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Sanjib

Sanjib Jha  | Answer  |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  | 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.   

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Sanjib

Sanjib Jha  | Answer  |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  |6992 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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Ramalingam

Ramalingam Kalirajan  |6992 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Nov 08, 2024

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Sir please review my mutual fund sip portfolio * Axis Mid Cap Fund - Direct Growth = 1000 * ICICI Prudential BHARAT 22 FOF - Direct Plan = 1000 * Mirae Asset Emerging Bluechip Fund - Direct Plan = 1000 * Parag Parikh Flexi Cap Fund - Direct Plan = 1000 * quant Small Cap Fund - Direct Plan Growth = 1000 * SBI Small Cap Fund Direct Growth = 2000 * SBI PSU direct plan growth = 1000 My age is 27 . Looking a long term investment with higher return. Shall I continue this portfolio or any changes required? Kindly give your valuable suggestions . Thank you
Ans: Your portfolio looks well-constructed, with a strong foundation in mid-cap, small-cap, and flexi-cap funds. Each fund you've chosen reflects a strategic approach for growth. Let's evaluate each category and make any necessary suggestions to ensure you achieve the best potential returns over the long term.

Overview of Your Current Portfolio
You’ve diversified well across categories, with each fund serving a unique role. Let’s analyze the strengths and potential improvements in each area of your portfolio.

Mid-Cap Funds
Mid-cap funds, like the one in your portfolio, focus on companies with substantial growth potential but higher risk compared to large-cap companies. Over the long term, these funds often outperform due to their growth-focused nature.

However, consider monitoring this fund periodically. Mid-cap stocks can face higher volatility, which may impact returns if held solely without re-evaluation.

Small-Cap Funds
Small-cap funds are growth-oriented, targeting smaller companies with significant room for expansion. You’ve allocated well to this category, focusing on funds with robust track records.

Due to their volatile nature, however, they can experience sharp swings. A Certified Financial Planner can offer guidance to rebalance if necessary, which could enhance returns and help you avoid undue risk over the long term.

Flexi-Cap Funds
Flexi-cap funds have the flexibility to invest across large, mid, and small-cap companies, making them versatile. This allocation ensures that you have exposure to high-growth stocks while benefiting from the stability of large-cap stocks.

This type of fund aligns well with your long-term goal as it can balance risk across market cycles. Continue with this allocation for stable yet high-growth potential.

Sectoral Funds (Public Sector & PSU Funds)
Sectoral funds focused on PSUs add a thematic angle to your portfolio, providing exposure to government-linked companies. Such funds may perform well during economic growth phases or government-led initiatives but might also experience phases of underperformance.

For long-term investors like you, relying heavily on sectoral funds can add cyclical risk. A diversified equity fund may offer higher long-term growth with less risk than sector-specific investments.

Evaluation of Direct Fund Plans
Sir, investing through direct plans saves on expense ratios, which may seem beneficial at first. However, there are significant drawbacks:

Lack of Advisory Support: Direct plans don't offer professional guidance. Over time, tracking and rebalancing become crucial, and a Certified Financial Planner (CFP) with an MFD (Mutual Fund Distributor) credential ensures optimal management.

Market Cycles and Rebalancing: Without expert oversight, you could miss critical adjustments during volatile market phases, affecting returns. A CFP helps in such rebalancing for better performance.

Tax Implications and Withdrawals: Selling or withdrawing from mutual funds, especially equity funds, incurs tax. Long-term capital gains (LTCG) on equity mutual funds are taxed at 12.5% for gains above Rs 1.25 lakh, while short-term gains (STCG) incur 20%. A regular plan with an MFD provides ongoing tax-efficient strategies.

Opting for regular plans via an MFD with a CFP credential will enable you to maximize returns while accessing insights that make a difference long term.

Suggested Modifications for Higher Returns and Stability
Focus on Balanced Funds Over Sectoral Exposure

To limit risks tied to sectoral funds, consider allocating a portion to balanced or diversified funds. These funds balance equity with stable instruments like debt, reducing volatility and sustaining growth.

Revisit Small and Mid-Cap Allocations

With multiple small-cap and mid-cap funds, consider focusing on one fund in each category. Over-diversification in these can dilute returns and increase tracking requirements. A strategic reallocation could yield more focused, consistent growth.

