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Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Dec 22, 2022

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
Anand Question by Anand on Dec 22, 2022Hindi
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Dear Sir, recently I was admitted to Manipal hospital. As I am suffering from ESRD my transplanted kidney also not working properly after 7yrs. I planned for to go for peritoneal dialysis. So it involves PD catheter insertion in abdomen through surgery. I was in hospital for 3 days. As I was having Bajaj Allianz health guard policy I claimed for cashless claim on 16 the Nov ‘22 got discharged on 19the Nov. As there is no proper response from the company I paid by cash 210000/- got discharged and till today 24the Nov they haven't given final approval. Kindly request you to suggest me in this matter.

Ans: Hi Anand, very sorry to hear about your plight. Seeing that you are not getting any response from the insurer, my advice would be that you approach ombudsmen and register your complaint. You need to email them at complaints@irdai.gov.in with your query along with all the documents of your case.

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  |66 Answers  |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.   

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Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - 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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Ramalingam

Ramalingam Kalirajan  |7742 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 2024

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My father is 89 years old and has recurring abdominal pain from last few months. In Apr'23 he was admitted in one private hospital at our locality and admitted for 7 days due to the pain issue. Various tests were conducted including blood tests, CT scan, fibroscopy and endoscopy, no major issues observed except some liver irregularities and discharged after providing certain oral medication. The cashless benefits are obtained through corporate TPA (EWA). However after certain weeks intermittently severe pain recur for almost a week and this time, on first week of July, my father was taken to Kolkata at a hospital specific to liver and digestive treatment. As advised by doctor he was admitted and again various tests are conducted including blood and stool culture, LFT, CT scan and colonoscopy..But this time also no major issues observed and he was discharged after certain medications, which differs from earlier hospital medicines. But this time claim is denied by TPA (EWA) stating that the admission is done only for investigation and observations and no line of treatment was done.. although new medicines are prescribed in the discharge summary and along with that IV fluid and some other medicines were regularly given during his stay in hospital. As TPA has denied the claim, I have to pay the entire amount in spite of paying a hefty amount of premium for my father. Can you pls suggest, why the claim is denied and whether there is any possibility of reimbursement of the claim by any means?
Ans: I'm sorry to hear about your father's health issues and the challenges you're facing with the insurance claim. The denial of the claim by the TPA (Third Party Administrator) could be due to several reasons, including discrepancies in documentation, interpretation of policy terms, or classification of the treatment as investigational rather than therapeutic.

To address this issue and explore the possibility of reimbursement, here are some steps you can take:

Review Policy Documents: Carefully review the terms and conditions of your father's health insurance policy to understand the coverage and exclusions. Pay attention to the criteria for claim eligibility and the definition of covered treatments.

Seek Clarification: Contact the TPA or the insurance provider to seek clarification on why the claim was denied. Request detailed information on the specific reasons for denial and ask for clarification on any policy terms that are unclear.

Gather Documentation: Gather all relevant medical records, including discharge summaries, prescription details, invoices, and receipts for medications and treatments provided during the hospital stay. Ensure that the documentation clearly demonstrates the medical necessity and therapeutic nature of the treatment received.

Appeal the Decision: If you believe that the denial was incorrect or unjustified, consider filing an appeal with the insurance company. Provide supporting documentation and any additional information that may strengthen your case for claim reimbursement. Follow the appeal process outlined by the insurance provider and submit the appeal within the specified timeframe.

Consult an Expert: If necessary, consider seeking assistance from a healthcare advocate or insurance specialist who can help navigate the appeals process and advocate on your behalf. They may offer valuable insights and assistance in presenting your case effectively.

Explore Legal Options: If all attempts to resolve the issue through the appeals process are unsuccessful, you may consider seeking legal advice to explore further options, such as mediation or legal action, to resolve the dispute.

It's important to remain persistent and proactive in pursuing reimbursement for legitimate medical expenses. Keep thorough records of all communications and documentation related to the claim, and continue to advocate for your father's rights as a policyholder.

