Sir, i have issued a cheque to Bajaj Allianz for my health insurance for me and my wife under tieup with c.b.i on 05-12-2022.Though received premium of Rs12963/- i have not received policy. Even my regular followup with bank and ins.co things are not moving. Telling lame excuses.what to do

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.   

Ans: Hi Anand, very sorry to hear about your plight. Seeing that you are not getting any response from the insurer, my advice would be that you approach ombudsmen and register your complaint. You need to email them at complaints@irdai.gov.in with your query along with all the documents of your case.

Ans: I understand your concern about your mother's health insurance claim being rejected due to the waiting period clause. Here's what she can consider doing:
1. Review Policy Documents: First, carefully review the policy documents of both the Religare and Bajaj health insurance plans to understand the terms and conditions regarding waiting periods, coverage, and claim procedures.
2. Contact Bajaj Customer Support: Reach out to Bajaj's customer support or claims department to discuss the situation and seek clarification on the rejection of the claim. Provide all relevant details and documentation related to the policy switch and the cataract surgery.
3. Appeal the Decision: If Bajaj maintains its decision to reject the claim, consider filing an appeal with the insurance company. Provide additional information or documentation if available to support the claim and demonstrate the necessity of the surgery.
4. Seek Assistance from Insurance Ombudsman: If the appeal with Bajaj does not yield a satisfactory outcome, your mother can approach the Insurance Ombudsman for assistance. The Insurance Ombudsman is a regulatory authority that resolves grievances and disputes between policyholders and insurance companies.
5. Consult Legal Counsel: In cases where the insurance company's decision appears to be unjust or in violation of the policy terms, seeking legal advice from a qualified lawyer specializing in insurance law may be necessary. They can provide guidance on the available legal options and represent your mother's interests if required.
6. Consider Policy Renewal Options: Depending on the circumstances, your mother may also explore options for switching to a different health insurance provider or policy during the next renewal period. Ensure thorough research and comparison of policy features, coverage, waiting periods, and claim settlement records before making a decision.
It's essential to act promptly and diligently in addressing the issue to ensure that your mother receives the rightful coverage and benefits under the health insurance policy.

Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner
www.holisticinvestment.in

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