Hassle-free Health Insurance Claims with Acko

Health insurance is designed to mitigate your medical care costs and provide you with a cushion if your health fails. There could be different situations when you may have to make a claim against your policy. This could be due to a planned or unplanned hospitalisation.

There are two ways you can raise a claim against your policy: Cashless or Reimbursement Claims. But, the procedures for these two types of health insurance claims are different, and it is vital that you understand their guidelines for a hassle-free experience. 

A health or medical insurance claim is a process of requesting the insurer (in this case, 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.

There are three types of health insurance claims. These are as follows.

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.

You can also utilize our cashless facility even if the hospital is not part of the Acko network. This initiative aims to ensure smooth health services for our customers. If you are planning for hospitalization or in case of emergency hospitalization at a non-network hospital, please request the hospital to send the cashless request in the specified format (download the Preauthorization request form) to our support email ID [email protected] for further assistance. We would connect with the hospital for onboarding as a network provider, to be able to process your request for a cashless facility further. You may contact us at our helpline number 1800 266 2256 or email us at  [email protected] for any assistance.

To initiate this process, the healthcare provider should submit a pre-authorization request using the specified format, which must be emailed to the aforementioned email ID within a specified time period. For planned hospitalization, this should be done 48 hours before admission and in case of emergencies, within 48 hours of admission, so as to allow us time for onboarding formalities of the provider.

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.

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

If a cashless claim is not sanctioned, you can pay the bills and file for reimbursement of the medical expenses.

Here are the steps for the cashless claim process in case of emergency admission.

If the cashless claim is not approved, you can file for reimbursement.

Here is the process for reimbursement of the hospitalisation bills.

Note: In both types of claims, you must inform ACKO before or while seeking hospitalisation.

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.

For the reimbursement of the hospitalisation bills, you can raise your claim against your policy through our online platform or by writing to us. For more details, you can refer to our article on the step-by-step guide for raising a health insurance claim.

It is ideal for securing yourself and your family with adequate health insurance to mitigate the rising medical expenses. You may have employer health insurance (mediclaim insurance/corporate health insurance) and a personal health insurance policy, or you may have taken two different private health insurance policies. You may be wondering if you can raise a claim from multiple insurance companies. The answer is yes.

All you need to do is make a claim with the first insurer against the medical care expenses. Then, you need to procure the summary of the claim settlement from the first insurer, get the hospital bills and receipts attested by the hospital, and approach the second insurer to settle the balance of your medical expenses.

Also, read: How to claim medical insurance from multiple insurers

You must secure yourself and your family with a health insurance policy that offers an adequate sum insured amount to mitigate rising healthcare costs and unforeseen hospitalisation expenses. However, it is also essential to select a dependable insurer. To help you find the right insurer, two ratios that can help you is - Claim Settlement Ratio (CSR) and the Incurred Claim Ratio (ICR).

A Claim Settlement Ratio of an insurer represents the total number of claim settlements against the total number of claims registered in a financial year.

Following is the calculation of the claim settlement ratio in medical insurance.

Claim Settlement Ratio = Claims settled in a year/Claims received in a year x 100

Incurred Claim Ratio represents the net amount of claims settled against the total premium received during the financial year.

Following is the calculation of the incurred claim ratio in health insurance.

Incurred Claim Ratio = Claims settled in a year/Total premium received in a year x 100

Sometimes, a health insurance claim may be rejected, and this can be due to various reasons. Here are the instances under which your health insurance claim can get rejected.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content, and before making any insurance-related decisions.