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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
Mittal Question by Mittal on Nov 24, 2022Hindi
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I have been operated for Wilson's disease for my liver. I got admitted in Nov 21 and got discharged in Dec 21. My insurance company paid all expenses up to Sum insured and the same got exhausted in Dec 21 and then I renewed the policy in Jan 22. As per my Policy I am eligible for claiming 60-days medical expenses post hospitalisation and submitting the bills but the TPA is repudiated it with remarks that not eligible as the treatment done in 2021 and bills for 2022 are not admissible though the insurance company is same.

Please help to know how do I tackle it and is there any alternate possibility.

Ans: Hi Mittal, as far as I have understood your query, your sum insured exhausted during the hospitalisation process. Once the sum insured is exhausted, you cannot claim post hospitalisation bills.  

However, if your sum insured was not completely exhausted, you would have got the claim for post hospitalisation even if the bills were dated in Jan 2022, i.e. within 60 days of discharge.

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 Sep 08, 2022

Ramalingam

Ramalingam Kalirajan  |8192 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 2024

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My father is 89 years old and has recurring abdominal pain from last few months. In Apr'23 he was admitted in one private hospital at our locality and admitted for 7 days due to the pain issue. Various tests were conducted including blood tests, CT scan, fibroscopy and endoscopy, no major issues observed except some liver irregularities and discharged after providing certain oral medication. The cashless benefits are obtained through corporate TPA (EWA). However after certain weeks intermittently severe pain recur for almost a week and this time, on first week of July, my father was taken to Kolkata at a hospital specific to liver and digestive treatment. As advised by doctor he was admitted and again various tests are conducted including blood and stool culture, LFT, CT scan and colonoscopy..But this time also no major issues observed and he was discharged after certain medications, which differs from earlier hospital medicines. But this time claim is denied by TPA (EWA) stating that the admission is done only for investigation and observations and no line of treatment was done.. although new medicines are prescribed in the discharge summary and along with that IV fluid and some other medicines were regularly given during his stay in hospital. As TPA has denied the claim, I have to pay the entire amount in spite of paying a hefty amount of premium for my father. Can you pls suggest, why the claim is denied and whether there is any possibility of reimbursement of the claim by any means?
Ans: I'm sorry to hear about your father's health issues and the challenges you're facing with the insurance claim. The denial of the claim by the TPA (Third Party Administrator) could be due to several reasons, including discrepancies in documentation, interpretation of policy terms, or classification of the treatment as investigational rather than therapeutic.

To address this issue and explore the possibility of reimbursement, here are some steps you can take:

Review Policy Documents: Carefully review the terms and conditions of your father's health insurance policy to understand the coverage and exclusions. Pay attention to the criteria for claim eligibility and the definition of covered treatments.

Seek Clarification: Contact the TPA or the insurance provider to seek clarification on why the claim was denied. Request detailed information on the specific reasons for denial and ask for clarification on any policy terms that are unclear.

Gather Documentation: Gather all relevant medical records, including discharge summaries, prescription details, invoices, and receipts for medications and treatments provided during the hospital stay. Ensure that the documentation clearly demonstrates the medical necessity and therapeutic nature of the treatment received.

Appeal the Decision: If you believe that the denial was incorrect or unjustified, consider filing an appeal with the insurance company. Provide supporting documentation and any additional information that may strengthen your case for claim reimbursement. Follow the appeal process outlined by the insurance provider and submit the appeal within the specified timeframe.

Consult an Expert: If necessary, consider seeking assistance from a healthcare advocate or insurance specialist who can help navigate the appeals process and advocate on your behalf. They may offer valuable insights and assistance in presenting your case effectively.

Explore Legal Options: If all attempts to resolve the issue through the appeals process are unsuccessful, you may consider seeking legal advice to explore further options, such as mediation or legal action, to resolve the dispute.

It's important to remain persistent and proactive in pursuing reimbursement for legitimate medical expenses. Keep thorough records of all communications and documentation related to the claim, and continue to advocate for your father's rights as a policyholder.

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Ramalingam

Ramalingam Kalirajan  |8192 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 2025

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I am 49 yrs and monthly expense is 165000. no other liabilities of children's and parents. Only expense of myself and wife and if want to retire in next 1 year what corpus would be needed for next 25 yrs considering inflation. we have adequate Mediclaim policy of 75 lakhs.
Ans: You are 49 now, with monthly expenses of Rs. 1.65 lakh. You have no children's or parents' liabilities. You plan to retire in one year. Also, you and your wife are well-covered by a Rs. 75 lakh Mediclaim policy.

