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Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Nov 24, 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
Gora Question by Gora on Nov 24, 2022Hindi
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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.

Ans: Hi Gora Lal Gargi, to solve your query I will need more information. Firstly, please do check if your sum insured value was exhausted in the first claim.

If yes, then check the policy document to know if your insurer provides claim for same person, same illness on the second claim i.e. restoration benefits.

In case, the sum insured is not exhausted then you are eligible for the second claim and I advise you to write to ombudsmen about your issue. You need to email them at complaints@irdai.gov.in (external link) 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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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.

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I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
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Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

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You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

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Have you analyzed your failure in 2 successive attempts in the NEET examination? If yes, then the question is what you have done for improvement and not then again the question arises why not? Here, I would like to suggest you focus now only on the NEET examination which is your 3rd attempt. Don't think about any other options right now till May 2025. After the NEET exam is over, you have ample time to explore the options available. Depending on your score in NEET 2025, we will guide you at that time. But yet, if you are confused, then looking towards your question and anxiety, you need personal counseling where you can express yourself face-to-face. Only after the NEET exam is over, you contact a counsellor for one-to-one counseling. Till then, keep mum and focus only on NEET. Take this exam as your mission and project. Work on this project, apply forces from all sides, success is there which is waiting for you eagerly.
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I hv started sip in 2008 and still continued , now the monthly sip is 55k and total value is 1.85cr. Need to accumulate 7cr with in next 4 yrs pls guide how can i achieve. - Deepak J. Hajari
Ans: Deepak, your long-term SIP discipline is impressive. Accumulating Rs. 7 crore in 4 years is ambitious. Achieving this goal requires a strategic approach, as time is limited. Let's create an actionable plan for your success.

Current Financial Snapshot
Ongoing SIPs: Rs. 55,000 monthly.
Current Portfolio Value: Rs. 1.85 crore.
Target Corpus: Rs. 7 crore within 4 years.
Your consistent investing habits have built a solid foundation. However, to achieve your target, adjustments are needed.

Key Challenges
Short Time Frame: Four years is a limited period for aggressive wealth accumulation.
Significant Gap: A gap of Rs. 5.15 crore remains to meet the Rs. 7 crore goal.
Market Volatility: Equity investments might face short-term volatility.
Recommendations to Bridge the Gap
1. Increase Your SIP Contributions
Raise your SIP amount to Rs. 1.25 lakh per month.
This increase ensures faster wealth creation through compounding.
Prioritise high-growth funds in equity-oriented categories.
2. Invest Lump Sum Amounts
Consider deploying a lump sum if you have idle savings or low-yield investments.
Invest in aggressive equity mutual funds for higher potential returns.
Break down the lump sum into tranches for better market timing.
3. Diversify into High-Growth Mutual Funds
Focus on small-cap and mid-cap mutual funds for higher growth potential.
Maintain a balance with some large-cap exposure for stability.
Ensure the portfolio aligns with your high-return requirements.
4. Avoid Overexposure to Debt or Low-Yield Instruments
Limit debt investments during this aggressive growth phase.
Avoid instruments like FDs or debt mutual funds with lower returns.
Rely on equity for the next four years to maximise growth.
5. Rebalance Your Portfolio Regularly
Conduct a portfolio review every 6 months.
Reallocate funds based on underperforming or outperforming sectors.
Keep your portfolio aligned with market trends and your goals.
6. Capitalize on Bonus or Windfall Gains
Direct any bonuses, salary hikes, or windfall gains towards your target.
Avoid unnecessary expenses during this focused phase.
Tax Efficiency Matters
Equity Mutual Funds Taxation: Gains above Rs. 1.25 lakh are taxed at 12.5%.
Debt Mutual Funds Taxation: Taxed as per your income slab.
Plan redemptions strategically to minimise tax liabilities.
Leverage Market Opportunities
Benefit from Market Corrections: Use corrections as opportunities to invest lump sums.
Stay Invested for Compounding: Avoid early redemptions to let compounding work fully.
Role of Regular Monitoring
Track Performance: Ensure funds are performing as per expectations.
Switch Funds if Needed: Shift from underperforming funds to high-growth options.
Final Insights
Deepak, achieving Rs. 7 crore in 4 years requires aggressive yet calculated strategies. Increase your SIPs, deploy lump sums, and focus on high-growth funds. Regular monitoring and disciplined investing are key to your success. Stay patient and consistent.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

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

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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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