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Roopam

Roopam Asthana  | Answer  |Ask -

Answered on Jul 06, 2021

Balakrishnan Question by Balakrishnan on Jul 06, 2021Hindi
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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.
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Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 21, 2022

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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  |10924 Answers  |Ask -

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

Asked by Anonymous - May 07, 2024Hindi
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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  |10924 Answers  |Ask -

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

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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  |10924 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 23, 2025

Money
Hi Sir, I started a SIP of 3k from 3months investing in Nipon India Small Cap fund. I started investing via \xis bank mobile app. Please suggest me if thats the safe way to do through bank app. And I am willing to start another SIP of 3k per month. Planning to do it on groww app. Please suggest some good SIP plans and guide me on how good and safe to start via groww app.
Ans: I appreciate your early step into disciplined investing.
Starting SIPs shows long-term thinking.
Beginning small builds confidence and learning.
Your willingness to ask questions is healthy.

» Your Current SIP Action Review
– You started SIP of Rs 3,000 monthly.
– SIP duration is three months.
– Investment is through a bank mobile app.

This shows good initiative.
Early habits shape future wealth.

» Understanding Your Chosen Fund Category
– The fund belongs to small-sized companies category.
– Such funds are high risk.
– Such funds give high volatility.

Returns can be uneven yearly.
Patience is very important here.

» Suitability Of Small Company Funds
– Small companies grow faster sometimes.
– They also fall harder during corrections.
– Not suitable as first-only investment.

Exposure should be limited initially.
Balance is essential.

» Starting Early
– You started without waiting for perfection.
– Many delay investing unnecessarily.
– Action matters more than perfection.

This mindset helps long-term success.

» Risk Awareness Is Necessary
– Small company funds fluctuate sharply.
– Short-term losses are common.
– Emotional control is required.

Three months is too short to judge.
Time horizon should be long.

» Minimum Suggested Time Horizon
– Such funds need at least seven years.
– Shorter periods cause disappointment.
– SIP helps reduce timing risk.

Consistency matters more than returns initially.

» Bank App As Investment Platform
– Bank apps are generally safe.
– Transactions are regulated.
– Holdings are stored with registrars.

Platform safety is not the main risk.
Investment choice matters more.

» Limitations Of Bank Apps
– Limited guidance provided.
– Product pushing is common.
– Advice is not personalised.

Banks focus on convenience.
Planning depth is usually missing.

» Bank Staff Support Limitations
– Staff change frequently.
– Knowledge levels vary.
– Long-term accountability is absent.

This affects continuity of advice.

» Safety Of Investments Versus Platform
– Funds are held in your PAN.
– Platform failure does not erase investments.
– Units remain safe with fund house.

So platform safety fear is minimal.
Decision quality matters more.

» Planning Another SIP Thought
– You want another Rs 3,000 SIP.
– Total SIP becomes Rs 6,000 monthly.

This is positive growth behaviour.
But structure needs correction.

» Platform Comparison Perspective
– You plan using another app.
– Such apps promote self investing.
– Guidance quality is limited.

Ease should not replace planning.

» Direct Platform Reality Check
– Such apps promote direct plans.
– Expense difference looks attractive.
– But hidden costs exist.

Cost is not only expense ratio.
Mistakes cost more.

» Disadvantages Of Direct Plans
– No personalised advice.
– No behaviour guidance during falls.
– No portfolio review support.

Investors act emotionally without guidance.
This hurts returns badly.

» Decision Errors In Direct Investing
– Panic selling during market falls.
– Overconfidence during rallies.
– Frequent fund switching.

These mistakes destroy compounding.
They are very common.

» Lack Of Accountability In Apps
– Apps do not call you.
– Apps do not stop wrong actions.
– Responsibility lies fully on investor.

This is risky for beginners.

» Why Regular Plans Add Value
– Guidance helps discipline.
– Asset allocation stays balanced.
– Behavioural mistakes reduce.

Value is beyond commission.
Support matters during volatility.

