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Leg Fracture Recovery: Covered by Health Insurance After 4 Years?

Ramalingam

Ramalingam Kalirajan  |10872 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 25, 2024

Ramalingam Kalirajan has over 23 years of experience in mutual funds and financial planning.
He has an MBA in finance from the University of Madras and is a certified financial planner.
He is the director and chief financial planner at Holistic Investment, a Chennai-based firm that offers financial planning and wealth management advice.... more
Sudhakar Question by Sudhakar on Jul 14, 2024Hindi
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Before ihave accidentally my leg fracture that no insurence after two years get coved time I have health insurance policy taken now fourth year surgery cover

Ans: Health insurance covers medical expenses. It includes hospital stays, surgeries, and treatments. You need to check the policy details.

Coverage for Pre-existing Conditions
Pre-existing conditions are medical issues you had before getting insurance. These conditions often have a waiting period before coverage starts.

Your Specific Case
You mentioned a leg fracture. Since it's now two years old, check if the policy covers it. Most policies cover pre-existing conditions after a specific waiting period. Since your policy is now in its fourth year, it's likely the surgery will be covered.

Action Steps
Review Your Policy: Check the terms for pre-existing conditions and waiting periods.

Contact Your Insurer: Confirm coverage for your surgery.

Plan for Surgery: Ensure all paperwork and approvals are in order.

Future Considerations
Stay Informed: Keep updated on your policy's terms and conditions.

Regular Health Check-ups: This helps in early detection of health issues.

Emergency Fund: Always have some savings for medical emergencies.

Final Insights
Your health insurance is crucial. Ensure you understand its terms and use it wisely. Stay proactive about your health and insurance details.

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner,

www.holisticinvestment.in
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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Ramalingam

Ramalingam Kalirajan  |10872 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 16, 2024

Asked by Anonymous - Apr 02, 2024Hindi
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i have tata aig insurence can i get money for reservice of hip joint i had been operated for both hip replacemt done 15 yrs back
Ans: The coverage for hip joint replacement surgery under your Tata AIG insurance policy would depend on the specific terms and conditions of your policy. Generally, health insurance policies may cover joint replacement surgeries, including hip replacement, if it is deemed medically necessary.

Here are steps to determine coverage:

Review Policy Document: Check your Tata AIG insurance policy document to understand the coverage details, exclusions, and limitations related to joint replacement surgeries.

Pre-Authorization: Before undergoing the surgery, it's essential to inform the insurance company and obtain pre-authorization for the treatment. This process involves submitting relevant medical documents and getting approval from the insurer.

Claim Submission: After the surgery, submit a claim to Tata AIG along with all the necessary documents, including medical bills, doctor's prescription, hospitalization records, and pre-authorization approval letter.

Policy Coverage: Review the policy's coverage limit, co-payment, deductibles, and any waiting periods related to joint replacement surgeries.

Exclusions: Be aware of any exclusions related to pre-existing conditions, waiting periods, or specific treatments not covered under your policy.

Claim Settlement: Once the claim is submitted, Tata AIG will review the documents and process the claim as per the policy terms. If the surgery is covered under your policy, you may receive reimbursement or cashless treatment as per the policy terms and conditions.

Alternative Coverage: If the joint replacement surgery is not covered under your current policy or the coverage is insufficient, consider exploring additional health insurance options or upgrading your existing policy to include better coverage for such treatments.

It's crucial to read the policy document carefully and consult with Tata AIG customer service or your insurance agent to understand the coverage details and claim process related to hip joint replacement surgery. Remember to keep all the medical records and bills safely for claim submission and reimbursement.

..Read more

Ramalingam

Ramalingam Kalirajan  |10872 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 12, 2024

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my car met an accident with a person 3 month ago. my car had collied with a boy and boy get minor injury. we did not log any police complaint at that time, but call insurance compnay. later i paid expanse of the treatment of the boys injury. i have 3rd party insurance also. now please let me know how can i claim of the treatment expanse from insurance company. if they will pay to the injured person, i am ok to it.
Ans: I’m sorry to hear about the accident and hope the boy is recovering well. It’s great that you took responsibility for his medical expenses. Since you have third-party insurance, you can potentially claim the treatment expenses from your insurance company. Here’s how you can proceed:

Steps to Claim Treatment Expenses from Third-Party Insurance
1. Gather Necessary Documents
Ensure you have all the necessary documents ready, including:

Insurance Policy Details: Your third-party insurance policy
Accident Details: Date, time, and location of the accident.
Medical Bills and Receipts: Copies of all the treatment expenses you paid for the injured boy.
Medical Reports: Any medical reports or discharge summaries from the hospital.
Witness Statements: If possible, get statements from any witnesses of the accident.
2. Inform Your Insurance Company
Contact your insurance company as soon as possible. Provide them with the details of the accident and the treatment expenses incurred. Inform them that you wish to claim these expenses under your third-party insurance.

