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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
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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  |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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Sanjib

Sanjib Jha  |66 Answers  |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  |8192 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 Nagarajan Jsk

Dr Nagarajan Jsk   |314 Answers  |Ask -

NEET, Medical, Pharmacy Careers - Answered on Apr 06, 2025

Asked by Anonymous - Apr 03, 2025Hindi
Career
Hello sir, Saranya from chennai. Doing final year B pharm. Heard about gpat from my friends How to do this entrance exam for joining pg course Please tell me if any other entrance exam is there for pg
Ans: Hi Saranya,

As you mentioned, many pharmacy graduates are considering the GPAT after completing their undergraduate studies in pharmacy. However, there are several more options available for pursuing a postgraduate degree in pharmacy today.

Here are the options for pursuing a PG in pharmacy:

1. GPAT: You can appear for the GPAT exam, and if you qualify, you will be eligible for a scholarship.

2. NIPER: You can also take the entrance exam for NIPER (National Institute of Pharmaceutical Education and Research) campuses, which include Ahmedabad, Guwahati, Hajipur, Hyderabad, Kolkata, Raebareli, and Mohali. Qualifying here also makes you eligible for a scholarship.

3. PG-CUET: A new option is the PG-CUET (Common University Entrance Test), which is being conducted by the NTA (National Testing Agency) under the Department of Higher Education.

4. Government Institutions: State governments will announce admission through advertisements. Admission will be based on marks or an entrance exam.

5. Deemed Universities: Some deemed universities offer admission through their own entrance exams.

Historically, GPAT and NIPER were the primary options for national-level aspirants. Starting from the academic year 2025-26, the NTA will also conduct the PG-CUET for national-level admissions.

I have included more details about the PG-CUET below.
PGCUET (CODE - SCQP23)
The Common University Entrance Test (CUET) is a National level Test conducted for admission into PG programmes in Central, State, and Participating Universities/ Institutions. The Common University Entrance Test CUET (PG) will provide a common platform and equal opportunity to candidates across the country, especially those from rural and other remote areas, and help establish better connections with the Universities. A single application form will enable the Candidates to cover a wide outreach and be part of the admission process to various Central and participating Universities. NTA has been assigned the responsibility of conducting the Common University Entrance Test (CUET).

Under Participating universities/instituttions are: Central and State Universities, Deemed and Private universities and Government institutuions.

Candidate must only select the test paper code. As the list of universities is dynamic and keeps on changing during the registration period.

A candidate can apply for two (02) Test Papers by paying the application fee (details mentioned at point 18).

A candidate can further apply for (02) additional Test Papers by paying additional application fees as applicable and maximum of four (04) test paper codes can be selected.

Mode of exam is CBT (Computer Based Test).
All Question Papers will be MCQ type. • Candidates can choose a maximum of four question paper codes. • The comprehension section in the General Paper will be available in either English or Hindi, based on the candidate's preference indicated during registration. • The duration of the Exam would be 90 Minutes. • The Question paper will have 75 Questions. • Four marks will be awarded for each correct answer and one mark will be deducted for each wrong answer.
• Language papers will be in the concerned language only.
• M.Tech/Higher Sciences will be in English only.
•Acharya papers will be in Sanskrit except for Hindu Studies, Indian Knowledge System, and Baudha Darshan.
• Humanities, Sciences, and Common papers would be bilingual (English and Hindi).
• The examination would be conducted in 2-3 shifts.
• The English version of the questions in all the question papers except languages and Acharya will be taken as final.

Syllabus: The Examination Syllabus will be uploaded on the Exam.

For the current year the examination dates (13.03.2025 to 31.03.2025) got over. iI THINK YOU HAVE MISSED IT. DONT WORRY. NEXT YEAR YOU CAN TRY OR YOU CAN ASSIST YOUR JUNIORS.

ADMISSION: Admissions will be handled at the level of each of the participating Universities for their respective programmes. After the declaration of the CUET(PG) 2025 results, the respective Universities will declare the counselling/admission schedule and merit list based on the CUET (PG) - 2025 score and any other criteria of participating universities. Please see the website of the concerned university for details regarding admission. There may be admission counselling by the universities with additional fees.

Applicants as per eligibility can apply for multiple test paper codes in one registration form. Candidates should not apply through duplicate or multiple forms, which may lead to the cancellation of all his/her Application Forms

CODE FOR PHARMACY: SCQP-23
SYLLABUS [POC, PIC, MATHS, OC - II, MICRO, APH (I&II), PHARM ENGINEERING, DCH PHARMACY, PHARM ANALYSIS (I -IV ), COGNOSY, CEUTICS-II, BIOCHEM, JURIS, COSMETICS, PHARM TECH, MED CHEM I-III, PHARMACOLOGY I-IV, BIOTECH, DRUG DESIGN, MARKETING, FOOD SCIENCE, QA, MANAGEMENT] HAS SHARED IN NTA WEBSITE.

THIS YEAR 57 INSTITUTIONS PARTICIPATED FOR THE SAID PURPOSE. NEXT YEAR THIS MAY INCREASE.

THE ADVANTAGES ARE NOT ONLY CAN PURSUE PHARMACY, APART FROM PHARMACY, YOU CAN PURSUE - DATA SCIENCE & AI, PUBLIC HEALTH, BIOINFORMATICS, PACKAGING TECH, ENVIRONMENTAL MANAGEMENT, GEOSPATIAL SCIENCE, PG DIP IN AI DIGITAL IMAGING, HEALTH CARE DATA, GEOINFORMATICS, PB-PHARMD, M.PHARM-PV, MSc- MICRO, MSc-NUTRITION, DIETICS.

I believe this information will be beneficial for your future education.

POOCHO. LIFE CHANGE KARO!

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Dr Nagarajan Jsk

Dr Nagarajan Jsk   |314 Answers  |Ask -

NEET, Medical, Pharmacy Careers - Answered on Apr 06, 2025

Asked by Anonymous - Mar 09, 2025Hindi
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Career
I am a 12th student now in state board of tamil Nadu and I am a government school student what is the minimum requirement for me to join mbbs in AFMC medical College
Ans: The following requirements are mandatory for admission to AFMC.

Age: 17-24yrs
Academic qualitfication: FIRST ATTEMPT with English, Physics, Chemistry and Biology/ Bio-technology taken simultaneously and securing not less than 60% of the aggregate marks in these three science subjects taken together and not less than 50% marks in English and 50% marks in each of the science subjects. They must have also passed an examination in Mathematics of the tenth standard.
Candidates seeking admission for MBBS course at AFMC Pune will have to mandatorily qualify the NEET UG 2024 Examination conducted by National Testing Agency (NTA). 11. Eligible candidates who are interested to join AFMC, Pune to pursue the MBBS course will have to mandatorily register and apply for AFMC, Pune on DGHS

The shortlisted candidates will be called for screening which comprises of Test of English Language and Reasoning (ToELR), Psychological Assessment Test (PAT), Interview and Medical Examination at AFMC, Pune.

ToELR & PAT - Test of English Language and Reasoning (ToELR) in the form of Computer Based Test (CBT) and also Psychological Assessment Test (PAT) to be conducted at AFMC, Pune only for candidates shortlisted for interview. (t) Written Examination Score - Score obtained in NEET (UG) 2024 (720 marks) added to ToELR Score (80 marks) divided by 4 to get a score out of 200. (u) Final Score - Written examination score (200 marks) + Interview marks (50 marks).

MEDICAL FITNESS: MANDATORY AS PER AFMC

ALL THE BEST

POOCHO. LIFE CHANGE KARO!

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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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