1 Crore Health Insurance in India: Is It Worth It & Which Plan Should You Choose?

Advanced cancer treatment over two years in a family floater

A family of four in a metro city has a ₹20 lakh family floater. Here are the overall medical costs this family would need to spend in a private hospital if one member is diagnosed with Cancer. 

• Diagnostics, scans and surgery in the first phase may cost ₹6 to ₹12 lakh
• Chemotherapy or radiation over multiple cycles can add ₹12 to ₹25 lakh
• Follow up admissions, medicines and ongoing treatment over the next year can add another ₹8 to ₹15 lakh

Over two years, total expenses often reach ₹30 to ₹50 lakh. A ₹1 crore health insurance plan helps by absorbing these long-running costs without exhausting the cover early, while still leaving room for other family members to claim if needed.

Organ transplant with ICU stay under a family floater

In a two-adult family floater, one member suddenly needs a kidney or liver transplant.

• Kidney transplant at a private hospital typically costs ₹15 to ₹25 lakh
• Liver transplant costs are higher, often between ₹25 to ₹40 lakh
• ICU stay, hospitalisation and post surgery care can add ₹5 to ₹10 lakh
• Even without complications, the total cost usually falls in the ₹25 to ₹45 lakh range

With a ₹1 crore plan, families are less likely to dip into savings or sell investments to cover the gap left by a lower sum insured.

Multiple hospitalisations across family members in one year

If there is more than one hospitalisation for a family of four then the cost of hospitalisation is much more. Here are some examples.

• A child’s hospitalisation for infection or surgery may cost ₹2 to ₹4 lakh
• An adult’s accident-related surgery and recovery can cost ₹6 to ₹10 lakh
• A second admission later in the year for complications may add ₹4 to ₹8 lakh

Together, expenses can cross ₹15 to ₹25 lakh, even though no single hospital bill looks extreme. A ₹1 crore cover provides enough buffer so that one person’s treatment does not wipe out the entire family’s protection for the rest of the year.

When does a ₹1 Crore Health Cover Make Sense?

• You can think of buying a ₹1cr health plan for yourself and your family if the following holds true in your case.
• You live in a metro city. The healthcare costs in these cities are more than in rural areas.
• You prefer private hospitals with single rooms, advanced procedures, and specialist care.
• There is a family history of a major illness such as cancer, heart disease, or kidney failure.
• You are a high-income professional or business owner who wants financial protection without worrying about hospital bills.

The risk of exhausting a lower sum insured is much higher in these situations.

When a Lower Cover May Be Enough

A 1 crore cover may not be necessary when:

• You are young, healthy and have no major medical history
• You have a smaller family and a limited budget
• You are comfortable using good quality Tier 2 or Tier 3 hospitals and shared rooms

In such cases, many people choose smarter, more affordable alternatives like:

• A ₹15 to ₹25 lakh base health insurance plan with restoration benefits
• A base plan combined with a super top-up to increase total coverage at a lower cost
   

Simple rules of thumb

If you live in a metro and usually head to a private hospital when something goes wrong, a higher cover can save you a lot of stress later. Bills add up fast in these hospitals, and smaller covers can disappear before treatment is over. But if you are younger, watching your budget, and open to different hospital options, you do not always need a very high base cover. A well planned mix of a base plan and a super top up can still protect you well, without stretching your finances too early.

Rising Medical Inflation

Medical costs in India have been increasing at a rate significantly higher than general inflation. According to the IRDAI Annual Report, healthcare inflation stands at around 14–15% per year. Health insurance premiums and claim settlement data reflect significant growth in coverage along with ongoing pressure from rising healthcare costs.

This means treatments that cost ₹5 lakh five years ago may now cost ₹10 lakh or more. Even routine hospitalisations or surgeries can become expensive quickly. Higher coverage ensures you’re financially prepared for both planned and unexpected medical expenses, without having to worry about running out of insurance mid-year.