That’s a strong and admirable starting point. Let us now assess your retirement readiness. We will consider inflation, lifestyle, and long-term wealth management.

Let us start with the key areas you must evaluate before retirement.

Monthly Expenses and Lifestyle Assessment
Your current monthly expenses are Rs. 1,65,000. That is Rs. 19.8 lakh a year.

This includes only you and your wife. That simplifies planning.

It seems your lifestyle is stable and well-managed.

As inflation rises, your expenses will rise each year.

With average inflation of 6%, costs double in 12 years.

So, your Rs. 1.65 lakh today can become about Rs. 3.3 lakh per month in 12 years.

You must plan for these higher costs in future years.

Retirement corpus should grow steadily and beat inflation.

That way, your wealth can support you for 25+ years.

Evaluating Retirement Duration
You are retiring at 50. We will plan till 75 years.

But people are living longer now. Life expectancy is increasing.

So, it is better to plan till 85 or 90 years.

That means your money must last for 35 to 40 years.

But your question is for 25 years. Let us assess for 25 first.

Later, we will share how to stretch this for longer, if needed.

How Much Corpus Is Needed?
You will need income for 300 months (25 years × 12 months).

Each year, expenses will rise due to inflation.

So, in early years you may spend less.

But in later years, your expenses will be much more.

Your corpus must grow and give monthly income.

At the same time, the principal must not fall quickly.

A safe starting estimate: You will need around Rs. 8 to 10 crores.

This is to cover 25 years with rising expenses.

This estimate assumes post-retirement returns of 10% to 11%.

It also assumes inflation at 6% per year.

The more return your investments earn, the less corpus you need.

The less return, the more corpus you need.

Corpus must be invested smartly to earn and grow.

We will now see how to manage this corpus efficiently.

Key Factors That Affect Your Retirement Plan
Inflation: Your biggest hidden enemy. It silently eats wealth.

Longevity: If you live longer, you need more money.

Medical Expenses: You have good Mediclaim cover. That is great.

Unexpected Costs: Home repair, travel, or emergencies may arise.

Return on Investments: You must beat inflation every year.

Tax Efficiency: Returns must be tax-optimized.

Withdrawal Plan: Monthly withdrawal must be well structured.

Ideal Investment Strategy for Retirement
Your goal is simple: monthly income of Rs. 1.65 lakh, rising with inflation.

At the same time, principal must stay intact or reduce slowly.

Here is the strategy:

Invest the full retirement corpus in mutual funds.

Choose a mix of equity and hybrid funds.

Start with a 60:40 ratio. 60% equity, 40% debt/hybrid.

This gives growth and stability.

Every year, rebalance the portfolio.

If equity grows fast, shift some to hybrid for safety.

Use Systematic Withdrawal Plan (SWP) for monthly income.

Withdraw only what you need. Let the rest grow.

Avoid fixed deposits for full corpus. They do not beat inflation.

Keep only 6 to 9 months of expenses in FDs or liquid funds.

That acts as an emergency buffer.

You should invest through a Certified Financial Planner.

A CFP will help you create a strong plan.

They can also handle taxes, rebalancing, and fund review.

Why You Should Avoid Index Funds
Index funds follow the market blindly.

They invest in every stock, good or bad.

No fund manager takes active decisions.

During market fall, they fall fully.

They cannot protect your money in crisis.

They do not outperform consistently.

In retirement, you cannot afford sudden deep losses.

You need actively managed funds.

These funds are managed by experts.

They aim to protect during fall and grow during rise.

That is safer for long-term retired life.

Why You Should Avoid Annuities
Annuities give fixed income for life.

But they are not inflation protected.

If you get Rs. 1 lakh today, it stays Rs. 1 lakh forever.

After 10 years, that has much less value.

They also offer very low returns.

Most annuities lock your money permanently.

There is little flexibility and no liquidity.

You cannot exit midway if your needs change.

That is not ideal for someone in your situation.

You need a growing income, not fixed.

SWP from mutual funds is better than annuities.

Why You Should Avoid Real Estate
Real estate needs large one-time investment.

It has poor liquidity. You cannot sell fast.

Maintenance cost is high.

Rental income is often low and irregular.

Property disputes are common.

In retirement, you need easy-to-manage assets.

Real estate is not ideal for retirees.

Tax Planning for Retirement
SWP from equity mutual funds is taxed.

Long-term capital gains (LTCG) above Rs. 1.25 lakh yearly are taxed at 12.5%.

Short-term capital gains are taxed at 20%.