3. Submit a Claim Form
The insurance company will provide you with a claim form. Fill out the form accurately, providing all necessary details. Attach the gathered documents, including medical bills and reports, with the claim form.

4. Cooperate with the Investigation
The insurance company may conduct an investigation to verify the details of the accident and the incurred expenses. Cooperate with their inquiries and provide any additional information or documents they may request.

5. Follow Up
Keep in regular contact with the insurance company to follow up on your claim status. This will ensure that your claim is processed promptly.

6. Payment to the Injured Person
If the insurance company agrees to cover the expenses, they may pay the amount directly to the injured person or reimburse you for the amount you have already paid. Confirm this with your insurance company and provide the injured person’s contact and bank details if needed.

Points to Remember
Document Everything: Keep copies of all communications with the insurance company, including emails, letters, and phone call records.
Legal Advice: If you face any difficulties in the claim process, consider seeking legal advice to ensure your claim is processed smoothly.
Possible Outcomes
Reimbursement to You: The insurance company reimburses you for the medical expenses you have already paid.
Direct Payment: The insurance company pays the medical expenses directly to the injured person or their family.
By following these steps, you can navigate the claim process with your third-party insurance company and ensure that the medical expenses are covered. Your proactive approach in taking responsibility for the injured boy’s treatment is commendable and should help in facilitating a smooth claim process.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Ramalingam

Ramalingam Kalirajan  |10872 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 25, 2024

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Hi sir good evening hip replacement surgery cover by health insurance plz help me
Ans: Health insurance policies typically cover various medical procedures, including surgeries. Hip replacement surgery is a significant medical procedure, and understanding its coverage under your health insurance is crucial. Let’s break it down.

Coverage for Hip Replacement Surgery
Inclusion in Policies

Major Surgeries: Most comprehensive health insurance plans cover major surgeries, including hip replacement.

Hospitalisation Costs: Covers hospitalisation expenses, including room rent, doctor fees, and nursing charges.

Pre- and Post-Hospitalisation

Medical Tests: Pre-hospitalisation expenses, like diagnostic tests, are often covered.

Follow-Up: Post-hospitalisation expenses, such as follow-up visits and medications, are typically included.

Checking Your Policy
Policy Document

Terms and Conditions: Review your health insurance policy document for specific coverage details.

Exclusions: Look for any exclusions related to hip replacement surgery.

Customer Support

Insurance Provider: Contact your insurance provider’s customer support for clarification.

Detailed Information: Ask for detailed information about coverage limits and conditions.

Additional Considerations
Waiting Periods

Initial Waiting Period: Check if there is an initial waiting period before you can claim for surgeries.

Specific Waiting Period: Some policies may have a specific waiting period for certain surgeries.

Co-Payment Clause

Shared Costs: Some policies have a co-payment clause, where you pay a part of the expenses.

Percentage: Understand the percentage you need to co-pay.

Disadvantages of Index Funds
Lack of Flexibility

Fixed Portfolio: Index funds have a fixed portfolio, limiting flexibility.

Underperformance: They may underperform compared to actively managed funds.

Benefits of Regular Funds
Professional Management

Expertise: Managed by professional fund managers.

Higher Returns: Potential for higher returns compared to direct funds.

Importance of a Certified Financial Planner
Expert Guidance

Personalised Advice: Provides tailored advice based on your specific needs.

Continuous Support: Offers ongoing support and adjustments to your financial plan.

Final Insights
Review Your Policy: Always review your health insurance policy for specific coverage details.

Seek Professional Help: Consider consulting with a certified financial planner for expert guidance.

Stay Informed: Stay informed about your policy terms and conditions to avoid surprises.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Latest Questions
Ramalingam

Ramalingam Kalirajan  |10872 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 06, 2025

Asked by Anonymous - Dec 06, 2025Hindi
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Dear Sir/Ma'am, I need some guidance and advice for continuing my mutual fund investments. I am a 36 year old male, married, no kids yet and no debts/liabilities as such. I have couple of savings in PPF, NPS, Emergency funds and long term investing in direct stocks. I recently started below mentioned SIPs for long term to grow wealth. Request you to review the same and let me know if I should continue with the SIPs or need to rationalize. Kindly also advice on how to invest a lumpsum amount of around 6lacs. invesco small cap 2000 motilal oswal midcap 2700 parag parikh flexicap 3000 HDFC flexicap 3100 ICICI prudential largecap 3100 HDFC large and midcap 3100 HDFC gold etf FOF 2000 ICICI Pru equity and debt fund 3000 HDFC balanced advantage fund 3000 nippon india silver etf FOF 2000
Ans: You already built a solid foundation. Many investors delay planning. But you started early at 36. That gives you a strong advantage. You have no liabilities. You have long term thinking. You also have diversified savings like PPF, NPS, Emergency funds and direct stocks. That shows clarity and discipline. This approach builds wealth with less stress over time.

