How To Claim ACKO Health Insurance

A health or medical insurance claim is a process of requesting ACKO to provide the benefits and services covered in your health insurance policy. You can either opt for a cashless claim (also known as direct claim settlement) or a reimbursement claim for medical expenses incurred.

Types Of Health Insurance Claims

There are primarily two types of health insurance claims. These are as follows.

Cashless claims
Under this type of health insurance claim, the insurer (ACKO) settles all the medical expenses (as covered by the policy) with the hospital directly. However, to avail of the cashless mode of claim settlement, the policy’s beneficiaries need to be hospitalised at a network hospital.

Reimbursement claims
Under this type of health insurance claim, you pay the hospitalisation bill first and then file for the reimbursement of the hospitalisation expenses. The insurer (ACKO) will pay the amount to you as per the terms and conditions of the policy.

Cashless Procedure For Planned Hospitalisation

Here are the steps for the cashless claim process in case of a planned hospitalisation.

• Choose from the list of network hospitals as specified in the policy document.
• Approach the hospital’s insurance help desk at least 72 - 48 hours before admission and provide your policy card to initiate the claim process.
• Fill the pre-authorisation form and other forms as required.
• If the case is found admissible, ACKO will settle the hospital bills up to the approved amount as per the terms and conditions of the policy.
• If a cashless claim is not sanctioned, you can pay the bills and file for reimbursement of the medical expenses.

Reimbursement Procedure For A Health Insurance Claim

Here is the process for reimbursement of the hospitalisation bills.

• Inform your insurer (in this case, ACKO) about the medical treatment and the details of the hospital.
• Avail of treatment at a hospital of your choice.
• Settle all the hospital bills.
• Ensure you obtain the original hospitalisation documents such as discharge summary, diagnostic and laboratory reports, prescriptions, payment receipts, etc.
• Download the health insurance claim form from website and duly fill in all the required details. Ensure the hospital attests all the documents with seal and signature. You can refer to the section below for the list of common documents required to make a claim.
• Apply for the reimbursement claim online or by writing to them.
• Submit all the hospitalisation-related documents along with the health insurance claim form.
• If your claim is sanctioned, ACKO will settle your claim as per the terms and conditions of the policy. If your claim is not approved, ACKO will communicate the reason for the rejection.

What Are The Documents Required To Make A Claim?

Here is the list of common documents required while making a claim against your health insurance policy. However, documents may differ depending on the case.

• Duly filled health insurance claim form.
• Discharge summary of the patient
• Cash invoice
• Prescriptions
• Diagnostic reports (ECG/X-Ray/Scans/Laboratory)
• First Information Report (FIR) or Medico-legal Certificate (MLC) in case of an accident
• Copy of the insurance policy
• Original medical bills
• Original payment receipts
• Canceled cheque in case of reimbursement claims

Conclusion

You pay a premium to ACKO, in return for financial protection in case of any unforeseen medical expenses. A health insurance claim is the process of informing ACKO about the medical expense, so they can compensate you as per the policy terms and conditions. The insurer is liable to pay your hospitalisation bills as per the terms and conditions mentioned in the policy.

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