Acko Platinum Health Insurance

Quick Information

Basic Details

Entry Age 18 to 65 years

Coverage Amount ₹10,000,000 onwards

Claim Settlement 92.44% (FY FY 2024-2025)

Claim Repudiation 0.00%

Incurred Claim Ratio 58.43%

Claims Paid Amount 81.11%

Best For

Customers wanting high cover

no room rent restriction

OPD/non-medical expense support

and digital-first servicing.

What Works Well

No room rent limit in Platinum plan data

No ICU rent limit

OPD costs covered including consultations

diagnostics and pharmacy when OPD benefit is active

Non-medical expenses/consumables covered without stated limit

No co-payment and no deductible in provided Platinum plan data

Watch Out For

Only ₹1 Crore and Unlimited cover options shown for Platinum

so sum insured flexibility is limited

PED waiting can still apply from 0 to 36 months depending on medical evaluation

Product benefits and claims experience were not rated in the provided dataset

Claim rejection ratio of 4.24% is higher than many stronger insurers

Restore benefit has conditions and may apply only from subsequent claims/unrelated illness as per provided data

Hidden Clauses - Read Very Carefully!

These clauses are often buried in fine print. MyInsureBuddy surfaces them so you're never surprised at claim time.

Day-one coverage depends on underwriting/medical evaluation; do not assume PEDs are automatically covered from day one.

PED waiting can be assigned up to 36 months based on tests or disclosed conditions.

Room rent/no limit should always be verified in the final policy schedule because policy wording says room category/ICU limits are schedule-based.

Restore benefit may not mean unlimited cover for every same claim; it generally triggers on subsequent claims and after partial exhaustion.

OPD benefit is available only if the OPD add-on/benefit is in force and may be restricted to ACKO network/service providers.

Cashless network list can change; customer should re-check network hospital before hospitalization.

⚡ At a Glance

Cashless Available No Room Rent Limit Online Claim Tracking Domiciliary Cover Family Floater PED Reduction Modern Treatments AYUSH Cover Reset Benefit Organ Donor Teleconsultation Preventive Checkups Complex Exclusions Restore Restrictions Claim Restrictions

Cum. Bonus

10%/yr (max 100%)

Special Benefits

•Restore Benefit

•Protect Benefit

Wellness Benefits

•Preventive health check-up available

•Doctor-on-call available as add-on/benefit

•Family physician available as add-on/benefit

•Value added services mentioned in policy wording

Modern Treatments

•Stem cell therapy where approved/covered

•Radio surgeries

•Other modern treatments as per policy schedule and applicable IRDAI list

Optional Add-ons

•Doctor-on-call

•Family Physician

•Out-Patient Department Medical Services

•Access to OPD Medical Services Network

•Monthly No Claim Bonus OPD Sum Insured

•Daily Hospital Cash

Domiciliary Exclusions

•Data Not Available

Key Benefits (Pros)

•Fewer claim settlement complaints in provided analysis

•Fewer after-sales complaints in provided analysis

•Higher claim settlement ratio than other insurers in provided analysis

•Lower claim repudiation ratio than other insurers in provided analysis

•Strong digital purchase and claim process

Policy Drawbacks

•Average/quick response metrics vary by source section

•Product benefits and claims experience not rated in provided dataset

•Claim rejection ratio still needs customer attention

•Offline support/branch-led assistance may be limited due to digital-first model

Day 31 Covered Diseases

•Data Not Available

User Testimonial

Abhinand Reddy★ 5.00/5

"Customer testimonial in provided reference praises expert guidance for choosing a suitable policy; not a direct ACKO claim testimonial."

Insurer Positives

•Fewer claim settlement complaints in provided analysis

•Fewer after-sales complaints in provided analysis

•Higher claim settlement ratio than other insurers in provided analysis

•Lower claim repudiation ratio than other insurers in provided analysis

•Strong digital purchase and claim process

Insurer Negatives

•Average/quick response metrics vary by source section

•Product benefits and claims experience not rated in provided dataset

•Claim rejection ratio still needs customer attention

•Offline support/branch-led assistance may be limited due to digital-first model

Not Available Data - Exact Premium

•Exact premium minimum/maximum is not available in the provided data. Premium should be fetched using age, city/zone, family size, medical history, sum insured and selected benefits.

Not Available Data - Exact Ambulance Limits

•Ambulance is available, but exact road ambulance/air evacuation rupee limits are not provided in the pasted Platinum dataset. Policy wording confirms emergency road ambulance/public transport and domestic emergency evacuation are covered when medically necessary and claim conditions are met.

