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Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 21, 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
Jyoti Question by Jyoti on Jun 21, 2022Hindi
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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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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.   

..Read more

Ramalingam

Ramalingam Kalirajan  |6268 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 12, 2024

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Sir, I am covered under ECHS scheme as an Oficer. I have been recommmended for Left Eye Cataract surgery and the ECHS has a cap on the expenditure. I have an additional insurance policy whose cap is Rs 30000/ for monofocal lens only. Since I am going in for a better lens how can I avail the insurance also so as to pay minimum from my pocket. Please advice
Ans: Here's how you can potentially minimize your out-of-pocket expense for cataract surgery with ECHS and your insurance:
1. Understand Your ECHS Coverage:

ECHS has pre-defined package rates for cataract surgery. These rates may cover a specific type of lens (likely monofocal).
Check the ECHS policy documents or contact your local ECHS office for details on their coverage for cataract surgery, including the type of IOL (Intraocular Lens) covered.
2. Explore Options with the Hospital:

Discuss your situation with the empaneled hospital performing the surgery.
Explain your ECHS coverage and the additional insurance benefit for a better lens.
Hospitals might be able to provide a breakdown of costs for surgery with a monofocal lens (covered by ECHS) and the additional cost for the better lens you desire.
3. Leverage Your Insurance:

If the chosen lens falls under the Rs. 30,000 limit of your insurance plan and isn't covered by ECHS, you can likely claim the additional cost through your insurance.
Contact your insurance provider and understand their claim process for cataract surgery with a specific lens type.
Here's a possible scenario:

Let's say the ECHS covers surgery with a monofocal lens costing Rs. 20,000.
The better lens you desire costs Rs. 10,000 extra (total cost Rs. 30,000).
Since it falls under your insurance coverage limit, you can potentially:
Pay Rs. 20,000 to the hospital, covered by ECHS.
Claim Rs. 10,000 for the lens upgrade from your insurance company.
Important Note:

This is a simplified scenario. Actual costs and claim processes may vary.
Recommendations:

Get a written cost breakdown from the hospital for surgery with different lens options.
Contact your insurance company and understand their claim process for cataract surgery with a specific lens type.
Once you have this information, you can calculate the potential out-of-pocket expense for each scenario (monofocal vs. preferred lens).
By following these steps, you can make an informed decision about the lens and minimize your out-of-pocket expense for cataract surgery.
Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Latest Questions
Nitin

Nitin Narkhede  |5 Answers  |Ask -

MF, PF Guru - Answered on Sep 11, 2024

Asked by Anonymous - Sep 10, 2024Hindi
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I have 10 lakh rupees which I want invest in MF. Please suggest some fund for lump sum amount to invest for 1 and half years.
Ans: Dear Friend,
Thank you for your query. 1.5 Years is a very short time for getting high returns. Investing Rs 10 lakhs in mutual funds for a short-term horizon of 1.5 years requires a cautious approach. For such small period, you should look for low to moderate-risk funds that offer stability with reasonable returns, as investing in high-risk equity funds might be too volatile for a short time frame. Since your investment horizon is just 1.5 years, avoid high-risk equity mutual funds as they can be volatile in the short term. Check for exit loads and tax implications before investing. Most short-term capital gains (if you withdraw before 3 years) from debt funds are taxed according to your income tax slab.
You have to evaluate your risk Appetite , Short-Term Debt Funds are invested in government securities, corporate bonds, and other debt instruments with short maturities, offering stability and moderate returns. For a 1.5-year investment, these are ideal as they are less volatile. you can expect 5-7% per annum Returns. You can think of
• ICICI Prudential Short Term Fund
• HDFC Short Term Debt Fund
• Axis Short Term Fund
• ICICI Prudential Corporate Bond Fund
• HDFC Corporate Bond Fund
• Aditya Birla Sun Life Corporate Bond Fund.
Best regards,
Nitin Narkhede
Founder & MD, Prosperity Lifestyle Hub https://Nitinnarkhede.com
Free Webinar https://bit.ly/PLH-Webinar

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Ramalingam

Ramalingam Kalirajan  |6268 Answers  |Ask -

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

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Hello Sir, I am Naveen Raja from Chennai. I am investing from Sep 2021 in ELSS SIP. Now I have been stopped due to monthly expenses. Question 1: I want to start again on a daily sip basis to achieve 5 cr in next 10 years suggest me a fund which will give this target amount over 10 years on an average of 20% interest Y-o-Y compunding to the investment amount? Question 2: Also, which I stopped in ELSS SIP - Axis Long term - Growth should I need to continue for a longer period or should take that money and invest in any different hybrid funds ?
Ans: Naveen, thank you for reaching out. Investing in ELSS funds is a good choice, especially considering tax-saving benefits. Stopping your SIPs due to monthly expenses is understandable, but restarting is crucial to achieving your financial goals.

