ACKO Health Insurance Claim Settlement Ratio

A health plan is one of the best gifts you can give yourself and your family. But have you ever considered what would happen if your health insurance company couldn't settle your claim, or if the process was delayed?

The thought of facing additional problems during a medical emergency can be daunting. To avoid such situations, it's crucial to check the Claim Settlement Ratio (CSR) of the company you choose. You might be wondering about ACKO's Claim Settlement Ratio and how it helps prevent these issues.

Continue reading to learn more.

What is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) is the percentage of claims a health insurance company has paid out in a given financial year. It is calculated by dividing the total number of claims settled by the total number of claims received.

The formula for the Health Claim Settlement Ratio is: (Number of claims settled / Number of claims received) * 100.

ACKO Health Insurance Claim Settlement Ratio

As per IRDAI, ACKO Health Insurance's Claim Settlement Ratio is 98%. Below is an insight into ACKO's Claim Settlement Ratio for 2021-22, showing the age analysis of claims paid:

Status of ACKO Health Insurance Claim Settlement Ratio - 2021-22

Age Analysis of Number of Claims Paid (%):

• Less than 3 months: 97.2%
• 3 months to 6 months: 1.67%
• 6 months to less than 1 year: 0.8%
• 1 year to less than 3 years: 0.33%
• 3 years to less than 5 years: 0.00%
• 5 years and above: 0.00%

What is the Claim Procedure for ACKO Health Insurance Plans?

ACKO's claim settlement ratio demonstrates the company's commitment to quick and timely claim settlements. The company allows policyholders to raise claims in two ways:

• Cashless Claims: The insurance company settles medical bills directly with the hospital.
• Reimbursement Claims: Policyholders must clear their medical expenses arising from hospitalisation and then raise a reimbursement claim by submitting proper medical bills and documents.

Online Procedure for Cashless Claims

• Get hospitalised 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 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 a network hospital.
• Get yourself treated and settle all medical bills at the time of discharge.
• Collect all documents provided by the hospital, such as the discharge summary and payment receipts.
• Submit all documents to the Third-Party Administrator 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 into the bank account) and a cancelled cheque.
• KYC (Identity proof with address) of the proposer, where claim liability is above ₹1 Lakh, as per AML Guidelines.
• Legal heir/succession certificate (if applicable)
• Any other relevant documentation as required by the company/TPA for claim assessment.

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

Conclusion

ACKO Health Insurance offers excellent customer service and reliable claim support. For more information about ACKO's claim settlement process, reach out to our insurance advisors at 1800-4200-269.