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

Ramalingam

Ramalingam Kalirajan  |7550 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  |7550 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.

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Ramalingam

Ramalingam Kalirajan  |7550 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  |7550 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  |7550 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 19, 2025

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Hello Sir. I have Rs1,00,000 that I want to invest as a lump sum in SBI Mutual Funds for the long term (15+ years). Considering that SBI has one of the largest Asset Management Companies (AMCs), could you please recommend which SBI Mutual Funds would be suitable for such an investment and have the potential to deliver good returns over this period? I am doing this investment for my daughter's education.
Ans: Your decision to invest Rs 1,00,000 for your daughter's education is commendable. A long-term horizon of 15+ years offers significant growth potential through mutual funds. Below are insights and recommendations to guide your investment.

Why SBI Mutual Funds?

SBI is one of India’s largest and most trusted AMCs.

They offer a wide range of funds suitable for different goals and risk levels.

Their consistent performance track record reflects sound fund management.

Key Factors to Consider for Long-Term Investments

Investment Objective:

Education is a critical financial goal.

Focus on wealth accumulation through equity-oriented funds.

Risk Appetite:

Equity funds involve volatility but offer high growth.

Ensure alignment with your risk tolerance.

Fund Type Selection:

Choose funds based on asset allocation and diversification.

Evaluate the performance of large-cap, mid-cap, and hybrid funds.

Tax Implications:

LTCG over Rs 1.25 lakh is taxed at 12.5%.

Understand taxation for equity and debt funds.

Suggested Fund Categories for Your Investment

1. Large-Cap Funds

Invest in funds focusing on well-established companies.

They offer stability and moderate risk.

Suitable for conservative investors.

2. Mid-Cap Funds

These funds focus on medium-sized companies with high growth potential.

They are riskier than large-cap funds but offer higher returns.

Suitable for investors willing to take calculated risks.

3. Flexi-Cap Funds

Invest across large, mid, and small-cap companies.

They offer diversification and the flexibility to adapt to market conditions.

Ideal for investors seeking balanced growth.

4. Equity-Linked Savings Schemes (ELSS)

ELSS funds offer tax benefits under Section 80C.

They have a lock-in period of three years.

Suitable for investors aiming for tax-efficient long-term growth.

5. Hybrid Funds

Invest in a mix of equity and debt instruments.

They offer stability through debt and growth through equity.

Suitable for moderate-risk investors.

Benefits of Investing Through a Certified Financial Planner (CFP)

CFPs offer expert guidance tailored to your goals.

They help monitor fund performance regularly.

They ensure optimal fund selection and rebalancing.

Regular plans through CFPs provide dedicated service and support.

Why Choose Actively Managed Funds?

Active funds aim to outperform benchmarks through expert fund management.

They offer higher potential returns compared to index funds.

Fund managers actively adjust portfolios based on market trends.

Ideal for long-term investors seeking growth.

Key Steps to Start Your Investment

Define your financial goal clearly.

Consult with a CFP for fund selection.

Review the chosen fund’s historical performance and portfolio composition.

Use SIPs for additional investments to benefit from rupee cost averaging.

Monitor your portfolio periodically to ensure alignment with your goals.

Final Insights

Investing in SBI Mutual Funds is a smart choice for your daughter’s education. Selecting the right fund category ensures growth and stability over 15+ years. Partnering with a Certified Financial Planner ensures professional guidance and optimal returns. Stay committed to your goal, review your investments regularly, and focus on long-term growth.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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

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Ramalingam

Ramalingam Kalirajan  |7550 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 19, 2025

Asked by Anonymous - Jan 19, 2025Hindi
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I am an NRI with an NRO trading account through Zerodha, but I cannot trade in F&O and Intraday. I have been filing my returns consistently though I have had no income in India in the last 10 years. But I have investments in MF, PPF, NPS, Medical and Life Insurances, ULIPs which were initiated while working in India and had tax saving options and it is being continued. I would like to trade in F&O and Intraday. My wife is not employed till date and has a regular savings account with the Bank which is Resident Indian normal account. She has never filed any IT returns since as there was no income and transactions from my side were only for family maintenance. My question is, can I open a regular trading account in her name so that we can do trading in F&O and Intraday? What are the necessary things which I need to follow for filing IT returns and how my investments can be helpful to file returns through her account. She doesn't have any investments except LIC & Health Insurance policies in her name for which I pay from myside.
Ans: Yes, you can open a trading account in your wife's name to trade in F&O and intraday; however, there are a few important considerations:

Steps to Open a Trading Account:
Convert Savings Account to a Trading-Compatible Account: Ensure her existing bank account supports trading transactions. If not, convert it to a trading-compatible savings account.
KYC Compliance: Complete her KYC process with updated details, including PAN, Aadhaar, and a valid address proof.
Link Demat and Trading Account: Open a Demat and trading account in her name with a broker that supports F&O and intraday trading for resident individuals.
Nominate a Separate Source of Funds: Ensure the funds transferred to her account are not directly linked to your NRI account to avoid legal and taxation issues.
Tax Implications:
Income from Trading: Any income generated from trading in her account will be considered her income. Since she has no other sources of income, her income from trading may be taxed as per the slab rate applicable to her.
Gift Declarations: Funds transferred to her account can be considered a gift. Gifts from a spouse are exempt from tax, but the income generated (through trading) will be clubbed with your income under Section 64 of the Income Tax Act.
Filing IT Returns:
She will need to file her own ITR if her total income (including trading profits) exceeds the taxable limit (Rs. 2.5 lakhs for individuals below 60).
Any clubbed income will still require an ITR to declare the source and details.
Investments for IT Filing:
Investments in her name (e.g., LIC and health insurance) can help:

Claim deductions under Section 80C for LIC premiums.
Claim deductions under Section 80D for health insurance premiums.
Alternative Suggestions:
Joint Investments: Instead of opening an account in her name, consider using investments in her name (LIC, insurance, etc.) to improve her financial standing without additional compliance.
Professional Advice: Engage a CA familiar with NRI taxation and clubbing provisions to ensure full compliance and proper structuring.
If you'd like detailed help with tax planning, compliance, or investment strategies, let me know!