Let’s address your two concerns one by one.

Question 1: Achieving Rs. 5 Crores in 10 Years
You aim to accumulate Rs. 5 crores in the next 10 years, with an expected 20% annual growth. While this is a high target, it’s not impossible. But I must highlight that 20% returns over 10 years are aggressive, and the market may not guarantee such consistent growth. Equity mutual funds, however, can potentially give you strong returns if you stay disciplined.

Steps to Achieve Rs. 5 Crores in 10 Years
Daily SIP Approach:
Daily SIP is a good way to spread out your investments. It allows for better averaging as the market fluctuates daily.

Focus on Equity Mutual Funds:
For such high returns, equity mutual funds are ideal. These funds have a strong track record of delivering long-term growth. However, keep in mind that they come with market risk.

Avoid Setting Unrealistic Return Expectations:
A 20% return every year is optimistic. A more realistic return from equity funds would be around 12% to 15%. Anything beyond that would require consistent high-performing market conditions.

Recommended Strategy
Diversified Equity Funds:
Instead of chasing returns with a single fund, diversify your investments across various equity funds. This reduces risk and ensures balanced growth.

Mid and Small Cap Funds:
These funds offer higher returns but come with more volatility. You can allocate a portion of your investments to these funds for higher growth potential.

Large Cap Funds:
They offer stability. Having some exposure to large-cap funds can help you maintain balance in your portfolio.

Avoid Index Funds:
Index funds might not meet your target as they only track the market. Actively managed funds can provide better returns through stock selection.

Calculating SIP Contribution
Achieving 5 Crores in 10 Years:
If you want to achieve Rs. 5 crores in 10 years, based on a more realistic 12% to 15% annual return, you would need to invest a significant amount every month. A Certified Financial Planner can help you calculate the exact monthly SIP amount based on your goal and risk tolerance.
Question 2: Should You Continue ELSS SIP or Shift to Hybrid Funds?
Your current ELSS investment in Axis Long Term Equity Fund is a tax-saving fund with a 3-year lock-in period. Since you’ve already completed the minimum holding period, you may wonder if it’s wise to continue or switch to a different type of fund.

Assessing ELSS Funds
Tax Benefit:
ELSS funds provide tax benefits under Section 80C. This is a significant advantage if you still need to save tax. Continuing with your ELSS investment can help you keep your tax-saving advantage.

Equity Exposure:
ELSS funds are equity-oriented, which means they have good long-term growth potential. If your goal is to build wealth over time, equity exposure is necessary.

Disadvantages of Switching to Hybrid Funds
Lower Returns:
Hybrid funds invest in a mix of equity and debt, which may offer lower returns compared to pure equity funds. While they are less volatile, their growth potential may not meet your goal of Rs. 5 crores in 10 years.

Not Ideal for High Growth:
If you want aggressive wealth creation, hybrid funds may not be the best fit. Their balanced approach is better suited for those with low to moderate risk tolerance.

What You Should Do
Continue with ELSS:
Since you’ve already started with Axis Long Term Equity Fund, consider continuing for a longer period. ELSS funds provide both tax benefits and growth. You’ve already endured the initial market volatility, and over time, equity funds tend to deliver better returns.

Avoid Hybrid Funds for Now:
If your goal is aggressive wealth creation, hybrid funds might not align with this. Instead, stick to equity funds with a high growth potential.

Final Insights
Set Realistic Expectations:
While you aim for 20% annual returns, the market is unpredictable. A more realistic expectation of 12% to 15% will help you stay grounded and focused.

Daily SIPs Can Be Helpful:
A daily SIP strategy can help you achieve better averaging. However, for high returns, focus on equity funds with a long-term horizon.

Continue Your ELSS Investments:
Since you’ve already invested in Axis Long Term Equity Fund, consider continuing with it. It offers both tax benefits and long-term growth.

Consult with a Certified Financial Planner:
To determine the exact amount you should invest monthly, it’s essential to work with a professional. They can help you build a diversified portfolio aligned with your goals.

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

...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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