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Ravi

Ravi Mittal  |518 Answers  |Ask -

Dating, Relationships Expert - Answered on Jan 31, 2025

Asked by Anonymous - Jan 22, 2025Hindi
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Relationship
I’m 36M, I met a girl in my office, who works in the same department. It was love at first site for me, but I was scared to tell her that. As time passed, I used to strike some casual conversations with her or her team to connect with her and there were some clear signs that she liked me, for example, she would call me or text me why I’m not talking to her if I didn’t message her for some time (a week) or she would ask me if I was coming to office as we were working Hybrid if not she would also not come to office. But she always refused to come out with me for a movie or date/meet saying she had a very strict family and cannot come out other than office. I used to think that this was a real thing. But all this went on until her birthday arrived. I got some gift to give her on her birthday only to know that she suddenly stopped talking to me, no replies to my messages, calls or anything. At first, I was bit concerned if there was any problem or if she was in any trouble. But little did I know it was not the case at this time. After few (many) attempts trying to reach her. I though maybe she could be busy or something and I understood may be if I did not disturb her, she might call back. Time went on I again met her after 4 or 5 months in Office with no contact. By this time, I had already realised there was something wrong and she had already lost interest in me. But still I felt like I wanted to have a closure on this and I went on and gave the gift and proposed her, that is when she told me that she was in a relationship with some other person for 4 years. This blew my mind to pieces, as I was thinking why would someone shows any sort of interest on someone when they are already in relationship with some other person. I tried to move away from her after this incident, but fate we still are working in the same department and that I have to see her more often than not. I still have strong feelings for her, but I cannot show this to her and worst act normal. Whenever I see her, I want to talk to her and If I talk to her, I fall for her again and again. But she is happy and casual about all this as if there was not casualty in whole of this thing. Even now she asks me if I’m coming to office so that she could meet me. So, through all this, I have some questions 1. Why does a women show any sort of Interest on someone else when she is already in a relationship, so she can use me as a options and throw away when done 2. How do I move on, as I did not love her for some superficial features, rather I really liked her character, and that is the worst as I feel like I’ll never be able to find anyone like her in my life. Feeling down for a long time now. I’m already 36, feels like all the doors have closed for me.
Ans: Dear Anonymous,
I understand that you are hurt and upset, and rightfully so. You thought she liked you but turns out, she is with someone else. It's a good enough ground to be upset. But I want you to understand one thing- you thought; she never gave you verbal confirmation. You assumed it all. So to answer your first question- all of her interest in you might have been friendly. It is difficult for me to say it with confidence because I have not seen any of this while it happened; I am only hearing your version of it. But my guess is that she thought of you as a friend or maybe, for a while there, she might have had feelings for you, but then realized that she was committed and pulled herself back. Again, all of these are my assumptions. We do not know the truth. Only she does. The next time, whenever you think someone likes you, get verbal confirmation before you act on it.

I understand that whether she showed friendly interest and you mistook it for romantic interest or she actually showed romantic interest and ghosted you, your pain remains the same because everything was real and romantic from your end. I suggest that you focus on yourself. It's unfortunate that you have to see her every day, but so be it. Take it one day at a time. Stick with your friends in your office. Find some hobby that makes you happy and when you are ready to move on, be open to finding love. I understand that this experience was bad, but it won't be the same way every time.

Best wishes.

