Acko General Insurance Claim Settlement Ratio (CSR) 2025

Selecting an insurance provider isn’t just about looking at the health insurance claim settlement ratio. Acko, being a digital-focused player, places a big emphasis on effective claim settlement. While ratios like the Acko Health Insurance Claim Settlement Ratio are important, real dependability is more than just statistical data. Life is unpredictable, and in case of health-related emergencies, having a dependable health insurance provider to fall back on can make all the difference. Since health emergencies are usually unforeseen and can be very costly, choosing the right insurer with a proven track record can offer true peace of mind.

This article attempts to provide an in-depth review of Acko General Insurance Company’s claim settlement ratio, covering its key aspects and role in the insurance landscape. Whether you're looking to secure coverage or simply comparing options, understanding Acko’s health insurance claim settlement performance can empower your decision-making while choosing the best options regarding your health and financial prospects.

What Is The Claim Settlement Ratio And How Is It Calculated?

The health insurance claim settlement ratio is the percentage of insurance claims that an insurance company settles during a specific fiscal year. Calculating the claim settlement ratio of an insurance company is pretty straightforward. Here's a formula for you to look at:

Claim Settlement Ratio = (Total number of claims resolved) / (Number of claims received + Outstanding claims at the start of the year) X 100

While insurers often emphasise this ratio as a measure of dependability, it is important to note that relying solely on this metric cannot provide a complete view. emphasise

We will discuss this topic further in the next section, starting with a detailed explanation of how the claim settlement ratio is calculated. First, let’s explore the Acko Health Insurance Claim Settlement Ratio and other key aspects.

Acko General Insurance Company’s Key Features and Benefits

Acko General Insurance Company Limited is a digital-first insurance firm founded in India. It offers a wide variety of insurance products to satisfy the needs of its clients. These include health insurance, car insurance, bike insurance, and travel insurance. The company has headquarters based in Bengaluru and was founded in 2016. Mr. Sanjeev Srinivasan is the MD and CEO of the company.

The following are some of Acko General Insurance Company's salient features -

Source: The website and Public Disclosure of Acko General Insurance Company for the financial year 2023-2024.

Acko Health Insurance Benefits:

Health insurance is like a safety net when medical expenses hit unexpectedly. The real advantage? It takes care of a big portion of healthcare costs, sparing you from draining your savings. From hospital bills to treatments, it covers a wide range of expenses and brings along perks like:

1. Covers Inpatient Hospitalisation Expenses
   Health insurance covers your back when it comes to hospitalisation costs. Health insurance coverage for inpatient care typically requires a hospital stay of at least 24 consecutive hours. Once that is in place, the policy usually covers a significant portion, sometimes even all, of the costs. This includes room charges, nursing fees, medical tests, surgery expenses, and other hospital-related bills.
    
2. Includes Pre-And Post-Hospitalisation Costs
   Health insurance doesn’t just stop at covering hospital stays. It also takes care of expenses before and after hospitalisation for a certain number of days. Pre-hospitalisation costs are covered if they’re directly related to the condition that led to hospitalisation and are approved under inpatient care. The same goes for post-hospitalisation expenses — they have to be tied to the same medical issue and fall under approved inpatient coverage.
    
3. Covers Daycare Treatments
   Medical technology has made enormous strides so that treatments and surgeries can be completed without having to spend a night in the hospital. Health insurance covers these daycare procedures as well, taking care of quick treatment expenses such as gallbladder removal, hernia repairs, and chemotherapy.
    
4. Supports Domiciliary Treatments
   Domiciliary treatments become applicable when medical attention needs to be given at home, owing to the reasons of the severe condition of a patient or insufficient beds in a hospital. Many health insurance plans spring into operation in such situations and cover the costs to ensure immediate healthcare needs are met right in the comfort of home.
    
5. Provides Preventive Health Check-ups
   Preventive care is a vital part of health insurance policies, with most of them including routine health check-ups. It's a clever way of taking care of your health since regular tests and screenings can identify problems early and keep them in check before they are serious.
    
