Care Treatment","page":12,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-2-3"},{"clause":"3.4.3","heading":"Out-Patient Department (OPD) Medical Services","page":19,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-3-4-3"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"quote-verified","value":"Premium is calculated using two zones based on city of residence: Zone A and Zone B. The documents do not state a treatment-city co-pay.","display":"Premium based on city of residence: Zone A and Zone B","note":null,"quote":"For the purpose of calculating premium, based on Your city of residence, We have classified two zones. In case of family floater policies, a single zone shall be applied to all the members covered under the same Policy. The two zones are defined below:\nZone A: Delhi/NCR, Mumbai including (Navi Mumbai, Thane and Kalyan) Kolkata (including Howrah) and certain non-preferred pin codes as per the company’s own experience or industry experience. Zone B: Rest of India opted by You is mentioned in Your Schedule.","sources":[{"clause":null,"heading":"Zone-wise classification","page":33,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-zone-wise-classification"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless claims are available with ACKO or at cashless network hospital providers, where the insurer pays a network hospital directly before discharge. The network hospital list is available in the ACKO app, on the ACKO website or through customer service.","display":"Available at cashless network hospital providers","note":"The insured must pay non-covered expenses, amounts above sum insured or sub-limits, co-pay or deductible directly to the hospital.","quote":"You can file a cashless claim with ACKO or at any of our cashless network hospital providers. You can view our network hospital list directly in the ACKO app or on the ACKO website, or by calling our customer service number. ... Cashless claim is a process where you can have your insurance company pay a network hospital directly before discharge rather than requiring you to register a reimbursement claim after discharge from a hospital.","sources":[{"clause":"6.1","heading":"Claims Procedure","page":36,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1"},{"clause":"6.1.3","heading":"Cashless Claims Process","page":37,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1-3"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims can be filed directly with ACKO. For hospitalization notice and cashless desk processes, the wording also refers to TPA partners at the hospital cashless desk.","display":"ACKO directly, or through TPA partners at the hospital cashless desk","note":null,"quote":"You can file a reimbursement claim directly with ACKO. ... you or your dependents / nominee must notify ACKO - either directly through our app, email or call center or through our TPA partners at the hospital cashless desk.","sources":[{"clause":"6.1","heading":"Claims Procedure","page":36,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1"},{"clause":"6.1.2","heading":"Claim Registration","page":36,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459#c-6-1-2"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, individual and/or family floater basis","note":null,"quote":"This policy can be issued on an individual and/ or a family floater basis. ... The Sum Insured for hospitalization cover may be taken on Individual or Floater basis for the family.","sources":[{"clause":"2.1","heading":"Eligibility Criteria","page":1,"url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445#c-2-1"}],"law":[]}],"documents":[{"kind":"wording","label":"Acko Health II - Policy Wordings","pages":44,"fetched_at":"2026-10-17 19:31:06+00","source_url":"https://acko-cms.ackoassets.com/5_Policy_Wordings_AH_II_b6ad49f686.pdf","url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1459"},{"kind":"prospectus","label":"Acko Health II - Prospectus","pages":36,"fetched_at":"2026-10-17 19:30:47+00","source_url":"https://acko-cms.ackoassets.com/7_Prospectus_66c5530d5e.pdf","url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1445"},{"kind":"cis","label":"Acko Health II - CIS","pages":5,"fetched_at":"2026-10-17 19:30:43+00","source_url":"https://acko-cms.ackoassets.com/3_CIS_AH_II_23857cde81.pdf","url":"https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627/document/1443"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Acko General Insurance official website","url":"https://www.acko.com/gi","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Car insurance claims","url":"https://www.acko.com/car-insurance/claims/","note":null},{"purpose":"claim","kind":"insurer","name":"Travel insurance claim process","url":"https://www.acko.com/travel-insurance/claim-process/","note":null},{"purpose":"claim","kind":"insurer","name":"Two-wheeler insurance claims","url":"https://www.acko.com/two-wheeler-insurance/claims/","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Health insurance renewal","url":"https://www.acko.com/health-insurance/renewal/","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Acko Health II (UIN ACKHLIP27042V022627), IndiaInsurances, https://indiainsurances.com/policy/acko-general-insurance/acko-health-ii-ackhlip27042v022627"}