ACKO Claim Settlement Ratio
  • Check the CSR of ACKO Health
  • Compare the CSR performance
  • Know the Claim Settlement process
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ACKO 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 Acko Claim Settlement Ratio and how it helps you avoid the above-mentioned situations.

Well, continue reading to find out for yourself.

Health Insurance Claim Settlement Ratio

What is the Claim Settlement Ratio?

The claim settlement ratio, or CSR, is the percentage of claims that an health insurance company has paid out. 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

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Acko General Insurance Claim Settlement Ratio

As per IRDAI, Acko General insurance claim settlement ratio is 93.65%. Take a look at the below table for insight and get the idea of Acko Claim Settlement Ratio

Status of Acko Insurance Claim Settlement ratio- 2020-21
Age Analysis of Number of Claims Paid (%) < 3 months 3 months to 6 months 6 months to <1 year 1 year to <3 year 3 years to <5 years 5 years
Claims Settled 93.65 2.90 2.46 0.99 0.00 0.00

What Is the Claim Procedure of ACKO Health Insurance Plans?

Acko insurance claim settlement ratio showcases that the company understands the need of 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: wherein the policyholders are required to clear their medical expenses arising out of hospitalisation and then raise a reimbursement claim by submitting proper medical bills and documents.

Read below to get a detailed understanding of the claim settlement Process:

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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 are not able to 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 claim amount in the bank account) and a canceled 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 Company/TPA for assessment of the claim

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

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Naval Goel

Reviewed By : Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.