| Acko Health Claim Settlement Ratio 2024 - 2025: 95.75% |
Wondering if your insurer will actually pay up when you need them to? Answering this question is pretty easy in the insurance landscape thanks to the claim settlement ratio metric. It is an important indicator of how reliably and efficiently an insurer processes and settles claims. And if you’re eyeing a newer player like Acko Health Insurance, the CSR becomes even more important to look at.
Founded in 2016, Acko began its journey in the general insurance space with a strong focus on motor insurance. It formally entered the health insurance segment in 2020, introducing plans designed to be more accessible, digital-first, and customer-friendly. Unlike traditional insurers that rely heavily on agents or intermediaries, Acko operates on a direct-to-customer (D2C) model. This allows them to offer competitively priced, feature-rich policies with a seamless online experience.
Thanks to its affordability and innovation, Acko quickly gained popularity, especially among tech-savvy and price-conscious customers. However, as with any insurer, the customer experience can vary, while many appreciate its smooth digital processes, others have reported concerns around claim approvals and documentation. According to our advisors at Ditto, Acko’s pricing and features are appealing but customers should carefully review claim procedures and documentation requirements before buying.
In this article, we explore the Acko health insurance claim settlement ratio, understand how it's calculated, and assess what it means for prospective policyholders.
Pro tip: The health insurance market can be a labyrinth. Instead of spending hours navigating through the hundreds of policies out there, why not book a 30-minute call with our expert IRDAI-certified advisors? We don’t spam or pressure you to buy. Just honest insurance advice.
What is the Claim Settlement Ratio (CSR) in Health Insurance?
The Claim Settlement Ratio (CSR) is a crucial metric that indicates an insurance company’s reliability in honoring and paying out insurance claims. Specifically, it refers to the percentage of total claims approved by the insurer against the total number of claims received in a financial year.
CSR formula:
Claim Settlement Ratio = (Total Claims Approved ÷ Total Claims Received) × 100
For example, if an insurer receives 10,000 claims and settles 9,700 of them, the CSR would be 97%.
While calculating this, insurers include both claims from the current year and pending claims from the previous year that have been settled. Any unresolved claims at the end of the year are excluded from the calculation.
Why Claim Settlement Ratio (CSR) Alone Is Not Enough
A high Claim Settlement Ratio (CSR) looks great on paper but it doesn’t always tell the full story. An insurer might settle most claims but still fall short when it comes to affordability, hospital coverage, or overall service quality.
At Ditto, we always recommend looking beyond just the CSR. To really understand how good an insurer is, you should consider these key factors:
- Incurred Claim Ratio (ICR): This shows the total value of claims paid out versus the total premiums collected. A balanced ICR (usually 55-80%) indicates financial stability of the insurer.
- Complaint Volume: Measures the number of grievances filed against the insurer, often per 10,000 claims. A lower volume suggests better customer satisfaction and smoother processes.
- Time Taken to Settle Claims: How quickly does the insurer process and settle claims? Based on claims team experience, cashless claims are typically expected to be approved within 2–6 hours post-discharge and document submission. Reimbursement claims processed within 7–10 working days are considered efficient. Delays beyond 15–30 days, especially without clear communication, can impact customer satisfaction.
Also, as per IRDAI guidelines, all insurers must publicly disclose claim settlement timelines across four categories: under 30 days, 30–90 days, 90–180 days, and over 180 days. These figures are published in each insurer’s public disclosure report.
For instance, Acko reported that 99.65% of its health claims were settled within 30 days, amounting to over ₹470 crores which is an indicator of strong claim efficiency. - Network Hospitals: The size and quality of the insurer's cashless hospital network, especially in your locality.
- Product Portfolio/Policy Features: Does the insurer offer comprehensive plans with essential features (e.g., no room rent limits, no disease-wise sublimits, no co-pay, restoration benefits, cumulative bonus, daycare, etc.)?
- Track Record: The insurer's operational history and consistency in performance over several years.
- Customer-Centric Experience: Beyond the numbers, it’s important to consider service quality, user experience, and customer feedback. These factors reflect how responsive, easy to use, and reliable the insurer really is in practice.
Ultimately, a well-informed decision comes from balancing all these factors and not just CSR, to find a policy that aligns with your health needs, budget, and expectations.
How to Interpret Acko Health Insurance Claim Settlement Ratio
Given CSR’s importance, it’s not just about knowing the percentage, it is about understanding what that number means. Let’s break down how to interpret the Acko health insurance claim settlement ratio:
- Below 80%: This is a red flag. A CSR below 80 usually indicates frequent claim rejections or delays. It’s best to avoid such insurers.
- Between 80% and 90%: This is a moderate range. It doesn’t necessarily mean the insurer is unreliable, but you will need to be more selective. Make sure to consider other metrics like the number of complaints per 10,000 claims, ICR, and hospital network before deciding.