You also started systematic investments in equity funds. That is a positive step. Your selection covers multiple categories like large cap, mid cap, small cap, flexi cap, hybrid and precious metals. So the intent is right. You are trying to create a broad portfolio. That gives balance.

» Your Portfolio Composition Understanding
Your current SIP list includes:

Small cap

Mid cap

Flexi cap

Large cap

Large and mid cap

Hybrid category

Gold and Silver FoF

Equity and Debt allocation fund

Dynamic hybrid fund

This shows you are trying to cover many segments. But too many categories can create overlap. When there is overlap, you get confusion during review. It also makes portfolio discipline difficult. You may think you are diversified. But the holdings inside may repeat. That reduces efficiency.

Your portfolio now looks like:

Equity dominant

Hybrid for stability

Metals for hedge

So the broad direction is fine. But simplifying helps in long-term habit building.

» Fund Category Duplication
You hold:

Two flexi cap funds

One large and mid cap fund

One pure large cap fund

One mid cap fund

One small cap fund

Flexi cap funds already invest across large, mid, small. Then large and mid also overlaps. So the large cap exposure gets repeated. That may not add extra benefit. But it increases monitoring complexity.

So I suggest rationalising. Keep one fund per category in core. Keep satellite space for only high conviction.

» Core and Satellite Strategy
A structured portfolio follows core and satellite method.

Core portfolio should be:

Simple

Long term

Stable

Satellite portfolio can be:

High growth

Concentrated

Based on your thinking level, you can structure like this:

Core funds:

One large cap

One flexi cap

One hybrid equity and debt fund

One balanced advantage type fund

Satellite funds:

One mid cap

One small cap

One metal allocation if needed

This division gives clarity. You can continue SIPs with review every year. No need to stop and restart often. That reduces behavioural mistakes.

» Your Current SIP List Review with Suggested Streamlining

You can consider continuing:

One flexi cap

One large cap

One mid cap

One small cap

One balanced advantage

One equity and debt hybrid

You may reconsider keeping both flexi caps and both gold silver funds. One of each category is enough. Because too many funds do not increase returns. It complicates tracking.

Precious metal funds should not be more than 5 to 7 percent in your portfolio. This is because metals are hedge assets. They do not create compounding like equity. They act as protection during cycles. So keep them small.

» How to Use the Rs 6 Lakh Lump Sum
You asked about lump sum investing. This is important. Lump sum should not go fully into equity at one time. Markets move in cycles. So use a staggered method. You can invest the lump sum through STP (Systematic Transfer Plan). You can keep the amount in a liquid fund and set STP toward your chosen growth funds over 6 to 12 months.

This reduces timing risk. It also creates discipline. So your Rs 6 lakh can be deployed gradually. You may use 50% towards core equity funds and 30% toward satellite growth category. The remaining 20% can go into hybrid category. This gives balance and comfort.

» Regular Funds Over Direct Funds
One important point many investors miss. Direct funds look cheaper. But they demand deep knowledge, discipline, and behaviour control. Most investors lose more through emotional selling and wrong timing than they save on expense ratio.

With regular funds through a Mutual Fund Distributor with Certified Financial Planner qualification, you get guidance, structure and correction. The advisory discipline protects you during market extremes. That is more valuable than a small saving in expense ratio.

A personalised planner also tracks portfolio drift, rebalancing need and category shifts. So regular fund investing gives long-term benefit and behaviour coaching.

» Actively Managed Funds over Index or ETF
Some investors choose index funds or ETF thinking they are simple and cheap. But they ignore drawbacks.

Index funds or ETF will not avoid weak companies in the index. They will invest whether the company grows or struggles. There is no fund manager decision making. So when markets are at peak, index funds continue aggressive exposure. In downturns also they fall fully. There is no cushion.

Actively managed funds work with research teams. They can avoid bad sectors. They can shift allocation based on market and economy. Over long term, this gives better alpha and stability. So continuing with actively managed funds creates better wealth compounding.

