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Will My Health Insurance Cover Hip Replacement Surgery?

Ramalingam

Ramalingam Kalirajan  |7029 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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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
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

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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

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I am seeking guidance on my current financial situation. I am 50 years old, with a net take-home income of 1.42 lacs per month, while my wife earns approximately 75k monthly. We have two daughters pursuing higher education, with annual fees totalling 6.10 lacs. In the wake of the COVID-19 pandemic, I faced a significant setback when I was unable to pay my home loan EMI, leading me to opt for a moratorium. Despite having already paid approximately 43.85 lakhs towards my home loan of 58.50 lakhs taken in 2017, the principal outstanding has astonishingly increased to 59.45 lakhs. I now find myself committed to an EMI of 65,000 monthly, further straining our financial resources. To cover both my daughters first-year college fees, I took out a gold loan of 5.5 lakhs, for which I currently pay 50,000 a month. I had invested in a family health insurance policy with Star Health, covering 10 lakhs, but due to poor service I stopped paying my premium, which had an accrued value of 17.50 lakhs. I hold a provident fund account with a balance of 2.5 lakhs. I am concerned about planning for my elder daughter's wedding in the next 2 to 3 years and my retirement. I would appreciate any advice or strategies you could provide to help me navigate this situation effectively.
Ans: Hello;

Try and understand from the home loan lender as to how 59.45 L principal is overdue despite paying a sum of 43.85 L, despite factoring 80% of this as interest payment, the overdue principal should be below 50 L.

Double check if this is as per the terms of moratorium.

If you are not satisfied with replies from the lender escalate the matter to the highest authority at lender or RBI.

Lender can't behave irrationally just because you availed moratorium during COVID.

In my view you should have just sold the gold rather then taking loan against it.

That way you could have lessened EMI burden on your finances and ensured investments for retirement and other goals.

Unfortunately we have a tradition of attaching emotional value to precious metals and real estate.

The best "jewellery" you can offer to your kids is good education, which you have already done.

In matters of health insurance never discontinue a policy due to dissatisfaction with the insurer, port it to another insurer, 1.5/2 months before the renewal date so that your benefits remain intact. Now you may be need to find another health care insurance.

You may begin a monthly sip of 25-30 K in diversified large cap oriented mutual fund for 5 years.

Also give a thought to NPS, you can contribute till 70 age, for retirement pension.

Best wishes;

...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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