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner

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

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Kanchan

Kanchan Rai  |496 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Jan 19, 2025

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hi sir im in a relationship with a guy who i met in hyd we have been together since one year he is a hindu nd im a christian we both love eachother and wanna marry but my parents r against it bcoz he comes from a hindu family and they r forcing me to get married to a christian guy i love him i never got love from my parents when he is giving me the love i want my parents have seperated me from him im not able to understand what to do plz help
Ans: Dear Niveditha,
It’s important to start by having an open and honest conversation with your parents. Try to understand their concerns and share your feelings with them. Express how much this relationship means to you, focusing on the love, respect, and support you and your partner share, rather than just the religious differences.

If this approach doesn’t work, consider involving a trusted family member, friend, or community leader who might help mediate the situation. Sometimes, having an external perspective can help bridge the gap between differing viewpoints. You should also reflect on the long-term implications of your decision. Think about whether you’re ready to face the potential challenges of a mixed-religion marriage, including societal pressures and family dynamics. Having in-depth discussions with your partner about these issues is crucial to ensure you’re both on the same page.

If your parents remain opposed, you may need to consider seeking counseling or therapy. A counselor can help you process your emotions and provide strategies for dealing with family conflicts. They can also offer guidance on how to communicate more effectively with your parents. Building a support system outside of your family, whether through friends, mentors, or support groups, can also be invaluable during this time. It’s important to have people who understand and support your decisions.

Ultimately, the decision about whether to continue with your relationship despite your parents' opposition is yours. You’ll need to weigh the emotional and practical consequences, including the possibility of estrangement or ongoing family conflict. It’s vital to prioritize your happiness and well-being. If you believe that your relationship brings you genuine love and fulfillment, standing by your choice is valid. However, be prepared for the challenges that may come and have a plan in place to manage them. This is a deeply personal decision, and whatever path you choose should align with what feels right for you and your future.

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Kanchan

Kanchan Rai  |496 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Jan 19, 2025

Asked by Anonymous - Jan 19, 2025Hindi
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Relationship
URGENT Hello kanchan ma'am Please help. I am a divorced working woman , with a daughter 8 yrs. I have been pursued for remarriage with a guy who is 10 yrs older to me and have 2 kids. 11 and 14 yrs respectively living in a small town. Initially it was agreed the elder child who is a boy would be living in hostel , but now since we are approaching near to the marriage, it seems the elder male child is going to stay at home and not hostel. This is making me really uncomfortable as I won't get much privacy also the male child is aggressive.Already handling one kid was difficult before. Also moving to small town was difficult transition from a metropolitan that I stay in. Moving there could mean losing job opportunities in future. I am really worried if I let this match go, I end up alone again. I am not able to make a decision, it's difficult to raise others children. It's just not naturally inbuilt in us.Although I try really hard to mould my thinking and be more generous, but somehow it suffocates me.
Ans: start by having a direct and open conversation with your prospective partner. It’s crucial to clearly communicate your feelings about the elder child staying at home, especially regarding the need for privacy and the impact of his aggressive behavior. Explain how this change affects your comfort and daily life, emphasizing the importance of maintaining a harmonious living environment.

In tackling the privacy issue, consider discussing potential adjustments to the home’s layout. Creating separate living spaces or setting up rules that establish personal boundaries can help ensure everyone feels comfortable. Developing a routine that allows for private time with your daughter will also be essential in maintaining a balance.

Regarding the transition to a small town, research the local job market thoroughly. Look for opportunities that align with your career goals and consider remote work options if they’re available. It’s also important to engage with the local community to build a support network. Attend community events, meet potential neighbors, and get a feel for the town’s environment. Having a backup plan, such as maintaining connections in your current city or setting aside a financial cushion, will give you added security should the move not work out as expected.

Blending families is a significant emotional and practical challenge, so consider family counseling as a way to address potential conflicts and improve communication. A counselor can provide valuable strategies to help everyone adjust to the new living arrangements and understand each other’s perspectives. To ease into this change, propose a trial period where you can test the dynamics without committing long-term right away. This will give you the opportunity to evaluate how well you and your daughter adapt to the new situation.

Lastly, it’s essential to address your fear of being alone. Reframe this fear by focusing on the positives of independence. Remind yourself that it’s better to be single and emotionally secure than in a relationship that feels overwhelming or stifling. Use this time to invest in personal growth, hobbies, and building a fulfilling life for you and your daughter. Keeping an open mind about future relationships is healthy, but it’s important to ensure any new partnership aligns with your values and meets your emotional needs.

By taking these steps, you can approach the situation with clarity, ensuring that any decision you make is grounded in what’s best for your well-being and that of your daughter.

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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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