6. Provides No Claim Bonus
   Health insurance policies usually offer a no claim bonus, which is essentially a reward for not making any claims in a policy year. The bonus either increases the sum insured or lowers the premium at the time of renewal. It's a pleasant little encouragement to be healthy and not spend unnecessarily on medical bills.
    
7. Gives Tax Benefits
   Health insurance is not all about staying healthy; it also offers valuable tax benefits. The premiums you pay can be claimed as tax deductions under Section 80D of the Income Tax Act, provided all terms and conditions are fulfilled. The amount of the deduction differs based on who's insured, with additional benefits if senior citizens or dependent parents are added to the policy.
    
8. Cashless Treatment Benefits
   One of the best advantages of health insurance is the cashless treatment facility. It enables you to avail of medical treatment at network hospitals without the inconvenience of paying first. The insurance company pays the bills directly to the hospital, making the whole process hassle-free and stress-free. It's a saviour during emergencies when money and time are both scarce. You just need to pay for any additional charges that are not covered under the policy.

Health insurance is an essential shield for healthcare expenses management. It covers hospitalisation to preventive check-ups, offers tax benefits, and even provides options for additional coverage. It's like having a financial shield to take care of the unexpected turns and twists of medical expenses.

Just one word of caution: health insurance policies can differ from company to company, with coverage details, terms, and conditions differing. It's always best to read the policy wording carefully to understand what exactly is covered. Also, tax benefits are subject to the current tax laws and can differ with time.

What Is The Acko Health Insurance Claim Settlement Ratio?

The claim settlement ratio of Acko General Insurance Company as of March 2024 is 93.29%. (Source: Public Disclosure, FY-2023 -24).

What Is The Claim Process Of Acko Health Insurance?

There are two ways that Acko General Insurance Company accepts claims-

Cashless Claim

If you are treated in a hospital which is covered in the network of the insurer, you can select this option. When an insurance company enters into a tie-up with network hospitals, it simplifies the procedure for you. If you choose a hospital from its list of approved cashless facilities, the insurer will take care of your medical expenses directly with the hospital. You would only need to pay for costs that are not covered by your health insurance policy.

Cashless Claim Process

These are the procedures you must adhere to in making a cashless claim -

1. First, ascertain if the hospital you have selected for treatment accepts cashless services from your insurance company.
2. Verify whether your insurance provider offers cashless services at your chosen hospital for treatment.
3. Make sure your preferred hospital accepts cashless payments from your insurance company and is not on the list of providers that are excluded.
4. Review the conditions and limitations of your health insurance policy to figure out any potential out-of-pocket costs you could incur.
5. Collect the policy copy, the PAN and Aadhaar of the proposer, patient identification, medical reports or doctor's prescription, etc., to lodge a cashless claim.
6. Send in your claim request. Requests for emergency hospitalisation must be made within 24 hours after admission, whereas requests for planned hospitalisation should be submitted at least 3–4 days in advance.
7. Submit all necessary information and paperwork for pre-authorisation with the hospital through your insurance company. Here's a general list: health card, the proposer's KYC (PAN, Aadhaar), the patient's ID, policy information, the details of the attending physician, etc.
8. If it takes longer than anticipated for the pre-authorisation process, be prepared to pay an advance deposit.
9. Check that your documents are collected from the hospital insurance desk after fixing the date for discharge.
10.  Pay attention to any correspondence from your insurer and reply right away to any questions or requests for more paperwork.
11.  Keep yourself updated on the progress of your claim at every stage to prevent delays.
12.  Take your time going over the final bill and discharge letter to note the expenses incurred that have not been covered and the ones still to be catered for.
13.  In case of confusion or even any issue at any time, do not hesitate to seek a direct call from your insurance provider or consult with your financial advisor.
14.  Make sure you're ready to pay for any expenses not covered by your insurer before you're discharged from the hospital.