» SIP Continuation Strategy
Once the rationalisation is done, continue SIPs every month without interruption. Pause and restart behaviour damages compounding power. SIP works best when you go through all market cycles. You benefit more during corrections because cost averaging works.

So continue SIP amount. You can also review SIP increase every year based on income. Increasing SIP by 10 to 15 percent every year helps you reach large corpus faster.

» Asset Allocation Based Approach
One key point in wealth creation is having the right asset mix. Equity gives growth. Hybrid gives balance. Metals give hedge. Debt gives safety. Your asset allocation should stay aligned to your risk profile and time horizon.

Since you are young and have long term horizon, higher equity allocation is fine. But as time moves, rebalancing is important. Rebalancing protects gains and restores allocation.

So review your asset allocation every year or during major life events like child birth, home buying or retirement planning.

» Behaviour Management
Many portfolios fail not due to bad funds. They fail due to bad decisions. Selling during correction. Stopping SIP when market falls. Chasing past return performance. These mistakes reduce wealth.

Your discipline so far is good. Continue to stay patient during volatility. Equity rewards patience and time.

» Financial Goals Clarity
Since you have no children now, you can decide your long-term goals. Typical goals may include:

Retirement

Future child education

Dream lifestyle purchase

Health care reserves

When goals are clear, investment purpose becomes stronger. So you can map each fund category to goal horizon. Short-term goals should not use equity. Long-term goals should use equity with hybrid support.

» Role of Review and Monitoring
Review once in a year is enough. Frequent review can create anxiety. Annual review helps check:

Fund performance

Expense drift

Category relevance

Allocation balance

Then adjust only if needed. This progress helps you stay confident and aligned.

» Taxation Awareness
Equity mutual funds taxation rules are:

Short term (below one year holding) taxable at 20 percent

Long term (above one year holding) gains above Rs 1.25 lakh taxable at 12.5 percent

Debt mutual funds are taxed as per your income slab.

So always hold equity funds for long term. That reduces tax impact and gives better growth.

» SIP Increase Plan
You can create a simple plan to increase SIP over time. For example:

Increase SIP at every salary increment

Increase SIP during bonus time

Use rewards or extra income for investing

This habit accelerates wealth. So by the time you reach 45 to 50 years, your investments could reach a strong level.

» Insurance and Protection
Before investing large, ensure you have term insurance and health insurance. If not already done, it is important. Insurance protects wealth. Without insurance, even a small medical event can impact investment plan. So review this part also. Since you are married, cover both.

» Wealth Behaviour Mindset
You are already disciplined. Just keep these simple principles:

Invest without stopping

Review once a year

Avoid funds overlap

Follow asset allocation

Avoid reacting to media noise

This helps you reach long term milestones.

» Finally
You are on the right track. Only fine tuning and simplification is needed. Your discipline is visible. Your portfolio will grow well with structure, patience and periodic review. Use the Rs 6 lakh with STP approach. And continue SIP with rationalised categories.

With time and consistency, wealth creation becomes effortless and peaceful. You just need to stay committed and avoid overthinking during market movements.

Best Regards,
K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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

...Read more

Dr Dipankar

Dr Dipankar Dutta  |1837 Answers  |Ask -

Tech Careers and Skill Development Expert - Answered on Dec 05, 2025

Career
Dear Sir, I did my BTech from a normal engineering college not very famous. The teaching was not great and hence i did not study well. I tried my best to learn coding including all the technologies like html,css,javascript,react js,dba,php because i wanted to be a web developer But nothing seem to enter my head except html and css. I don't understand a language which has more complexities. Is it because of my lack of experience or not devoting enough time. I am not sure. I did many courses online and tried to do diplomas also abroad which i passed somehow. I recently joined android development course because i like apps but the teaching was so fast that i could not memorize anything. There was no time to even take notes down. During the course i did assignments and understood the code because i have to pass but after the course is over i tend to forget everything. I attempted a lot of interviews. Some of them i even got but could not perform well so they let me go. Now due to the AI booming and job markets in a bad shape i am re-thinking whether to keep studying or whether its just time waste. Since 3 years i am doing labour type of jobs which does not yield anything to me for survival and to pay my expenses. I have the quest to learn everything but as soon as i sit in front of the computer i listen to music or read something else. What should i do to stay more focused? What should i do to make myself believe confident. Is there still scope of IT in todays world? Kindly advise.
Ans: Your story does not show failure.
It shows persistence, effort, and desire to improve.

Most people give up.
You didn’t.
That means you will succeed — but with the right method, not the old one.

...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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