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Ravi

Ravi Mittal  |518 Answers  |Ask -

Dating, Relationships Expert - Answered on Jan 31, 2025

Asked by Anonymous - Jan 25, 2025
Relationship
Hi..., I feel in love with a muslim girl. I wasn't planned, it just happened I love her exactly the way she is, unconditionally, deeply, endlessly. For the last six years, Six years of loving her without expecting anything in return, without asking for anything but the chance to admire her from a distance. Every smile, every word, every little thing about her has been etched into my heart like poetry. I never saw her religion or background—only her beautiful soul. My love for her has always been pure, unconditional, and endless. It’s not about possessing her, it’s about cherishing her, even if it means keeping my feelings hidden all this time. But six years is a long time, and my heart is heavy with this love that I’ve kept inside. Should I finally tell her what I feel? Should I risk everything to let her know how much she means to me, even if it changes everything? Love knows no boundaries, no religion, no rules—it just is. But society doesn’t think the same way. What would you do if you were in my place? After six years of love, how do you decide what’s right for the person you love?
Ans: Dear Anonymous,
It does not matter what anyone else would do in your place or what society thinks. All that matters is what you think and want to do. If you have genuine feelings for her, what's stopping you from expressing them to her? If you don't tell her, how would you know if everything is going to change for the good or bad? Do as your heart wants. After all, you are not harming anyone.

Best wishes.

...Read more

Ramalingam

Ramalingam Kalirajan  |7742 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 31, 2025

Asked by Anonymous - Jan 31, 2025Hindi
Money
Hello Sir, I am a 36 years old man, father of 2 (5y & 2y), Our income is 40Lacs pa post tax addition to that we have a rental income of 50K pm, our monthly expense is around 40K which is taken care by rents. Doing a SIP of 2.5 lac with total investment of 28L , have a RD of 25 L, ULIP -10L, Gold- 50L, I want to be financially independent in next 10 years. No loan , no credit cards., Has a medical policy of 25L. Emergency fund of 10L. Please advice how i can achieve financial independence in next 10 years.
Ans: 1. Understanding Your Financial Position
You are 36 years old with a goal of financial independence in 10 years.

Your annual post-tax income is Rs 40 lakh, with an additional rental income of Rs 50,000 per month.

Your monthly expenses are Rs 40,000, which are fully covered by rental income.

Your current investments include:

Rs 2.5 lakh SIP per month
Rs 28 lakh in mutual funds
Rs 25 lakh in RD
Rs 10 lakh in ULIP
Rs 50 lakh in gold
Rs 10 lakh emergency fund
You have no loans or credit cards, which is a strong financial position.

Your health insurance is Rs 25 lakh, which is good but may need a review later.

2. Defining Financial Independence
Financial independence means having passive income that covers all expenses.

You need enough wealth to generate returns that sustain your lifestyle.

Your target should be to build a portfolio that provides stable income after 10 years.

3. Optimising Your Current Investments
Mutual Funds – Increase Allocation
Your Rs 2.5 lakh SIP is excellent, but it needs active management.

Actively managed funds provide better returns than index funds.

Direct mutual funds lack professional management. Investing through an MFD with CFP credential helps maximise returns.

Maintain a mix of large-cap, mid-cap, and hybrid funds for stability and growth.

Recurring Deposit (RD) – Shift to Growth Assets
Rs 25 lakh in RD earns lower returns compared to equity.

Consider shifting RD funds gradually into mutual funds for better compounding.

Keep only a portion in fixed-income instruments for stability.

ULIP – Consider Surrendering
ULIPs mix insurance with investment, which reduces returns.

Surrendering and reinvesting in mutual funds can improve returns significantly.

Keep insurance separate from investments for better wealth creation.

Gold – Maintain a Balanced Allocation
Rs 50 lakh in gold is a significant portion of your portfolio.

Gold is good for diversification but does not generate passive income.

Consider reducing gold exposure and reallocating to growth-oriented assets.

4. Asset Allocation for Financial Independence
A well-diversified portfolio ensures long-term stability and wealth growth.

Your asset allocation can be:

60% in equity mutual funds
20% in debt funds and bonds
10% in gold and other assets
10% in liquid funds for short-term needs
Adjust allocation every year based on market performance.

5. Passive Income Strategy
Your goal is to generate passive income through investments.

SIPs will build a strong equity base over the next 10 years.