High-Cost Treatments & ICU Stays

Certain treatments can be financially draining, especially in private hospitals or metropolitan cities. 

Cancer treatments:

• Typical cost range: ₹5,00,000 to ₹20,00,000
• Coverages: Includes surgery, chemotherapy, radiation, and targeted therapies. Multiple treatment cycles over one to two years can easily exhaust lower sum insured plans.

Major cardiac procedures:

• Typical cost range: ₹7,00,000 to ₹15,00,000
• Coverages: Covers procedures such as bypass surgery or valve replacement in private hospitals, along with hospitalisation and recovery care.

Organ transplants:

• Typical cost range: ₹10,00,000 to ₹25,00,000
• Coverages: Includes kidney or liver transplants, ICU stay, post surgery care, and long term medication. Costs vary based on complications and hospital choice.

Longer Lifespans and Lifestyle Diseases

People are living longer, which is good news. But lifestyle related conditions like diabetes, high blood pressure, heart disease, and obesity are also showing up earlier in life. These conditions rarely involve just one hospital visit.

They often mean regular check ups, medicines, occasional hospitalisation, and sometimes surgery later on. Over time, the medical costs add up. A higher health insurance cover is not just about one big emergency. It is about being prepared for ongoing care across different stages of life, without worrying every time the policy limit gets tested.

Key Features of the ACKO ₹1 Crore Platinum Health Insurance Plan

Here is the list of useful features of the ACKO ₹1 Crore Platinum Health Insurance Plan.

✔️ 100% Coverage for hospital bills
✔️ Zero Waiting Period 
✔️ No room rent limit
✔️ Coverage for domestic emergency evacuation
✔️ App based claims with 24x7 assistance
✔️ Wide hospital network with over 11,500+ hospitals PAN India

These features help you focus on recovery, not paperwork or deductions.

Who is the Platinum Plan Best Suited For?

Platinum tends to work well for the following:

• Families living in metro cities
• Professionals with higher incomes
• People who have seen major illness, either personally or in their family 

If you prefer private hospitals and do not want to worry about what is or is not covered during a claim, this plan offers that peace of mind.

Many people start with the Standard plan when they are younger or more budget-conscious, and move to the Platinum plan later as their needs change. There is no single right answer. The right plan is the one that fits your life today and can grow with you over time.

What’s Covered?

ACKO ₹1 crore health insurance plan covers a wide range of medical needs, including:

• In patient hospitalisation, including treatment for COVID
• Pre-hospitalisation and post-hospitalisation expenses, usually for up to 60 days before and 120 days after hospitalisation
• Daycare procedures, even if they do not require a 24 hour hospital stay
• Domiciliary treatment, when medical care is needed at home due to specific conditions
• Ambulance expenses, including road ambulance and air ambulance where applicable
• Organ donor expenses related to transplant procedures
• AYUSH and alternate treatments, as per policy terms

What’s Not Covered or Has Limitations

Like all health insurance plans, there are certain exclusions you should be aware of:

• Undisclosed pre-existing diseases: We will cover a pre-existing disease only if you tell us about it at the time of buying the ₹1 Cr. plan.
• Sterility and infertility treatment: Treatments related to birth control, infertility, or sterility are not covered.
• Maternity expenses: The cost of hospitalisation related to childbirth is not covered in the 1 Cr. plan. However, hospitalisation expenses for the newborn baby are covered.
• Change-of-gender treatments: Gender reassignment surgeries or related treatment costs and hospitalisation are not covered.
• Eyesight correction: It is excluded if the refractive error is less than 7.5 dioptres.
• Cosmetic surgery: Any type of cosmetic surgery is not covered unless it is medically necessary as a result of an accident.
• Dental treatment: Any type of dental treatment is not covered unless it is medically necessary as a result of an accident.
• Weight control surgery: These expenses are not covered unless medically necessary. The treatment and related surgery must fulfil certain conditions if covered.
• Attempted suicide: Treatments related to a suicide attempt are not covered. 
• Supplements and hormonal therapy: The cost of supplements and hormonal treatments are not covered. Also, the cost of prosthetics and other devices, investigation & evaluation, etc. is not covered.

