Acko Health Insurance Claim Settlement

Although cashless treatment is a preferred choice for most when it comes to filing a health insurance claim, you can also make a reimbursement claim settlement under your Acko health insurance policy by following the steps given below:

• Visit a non-network hospital of your choice.
• Intimate Acko General Insurance within 24 hours in case of hospitalisation.
• Avail the required treatment at the hospital.
• Collect the relevant documents at the hospital to submit them to the insurance company. These include original documents like discharge reports, prescriptions, etc.  
• Settle the medical bill related to your treatment at the hospital at the time of discharge.  
• Submit the documents to the insurance company after discharge.
• After verifying your documents, the insurance company will pay you for the treatment availed, provided your health insurance policy covers you for the same.  

You will be required to submit the following documents at the time of claim settlement under your Acko health insurance company plan: 

• Duly filled claim form
• Photo identity proof of the patient
• Medical practitioner's prescription advising hospitalisation
• Original bills with the break-up
• Payment receipts
• A discharge summary that includes a complete medical history of the patient along with other details
• Investigation/diagnostic test reports etc. along with the prescription from the attending medical practitioner
• OT notes or the Surgeon's certificate that includes the details of the operation performed (in case of surgeries)
• Sticker or invoice of the implants, wherever applicable.
• MLR (Medico-Legal Report copy if carried out and FIR if registered, wherever applicable
• NEFT Details are required to enable direct credit of claim amount in a bank account) and canceled cheque
• KYC (identity proof with address) of the proposer, where claim liability is more than Rs. 1 lakh as per AML guidelines
• Legal heir/succession certificate, wherever applicable
• Any other relevant document required by the company or the TPA for assessment of the claim

Incurred Claim Ratio (ICR) in health insurance is the proportion of claims paid out against the total amount of claims received in a financial year. For instance, if the company has paid out claims of Rs. 80 crore out of total premium received of Rs. 10 crore, then it indicates that the ICR of the insurance company is 80%. The Acko Health Insurance Claim Settlement Ratio for the financial year 2018-19 is 24%. Note that ICR is subject to change.