What is Covered and Not Covered in Acko’s Health Insurance Plans?


Health insurance is a type of insurance that covers medical expenses that arise due to any illness, injuries, & more. These costs could include the price of a hospital stay, the price of medications, or the cost of medical visits. A health insurance plan is not just an add-on benefit; it also serves as a lifesaver in times of medical emergency. Acko’s health insurance plans are among the best available in the market because of the coverage they provide.

All health insurance plans be they standardized or non-standardized have their terms and conditions of what is covered and not covered under the policy claim. These are called inclusions and exclusions. Inclusions are those circumstances under which you can claim your medical expenses. The inclusions and exclusions are listed in the policy documents.

Health Insurance Plans

Inclusions in Acko’s Health Insurance Plans

Some of these inclusions in Acko’s health insurance plans are:

  1. Inpatient Care – This covers the policyholder’s hospital expenses. The costs associated with in-patient treatment include items like accommodation and board, nursing, ICU, and doctor visits, among other expenses.
  2. Daycare Procedures- Minor surgeries like cataract removal, tonsil removal, or similar procedures that require less than 24 hours of hospitalization are covered under daycare procedures.
  3. Pre-hospitalization– Some surgeries or medical issues necessitate treatment before hospitalization. According to the terms and circumstances of the insurance plan, the cost of such treatments may be covered.
  4. Post-hospitalization– The cost of follow-up treatment is covered under individual health insurance policies as per the policy’s terms and conditions.
  5. Domiciliary Treatment– The cost of receiving treatment at home can be covered under specific circumstances for a predetermined number of days.
  6. Organ Donation– The cost of medical treatment related to donating an organ is covered as per the policy’s terms.
  7. Ambulance– The cost of hiring an ambulance for transportation to the hospital will be borne as per the policy’s terms and conditions.
  8. AYUSH Benefits- The cost of availing Ayurveda, Unani, Siddha, or Homeopathy (AYUSH) treatment can be claimed as per the policy document.
  9. Newborn Baby Coverage– Insurance coverage for newborn babies as per the policy’s terms.
  10. Daily Cash Benefit– Typically, this is an extra cover. You can use this money to buy any necessary medications or other items.

Family health insurance plans provide all these inclusions usually covering 5 members of your family. This gives you the relaxation of not having to buy different plans for different family members and allows you to cover medical expenses in times of need.

Exclusions in Acko’s Health Insurance Plans

Exclusions are the spelled-out legal circumstances under which an insurance provider will refuse to pay your claim, even for occurrences or dangers covered by the policy. Basic exclusions are a part of all insurance plans, including ones that may have been standardized. Even more exclusions may be present in non-standard policies.

There are numerous types of exclusions.

  1. Intentional Injuries– When you get insurance, the cost of treating intentional injuries, such as those brought on by a failed suicide attempt, is not covered by the policy.
  2. Adventure Sports– Injuries arising from participating in adventure sports are not covered.
  3. Criminal Activities– Medical attention required due to participating in criminal activity is not covered.
  4. Cosmetic and dental procedures – They are not covered by insurance unless they are necessary as a result of an accident.
  5. Infertility Treatment- Mediclaim policy in India generally does not cover the cost of infertility treatment.
  6. Not Mentioned in Policy– Any other medical treatments/surgeries that are not mentioned in the policy document will not be covered.
  7. Pre-existing disease: Pre-existing disease (PED) exclusion or delayed coverage for specific diseases is the most frequent exclusion in health insurance.


It is extremely important to go through the policy and understand its inclusions and exclusions to save you from surprise at times when you are in need to claim insurance cover. So, next time you plan to take on any insurance policy, pay attention to all the aspects of the policy and choose wisely.