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Sanjib

Sanjib Jha  | Answer  |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  | Answer  |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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Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 21, 2022

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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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Ramalingam

Ramalingam Kalirajan  |7026 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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Dr Shyam

Dr Shyam Jamalabad  |78 Answers  |Ask -

Dentist - Answered on Nov 14, 2024

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Dr. Shyam, I had my teeth cleaned 6 months ago and after that was done I saw discoloration on certain teeth that wasn't there before. Years ago I had my teeth cleaned and one particular tooth after the cleaning was sensitive to touch. I had a crown put in from two different dental offices. The first one did the crown right, but was trying to charge me $3,500 more than the agreement they made with Medicare. Medicare corrected that. I other dentist did a crown and it didn't go all the way up to my gums and is sensitive to especially cold things. I'm not having very good experiences with dentist by and large. Can't find an honest one or one that can actually do the job right. I feel being on Medicare your a target to bring in money. Not sure what to do next. Supposed to go back and have them redo the crown that didn't go to my gums, but it also was ttd place to didn't clean my teeth right and discolored some of them. Any suggestions on how to trust there is actually an capable and honest dentist out there who can perform properly?
Ans: Identifying a capable and honest dentist is crucial for your oral health and well-being. Here are some tips to help you find one:

1. Ask for referrals: Ask friends, family, or coworkers for recommendations. They can provide valuable insights into a dentist's work quality and bedside manner.

2. Check credentials: Ensure the dentist has the necessary qualifications, certifications, and licenses. You can verify this information with your state's dental board or professional organizations like the American Dental Association (ADA).

3. Check online reviews: Look up the dentist on review platforms. Pay attention to the overall rating and read the comments to understand the strengths and weaknesses. At the same time, do not rely on reviews alone as these can be manipulated, fake reviews can be easily generated.

4. Evaluate their communication style: A good dentist should listen to your concerns, explain procedures clearly, and answer questions patiently. Ensure you feel comfortable asking questions and discussing your treatment.

5. Assess their facility and equipment: A well-organized and modern dental office with up-to-date equipment is a good sign.

6. Check their approach to preventive care: A capable dentist emphasizes preventive care, including regular cleanings, exams, and education on oral hygiene.

7. Be wary of over-treatment: A honest dentist will not recommend unnecessary procedures. Be cautious if you feel pressured into extensive treatments.

8. Trust your instincts: If something feels off or you don't click with the dentist, it's okay to explore other options.

10. Schedule a consultation: Many dentists offer initial consultations or meet-and-greets. Use this opportunity to assess their approach, ask questions, and gauge your comfort level.

By following these steps, you can increase your chances of finding a capable and honest dentist who prioritizes your oral health and well-being.

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Ravi

Ravi Mittal  |416 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 14, 2024

Asked by Anonymous - Nov 03, 2024Hindi
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Hi, I am 30 years old not married & now my parents are forcing me to get married. I think i am good looking guy. It's not like i have never been with girls. I have had brief flings with multiple girls. And there was one girl whom i was in a platonic relationship with with lot of emotional sharing & have spent a lot of time with her. The same goes with another girl. Both of them have told me that i have been pretty cool & girls would like me to be their bf or husband. But i am not able to accept anyone because of the guilt that of my past that i never had a relationship. Never been able to tell anyone that i had a gf. I know this is wrong to compare my life but i can't stop thinking that way. Can you tell me what to do? Like a contsant regret of not having a very steamy cool fancy relationship from outside. I know relationships have it's own ups & downs. But this guilt is killing me that i missed out lot of things in life & if get married in an arranged marriage i would feel myself to be a looser who couldn't even find a girl on his own. Though i know all of these comparisons are wrong & i should be rational. I am not able to help it. Please help me out
Ans: Dear Anonymous,
Whatever you are feeling, it is very normal. More people than you could imagine go through this same phase. But as you mentioned, these are just thoughts; there is no truth to them. Not having a relationship does not make you uncool. It merely means that you did not meet your perfect match yet. I understand that you feel like you have missed out on something and that feeling is valid. It might not be reasonable, but it's very natural to think this way. I can suggest one thing- why don't you try a dating or matchmaking app to find your own partner? That way, you will be keeping your parents' wishes and won't let yourself down either. It will also give you more control over choosing your life partner.

