Home > Money > Question
Need Expert Advice?Our Gurus Can Help
Roopam

Roopam Asthana  |25 Answers  |Ask -

Answered on Jul 06, 2021

Balakrishnan Question by Balakrishnan on Jul 06, 2021Hindi
Listen
Money

I have 2 health insurance policies of 5 lakhs each. If my claim, let us say, is 4 lakhs and one company settles at 2 lakhs, can I claim with the second company for balance amount? One insurance company rejected my policy for some reason. Later, another company approached me, and I took a policy. I had only signed the document and I do not know the details. To this company, I have paid premiums for 10 years without break. Can this company reject my claim in the future?

Ans: You can have 2 health insurance policies but cannot claim reimbursement for the same expense from multiple insurance companies. Also, if the sum insured of one policy is not adequate then the other insurance policy can be used to cover the balance expenses with proper disclosures to the second insurance company.

The rejection of any claim is basis incomplete or incorrect disclosure at the time of policy issuance or on account of applicable terms and conditions. I would advise you to go through the terms & conditions of the policy/ies purchased by you.

:
DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.
Money

You may like to see similar questions and answers below

Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Jun 21, 2022

Listen
Money
Dear Sir, Greetings of the day. I have got a health insurance of family floater type from Tata AIG for a sum of four lakhs. Recently, I got hospitalised and full four lakhs was paid by Tata Aig. But my hospital bill was six lakhs and sixty two thousand. So there was a shortfall of two lakhs sixty-two thousands. I have an Aditya Birla health Policy of family floater type for 45 lakhs. But it will come in to effect after 5 lakhs expenditure. So I myself paid one lakh from my pocket. And for rest one lakh sixty two thousand only I applied for cashless to Aditya Birla .But they denied it. Finally I paid that amount myself and came home. Afterwards I kept continuous follow up with them. Reconsideration and reminder letter was sent by TPA and Treating doctor. But again it was rejected. Now Aditya Birla employee is saying apply for reimbursement. When Tata Aig is clearing full amount, how come Aditya Birla is denying it? And how can I bridge the gap one lakh between two policies? Tata Aig says you have taken full claim so we cannot make your limit from four to five lakhs this year. Pls advise suitably. Best Wishes
Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

..Read more

Ramalingam

Ramalingam Kalirajan  |8319 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 20, 2024

Asked by Anonymous - May 07, 2024Hindi
Listen
Money
Hi, I have a query regarding health insurance. I have 2 policies from different providers. 1 policy has copay clause. Can I claim the copay amount from the other provider?
Ans: Claiming Copay from Another Health Insurance Policy
That's a good question! Unfortunately, you cannot claim the copay amount you pay under one health insurance policy from another provider. Here's why:

Copay is a fixed amount you share with your first insurer for covered medical expenses. It reduces your premium but requires you to pay upfront.
Each insurance policy works independently. They only cover your expenses as per their terms and conditions.
Here's how things work:

You file a claim with the insurer that has the copay clause.
They approve the claim amount after deducting the copay amount.
You pay the copay directly to the hospital or yourself (depending on the policy).
Alternatives to Consider:

Choose plans without copay: If copays are causing trouble, consider switching to plans with higher premiums but no copay requirement.
Increase coverage limits: If your current plans have low coverage limits, explore options with higher limits to minimize out-of-pocket expenses.
Speak to a CFP Professional:

A Certified Financial Planner can review your health insurance plans and suggest options that better suit your needs. They can also help you understand coverage details and claim procedures.

Remember: It's important to choose health insurance plans that complement each other and provide comprehensive coverage.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Ramalingam

Ramalingam Kalirajan  |8319 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 11, 2024

Listen
Money
I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Latest Questions
Ramalingam

Ramalingam Kalirajan  |8319 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 05, 2025

Money
Dear Sir, I am aged 40 years a aggressive investor I have recent corpus of 13 lac in mutual fund and doing SIP of Rs30500 monthly in following funds . Nippon small cap - 9000 , Tata small cap - 7500 , Quant Small cap - 6000 , kotak small cap - 5000 and Pgmi Flexi cap -3000 and a vision for next 22 years with step up of 10 %. I also invest in PPF of 12500 monthly and In EPF with 25000 basic salary and i will also get Rs 50 lac from various LIC policy at the age of 60 . I want to know that is my approach is right and what would be the future corpus at the age of 62 years .
Ans: You are doing a disciplined and smart job with your investments. You have a long-term horizon, a strong SIP commitment, and a clear goal in mind. That’s a big step many don’t take seriously. Let me now evaluate your approach from all angles. This will be a 360-degree review of your investment plan and future readiness.

Let us go step-by-step to understand if your approach is right and what the future looks like.

Your Current Financial Setup

You are 40 years old now.

You have a mutual fund corpus of Rs 13 lakh.

You invest Rs 30,500 monthly through SIP.

You invest in four small cap funds and one flexi cap fund.

You step up your SIP by 10% annually.

You have a PPF investment of Rs 12,500 monthly.

You contribute to EPF. Your basic salary is Rs 25,000.

You will receive Rs 50 lakh from LIC policies at age 60.

Your investment horizon is 22 years from now.

This is a solid plan and shows discipline. Now, let us evaluate it carefully with insights and suggestions.

Assessment of Mutual Fund Investments

You are investing heavily in small cap mutual funds.

Four out of five funds are from the small cap category.

Small caps give high returns, but they also carry high risk.

Over 22 years, this risk may work in your favour.

But the ride will be bumpy. There will be sharp ups and downs.

At times, you may see short-term losses. That is normal.