Consider SIP Step-Up for Long-Term Compounding

An annual SIP step-up, even a small amount, could enhance long-term wealth creation significantly. This adjustment boosts your corpus over time and aligns with your long-term goal of maximizing returns.

Seek Guidance from a Certified Financial Planner

Having a CFP manage your portfolio brings personalized insight into market trends, rebalancing, and tax-efficient strategies. A CFP ensures you capitalize on growth while maintaining balance and tax efficiency.

Key Benefits of Actively Managed Funds Over Index Funds
Sir, I noticed you are not invested in index funds, which is beneficial for your growth objective. Actively managed funds outperform index funds, especially in dynamic market conditions. Here’s why:

Higher Returns Potential: Actively managed funds provide the flexibility to capitalize on changing market opportunities, which index funds lack due to their passive structure.

Adaptive Strategy: Fund managers of actively managed funds adjust to market shifts, providing growth and safety in a fluctuating market.

Downside Protection: During bear markets, actively managed funds can adjust exposure, while index funds simply follow the market downturn. Active management can minimize losses, giving a steadier performance over time.

Final Insights
Sir, you have built a promising portfolio with well-selected funds across categories. A few modifications could ensure a more balanced, growth-oriented, and tax-efficient portfolio. The following adjustments will help you achieve higher returns with sustained stability:

Consider balanced or diversified funds for steadier growth.

Limit mid-cap and small-cap fund overlaps to reduce portfolio complexity.

Use the expertise of a CFP to handle rebalancing, tax efficiency, and market cycle adaptations.

Continue focusing on actively managed funds over index funds, as these provide better long-term value.

Through these steps, you can optimize your portfolio for maximum growth and stability, setting a strong foundation for your long-term investment goals.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

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

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Anu

Anu Krishna  |1287 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 08, 2024

Asked by Anonymous - Nov 07, 2024Hindi
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Relationship
Hi Anu Mam Im 27 yrs old ( married) and 10 yrs old daughter. Im seperated from my husband since 2 yrs due to several reasons like he is drinking and Totally addicted to it. And he is totally dependent and now today also roaming on the roads of some streets of hyd. I belongs to an orthdox family. Now the question is one backward caste man who is married age : 33 he is interested in me and proposed me to a marriage after knowing all my past and saying that he accepts my child too. And the thing is he said a lie to me at first that he is unmarried and even though i had a good impression on him about the way he behaves with me he even treat me in a very polite manner. He says he loves me even though i too had a good impression but the things are the castes and can we both settle down with a marriage can we be happy or he is only trying to convince me to get him a wife to care care of him or only for his parents, he always talks about his own sister and also the office colleagues calls them sister and get emotional about them those who left the office. And he cries a lot which i dont trust on him and the face i see him that was not an real cry that looks like an act which i dont like in him. May he is acting ? Or really loving me, ge cares alot i feel like he is over reacting
Ans: Dear Anonymous,
If you are in doubt, then it's highly likely that he is putting on an act. Go with your intuition and hey hey, you said that he is married and so are you...You do realize that you just can't go ahead and marry while you are already to other people, right?
Focus on what's happening in your life; you obviously have to do something about it...Other relationships can wait!

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

...Read more

Anu

Anu Krishna  |1287 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 08, 2024

Asked by Anonymous - Nov 06, 2024Hindi
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Relationship
Hello Ms Anu, I am a 42yr female..married since 14 yrs and have 10yr old son . I am highly qualified and financially independent. My marriage was a arranged one.. but in these 14 yrs.. I never experienced love or and attachment from my husband's side. He is a family man.. there is no other woman involved..He loves his parents and his two sisters immensely... but always treats me as a option. I feel humiliated and lonely and he has short temper when i talk about this issue... so basically I don't discuss... but that is no solution... I am suffering and unhappy. What should I do?
Ans: Dear Anonymous,
A few married men can be more focused on the women on their side of the family; it becomes easy to express love, care and attention to them as he has grown with them.
A wife happens to be someone that he is yet to understand. It requires effort to make a marriage work; your husband finds it convenient to take the easy way out and 'hang out' with his family.
So, here you take the lead and start. Start not by bringing forth your complaints as this is going to push him further to them which is going to annoy you BUT by inviting him to be with you. A lot of work, I get it...but the bottom line: that's what you want, right?
Plan dates evenings, take short vacations together, work-out together...the key is to establish a connection which never had its chance in the first place...So, give your best shot! Most times actions speak louder than words ever can...

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

...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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