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Financial Planner - Answered on Oct 13, 2023

Sunil Lala founded SL Wealth, a company that offers life and non-life insurance, mutual fund and asset allocation advice, in 2005. A certified financial planner, he has three decades of domain experience. His expertise includes designing goal-specific financial plans and creating investment awareness. He has been a registered member of the Financial Planning Standards Board since 2009.... more

Question by Avinash on Jul 20, 2023Hindi

Having medical insurance, senior female however treatment not covered under medical insurance such as dental/cataract treatment or Diagnostic test conducted on Registered Medical Practioner at various diagnostic canters costing more than Rs. 5,000/- can be claimed ? If so under which section "

Ans: Health check ups are not covered in medical insurance however check your policy if it offers free health check up

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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Question by Jyoti - Jun 21, 2022Hindi

I have mediclaim policy from Oriental Insurance Co since 1992 for 5 lakhs and other from New India Assurance for 7.5 Lakhs under SCUM scheme with my spouse. However both the policies have set a limit of Rs. 40,000 for Cataract surgery even though I have been diagnosed with 1) Cataract Phaco with Panoptix IOL, 2) Pupilloplasty, 3) CTR Implantation for which a renowned hospital billed me as below for separately for each eye. 1) Cataract Procedure Cost. Rs. 27000/- which is approved by Oriental in their contract with Hospital 2) IOL Cost Rs. 49000/- 3) Pulilloplasty Rs. 6950/- after discount 4) CTR Implantation Rs. 1600/ after discount Now in Claim No. 1 Oriental approved. Rs 36,000/- Only and balance Rs 48500 I had to pay Claim No. 2 Oriental approved Rs.73,300/- Only and balance Rs.11250/- I had to pay Surgery was done 1 week apart. In my case I was advised Cataract with multifocal IOL + Pupilloplasty + CTR Implantation So, I need your advice on: How can Insurer Oriental approve and give different claim amount for each eye and how can I claim for reimbursement of balance amount I had to pay. Appreciate your guidance and help.

Ans: Hi Jyoti, hope you are doing well. As you have mentioned that the claim amount for each eye has been different, to understand the reason behind this disparity, you will have to check the documentation submitted to the insurer for both the surgeries. Request you to contact your insurance advisor and discuss the same with the insurer to understand this gap further and help you resolve this issue.

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Answered on Aug 03, 2021

Question by A - Aug 03, 2021Hindi

Is there any insurance company which offers both hospitalisation and non-hospitalisation bills under insurance policy of health including senior citizen? Also, we can claim premium paid u/s. 80d?

Ans: Many insurance companies offer both features either in a single plan or under separate plans. Amongst the two features, the most preferred and essential feature is the one covering hospitalisation expenses.

The non-hospitalisation or out-patient expense cover usually comes at a high premium with a lower limit. However, the hospitalisation plan usually covers non-hospitalisation bills related to pre-hospitalisation & post-hospitalisation period.

There are multiple advanced health insurance plans available offering limit up to 1 crore that cover hospitalisation and pre/post hospitalisation expenses and bundled with other prominent features such as ‘Daily cash allowance’ to count on in case of hospitalisation – to cover expenses that are not usually covered in hospitalisation only linked plans.

Under section 80D of the Income Tax Act, 1961, the premium paid is eligible for tax deduction up to an amount of Rs. 50,000 for senior citizens.

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Question by Srinivas - Jul 29, 2022Hindi

2. For claim-free years, I am allowed eligibility for Rs. 1500 Medical check-up; this has to be lost as well in case of renewal, as new insurers upon porting do not offer this facility rather, they have some lesser benefit tests (or) nothing at all depending on the plans we chose.

Ans: This is true. Medical check-up is a kind of complementary service which insurers provide along with selective plans. In case of portability, some of the insurers have waiting period & some insurer provide the same from day one.

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Insurance Expert - Answered on Nov 24, 2022

Question by K - Nov 24, 2022Hindi

I have a Mediclaim insurance policy (senior citizens) from National Insurance co Ltd. My wife was operated for Knee replacement surgery. Against the claim of Rs 3.48 lakh, the claim was passed for 51000/- only. I wrote to the Insurance co and wanted to know the reason but no answer. I seek your help and guidance.

Ans: Hi KD, hope your wife has recovered. To answer your query, I advise you to check your policy document again. There are many health insurance policies that have capping/limitations on the list of ailments. You can find the same in the policy documents or policy wording.

I suggest you approach your insurance company and inquire about the same and if you still fail to get a response from them then you can approach insurer ombudsman for this issue.

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