However, putting over 85% of SIP in small caps may be risky.

You need better diversification for stability.

Adding large cap and mid cap funds may balance the risk.

Your Flexi cap fund does help a bit, but it is still not enough.

A blend of market caps will give smoother long-term growth.

It is better to slowly bring down small cap exposure to 50%.

Increase exposure to diversified and mid-cap funds gradually.

Don’t exit small cap funds suddenly. Take a phased approach.

This change will make your portfolio strong and well-balanced.

Step-Up SIP Strategy – Strong and Effective

Increasing SIP by 10% annually is a smart idea.

This fights inflation and grows your wealth faster.

It uses your rising income to build a big corpus.

Many investors ignore step-up. You are doing it correctly.

Keep increasing the SIP without fail every year.

Even a break in step-up can delay your target.

Review your SIPs yearly and adjust as income rises.

This strategy will help you reach your target corpus faster.

Investment in PPF – A Safe Long-Term Cushion

PPF offers guaranteed, tax-free interest.

You are investing Rs 12,500 monthly in PPF.

Over 22 years, this will become a strong safe corpus.

It adds stability to your overall financial plan.

PPF is good for retirement since it is risk-free.

Keep continuing till maturity. Do not withdraw early.

Interest rate may vary, but long-term returns are good.

You also get tax exemption under Section 80C.

This risk-free asset will protect you from equity market shocks.

EPF – A Reliable Retirement Contributor

Your EPF is linked to your Rs 25,000 basic salary.

The employer also contributes monthly.

Over 22 years, this will grow into a big amount.

EPF offers fixed, tax-free returns with no market risk.

It is an excellent tool for retirement planning.

Avoid premature withdrawals from EPF.

You can withdraw after retirement for use as income.

This will be a strong pillar of your retirement security.

LIC Maturity at Age 60 – A Special Boost

You will receive Rs 50 lakh from LIC policies at age 60.

This will come at a perfect time near retirement.

You must check if these are traditional or ULIP plans.

Traditional plans offer low returns, mostly below inflation.

ULIPs carry market risk and high charges.

If these are investment-cum-insurance plans, surrendering is wise.

You can reinvest that surrender amount in mutual funds.

Use proper asset allocation while reinvesting.

For insurance needs, use only term insurance.

Reinvesting in mutual funds can make this Rs 50 lakh grow further.

Future Corpus at Age 62 – What to Expect

With SIPs, EPF, PPF and LIC money, your total savings will be huge.

Your mutual fund corpus will grow rapidly with step-up.

Your PPF and EPF will grow safely, year after year.

LIC amount will give a big boost just before retirement.

With 10% SIP step-up, your corpus can cross Rs 9 to 10 crore.

Exact figure depends on market returns, SIP discipline, and inflation.

But you are definitely on the right path to reach financial freedom.

You are preparing for retirement very well.

This kind of planning gives peace of mind and confidence.

Things You Are Doing Right – A Quick Look

Strong SIP discipline and long-term vision.

Investing in equity for long-term wealth creation.

Following step-up SIP approach.

Investing in PPF and EPF for safe returns.

Keeping investment horizon of 22 years.

Maintaining separate LIC maturity plans.

You are showing smart behaviour as an aggressive investor.

Key Improvements You Should Consider

Reduce small cap exposure to 50% slowly.

Add more mid-cap and flexi cap funds.

Avoid overlapping funds from same category.

Review performance of all funds every 6 months.

Check expense ratios and consistency of returns.

Track goal progress once a year with clear targets.

Make sure your portfolio has good asset allocation.

Don’t hold funds only based on past returns.

Always go through a Certified Financial Planner for changes.

This will make your portfolio more stable and return-oriented.

Important Taxation Insight

Long-Term Capital Gains above Rs 1.25 lakh are taxed at 12.5%.

Short-Term Capital Gains are taxed at 20%.

Plan redemptions smartly to reduce tax.

Use staggered withdrawals near retirement.

Redeem equity funds over time, not all at once.

PPF and EPF are tax-free. LIC maturity is also tax-free.

But for mutual funds, plan redemptions with tax efficiency.

This will help you protect your wealth from tax erosion.

Important Notes on Fund Types and Investments

Do not use direct mutual funds if you are not an expert.

Direct funds need self-review and research, always.

There is no handholding or guidance with direct funds.

If you miss fund underperformance, losses may happen.

Regular funds through MFD with CFP advice are safer.

CFP will do goal review, fund analysis and rebalancing.

This adds value and protects your goals from derailment.

Always go through a trusted CFP for a 360-degree plan.

Your long-term wealth deserves the right expert attention.

Finally – Our Insights for You

You are on a great track with vision and discipline.

You are investing smartly across equity and debt.

With minor changes, your plan can become stronger.

Keep focus on diversification and risk management.

Review your goals and progress yearly with expert help.

Stick to your plan even during market falls.

Continue your SIP step-up and never skip contributions.

Use professional guidance to ensure smooth journey.

Your retirement will be financially independent and stress-free.

This approach will help you lead a proud, peaceful life post-60.

Stay committed and consistent. You are doing excellent already.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

...Read more

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.

Close  

You haven't logged in yet. To ask a question, Please Log in below
Login

A verification OTP will be sent to this
Mobile Number / Email

Enter OTP
A 6 digit code has been sent to

Resend OTP in120seconds

Dear User, You have not registered yet. Please register by filling the fields below to get expert answers from our Gurus
Sign up

By signing up, you agree to our
Terms & Conditions and Privacy Policy

Already have an account?

Enter OTP
A 6 digit code has been sent to Mobile

Resend OTP in120seconds

x