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Sanjib

Sanjib Jha  | Answer  |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
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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.
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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  |7097 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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Radheshyam

Radheshyam Zanwar  |1054 Answers  |Ask -

MHT-CET, IIT-JEE, NEET-UG Expert - Answered on Nov 21, 2024

Asked by Anonymous - Nov 21, 2024Hindi
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Hello, I am 3 yr neet dropper.in 2025 it will be my third attempt... I'm trying my best to crack neet ...i don't know what will happen will i score good marks or not ... please help me in suggesting good career options if not crack neet .....there are many options through neet marks also like bhms , veterinary...etc. i will also give entrance exam also like cuet ,gbpuat ,....but i want that what to choose which course will be best for me ...i want to make my life good and happy... having a good degree, good job ,...
Ans: Hello.
Have you analyzed your failure in 2 successive attempts in the NEET examination? If yes, then the question is what you have done for improvement and not then again the question arises why not? Here, I would like to suggest you focus now only on the NEET examination which is your 3rd attempt. Don't think about any other options right now till May 2025. After the NEET exam is over, you have ample time to explore the options available. Depending on your score in NEET 2025, we will guide you at that time. But yet, if you are confused, then looking towards your question and anxiety, you need personal counseling where you can express yourself face-to-face. Only after the NEET exam is over, you contact a counsellor for one-to-one counseling. Till then, keep mum and focus only on NEET. Take this exam as your mission and project. Work on this project, apply forces from all sides, success is there which is waiting for you eagerly.
Best of luck for your bright future.

Some tips: (1) Analyse separately Phy, Che, Bio (2) Prepare a list of hard topics (3) First focus more on the topics which are easy for you and then try to excel in hard topics (4) Appear more and more online/offline examinations (4) Prepare your short-cut file for all subjects (5) Prepare a file for each subject having only synopsis of all chapters (6) Try to solve the problems at the lightening speed and observe the period on regular basis (7) Create your time table to revise the topics on regular basis (8) Do not hesitate to ask your difficulties to your teachers, if you have joined to offline classes (9) Keep the habit of marking the answers which you know 100%. Don't guess the answers and mark them, as there is -ve marking scheme. (10) Be calm, quite, and smiling all the time to release the tension and always have a healthy chat with your friends.

If satisfied, please like and follow me.
If dissatisfied with the reply, please ask again without hesitation.
Thanks.

Radheshyam

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Pradeep

Pradeep Pramanik  |186 Answers  |Ask -

Career And Placement Consultant - Answered on Nov 21, 2024

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I am looking for a job, I had uploaded my resume in job site. A consultant called me & introduced himself telling he know some of the openings. He had a detailed discussion about my job & my skills. He told need to register to his consultancy for scheduling interview. I registered with him & he got me a interview. Interview was done by the company through skype. I could not see the company persons. They told only they can see me. Interview went on well & regarding salary I told my expectation but they told it is not possible & they told their proposal. Finally I agreed to them. They gave me code & told to visit the company for next round. Consultant called me after first round & told recruiter is very happy with the interview. Regarding salary he told why I agreed for the proposal,he will discuss again & asked to pay charges for some of his services which he will refund the day I visit to the company & take the orders. I paid him. He told there is a increase in salary he has discussed with recruiter & again asked for the money I did only partial payment & further will not pay anything. Second round also happened through skype instead of in person. Interview went on well & salary offered was good comparing to before & there was a big jump. Recruiter told they have planned to give additional responsibilities so they have increased. Finally they gave me a date to visit company. I asked when will I get the order, he replied he will send to consultant as I was taken by them. Till now i did not get the orders, consultant is keep on postponing. Now he told visit to company date is also postponed, he will update in next week & not to worry as job is confirmed. Now not understanding what to do, am I been cheated or wait.
Ans: Dear Mr. Keshava ,

There are many unscruplous job agents who are fake and claim themselves to be a Placement consultant. In short You have been cheated . Before paying any fee for registration , you must ensure that the agency is genuine . If not don't even upload your resume . You may write to company , lodge a complaint against the agency. If the amount is very high , pl. take the help of police . .

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Ramalingam

Ramalingam Kalirajan  |7097 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Nov 21, 2024

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I hv started sip in 2008 and still continued , now the monthly sip is 55k and total value is 1.85cr. Need to accumulate 7cr with in next 4 yrs pls guide how can i achieve. - Deepak J. Hajari
Ans: Deepak, your long-term SIP discipline is impressive. Accumulating Rs. 7 crore in 4 years is ambitious. Achieving this goal requires a strategic approach, as time is limited. Let's create an actionable plan for your success.

Current Financial Snapshot
Ongoing SIPs: Rs. 55,000 monthly.
Current Portfolio Value: Rs. 1.85 crore.
Target Corpus: Rs. 7 crore within 4 years.
Your consistent investing habits have built a solid foundation. However, to achieve your target, adjustments are needed.

Key Challenges
Short Time Frame: Four years is a limited period for aggressive wealth accumulation.
Significant Gap: A gap of Rs. 5.15 crore remains to meet the Rs. 7 crore goal.
Market Volatility: Equity investments might face short-term volatility.
Recommendations to Bridge the Gap
1. Increase Your SIP Contributions
Raise your SIP amount to Rs. 1.25 lakh per month.
This increase ensures faster wealth creation through compounding.
Prioritise high-growth funds in equity-oriented categories.
2. Invest Lump Sum Amounts
Consider deploying a lump sum if you have idle savings or low-yield investments.
Invest in aggressive equity mutual funds for higher potential returns.
Break down the lump sum into tranches for better market timing.
3. Diversify into High-Growth Mutual Funds
Focus on small-cap and mid-cap mutual funds for higher growth potential.
Maintain a balance with some large-cap exposure for stability.
Ensure the portfolio aligns with your high-return requirements.
4. Avoid Overexposure to Debt or Low-Yield Instruments
Limit debt investments during this aggressive growth phase.
Avoid instruments like FDs or debt mutual funds with lower returns.
Rely on equity for the next four years to maximise growth.
5. Rebalance Your Portfolio Regularly
Conduct a portfolio review every 6 months.
Reallocate funds based on underperforming or outperforming sectors.
Keep your portfolio aligned with market trends and your goals.
6. Capitalize on Bonus or Windfall Gains
Direct any bonuses, salary hikes, or windfall gains towards your target.
Avoid unnecessary expenses during this focused phase.
Tax Efficiency Matters
Equity Mutual Funds Taxation: Gains above Rs. 1.25 lakh are taxed at 12.5%.
Debt Mutual Funds Taxation: Taxed as per your income slab.
Plan redemptions strategically to minimise tax liabilities.
Leverage Market Opportunities
Benefit from Market Corrections: Use corrections as opportunities to invest lump sums.
Stay Invested for Compounding: Avoid early redemptions to let compounding work fully.
Role of Regular Monitoring
Track Performance: Ensure funds are performing as per expectations.
Switch Funds if Needed: Shift from underperforming funds to high-growth options.
Final Insights
Deepak, achieving Rs. 7 crore in 4 years requires aggressive yet calculated strategies. Increase your SIPs, deploy lump sums, and focus on high-growth funds. Regular monitoring and disciplined investing are key to your success. Stay patient and consistent.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

...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.

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