ACKO Claim Settlement Ratio
  • Check the CSR of ACKO Health
  • Compare the CSR performance
  • Know the claim settlement process
ACKO Claim Settlement Ratio
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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

Status of Acko Insurance Claim Settlement ratio- 2021-22
Age Analysis of Number of Claims Paid (%)< 3 months3 months to 6 months6 months to <1 year1 year to <3 year3 years to <5 years5 years
Claims Settled97.21.670.80.330.000.00

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

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To cater to the different medical needs of an individual & their family, Acko Health Insurance offers several Health Plans ranging from senior citizen plans to specialized plans for autistic children, to health insurance for cardiac patients, and many more.Take a look below to Acko Health Insurance plans explore more:

Individual and Family Health Insurance

Acko Platinum Health Plan offers you coverage for yourself and your family members. The plan offers a sum insured of INR 10 lakhs with many benefits. ...

Unique Features

  • Personal Accident Cover
  • Critical Illness Cover
  • SI up to 10 Lakhs

Acko Platinum Health Insurance (Pros)

Acko Platinum Health Insurance
  • Personal accident cover
  • Critical illness cover
  • SI up to 10 Lakhs

Acko Platinum Health Insurance (Cons)

Acko Platinum Health Insurance
  • OPD not covered
  • ICU coverage not available
  • Cosmetic surgeries not covered

Acko Platinum Health Insurance (Other Benefits)

Acko Platinum Health Insurance
  • Personal accident cover
  • Critical illness treatment cover
  • Doctor on call and second medical opinion available

Acko Platinum Health Insurance (Eligibility Criteria)

Acko Platinum Health Insurance
  • Minimum Entry Age - 18 Years
  • Maximum Entry Age - N/A
  • SI - Upto 10 Lakhs
  • Initial Waiting Period - 30 Days

Individual and Family Health Insurance

You must be thinking about how a basic health insurance policy like Arogya Sanjeevani can fulfil all your health goals. But only let this thought sink...

Unique Features

  • COVID-19 treatment coverage
  • No pre-policy health check-ups till 45
  • Lifelong renewability

Acko Arogya Sanjeevani Policy (Pros)

Acko Arogya Sanjeevani Policy
  • No Pre-Policy Check-up
  • COVID-19 cover
  • AYUSH coverage
  • Ambulance services

Acko Arogya Sanjeevani Policy (Cons)

Acko Arogya Sanjeevani Policy
  • OPD cover unavailable
  • Maternity unavailable
  • Newborn baby cover
  • Health check-ups unavailable

Acko Arogya Sanjeevani Policy (Other Benefits)

Acko Arogya Sanjeevani Policy
  • Family floater cover
  • Indemnity benefits
  • Pre &amp; post-hospitalization
  • Room rent &amp; ICU cover

Acko Arogya Sanjeevani Policy (Eligibility Criteria)

Acko Arogya Sanjeevani Policy
  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 1 L to 25 L
  • Waiting Period - 30 Days

Accident Health Insurance

According to a report from the World Economic Forum, there are over 2.5 lakh accidental deaths or fatalities happening per year in India. Accidents ar...

Unique Features

  • Zero waiting period
  • Accidental death cover
  • No health check-up required

Acko Personal Accident Policy (Pros)

Acko Personal Accident Policy
  • Zero waiting period
  • Accidental death cover
  • No health check-up required

Acko Personal Accident Policy (Cons)

Acko Personal Accident Policy
  • Pre and post-hospitalisation not covered
  • ICU cover not available
  • OPD not covered

Acko Personal Accident Policy (Other Benefits)

Acko Personal Accident Policy
  • Accidental death and disability
  • Permanent and total disability
  • Aid to uncertain injuries

Acko Personal Accident Policy (Eligibility Criteria)

Acko Personal Accident Policy
  • Min. Entry Age - 18 Years
  • Max. Entry Age - 70 Years
  • SI - NA
  • Initial Waiting Period - Day 1 Coverage For Accidental Death

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ACKO Claim Settlement Ratio: FAQs

1. What is the CSR of ACKO health insurance company?

The claim settlement ratio or CSR of ACKO health insurance company is 83.88%.

2. Do I need to reach out to the branch office for my policy claim against ACKO health insurance?

If you are receiving treatment at a non-networking hospital, you must need to reach out to the customer care executive or delivery agent assigned for your ACKO health insurance policy.

3. How much is the claim paid number of Acko Health Insurance Company?

Acko General Insurance Limited has several claims paid ranging up to 97.68% according to 2022-23 reports.

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Himanshu Kumar

Written By: Naval Goel

Naval Goel is the Founder and CEO of PolicyX.com (IRDA- Approved Insurance Comparison Website). He is a CFA charter holder (USA) and FRM (GARP). He holds an MBA from IIFT, Delhi, and is also an Associate from the Insurance Institute of India. Naval is an avid investor and entrepreneur who has a deep understanding of the Indian equity market and insurance sector. He has been investing for more than 10 years now and is a CFA charter holder.