Debt fund withdrawals are taxed as per your tax slab.

With right planning, you can reduce tax.

You can stagger withdrawals to stay under limit.

Keep long-term view for most equity funds.

Let them grow for at least 3 to 5 years before major withdrawals.

A Certified Financial Planner will guide your tax planning.

Annual Review of Retirement Plan
Every year, review your expenses.

Match your SWP amount with your needs.

If inflation rises faster, adjust SWP upward.

Rebalance portfolio to maintain equity and debt mix.

Track returns of each fund regularly.

Remove underperformers after 2-3 years.

Add new funds with good consistency.

Review Mediclaim and emergency fund each year.

Make a will or estate plan.

Ensure all documents are updated and in order.

Other Key Tips for Retired Life
Don’t give large loans to friends or relatives.

Avoid co-signing loans for anyone.

Keep your lifestyle simple and meaningful.

Spend more on health and wellness.

Invest time in hobbies and charity.

Keep your money safe from online fraud.

Don’t chase high return risky investments.

Always discuss big financial decisions with your wife.

If needed, involve your Certified Financial Planner for support.

What If You Live Beyond 25 Years?
Your current plan is for 25 years.

But you may live till 85 or 90.

So your corpus must grow even after withdrawals.

Let at least 40% of your corpus stay in equity.

Equity gives long-term inflation beating returns.

If your corpus allows, reduce SWP amount after 75.

Or maintain same SWP, but reduce expenses.

This will help your corpus last longer.

Review the corpus regularly post 75 years of age.

Final Insights
You are well prepared for retirement at 50.

Rs. 1.65 lakh monthly expenses are realistic.

But inflation must be planned seriously.

You will need about Rs. 8 to 10 crore corpus.

Invest in equity and hybrid mutual funds.

Use SWP for monthly income.

Avoid index funds, annuities, and real estate.

Keep liquidity for emergencies.

Review portfolio and expenses yearly.

Involve a Certified Financial Planner for full planning support.

Your focus now should be wealth preservation and moderate growth.

This is a golden phase of life. Plan it smartly.

You deserve peace, dignity, and freedom in retirement.

Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner,
www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

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Mayank

Mayank Chandel  |2176 Answers  |Ask -

IIT-JEE, NEET-UG, SAT, CLAT, CA, CS Exam Expert - Answered on Apr 05, 2025

Asked by Anonymous - Apr 04, 2025Hindi
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Hlo. Sir. Maine apna neet exam. 2024 mai diya tha. Sirf. 6 month hi preparation krke. I score well but negative marking ki wajah se. Mere mask kam hogye and maine vapis. 205 ke liye preparation Krna strt kiya ha. Without any coaching self study muje assa lg rha ha ki iss baat bhi nhi hoga. Stress ki wajah se overthinking ki wajah se mere kuch din bhut khrab hogya ha. Prr mere parents ne decide ki ha ki offline coaching krwagye. Kya muje 3 attempt ki. Jna chaiiye muje doctor hi bnna ha muje aur kuch nhi Krna ha mai bhut ache se pdh sakte hu bss ye ha ki 3 attempt dena worth it ha kya
Ans: Hello,
pehle toh main yeh kehna chahta hoon ki tumne sirf 6 mahine ki tayyari mein NEET jaise tough exam ko dene ki himmat ki — yeh kaafi badi baat hai. Tumhare andar definitely potential hai. NEET jaise exam mein negative marking sabko affect karti hai, especially jab preparation time kam ho.

Ab baat karte hain tumhare doubt par:
Kya 3rd attempt dena worth hai?
Tumhara answer tumne khud hi de diya:

"Mujhe doctor hi banna hai, mujhe aur kuch nahi karna."

Jab goal clear ho, toh answer bhi clear hota hai:
Agar doctor banna tumhara sapna hai aur tumhara belief hai ki tum mehnat kar sakte ho, toh 3rd attempt definitely worth it hai, lekin is baar smart aur structured preparation ke saath.

Offline coaching-jaise tumhare parents keh rahe hain
Agar ghar par overthinking, distractions, aur stress zyada ho raha hai, toh offline coaching environment tumhe discipline aur direction de sakta hai.
Daily study routine, regular tests, competition ka mahol — yeh sab tumhare liye helpful ho sakte hain.

Agar tumhara belief strong hai, toh koi bhi attempt waste nahi hota.
Bahut saare doctors ne 3rd, even 4th attempt me crack kiya hai. Tumhara vision clear hai, ab bas execution me discipline aur patience chahiye.

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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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