- Between 90% and 100%: This is the optimal range. It reflects a healthy claim settlement track record and suggests the insurer is dependable.
- Above 100%: Surprisingly, this is not a good sign. It implies that the insurer is clearing a large backlog of previous year’s claims, possibly indicating delays in processing claims. This is something no health insurance policyholder wants to deal with.
In the following sections, we will take a closer look at how the Acko health insurance claim settlement ratio has evolved over the years, and what it means for you as a policyholder today.
Acko Health Insurance Claim Settlement Ratio 2025
For the financial year 2024–2025, Acko reported a Claim Settlement Ratio (CSR) of 95.75% in health insurance.
To get a balanced view of Acko’s claim performance, Ditto experts looked at claim settlement data over the last four financial years. A single year’s CSR can sometimes be misleading due to one-off events. That’s why a multi-year average offers better insight into consistency and reliability.
Here’s how Acko has performed from 2022 to 2025, compared to the industry average:
Acko Health Insurance Claim Settlement Ratio (2022–2025)
| Financial Year | Acko CSR (%) | Industry Average CSR (%) |
|---|---|---|
| 2022–23 | 97.45% | 91.19% |
| 2023–24 | 96.31% | 92.25% |
| 2024–25 | 95.75% | Will be available later in the year |
| Average | 96.26% | 89.76% (till 2023–24) |
Note: Industry average for 2024–25 hasn't been published yet, so the average is based on available data till 2023–24.
Acko Health Insurance Claim Settlement Ratio (2021–2024) Table
| Financial Year | Acko CSR (%) | Industry Average CSR (%) |
|---|---|---|
| 2021–22 | 95.53% | 85.85% |
| 2022–23 | 97.45% | 91.19% |
| 2023–24 | 96.31% | 92.25% |
| Average | 96.43% | 89.76% |
Claim Settlement Ratio of Acko Health Insurance 2025: Key Insight
As we look at the table, it’s clear that Acko has consistently outperformed the industry average in terms of claim settlement ratio. With an average CSR of 96.26%, Acko stands out as one of the top performers in the sector. This is a strong indicator of its commitment to resolving claims promptly and reliably.
Now, let’s take a detailed look at how Acko performs when compared to other top health insurers in India, based on key metrics like claim settlement ratio, customer complaints, incurred claim ratio, and the size of their cashless hospital network.
Acko Health Insurance vs Top Insurers: Detailed Comparison 2021–2024
| Rank | Insurer | Avg. Claim Settlement Ratio (CSR) (%) | Avg Complaints/10,000 claims | Avg Incurred Claim Ratio (ICR) (%) | Network Hospitals |
|---|---|---|---|---|---|
| 1 | HDFC ERGO | 97.56 | 7.02 | 85.83 | 13000+ |
| 2 | Bajaj Allianz | 94.59 | 2.68 | 83.29 | 12000+ |
| 3 | New India | 99.36 | 5.13 | 111.25 | 3700+ |
| 4 | Acko | 96.43 | 17.06 | 81.51 | 10000+ |
| 5 | Digit | 96.68 | 16.12 | 71.56 | 16400+ |
| 6 | SBI General | 96.53 | 19.72 | 81.23 | 16600+ |
| 7 | Tata AIG | 95.74 | 10.8 | 80.93 | 11000+ |
| 8 | Oriental | 95.71 | 10.5 | 123.97 | 4000+ |
| 9 | Aditya Birla | 95.09 | 22 | 67.52 | 12000+ |
| 10 | Royal Sundaram | 93.94 | 16.3 | 88.55 | 10000+ |
| 11 | United India | 94.43 | 7.83 | 106.34 | 4000+ |
| 12 | ICICI Lombard | 85.24 | 8.96 | 82.62 | 10200+ |
| 13 | Care Health | 89.89 | 36.13 | 58.86 | 11400+ |
| 14 | Manipal Cigna | 89.5 | 25.4 | 68.2 | 8500+ |
| 15 | Star Health | 82.96 | 46.1 | 72.84 | 14000+ |
| 16 | Niva Bupa | 91.08 | 42.62 | 58.4 | 10000+ |
Note: We sourced data from IRDAI annual reports and insurer public disclosures (FY 2021–2024) and computed 3-year averages for each metric. This methodology helps highlight consistent performers over time, rather than one-time spikes or short-term fluctuations.
These metrics give a well-rounded view of each insurer’s efficiency, service quality, claim fairness, and treatment accessibility, all of which are critical in selecting a reliable health insurance provider.
Based on this comparison, Acko appears to hold its own among the top insurers. But how do these numbers translate into real-world reliability and customer experience? Let’s break it down further.