These exclusions are standard across most insurers, but it’s always a good idea to check the policy wording so there are no surprises later.

Add Ons and Value Added Services

Along with core hospitalisation coverage, ACKO offers a few value added services that can make a real difference during a medical emergency or in day to day health management:

• Wellness programs and preventive care support
• Access to health coaches and fitness tracking tools
• Discounts on medicines, diagnostics, and health check-ups
• Ambulance services in select cities, designed to help you reach the hospital quickly during emergencies
• Digital tools through the ACKO app to manage policies, claims, and health records easily

These services are meant to support you beyond just paying medical bills, especially when time, access, and convenience matter most.

Example Premium Range for ACKO Plans

Here’s a broad idea of how premiums for a 1 crore cover can look across different profiles. These are indicative ranges and may change based on your location, health details, and the benefits you choose.

Individual aged 30:

• ACKO Standard Plan: On the lower side
• ACKO Platinum Plan: Higher than Standard

Young couple aged 30 and 28:

• ACKO Standard Plan: Moderate
• ACKO Platinum Plan: Higher due to added benefits

Family-floater with 2 adults and 1 child:

• ACKO Standard Plan: Moderate to high
• ACKO Platinum Plan: Higher, reflecting wider coverage

Platinum plans usually cost more because they remove many of the things that lead to out of pocket expenses later, like room rent limits, uncovered consumables, or long waiting periods on certain conditions. What you pay extra upfront is often what you don’t have to pay during a hospital stay.

What Influences Your Premium?

A few key factors decide how much your premium are as follows.

• Age: As age increases, so does the chance of medical claims. Premiums rise gradually to reflect that risk.
• Health history: Pre-existing conditions or past medical issues can affect pricing and waiting periods.
• City you live in: Hospital costs are higher in metro cities, and premiums tend to follow that pattern.
• Who is insured: An individual plan costs less than a family floater that covers multiple people.
• Plan type and add ons: Plans with fewer limits and extra benefits cost more but usually reduce claim time stress.
• Lifestyle habits: Habits like smoking can increase premiums because they raise health risks.

Most insurers in India calculate premiums in a similar way. The real difference shows up when you make a claim. Lower premiums often come with more limits. Slightly higher premiums usually mean fewer deductions and a smoother experience when it matters most.

• If you live in a metro, prefer private hospitals, and want fewer conditions during claims → A higher base cover like ₹50 lakh or ₹1 crore makes sense
• If you’re younger, budget conscious, and comfortable with some complexity → A base plan plus super top-up can work well
• If you want long term peace of mind without tracking limits and resets → A ₹1 crore base plan keeps things simple

This approach helps you match your plan to your lifestyle, risk, and budget, so you’re not overpaying, or underinsured, when it matters most.

• Open the ACKO app or website and select the 1 Cr plan that fits your needs.
• Enter some basic details about yourself and your family members.
• Check the premium, benefits, and policy highlights to make sure it’s the right fit.
• Complete the payment online and we will connect with your instantly for the next steps

That’s it! Now you can track or manage your policy anytime through the app.

Cashless Claim Steps (App + Hospital Desk)

• Inform the hospital that you have an ACKO health insurance policy.
• Share your policy details with the hospital or via the ACKO app.
• The hospital initiates the cashless request through the TPA.
• Track your claim status in real time on the ACKO app.
• Get your treatment covered directly, just pay a small part of the hospital bill.

Reimbursement Claim Steps

• Pay your hospital bills first.
• Upload the bills and medical documents through the ACKO app.
• Track your claim status online until it’s approved.
• Receive reimbursement directly to your bank account.

For a step-by-step guide with more details, you can visit this link.