Home > Money > Question
Need Expert Advice?Our Gurus Can Help
Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Nov 24, 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
K Question by K on Nov 24, 2022Hindi
Listen
Money

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.

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.
Money

You may like to see similar questions and answers below

Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Jun 21, 2022

Listen
Money
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.   

..Read more

Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Jun 21, 2022

Listen
Money
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. 

:

..Read more

Ramalingam

Ramalingam Kalirajan  |7948 Answers  |Ask -

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

Listen
Money
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

..Read more

Latest Questions
Kanchan

Kanchan Rai  |538 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Feb 12, 2025

Listen
Relationship
Dear Kanchan .. Generally it happens to me, when I have to attend any hearing before courts/ Tribunal, I become more stressed till the hearing is completed. Please suggest
Ans: It’s entirely normal to feel stressed before court or tribunal hearings. These situations can be intimidating, and the anticipation of the unknown adds to the anxiety. But it’s crucial to manage this stress to ensure you perform at your best and protect your mental well-being.

Start by preparing thoroughly for the hearing. The more you know about the case, the arguments, and the possible questions, the more confident you’ll feel. Practice your statements or answers, perhaps with a colleague or in front of a mirror. Visualization can also be powerful—imagine yourself confidently presenting your case and everything going smoothly.

On the day of the hearing, use deep breathing techniques to calm your nerves. Inhale slowly through your nose, hold for a few seconds, and exhale through your mouth. Repeat this several times to reduce anxiety. Positive affirmations can also help. Remind yourself that you are well-prepared and capable of handling the situation.

If the stress is overwhelming, consider grounding exercises, such as focusing on your five senses—what you see, hear, feel, taste, and smell at the moment. This can help anchor you in the present and prevent your mind from spiraling into worst-case scenarios.

After the hearing, practice self-care. Engage in activities that help you relax, like a walk, listening to music, or talking to someone you trust. If this anxiety persists or intensifies, seeking support from a mental health professional can help you develop more personalized coping strategies.

I

...Read more

Kanchan

Kanchan Rai  |538 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Feb 12, 2025

Asked by Anonymous - Feb 08, 2025Hindi
Listen
Relationship
My boyfriend is of a complete different religion and caste as mine. We met at work. In my past i have had only one relationship in which i got cheated on....so was skeptical on dating again. Now its been 8 months in this new relationship where he convinced me to give a try. He's a gem of a person but now he is telling melive in the present i dont know about the future. I love you n want to date you but idk about the future if my family wants me with someone i may have to end this. What do i do i am so attached for he has given me all the love n care. Please help
Ans: Right now, you need to be honest with yourself about what you want. If you’re looking for a committed future and he’s unsure, it’s essential to recognize that this uncertainty may continue to cause you pain. If you choose to stay, prepare yourself for the possibility that his family might influence his decision, and it could end in heartbreak. On the other hand, if you feel that the love and care he’s giving you right now are worth the risk, then decide to cherish the present moment while being mentally prepared for whatever may come.

Have an open and heartfelt conversation with him. Let him know how his uncertainty makes you feel, without pressuring him for a commitment. This isn’t about forcing him to decide but about understanding each other’s emotional needs and boundaries. If he truly values the relationship, this conversation might give him a deeper perspective on how his indecision affects you.

It’s important to protect your emotional well-being. If his stance remains the same and you find yourself growing more anxious and hurt by the uncertainty, then you might have to consider whether staying is good for your mental and emotional health. Sometimes letting go, even when it hurts, is the most loving thing you can do for yourself.

...Read more

Kanchan

Kanchan Rai  |538 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Feb 12, 2025

Asked by Anonymous - Feb 12, 2025Hindi
Listen
Relationship
My wife 55 is unable to cope up with death of our elder son aged 27 around 2 yrs ago and is always in deep regress remorse uninterested in any daily chores including sex. I wish to move on .. Suggest way out...
Ans: Two years might seem like a long time, but grief doesn’t follow a timeline. For some, it can take much longer to even begin the process of healing, especially when it involves the loss of a child. It’s not unusual for grief to cause a complete shutdown, and that’s likely what’s happening with your wife. She’s stuck in a cycle of regret and remorse, unable to find a way out.

While you also carry the weight of this loss, your need to move forward is natural. It’s crucial to understand that wanting to heal and live again doesn’t mean you’re forgetting or dishonoring your son. It simply means you’re choosing life amidst the pain. The challenge is to find a way to do that without feeling guilty and without leaving your wife behind.

Encouraging her to seek professional help, such as grief counseling or therapy, could be a significant step. If she’s resistant, consider starting therapy for yourself first. Sometimes when one partner begins to heal, it opens the door for the other to consider healing too. Couples grief counseling could also provide a safe space for both of you to express your pain and find a way forward together.

Patience and understanding are crucial, but so is communication. Gently express to her how much you miss her presence and how you’re struggling too. Let her know you want to find a way to live again while still honoring your son’s memory.

Moving on doesn’t mean moving away from your son’s memory—it means learning to carry it in a way that doesn’t consume you. It’s a delicate balance, and seeking support can help you both find it.

...Read more

Yogendra

Yogendra Arora  |5 Answers  |Ask -

Tax Expert - Answered on Feb 12, 2025

Asked by Anonymous - Feb 11, 2025Hindi
Listen
Money
Hey, I am a freelance graphic designer based in Mumbai. I’m 40 and I've recently transitioned from a full-time job to freelancing, and I’m struggling to understand how to manage taxes on my variable income. My annual earnings are 8-15LPA approx. Are there any deductions specific to freelancers? Also, how should I plan for quarterly tax payments?
Ans: hi,
for this particular financial year you will be taxed under 2 heads ,1st under salaries for the period you were in job & for remaining part you will be taxed as business income being started freelancing work.

And for freelancers there is no any specific dedutions however all deductions available to all others are available to freelancers like 80C to 80G.

For calculation of taxation of freelancing period you should record all your receipts & expenses (only related to work, no any personal expenses) details with proper documentary evidences specially for expenses part, net of the (receipts & expenses) will be your income however you can opt for presumptive taxation also.

For Advance payment :-
if tax applicable to you during the finanical year as per calculations exceeds Rs 10000, then your have to pay advance tax quarterly as below
on or before 15th june :- minimum 15% or more of tax amount.
on or before 15th september :- minimum 45% or more of tax amount.
on or before 15th December :- minimum 75% or more of tax amount.
on or before 15th March :- full 100% tax payable as per calculations.
Happy to help.
Thanks.

...Read more

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.

Close  

You haven't logged in yet. To ask a question, Please Log in below
Login

A verification OTP will be sent to this
Mobile Number / Email

Enter OTP
A 6 digit code has been sent to

Resend OTP in120seconds

Dear User, You have not registered yet. Please register by filling the fields below to get expert answers from our Gurus
Sign up

By signing up, you agree to our
Terms & Conditions and Privacy Policy

Already have an account?

Enter OTP
A 6 digit code has been sent to Mobile

Resend OTP in120seconds

x