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Sanjib

Sanjib Jha

Insurance Expert 

66 Answers | 22 Followers

Sanjib Jha is the CEO of Coverfox Insurance. His expertise includes health and auto insurance. He has over 22 years of experience in the financial sector. He has completed his post-graduation from the Institute of Company Secretaries of India.... more

Answered on Nov 24, 2022

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I was customer of Oriental Bank of Commerce. Being a customer of Oriental Bank of Commerce, Oriental Insurance Company provided Group Health Insurance Policy and inception date was 04-05-2015. My policy with them continued till 03-05-2021 without any break. Because Oriental Bank of Commerce merged with Punjab National Bank, Oriental Insurance Company discontinued that policy from 03-05-2021 onward. Being a customer of Punjab National Bank, I approached them, and they migrated my Group Health Insurance Policy of Oriental Insurance Company to Star Group Health Insurance Policy for customers of Punjab National Bank from 04-05-2021 to 03-05-2022.  As All my policy periods were continued from 04-05-2015 till 03-05-2021 with Oriental Insurance Company, Star Health Insurance given me the benefit of pre-existing disease waiting periods being waived because of continuity (They mentioned it in Policy Document too). They reimbursed my 1st claim of 15 July to 22 July 2021 (Non Empaneled Hospital) and Cashless claim of 16 December to 19/12/2021 but denied reimbursement of 19/12/2021 to 26/12/2021 with the excuse of pre-existing disease even I directly shifted from cashless hospital to non-Empaneled Hospital for same problem because Empaneled hospital having been less facilities.  Here I want to address that I was discharged from Cashless Hospital, on request, to get treated in Higher Hospital and treatment was in continuation of previous cashless hospital to new hospital. So, sir, please guide me accordingly as my correspondence with them is not fruitful.
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Answered on Oct 12, 2022

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 I am an employee of central govt. PSU. My family consists of myself, spouse, two minor children and mother. I am covered by a corporate group medical insurance policy for Rs 2 lakh with an additional emergency coverage of Rs 4 lakh by the employer. I also have a personal Family Floater policy for Rs 3 lakh and a Sr. Ctzn. Policy for Rs 1 lakh. I have not used the personal policies till date for any hospitalisation claim. I am aware that a claim exceeding the corporate policy limit can be claimed in the personal policy. Recently I was made to know that any planned hospitalisation exceeding the corporate claim limit, cannot be done using the second policy. I also know that there is a product called as top up policy which can be used in such cases. I have 8 years of remaining service where there is a medical insurance cover during the period. After retirement, the employer provides a basic policy of 1.5 lakh for the family. The same feels to be insufficient in today’s times. What would be your advice with regards to the existing medical insurance policies and their amounts? Should I need to undertake any tweaking of the policy amounts or switch to a top up policy?
Ans: Hi Pradeep, yours is a legit concern. It would be best if you take advice from a professional person or company – having the necessary qualifications -- after discussing your issue with them.

Insurance is each to its own. Depending on your concerns and requirements a professional service provider will be able to give you the best advice, whether to tweak policy amount or switch to top up.

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Answered on Sep 23, 2022

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I am 73 (DOB 10-07-1949). I had an open heart surgery in Sept., 1999. I am taking blood thinner otherwise ok. My wife is 66 (DOB 13-09-1956). She has no problems. I have a 5L Family Floater health insurance from Oriental Insurance - Bank Saathi Policy at an annual premium of about Rs. 35,000 for self and wife. Since in these days this is not sufficient, I want another policy for 5L or Top Up for 5 / 10 L for self and wife. Please advise an honest suitable minimum cost affordable policy since I have limited capacity to pay because my life time savings in Punjab & Maharashtra co-op Bank Ltd., Mumbai, has been looted by bank Management, Senior Employees, HDIL Construction Co. (Wadwhans), RBI, Politicians and Govt. Another point. Earlier I had policies with National Insurance, New India Insurance and Oriental Insurance from my Bank tie-up but one after the other they broke the tie up with Banks and offered their direct policy raising annual premium from 11,000 to 43,000 (National Insurance) and others also on same lines because they follow dishonest business policy and just want to loot the common man. How anybody can afford such increase after 8 years with Govt. co. insurance Policy? IRDA is also on their side being dishonest. Not only private but Govt. cos. are also dishonest, corrupt and want to kill the common man.
Ans: Hi Mr RN Mitra, sorry to hear about your condition, wish you good health and recovery.

As far as the top up plan is considered, given your age and pre-existing diseases, your risk profile is high and most insurers may not be able to offer Super top up plans.

The best option is to apply for a new base plan with a higher sum insured, however the premium will be on the higher side.

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Answered on Jul 29, 2022

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