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Sanjib

Sanjib Jha  |66 Answers  |Ask -

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
Pannkaj Question by Pannkaj on Sep 08, 2022Hindi
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I have an individual health policy with Nivabupa. The current renewed policy document mentions:

1. Base Sum Insured Rs 5 lakh

2. Loyalty Additions Rs 2 lakh 

3. Next Column Sum Insured (Base Sum Insured + Loyalty Additions + Refill amount ^) (in Rs) 12,00,000

My 2 claims totalling Rs 6.25 lakh for Angiography and Bypass Surgery were settled only for Rs 500,000. 

Is this in line with norms? 

Ans: Hi Pannkaj,to answer your question we need to understand the plan details and the type of deduction done by the insurance company during the claim.

I suggest you speak with your insurer on why only Rs 500,000 was settled against your bills.

Also as a rule, do read all the terms and conditions on your policy document and the claim settlement process followed by your insurer.

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

Sanjib Jha  |66 Answers  |Ask -

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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Ramalingam

Ramalingam Kalirajan  |7831 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 11, 2024

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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
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

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.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

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

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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Anu Krishna  |1488 Answers  |Ask -

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Anu Krishna  |1488 Answers  |Ask -

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Anu Krishna  |1488 Answers  |Ask -

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Hi Anu I am a married woman with a very supportive husband and daughter. For last 10 years I am having an affair with a colleague and things are pretty well between us. Both of us have found the comfort and requisite from each other which we missed in married life and it saved our respective marriage though none of our family are aware of it. We balanced this till now effectively. Recently I got an opportunity within the company which is very lucrative and will enhance my career goals altogether however, for this I have to shift to another state. Now , my bf is very upset on this as it means he will not be able to meet me as we do every day. My husband and Daughter is fine with my shifting however my parents who are old are also apprehensive since I am the only child and do take care of them. My husband has assured to support them in absence of me and I have full confidence on him. All throughout my life I have focused on my professional career and have worked towards that and now when I got this opportunity I am emotionally unstable and unable to take the decision. My dilemma is surrounding various aspects. 1- Don’t want to leave my BF as he is my strength. 2- My parents are old and since I being the only child,they ae 3- If I could not perform in the new role then? 4- The daily hardship that I have to take over in a new place as my husband will not shift. 5- Remuneration wise not as such however if you say power then yes. Learning – knowledge enhancement and career upliftment - yes very much. 6- Current role will not grow much however stability as of now do exists. Can you help me to take the decision ?
Ans: Dear Nibedita,
What is important to you and what helps you grow professionally and personally must be looked at? Constraints are always going to play a role BUT working around it may help you make a decision. If professionally you are going to grow into the role and for this you need to work around things for the time being, then you must do just that. But in all this, do factor that you have a daughter who is still young and will need your presence a lot; physically and emotionally.
Now, how you work this with your BF is something that is between the two of you; but it's not power or money BUT how you grow in your new role.
Also, talk to your family and come to an arrangement whereby they also become your pillar of strength and support. You will then be able to come to a viable decision.

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

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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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