Is Acko Health Insurance a Good Choice Compared to Top Insurers: Key Insight
- Acko stands out with a high Claim Settlement Ratio, a balanced Incurred Claim Ratio, and a fairly wide cashless hospital network. These numbers suggest strong early performance.
- However, Acko remains a newer entrant in the health insurance space, and is still building its market presence. Its low business volume makes it difficult to fully evaluate the long-term reliability of these metrics. Also, Acko’s claims are primarily processed through third-party administrators, which can introduce delays and inconsistencies in claim settlement which again is a critical factor when assessing service quality.
| Ditto’s Take on Acko’s Claim Settlement Ratio: Based on IRDAI data, Acko shows promising metrics, but we recommend a “wait and watch” approach. It’s essential to monitor how they scale operations and maintain service quality as their customer base grows. Until then, policyholders should proceed with cautious optimism. But there’s more to the story. Acko runs on a direct-to-customer (D2C) model, which means there are no agents or intermediaries involved. This helps keep premiums low since you are not paying any commissions. But it also means you will be dealing directly with Acko for everything, including claims and support. For some, this works really well. The process feels fast, digital, and straightforward. But if you’re someone who prefers guided help or a bit of handholding, especially during claim processing, you might find the experience a little hands-off. Unlike traditional insurers where agents help coordinate claims, with Acko, you’re expected to manage everything on your own. At Ditto, we think this model suits people who are comfortable managing things independently online. But if you value personal support, especially during emergencies, it’s something to think about before choosing Acko. |
If you want a comprehensive breakdown of Acko Health Insurance, including its benefits, plan features, pricing, exclusions, and how it compares with other insurers, we have covered it all in our detailed review.
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Conclusion: Acko Health Insurance Claim Settlement Ratio – Should You Choose It?
Acko has emerged as a digital-first insurance provider with a strong Claim Settlement Ratio (CSR) over recent years. At Ditto, our analysis suggests that Acko is a strong pick for those who prefer digital convenience and are comfortable managing their insurance online.
We want to put this again: Acko is still relatively new, with a smaller customer base and lower claim volumes. Since much of its claims servicing is outsourced to Third Party Administrators (TPAs), it can sometimes lead to delays or service hiccups. So, as they scale, it will be important to track how well they manage claims and maintain service quality.
If you prefer strong offline support or the confidence that comes with a long-standing track record, more established insurers may be a better option. In any case, it is always wise to speak to an advisor (yes, that’s us) before making a decision.
Still unsure if Acko is right for you? Speak to a Ditto advisor for free. We will help you compare top plans, understand the fine print, and pick the best policy based on your specific needs. Book your free call today!
FAQs on Acko Health Insurance Claim Settlement Ratio
What is the Claim Settlement Ratio of Acko Health Insurance for 2023–24?
Acko's claim settlement ratio for FY 2023–24 stood at 96.31%, maintaining its strong track record above the industry average of 92.25%. This makes Acko one of the more reliable insurers in terms of claims paid.
How does Acko’s claim settlement ratio compare to other top health insurers?
Between FY 2021–2024, Acko maintained an average CSR of 96.43%, ranking 4th among major insurers. While the CSR is impressive, Acko still relies heavily on TPAs, which may affect claim speed and service consistency.
Where can I find the latest Acko Health Insurance Claim Settlement Ratio data?
You can check the latest CSR data on acko.com, in their public disclosures. At Ditto, we also break this data down for easier understanding during free consultations.
Does Acko use TPAs or have an in-house claim team?
Acko primarily uses external TPAs (Third Party Administrators) for claim processing, though some claims may be handled in-house. This setup can sometimes lead to slower communication and delays, especially when compared to insurers with fully integrated claims teams.
Is Acko’s claim process fully digital?
Yes, Acko promotes a fully digital experience. Especially for buying policies and filing claims. However, for cashless approvals or reimbursements, the involvement of TPAs means some offline coordination may still be required.
Are there sub-limits that affect claim approvals with Acko?
Yes. While Acko offers a decent base plan, some versions come with disease-wise sub-limits, room rent restrictions, or capping on procedures like cataract or joint replacements. These can impact the final claim amount.
What should I check beyond Acko’s Claim Settlement Ratio before buying?
You should check:
- All waiting periods (initial, PED, specific disease)
- Policy inclusions and exclusions
- Room rent cap, disease-wise sublimits
- Local network hospitals
- Customer service and digital claim experience
- Inflation protection features for sum insured
- Co-payment clause
Should I choose Acko over traditional insurers based on CSR alone?
Not necessarily. While Acko’s Claim Settlement Ratio is strong, factors like claim experience, pre-authorization speed, TPA dependence, and product limitations must be considered. CSR is one metric, not the only one.
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