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Rakesh

Rakesh Kaul  | Answer  |Ask -

Answered on Jan 18, 2022

Ganesh Question by Ganesh on Jan 18, 2022Hindi
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 I have family floater policy since 5 years with Apollo Munich, Which is changed now to HDFC Ergo. I am paying approximately 36000 for 2 +1 family, I am aged now 62 years.

I am not getting proper service from the person from whom i took the Apollo policy he is called Intermediator in the Apollo company and when it’s changed to HDFC his Records (like his name Mob Number and his Code) are not shown in the policy. In the absence of the above details, I don’t know whom to contact for any information and follow up for claim reimbursements.

In the past years, with Apollo and HDFC Ergo my reimbursement claims was not settled ON TIME as well as the full amount not settled, approximately 50 to 60 percentage only settled even after many follow ups, courier and emails. Though the claims were around 50000 only.

I am the bread winner in my family, after paying so much for Premium, if I get admitted in hospital, the family members can’t do follow up and intermediary is not helpful, even he doesn’t bother to attend phone call, though he is substantially earning 15% premium as his commission (I hope) in such scenarios I am fearing that you won’t get help.

What is your advise? Should I change the intermediary in the policy, if there is provision in system? Why in HDFC Ergo why those intermediary details not there or portability is another option and what are conditions to meet portability at the ripe age/ financial scenario I should not be denied cashless facility/ at the need of my HOUR.

Ans:  The intermediary can be changed in the policy by the Insurer upon a request by the customer. However, for claims assistance, I would advise you to connect with your Insurer’s customer service team to get a response swiftly.

Portability of a policy can be done at any age but there are certain guidelines that differ from insurer to insurer. It is advisable to get the complete details of the insurance company you wish to port to and thoroughly understand the portability/ continuity benefits which will be carried forward in your ported policy. Please ensure you check the product/ plan coverages offered and compare it with the existing policy before making your decision to port.

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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Roopam

Roopam Asthana  | Answer  |Ask -

Answered on Aug 03, 2021

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I have United India health insurance since 2009. I have paid a regular premium with only one claim for hysterectomy in 2012. My renewal date is 12/8/2021. I want to port my UIIC insurance. I have sent a proposal form to HDFC Ergo online for porting with my 2 months back medical test details so that I can get the exact loading amount if any. I am taking medication for hypothyroidism, hypertension and cholesterol at the moment, very minimum dosage. I have sent those details too. According to them the procedure is to pay a premium then you will receive a consent call which will decide about medical test requirements and loading amount if any. For any reason, if we want to discontinue, they will refund the full amount paid by us. This procedure of porting is not mentioned clearly on the website so all are non-proof. My query is: How much I should trust them? I was interested in family floater with my husband, who doesn't have any diseases at present. This is a new policy for him. So no loading for him for sure. HDFC ERGO advisor is suggesting me to go for individual policy as floater has more chance of rejection than individual policy for both of us. So my second query is: Will loading be charged according to floater premium which is almost double than the individual policy? My husband’s new policy without any diseases and mine is porting with pre-existing diseases. Please advise whether individual or floater is better for us with reasons. Seeking your help as soon as possible.
Ans: For your first query it is advisable to speak with the insurance company you wish to port to for understanding the exact procedure for porting. You may also wish to engage a trusted insurance agent to help you with the porting process as they will be fully abreast with the procedure and will guide you well.

Remember to ensure that you fully disclose your existing medical condition at the time of application itself.

As regards your second query it is advisable to go for separate individual policy for your husband because basis your current health status there are high chances of the insurance company charging higher premium for a floater.

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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  |7029 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 02, 2024

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Hello sir ,my huband has taken medical insurance frm manipal cigna frm 2015 till date never claimed anything all these years but last year july suddenly my husband got pneumonia he got hospitalized before joining inthe hospital we consulted the insurance agent and took necessary file number to claim insurance but sadly at the end insurance company rejected to pay bill saying(2.5lks) he used to pay 58 thosand per year family floater,now thy have canceled whole policy and thy didn't even paying the amt we paid all these years ,agent is not responding can we do anything to get our hard-earned money back now we dont have any medical insurance he is 57yrs now pls suggest anything we can do
Ans: I'm truly sorry to hear about your husband's health complications and the subsequent challenges with your medical insurance. Facing such situations can be distressing, especially when dealing with unexpected denials and cancellations. It's important to take action to address this issue.

Firstly, gather all relevant documents, including policy details, correspondence with the insurance company, and any communication with the agent. This documentation will be crucial in understanding the reasons for the denial and in any potential appeals or legal actions.