Not Available Data - Solvency Ratio

•Solvency ratio is not available in the provided pasted product data and should be updated from official IRDAI/public disclosure.

Not Available Data - Home Pickup / Dedicated Claim Manager

•Home pickup of claim documents and dedicated claim manager availability is not found in the provided product data.

Schedule-Based Benefits

•Room category, ICU limits, co-pay, deductible, OPD limits, restore, NCB and non-payable expense waiver must be verified from the final policy schedule/certificate for each customer.

📌 Other Custom Details

•Last Verified Date: 2026-06-13

•Founded Year: 2016

•Gross Written Premium Crore: 1825.13

•Number Of Policies: 765089351

•Number Of Claims: 549542

•Financial Year: FY 2024-2025

•Claims Settled 30 Days Percent: 99.66

•Claim Settlement Time Days: 15

Coverage & Benefits

In-patient Hospitalization

Covered up to Sum Insured

Room Rent

No limit in Platinum data; final schedule to verify

ICU Charges

No limit in Platinum data; final schedule to verify

Pre-Hospitalization

60 days

Post-Hospitalization

120 days

Day Care Treatments

All day care treatments covered

Domiciliary Treatment

Covered up to Sum Insured

Organ Donor Expenses

Covered up to Sum Insured

AYUSH Treatment

Covered in approved AYUSH hospital

Modern Treatments

Covered without stated financial limit

OPD Medical Services

Consultation, diagnostics, pharmacy and OPD treatment if benefit is active

Non-Medical Expenses

Covered with no stated limit

Road Ambulance

Reasonable emergency transportation cost covered if basic claim accepted

Domestic Emergency Evacuation

Covered; transport may include medically equipped aircraft, commercial airline, train, ambulance or air ambulance depending on medical need

What's Not Covered

Standard and specific exclusions under this policy.

Standard Exclusions

Investigation and evaluation

rest cure/rehabilitation/respite care

obesity/weight control unless conditions met

change-of-gender treatment

cosmetic/plastic surgery unless medically necessary after accident/burn/cancer

excluded providers

refractive error under specified threshold

sterility/infertility

maternity unless specifically covered.

Unique / Specific Exclusions

Sleep disorder treatment

venereal/sexually transmitted diseases except HIV

RF probe treatments unless pre-approved

hormone replacement/growth hormone therapies

external devices and cochlear implants unless accident-related or surgery-required

spine/bone manipulation/muscle stimulation/skeletal adjustments except fractures

EECP/hyperbaric oxygen/magnetic field therapy.

OPD Exclusions

OPD outside India

routine preventive check-ups unless specified

beauty/rejuvenation/Panchakarma/detox

spectacles/hearing aids/braces/implants/prosthetic devices

vaccination except post-bite treatment

employment/travel medical certificates

fertility/pregnancy related OPD

experimental treatments

routine eyesight correction

obesity/weight management

dental unless accident-related.

Official Policy PDF

Download the official IRDAI-filed brochure from Acko General Insurance Limited.

📄 Official PDF brochure not yet available for this policy.

MyInsureBuddy Score

Recommended

Among top 20% in category

Claim Settlement 86%

Coverage Quality 94%

Policy Terms 84%

Value for Money 88%

Network & Features 86%

Product Benefits 92%

Hidden Risk Safety 78%

Rider Strength NULL

Flexibility NULL

Risk Level Medium Risk (4/10)

Quick Actions

Add to My Policies Compare With Others Ask the Community →

How to View Policy Details

Find Support Branch

Coming Soon!

Find Cashless Hospital

Quick Information

What Works Well

Watch Out For

Hidden Clauses - Read Very Carefully!

⚡ At a Glance

Special Benefits

Wellness Benefits

Modern Treatments

Optional Add-ons

Domiciliary Exclusions

Key Benefits (Pros)

Policy Drawbacks

Day 31 Covered Diseases

User Testimonial

Insurer Positives

Insurer Negatives

Not Available Data - Exact Premium

Not Available Data - Exact Ambulance Limits

Not Available Data - Solvency Ratio

Not Available Data - Home Pickup / Dedicated Claim Manager

Schedule-Based Benefits

📌 Other Custom Details

Coverage & Benefits

Terms & Conditions (Simplified)

Policy Period

Initial Waiting Period

Pre-existing Disease Waiting

Specified Disease Waiting

Co-payment

Deductible

NCB

Restore

Claim Settlement Timeline

Cashless Network

What's Not Covered

Official Policy PDF

MyInsureBuddy Score

Quick Actions

Compare Acko Platinum Health Insurance with top health plans

HDFC ERGO Optima Secure+

Star Health Smart Health Pro