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Sanjib

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Insurance Expert - Answered on Sep 08, 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
Narayan Question by Narayan on Sep 08, 2022Hindi
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I have a health insurance policy, running continued from 2012 without any claim up to 2022. In 2021, I ported it to another company.

Unfortunately, this year in April my son was diagnosed with Crohn's disease and required repeated hospitalisation. Expenses were taken care of by the insurance company. Now my doubts are:

1. My son is advised to have an injection every 8 weeks continuously for next 2 years. This is expensive and will be done in PICU as a day-care procedure. It might take 10 to 12 hours for the procedure, to be done in PICU (He is 14 years old). How I can get these expenses covered by my insurance.

2. Is there any limit on number of claims, in a year, as I already have many this year?

Is there any possibility, that my insurance company might deny the next renewal due to more number of claims?

Ans: Hi Narayan, my best wishes to you and your family. To answer your questions, if your policy has Day Care treatment included in the policy document, then the same can be claimed for. There is no limit to the number of claims taken in a year. However, you can only apply for claims only up to the sum assured value of your health policy.

As far as insurer denying renewal due to number of claims, the answer is no, insurer will not deny your renewal. However, there is a possibility that the insurer will increase your yearly premium based on the re-evaluated risk.

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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Sanjib

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Insurance Expert - Answered on Jun 21, 2022

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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.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

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Sanjib

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Insurance Expert - Answered on Oct 12, 2022

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 I am an employee of central govt. PSU. My family consists of myself, spouse, two minor children and mother. I am covered by a corporate group medical insurance policy for Rs 2 lakh with an additional emergency coverage of Rs 4 lakh by the employer. I also have a personal Family Floater policy for Rs 3 lakh and a Sr. Ctzn. Policy for Rs 1 lakh. I have not used the personal policies till date for any hospitalisation claim. I am aware that a claim exceeding the corporate policy limit can be claimed in the personal policy. Recently I was made to know that any planned hospitalisation exceeding the corporate claim limit, cannot be done using the second policy. I also know that there is a product called as top up policy which can be used in such cases. I have 8 years of remaining service where there is a medical insurance cover during the period. After retirement, the employer provides a basic policy of 1.5 lakh for the family. The same feels to be insufficient in today’s times. What would be your advice with regards to the existing medical insurance policies and their amounts? Should I need to undertake any tweaking of the policy amounts or switch to a top up policy?
Ans: Hi Pradeep, yours is a legit concern. It would be best if you take advice from a professional person or company – having the necessary qualifications -- after discussing your issue with them.

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Dating, Relationships Expert - Answered on Nov 05, 2024

Asked by Anonymous - Sep 15, 2024Hindi
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I am 50 years old and got married 15 years ago. I am a very spontaneous sort of a guy and enjoy life, partying etc. I was also very active socially.My wife being the complete opposite put a stop to all that once we got married. She also does not display any affection and has no interest in physical intimacy. She is just concerned with her housework.We also have lot of differences in mental attitude & intellectual abilities. At no stage will we ever seperate, however, I am unhappy with her nature. She has lot of friends, however is always at daggers drawn with in her in laws. We had to stay separately for 6 months, and I tried looking for love else where, however after a couple of months, I realised, that I missed her. I am in a quandary. Despite requesting her to work on our relationship, I get no response. Please advise on how to proceed.
Ans: Dear Anonymous,
I understand you are in a tough spot. But it's nice to see that after all those years of differences, you still have genuine feelings for her. I strongly suggest considering marriage counseling. From your description of your marriage, it seems to be there have been issues from the very beginning of it. It's been too long and now those issues must've become deep-rooted. Seeing a professional can be a game-changer. They can guide you out of this slump more methodically and help you navigate the emotions you are feeling right now. It can also help you understand the reasons for your wife's disinterest and handle it better.

Best Wishes

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Dating, Relationships Expert - Answered on Nov 05, 2024

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Hii, I have an love marriage after 9 years of dating and 6 years, 2 children post marriage, my little one is 11 months old now. My husband has an affair upto chatting to someone in his company, his junior but in different department, when my Lil one was 1 month old, we had in a rough patch then due to child birth and family drama. When I saw it and confronted him, he said he is sorry and won't do it again, we had multiple fights for 3-4 months after then due to same reason, but he mostly listen and consol. It's been a lot of mental torture for me. I love my husband a lot and he is a good person, but sometimes sill I see her msg in his phone asking for small helps or casual msg. She is also married. I am not sure my husband deletes msg or what, I am not able to get over this. Before it, this is was preety much a good relationship. I am highly educated and independent women. I don't want anything form my husband apart from love. What should I do, whenever I tell him I want to just leave and let him have his life, he won't let me somehow. We are having a good physical relationship 2-4 times a week( just to tell where we are). Please help me...I can't overcome that he is making fool of me...
Ans: Dear Anonymous,
I am sorry to hear you are in such a tough spot. I would suggest considering marriage counseling. A professional who can help you both tackle these issues would be helpful in this situation. I understand that it was his mistake and he needs to put the effort to make you trust him again, but since you are still together, you will also have to put in the effort to let it. I know it is difficult and that's where marriage counselor comes in. They can help you navigate these feelings. Moreover, if he is indeed hiding something, therapy can help that come out in the open.

Hope this helps.