A mix of mutual funds and debt instruments will provide steady cash flow.

Rental income already covers monthly expenses, which is an advantage.

After 10 years, your investments should generate returns covering all financial needs.

6. Emergency Fund and Insurance Review
Emergency Fund
Your Rs 10 lakh emergency fund is good.

Keep this amount in liquid funds or fixed deposits for easy access.

Maintain at least six months of expenses as a backup.

Health Insurance
Your Rs 25 lakh health cover is decent, but medical costs rise over time.

Consider increasing coverage to Rs 50 lakh if affordable.

Ensure it covers critical illness and long-term care needs.

7. Retirement and Children’s Education Planning
Retirement Planning
Financial independence should include a secure retirement plan.

Your investments will continue growing even after achieving independence.

Keep investing to ensure financial security beyond the next 10 years.

Children’s Education
Education costs will rise significantly over time.

Start a dedicated investment plan for your children’s higher education.

Equity mutual funds with a long-term horizon will help meet this goal.

8. Tax Efficiency and Wealth Preservation
Efficient tax planning ensures you maximise post-tax returns.

Long-term capital gains tax is lower on equity investments.


Regularly review your tax liability to optimise investment returns.

9. Monitoring and Adjusting the Plan
Review your portfolio every six months.

Rebalance investments if market conditions change.

Keep track of financial independence progress based on wealth accumulation.

10. Final Insights
Your financial position is strong, and your goal is achievable.

Shifting from low-return assets to equity will help in long-term wealth creation.

Active management of investments will ensure better returns and financial security.

Keep insurance separate from investments to avoid lower returns.

A disciplined approach to investing and spending will lead to financial independence.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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

...Read more

Harsh

Harsh Bharwani  |73 Answers  |Ask -

Entrepreneurship Expert - Answered on Jan 31, 2025

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Career
Hi what business can I start with 20000rs?
Ans: Hello Mr. Anuj,
Starting a business in India with a budget of ?20,000 is entirely possible with strategic planning, local market research, and minimal infrastructure. Whether you prefer a home-based model, freelancing, or product-based business, several viable options can generate steady income. Here’s a detailed guide to ten promising business ideas tailored for the Indian market.

Online Reselling via Dropshipping
Dropshipping allows you to sell products without holding inventory. Popular categories include eco-friendly products, ethnic jewellery, and mobile accessories. Profit margins range from 30–50%, but success depends on social media marketing and supplier reliability.

Freelancing Services
If you have skills in content writing, graphic design, or video editing, freelancing can be a lucrative option. A laptop and internet connection are the only real requirements. Building a strong online presence on LinkedIn or Fiverr can help secure consistent clients.

Home Tutoring/Coaching
With increasing competition in academics, home tutoring is a stable business. Charging ?1,000–2,000 per student per month ensures recurring income. The demand peaks during exam seasons, making it a great long-term option.

Event Decoration
Event decoration, especially in Tier-2 and Tier-3 cities, is a creative and profitable business. Specializing in birthday parties, anniversaries, and wedding decor can help build a niche. However, the business is seasonal.

Customized Printing
Selling custom-printed T-shirts, mugs, and gifts online is a trendy business. With social media marketing, you can attract college students and young professionals who love personalized products. However, printer maintenance costs should be considered.

Key Tips for Success
Legal Compliance: Register as a sole proprietorship for hassle-free operations.
Smart Marketing: Use WhatsApp Business, Instagram Reels, and Google My Business for cost-effective promotions.
Cost Control: Rent equipment (e.g., cloud kitchens) instead of buying to minimize overheads.
Customer Feedback: Focus on refining offerings based on customer preferences.
Start Small, Scale Later: Test your business model before making large investments.
With careful planning, minimal investment, and the right strategy, starting a business with ?20,000 in India is not only possible but also profitable. Choose a business aligned with your skills and local market demand, and take the first step toward entrepreneurship today!

...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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