ACKO Health Insurance Claim Settlement Ratio

A health plan is one of the best things that you can gift yourself and your family. But have you ever thought about what will happen if your Health insurance company is unable to settle your claim? Or what if your claim settlement process is delayed?

The mere thought of struggling with another problem during an ongoing medical emergency is quite petrifying. To avoid such situations, it is best to check the Claim Settlement Ratio of the company you have chosen to buy. Now, you must be wondering about the Acko Claim Settlement Ratio and how it helps you avoid the above-mentioned situations.

Well, continue reading to find out for yourself.

What is the Claim Settlement Ratio?

The claim settlement ratio, or CSR, is the percentage of claims a health insurance company has paid. To put it another way, it’s the proportion of claims paid out by an insurer in a given financial year. The ratio is calculated by dividing the total number of claims filed by the total number of claims settled.

Health Claim Settlement Ratio=Number of claims settled/number of claims received * 100

Acko General Insurance Claim Settlement Ratio

As per IRDAI, Acko Health Insurance Claim Settlement Ratio is 98%. Take a look at the below table for insight and get an idea of the Acko Claim Settlement Ratio

What Is the Claim Procedure of ACKO Health Insurance Plans?

Acko insurance claim settlement ratio showcases that the company understands the need for quick claim settlement and settles your claims on time. The company allows the policyholders to raise claims in two ways:

• Cashless Claims: wherein, the insurance company settles the medical bill directly with the hospital. and,
• Reimbursement Claims: the policyholders must clear their medical expenses arising out of hospitalisation and then raise a reimbursement claim by submitting proper medical bills and documents.

  Online Procedure

  • Get hospitalized in any of the network hospitals empanelled with Acko Health Insurance.
  • Show your health card to the hospital authorities.
  • Duly fill out the cashless request form and submit it to the hospital.
  • After verification, the company will issue a pre-authorization letter to the hospital.
  • At the time of discharge, the insured person has to verify and sign all the medical bills and pay for any non-medical and inadmissible expenses.

  Procedure for reimbursement claims:

  • You can file a reimbursement claim if you cannot get admitted to the network hospitals.
  • Get yourself treated, and settle all the medical bills at the time of discharge.
  • Collect all the documents provided by the hospital such as discharge summary and payment receipts.
  • Submit all the documents to the Third-Party Administration or ACKO company.

  Documents Required for Filing ACKO Health Insurance Claim

  • Health insurance claim form
  • Photo ID proof of the patient
  • Medical practitioner’s prescription advising admission
  • Original bills and payment receipts
  • Discharge summary including complete medical history of the patient
  • Investigation/ Diagnostic test reports supported by the prescription
  • NEFT Details (to enable direct credit of the claim amount in the bank account) and a cancelled cheque.
  • KYC (Identity proof with Address) of the proposer, where claim liability is above Rs. 1 Lakh as per AML Guidelines
  • Legal heir/succession certificate
  • Any other relevant documentation as required by the Company/TPA for assessment of the claim

  The company will verify all the documents. On approval, the claim amount will be released.

Conclusion

Acko health insurance offers great customer service and satisfactory claim support. For more information about the claim settlement process of Acko health insurance, reach out to our insurance advisors at 1800-4200-269.