» Role Of MFD With CFP Credential
– Certified Financial Planner gives structure.
– Advice aligns with goals.
– Long-term handholding exists.

This improves investment experience.
Returns become smoother.

» Cost Versus Value Perspective
– Direct plans save small percentage.
– Wrong decisions lose big percentages.

Net outcome matters more.
Peace of mind matters too.

» Your Current Portfolio Concentration Risk
– Only one equity category exposure exists.
– Risk is concentrated.
– Diversification is missing.

This increases volatility risk.
Balance is needed urgently.

» Importance Of Diversification
– Different funds behave differently.
– Market cycles impact unevenly.
– Balance reduces shock.

Diversification improves consistency.

» Ideal SIP Structure For Beginners
– One aggressive component.
– One stable growth component.
– One flexible allocation component.

This spreads risk evenly.
Comfort increases automatically.

» Why Avoid Multiple Apps
– Tracking becomes confusing.
– Discipline weakens.
– Reviews become difficult.

One guided platform is better.
Simplicity improves adherence.

» Data Security Perspective
– Apps are regulated.
– Data security standards exist.
– Risk is minimal.

But advice quality remains missing.

» Behaviour During Market Corrections
– Small company funds fall sharply.
– Beginners panic easily.
– SIP stoppage becomes tempting.

Guidance prevents wrong reactions.

» Emotional Support Value
– Markets test patience.
– Fear appears suddenly.
– Someone must guide.

Apps cannot replace humans here.

» Why Starting With Only Small Companies Is Risky
– Volatility is high.
– Returns are uneven.
– Confidence may break early.

Balanced start builds trust.

» Gradual Exposure Approach
– Start with core stability.
– Add aggression slowly.
– Increase risk with experience.

This improves journey comfort.

» SIP Amount Increase Strategy
– Rs 6,000 is fine initially.
– Increase annually with income growth.
– Discipline matters more than amount.

Time creates wealth here.

» Tax Awareness Brief
– Equity funds tax applies on selling.
– Long-term gains have limits.
– Short-term gains are taxed higher.

Holding longer improves efficiency.

» Avoid Frequent Changes
– Switching funds harms compounding.
– Costs increase silently.
– Discipline reduces regret.

Stick to strategy firmly.

» Monitoring Frequency
– Review once a year.
– Avoid monthly checking.
– Noise causes confusion.

Long-term vision matters.

» Avoid Social Media Influence
– Tips are often misleading.
– Past returns are highlighted.
– Risk is hidden.

Structured advice avoids traps.

» Role Of Goal Mapping
– Define why you invest.
– Time horizon matters.
– Risk choice depends on goals.

Without goals, investing feels stressful.

» Emergency Fund Reminder
– Keep emergency money separate.
– Do not mix with SIPs.
– Liquidity is essential.

This prevents SIP stoppage.

» Insurance And Protection Check
– Health cover should be adequate.
– Life cover matters if dependents exist.

Protection supports investment continuity.

» Long-Term Wealth Mindset
– Wealth grows slowly.
– Patience beats intelligence.
– Process beats prediction.

Consistency wins always.

» Common Beginner Mistakes To Avoid
– Chasing last year returns.
– Using too many apps.
– Ignoring allocation balance.

Awareness saves money.

» How A CFP Helps In SIP Planning
– Designs suitable allocation.
– Reviews yearly changes.
– Guides during volatility.

This partnership adds value.

» Confidence Building Perspective
– You already started investing.
– You are learning actively.
– Improvement is natural.

This journey will get smoother.

» Platform Safety Final View
– Bank app is safe.
– App based platforms are safe.
– Investment safety lies with fund house.

Decision quality matters more.

» Final Insights
– Starting SIP is a good step.
– Small company exposure is risky alone.
– Diversification is necessary now.
– Avoid self-direct platforms initially.
– Regular plans with CFP guidance add value.
– Consistency and discipline build wealth.

You are on the right path.
Correct structure will improve outcomes.

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.

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