Reimbursement Claims

If you receive treatment at a non-network hospital, you'll need to pay the hospital bill and medical expenses out of pocket initially. Afterwards, you can submit a reimbursement claim to your insurer, who will refund you based on the terms and conditions of your policy.

Reimbursement Claim Process

To make a reimbursement claim, you must do the following -

1. Make sure the hospital of your choice does not appear on the list of excluded or blacklisted healthcare providers.
2. It's also important to contact your insurance company within 24 hours of admission to the hospital.
3. Before you leave the hospital, ensure that you collect all your original documents, including receipts and invoices, discharge summaries, medical reports, MRI/X-ray images, prescriptions from doctors, the claim form, which the hospital must fill out, etc.
4. Getting a copy of the patient's case sheet or indoor case papers, as well as a comprehensive bill from the hospital that breaks down all costs is essential.
5. Check that the patient's name, gender, and age are accurately stated in all records; if any mistakes are discovered, correct them.
6. You’ll need documents like the health card, policy copy, proposer’s KYC (PAN, Aadhar, passport-sized photo), and your bank details. Also required is the patient’s ID proof, duly-filled signed claim form, relevant documents, original discharge summary, and IOL sticker/invoice for implantation claims (knee replacement, cataract, etc.).
7. Make copies of these documents for your records and keep them all arranged in a file.
8. Fill out the claim form and send it to your insurance company with the necessary paperwork.
9. Get your insurer to acknowledge receipt of all the original paperwork you sent in.
10.  To monitor the status of your claim, it's critical to maintain communication with your insurer after submitting it.
11.  Provide extra documentation as soon as your insurance asks for it.
12.  Examine the claim settlement summary, taking particular note of any deductions.
13.  Do not hesitate to contact the insurer or your financial advisor if you require clarification or if you have any issues.

Documents Required For Acko Health Insurance Claims

Well, filing health insurance claims through Acko General Insurance Company can feel like a bit of a process, but if you're prepared with the right documents, it’s pretty straightforward. Whether it’s a cashless claim or a reimbursement claim, the documents you’ll need generally look something like this:

For Cashless Claims:

• Health card provided by the insurance company
• KYC documents of the proposer, including PAN card, Aadhaar card, recent passport-size photographs, etc
• Identity proof of the patient undergoing treatment
• KYC details of the insured individual
• Policy number for verification
• Full name of the policyholder
• Complete name and address of the insured person filing the claim
• Details of the illness or injury, along with the required treatment or surgery
• Contact information and address of the attending medical practitioner
• Expected date of hospital admission
• Medical history, both related and unrelated to the current condition, as discrepancies from initial policy disclosures may result in claim rejection

For Reimbursement Claims:

• Health card or a copy of the insurance policy
• The proposer's KYC documents, including:
  • PAN card
  • Aadhaar card
  • Recent passport-size photograph
  • A bank statement with the printed bank name, account number, and IFSC code, or a passbook with the latest transaction page, or an original cancelled cheque with the policyholder’s name printed on it
• Identity proof of the patient
• Duly filled and signed claim form
• All relevant documents, test reports, medical prescriptions, films, and receipts related to the treatment
• Hospital-issued original discharge summary
• IOL (Intra Ocular Lens) sticker and invoice for claims involving implantation procedures, such as knee replacement or cataract surgeries.

Note: It's advisable to reach out to the Acko General Insurance Company to confirm any specific documentation requirements or additional formalities.

How To Track Your Acko Health Insurance Claim Status?

Here, you may check the progress of your Acko Health Insurance claim - https://www.acko.com/myaccount. Additionally, you can contact a customer support agent by calling 1800-266-2256. They will guide you through the entire procedure if you let them know that you would like to monitor the progress of your claim.

In Conclusion

As of March 31, 2024, Acko General Insurance Company's claim settlement ratio is 93.29%. Be it cashless or reimbursement claims, if you know the process and have all the documents in hand, the experience will be hassle-free. In the complex landscape of health insurance, finding a trusted partner ensures that you and your loved ones are protected from unexpected medical expenses.

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