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Dating, Relationships Expert - Answered on Nov 05, 2024

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Hi, Me(M38) and wife(F37) happily married for 12 years and blessed with one daughter. Partner(F28)continuing friendship with a person[M] who had crush on her before marriage considered emotional infidelity? Me(M38) and wife(F37) happily married for 12 years and blessed with one daughter. My wife is having friendship (strictly platonic) with a guy from her 10tlh grade (same class). Before our marriage (she may be doing her college, our relationship just started may be 2 weeks) this guy told her he has genuine interest in her and he want to take the relationship further if she wants, she said she is not interested in a relationship and she got committed, she always saw him as a friend, no other feelings for him and we can be friends if you don't bring any romantic interest again. He never took this talk again ever after and happy to be a friend. They are talking as friends. She got married to me. He also got married. They still do chats once in a month. She introduced me to him and visited his home when we visited his city. He also came to our home once (me and my family was there). She used to update me with chat she had with him and the content they are chatting. I am ok with that When we were talking about our school life and college life 2 years before. She said this guy had crush on her during her college days. I asked her, why did not she tell me this info till now. She said it is not purposely, she does not feel the need to do as the person is not in-appropriate with her and continuing as good friend as promised after she rejected his proposal. I don’t want to create any unnecessary issues as I don’t have any felling or so with him. That time I checked their chats completely, it’s about update about their common friends, their recent travel, their job, meditation courses and the books they read recently. I haven’t seen any flirting or romantic message from either of them. So I am perfectly fine with it and had no problems. I recently came to know about the concept of emotional cheating which is very new to me. Before that cheating to me is only flirting, sexeting and physical sex. I have asked for advice in redddit.com in infedility sub forum about emotional cheating/ emotion affair. There persons are advising like even having friendship with someone who had crush on you is emotional cheating as it is indirectly leading them on you. So with an omission of lie he had crush on her and indirectly leading him on you wife was emotionally cheating on you. This is very much equal to cheating. I do have lots of friends in other gender, but no one had crush on me. Does this count as emotional cheating/affair as she did not mention he had crush on her before marriage? I am little depressed and not able to spend quality time with my wife who is in postpartum depression and take care of our daughter properly as before. Do you guys advise me how to navigate this situation?
Ans: Dear Anonymous,
Are you really going to ruin your happy relationship based on some new term you have learned recently? Emotional cheating and many more terms of the kind will come and go, what truly matters is the truth. She is merely friends with this guy and for your peace of mind, you have even checked their conversations- what part of it looks like cheating to you? If tomorrow, some random person projecting their own insecurities claims that a man speaking to a woman is some "new form" of cheating, would you start believing that? My point is that these are just random opinions of some people- it isn't the ultimate truth. The entire context matters. This man had a crush on your wife, she rejected it, and now they are just friends. I find absolutely no misconduct or infidelity in this. The fact that none of your friends had a crush on you does not factor in at all. Moreover, your wife is in postpartum depression- that should be your biggest concern but here you are, giving more importance to the random 2 AM thoughts of some people you don't even know. Please rethink if you are being fair to your wife- the mother of your child.

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Dating, Relationships Expert - Answered on Nov 05, 2024

Asked by Anonymous - Oct 26, 2024Hindi
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I (30M) am looking for Arranged Marriage Prospects. My Family has found a Prospect (27F) who seems like a Good Match, she's Well Educated, Earning Well & from the same Community. I haven't yet met her in Person, but connected with her on Social Media Platforms & interacting regularly. Recently, I scrolled through her Instagram Profile (It's a Public Profile). She seems to be a very Sociable Person, she has shared many Photos of herself, Partying/Travelling along with her Friends. My Problem is that she seems to like Wearing Clothes which are Revealing. She has shared many Photos/Videos, in which she's skimpily dressed (including some Bikini Photos at Beach/Swimming Pool). She also has a Pierced Navel Ring & Tattoos on some Private Parts like Chest, Hips, Thighs & Lower Back, which she flaunts proudly on Social Media. Though, I am not Judging her Character, based on her Choice of Clothing, but seeing all these made me a little Uncomfortable, as I am a very Modest & Simple Person myself. I have not discussed this issue with my Parents, as they have a very good opinion about her (which I don't want to Ruin). But I've discussed with some of my closest Friends (of both Genders) & some of them have Chided me for being so Judgemental. They suggested me to meet her atleast once in person, to understand what's her Character/Personality like. Shall I give it a try or Reject her Politely at this stage itself, without wasting any more Time (either her or mine)? Or am I being too Superficial to Judge a Woman, just based on her Social Media Profile, without even meeting her once, personally (This is what some of my closest Female Friends opined)? Please suggest me how to proceed with this Prospect in Arranged Marriage.
Ans: Dear Anonymous,
I know it might come off as you being judgmental of her choice of dressing, but you have a right to form an opinion in your mind, especially since in your case, you might be marrying the person. As long as you are not making up your mind about her based on her dressing, forcing her to dress the way she wants, or thrusting your opinion on her, it's alright. It's human nature to be a bit jerked by the choices others make that we won't make ourselves. Having said that, I believe meeting her once in person can be good for you; you might have a new perspective- both about her and on life. But no one can force you to do either. My suggestion is that do what you think is right- if you are sure you will reject this alliance based on her choice of clothes, even if she is the nicest person on the face of the earth, meeting up might be a waste of time. But if you think you are open to changing your mind, go for it.

I would also like for you to remember one important point if things work out between the two of you- do not try to push your opinions on dressing and change the way she is after getting married. That would not be fair. In case, you start hoping that she will change and fit YOUR mold of the perfect woman, I would strongly suggest keeping that thought in check.

Best Wishes.

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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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