Next, consider reaching out directly to the insurance company to request a review of the decision and clarification on why the claim was rejected. If you're unsatisfied with their response, you may escalate the matter through their grievance redressal mechanism or regulatory authorities.

Additionally, seeking legal advice from a lawyer who specializes in insurance matters could provide insight into your rights and options for recourse. They can help you navigate the complex legal landscape and pursue appropriate action to recover your hard-earned money.

While the situation is undoubtedly challenging, remember that you're not alone. Reach out to consumer rights organizations or advocacy groups that may offer support and guidance in dealing with insurance-related issues. Your perseverance and determination to seek justice are commendable, and I hope you find a resolution that provides the relief and security you deserve.

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Milind

Milind Vadjikar  |649 Answers  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on Sep 09, 2024

Asked by Anonymous - Sep 09, 2024Hindi
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Hello Team, I have clarification w.r.t Insurance and please find my details below 12-Jul-2023: Second Child born 10-Aug-2023: Floater Policy(2 Adults and 1 Child) took as suggested by Agent with 3 years Premium Second child cannot be added due to minimum eligibility days Agent recommended to add 2nd child after 60days and difference premium to be paid After 90 days (not sure about the date): Tried to add 2nd child to the policy through agent but it was not able to done Agent suggested that "We can add it in next year (i.e during Start of August 2024) 10-Aug-2024: When checked with Star health, they said that "Addition/deletion can be done at 2026" and said that "Addition of child should be done through mail after 91 days and website will not support to add a child" and when I asked the document reference for the same and no response yet from Star Health Current Policy holding: Corporate Insurane : SI (3L) for 2 Adults and 2 Childs Personal Insurance : SI (25L) for 2 Adults and 1 Child Star Health Suggestion: Take a separate policy for 2nd Child for 5L and it can be added to existing policy in 2026. Please let me know how to proceed further 1. Whether the Separate policy can be taken here or wait until 2026, to add the 2nd child 2. Whether the Star Health was really worth or can I consider for porting in 2026 due to disappointment with above issue Thank you in advance!
Ans: I suggest you go ahead with the separate health policy for the new child as of now. Going further if you still find their service quality level poor you can decide about porting suitably.

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Latest Questions
Milind

Milind Vadjikar  |649 Answers  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on Nov 17, 2024

Milind

Milind Vadjikar  |649 Answers  |Ask -

Insurance, Stocks, MF, PF Expert - Answered on Nov 17, 2024

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Dear Sir, I am 53 yrs. I want to retire @60 with a INR 2.00 Cr Corps. Currently I have following SIP Total SIP 30000/- PM Axis Bluechip Fund - Regular Plan - Growth HDFC Mid-Cap Opportunities Fund - Growth Plan Aditya Birla Sun Life Pure Value Fund - Growth Option Aditya Birla Sun Life Equity Advantage Fund - Regular Growth Sundaram Mid Cap Fund Regular Plan - Growth Bajaj Finserv Flexi Cap Fund -Regular Plan-Growth Franklin India Focused Equity Fund - Growth Plan Franklin India Smaller Companies Fund-Growth HDFC Top 100 Fund - Growth Option HDFC Multi Cap Fund - Growth Option I have MF Investment @ 26.00 Lakh Current Value is @ 52.00 Lakh. I have Savings of Rs. 10.00 Lakh, PPF Rs. 5.00 Lakh, Share investment Current Market Value around Rs. 20.00 Lakhs. I don't have any Loan. Insurance INR 1.50 Cr. up age of 70. Per month earning around Rs. 1.25 Lakh. I have a Investment in real estate which can give my INR 40.00 Lakh at current Market Price & Gold Investment of INR 20.00 Lakh which I think sufficient for my daughter Marriage. Current Monthly Expense INR 40-50 K. I am in a new tax regime, so discontinue my ELSS saving and PPF Saving. Suggest how i can increase my Corpus for retirement.
Ans: Hello;

You may top-up your monthly sip by 10% every year for 7 years. This will grow into a sum of around 0.51 Cr.

The MF corpus and direct equity holdings worth 0.72 Cr today will grow into a corpus of 1.59 Cr after 7 years.

Therefore you may achieve your intended corpus of 1.59+ 0.51=2.1 Cr, 7 years from now. A modest return of 12% is assumed from MF and direct equity holdings.

2-3 years before 60 you should start moving your gains from equity funds to liquid or ultra short duration debt funds to protect it against market volatility.

Also good health care insurance for yourself and your spouse.

RE property you may sell at a later date to boost your retirement income.

Happy Investing;
X: @mars_invest

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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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