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Ravi Mittal  |416 Answers  |Ask -

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Hi, I got married to my ex gf in an arranged setup. I had a 7 year of relationship with her before breakup. My career switch try from private to govt job was the reason. When I failed I returned back to corporate. 3 years after the breakup her father who is a good friend of my father sent proposal which led to our marriage. No one knew that we dated. We never had a word between the acceptance and marriage. None of us initiated the conversation. When she came after marriage her behavior towards me in private is totally strange. We never had an emotional conversation. Neither we discuss romance nor intimacy. In private we hardly have any intellect discussions which was an eternal part before our breakup. But when she is in public she behaves like she cares for me a lot. She is a darling of everyone in the house whether my parents or siblings. Most of the time she remains with my mother and she has good bond. In front of her she cares for me a lot. She had this double faced attitude from the first day. Our intimacy is limited to my ask she could agree or disagree but she never initiated it. She was pretty passionate before our breakup which I never saw after our marriage. I tried everything but nothing has happened she never opened up. She disconnected with almost all our mutual friends after marriage. Whenever I tried through some of her friends she says to them I overthink a lot. Marriages and relationships differs. All useless and weird reasons. Everyone blames my teenage short temper issue. Which I have completely overcame when I started working. After marriage we had a boy. She says no for a next child for which I am fine. But the problem is now my child is growing and she has started understanding her hypocrisy. Now she blames me for teaching him wrong things. We hardly had fights as she walks out or I won't say word usually after she didn't answer for anything. I am unable to see the light in this relationship. She had 3 relationships in between but I never had one which I never discussed. Now I hardly ask for anything. Day by day we are becoming only room partners or fake couples in public. Everyone sees her as an ideal daughter in law or wife due to her public hypocrisy. Please guide.
Ans: Dear Salman,
I understand that marital issues take a huge toll on people. Whatever you are feeling, it is very normal. I strongly suggest you seek professional help- you can either opt for personal counseling sessions to manage the distress caused by your partner's indifference, or the best approach is to convince your wife to go for marriage counseling with you. It would be good to get to the root of the matter; why is she behaving a certain way, where is this coming from, are there unresolved issues from when you dated? These questions will finally get an answer and you can work on them together. If she does not agree to go, tell her to do it for your child. No child should have to see their parents unhappy with each other.

Hope this helps.

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Dr Nagarajan J S K

Dr Nagarajan J S K   |163 Answers  |Ask -

Health Science and Pharmaceutical Careers Expert - Answered on Nov 14, 2024

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I want to give NEET exam but my 12th in Maharashtra Board marks are less than 150 in PCB (general), so I am not eligible. can I give retest of 12th to get better marks so that I can give NEET.
Ans: Hi, Being a retest candidate is considered a second attempt in +2. I think the medical council will not allow admission to medicine. Instead, you can consider B.Pharm / Pharm D.

To join, the following are the requirements:

For pharm D: Minimum qualification for admission to. – a) Pharm.D. Part-I Course – A pass in any of the following examinations - (1) 10+2 examination with Physics and Chemistry as compulsory subjects along with one of the following subjects: Mathematics or Biology. (2) A pass in D.Pharm course from an institution approved by the Pharmacy Council of India under section 12 of the Pharmacy Act. (3) Any other qualification approved by the Pharmacy Council of India as equivalent to any of the above examinations. Provided that a student should complete the age of 17 years on or before 31st December of the year of admission to the course.

FOR B.PHARM:
Minimum qualification for admission to – A. First year B. Pharm – A pass in any of the following examinations - i. Candidate shall have passed 10+2 examination conducted by the respective state/central government authorities recognized as equivalent to 10+2 examination by the Association of Indian Universities (AIU) with English as one of the subjects and Physics, Chemistry, Mathematics/Biology as optional subjects individually. “However, the students possessing 10+2 qualification from non-formal and non-class rooms based schooling such as National Institute of Open Schooling, open school systems of States etc. shall not be eligible for admission to B.Pharm Course.” ii. Any other qualification approved by the Pharmacy Council of India as equivalent to any of the above examinations. Provided that a student should complete the age of 17 years on or before 31st December of the year of admission to the course. Provided that there shall be reservation of seats for the students belonging to the Scheduled Castes, Scheduled Tribes and other Backward Classes in accordance with the instructions issued by the Central Government/State Government/Union Territory Administration as the case may be from time to time.

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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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