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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
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  | 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 Sep 08, 2022

Ramalingam

Ramalingam Kalirajan  |7596 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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Latest Questions
Ramalingam

Ramalingam Kalirajan  |7596 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 21, 2025

Asked by Anonymous - Jan 21, 2025Hindi
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I'm 32, with no savings other than my monthly SIP of 5000 which i have been doing since 2022 september. I have no financial backing, could you help me with a break up of how i can start investing and saving.
Ans: At 32, starting with Rs. 5,000 monthly SIP is a good first step. Building wealth requires a structured approach to saving and investing. Here's a step-by-step guide to help you achieve financial stability and growth.

Assessing Your Current Situation
You have no financial backing, so an emergency fund is critical.

Your monthly SIP indicates discipline in investing.

Prioritising goals and systematic planning will strengthen your finances.

Step 1: Establish an Emergency Fund
Save at least 6 months' worth of monthly expenses in a liquid fund or savings account.

Allocate a fixed portion of your income every month for this purpose.

Emergency funds should be easily accessible but not used for routine expenses.

Step 2: Manage Expenses Effectively
Create a monthly budget to track income and expenses.

Identify unnecessary expenses and redirect the savings towards investments.

Follow the 50-30-20 rule:

50% for necessities (rent, food, bills).
30% for discretionary spending (entertainment, hobbies).
20% for savings and investments.
Step 3: Continue and Enhance SIP Contributions
Your Rs. 5,000 SIP in equity mutual funds is a good start.

Gradually increase the SIP amount as your income grows.

Choose funds based on your risk tolerance and investment horizon.

Step 4: Diversify Your Investments
Equity Mutual Funds

Continue investing in actively managed funds for long-term growth.
Focus on funds with consistent performance over 5-10 years.
Debt Funds or Fixed Deposits

Allocate a portion to safer instruments for stability.
These options can balance risk in your portfolio.
PPF (Public Provident Fund)

Open a PPF account for tax-saving benefits and long-term compounding.
Invest a fixed amount annually to build a secure retirement corpus.
Gold for Wealth Protection

Allocate a small percentage (5-10%) to gold (SGB or gold mutual funds).
Gold acts as a hedge against inflation.
Step 5: Focus on Insurance and Risk Coverage
Purchase a term insurance policy with adequate coverage (10-15 times your annual income).

Ensure you have comprehensive health insurance to cover medical emergencies.

Avoid investment-cum-insurance policies as they deliver low returns.

Step 6: Plan for Long-Term Goals
Define specific financial goals like buying a house, retirement, or children's education.

Assign timelines and cost estimates to each goal.

Invest in equity for long-term goals (10+ years) and debt for short-term goals (1-3 years).

Step 7: Tax-Saving Investments
Use Section 80C instruments like ELSS, PPF, or NPS to save taxes.

ELSS funds provide equity exposure with tax benefits under Section 80C.

Avoid locking excessive funds in low-return tax-saving options.

Step 8: Automate Savings and Investments
Set up auto-debit for SIPs and savings to maintain consistency.

Automating investments reduces the temptation to spend unnecessarily.

Step 9: Regular Monitoring and Review
Review your portfolio every 6 months to track performance.

Rebalance your portfolio to maintain the right asset allocation.

Avoid frequent fund switching, as it may impact long-term returns.

Final Insights
Starting with limited resources can feel challenging but is achievable with discipline. Build an emergency fund, manage expenses wisely, and grow your investments systematically. Consult a Certified Financial Planner to optimise your portfolio and achieve your goals.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

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

...Read more

Ravi

Ravi Mittal  |514 Answers  |Ask -

Dating, Relationships Expert - Answered on Jan 21, 2025

Ravi

Ravi Mittal  |514 Answers  |Ask -

Dating, Relationships Expert - Answered on Jan 21, 2025

Asked by Anonymous - Jan 19, 2025Hindi
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I am a divorced working woman , with a daughter 8 yrs. I have been pursued for remarriage with a guy who is 10 yrs older to me and have 2 kids. 11 and 14 yrs respectively living in a small town. Initially it was agreed the elder child who is a boy would be living in hostel , but now since we are approaching near to the marriage, it seems the elder male child is going to stay at home and not hostel. This is making me really uncomfortable as I won't get much privacy also the male child is aggressive.Already handling one kid was difficult before. Also moving to small town was difficult transition from a metropolitan that I stay in. Moving there could mean losing job opportunities in future. I am really worried if I let this match go, I end up alone again. I am not able to make a decision, it's difficult to raise others children. It's just not naturally inbuilt in us.Although I try really hard to mould my thinking and be more generous, but somehow it suffocates me.
Ans: Dear Anonymous,
Let me ask you one thing, if you knew a plane was going to crash, would you still get on it because you are worried you will reach your destination late? No, right? Similarly, if you know this marriage could be really tough on you, with the added responsibilities of a teenager and another soon-to-be teenager, do you still want to go ahead with it, just because you might have to stay alone for a while longer?

I can't really make a decision for you, but I can urge you to rethink this alliance. It's great that you are trying to compromise but do not compromise so much that nothing that you want is given any importance. You cannot ask a father to send his child to a hostel so that you can have some privacy; similarly, no one can force you to raise him as well. The best decision would be to either reconsider the relationship or have an open conversation and come to a middle ground that works for all.

Best Wishes.

...Read more

Ravi

Ravi Mittal  |514 Answers  |Ask -

Dating, Relationships Expert - Answered on Jan 21, 2025

Asked by Anonymous - Jan 16, 2025Hindi
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How do I 32M get over my insecurity with 30F? (Seeking Advice) Met this girl via matrimony exactly 2 months back. We connect well. Our families have met recently and it went well. Somehow we found a lot of connections between our families. That's just a bonus. Her family likes me a lot and they wanted to do Roka when they met us last week. I had told her, that no matter our bond, we should talk a lot and give it 3 months before going for roka. We live in different metro cities and have met twice now. About her: She is 30, well behaved & spoken(most important thing for me), smart, good looking, and is extremely polite. She is an army brat, has had a lot of freedom from family. Due to her father's job, they kept getting posted to different cities so she doesn't really understand family part of things. She's in a IT job. About me: I'm 32, okayish guy, in IT. To take things ahead I need to know my partner's past. I have no judgements at all but need to know stuff. Getting to know things over time bothers me a lot. I've tried to work on it, and have always made sure I don't bother the other person too much. After a month of talking, she told me that she had a casual boyfriend for an year. All her friends were dating in Bangalore and she decided to try it out. Found a guy through bumble and started dating him. So, according to her there were no feelings, just a person for her to go to places with, have drinks, and party. She likes drinking a lot and I have never taken a sip. She said that it was just a phase and she was immature. This happened between 2018(Nov) to 2020(march). So, it's been like 5 years. Never dated anyone after that. Since covid(2020) she's been living with her parents due to wfh. I have been completely ok with that but new things surfaced and they are messing with my head. While snooping around her facebook I figured out who that person was and this guy is super close to a person in my distant family. In fact they both were flatmates until their respective marriages. This distant cousin of mine knows me and knows her really well. These 3 used to hangout a lot and he has seen her come to their flat regularly. Infact, she had a good bond with my cousin as well. There are things that bother me and I really can't shake things and feel super awful in my gut. She mentioned that she and her ex had a common love for drinking and regularly visited pubs, got drunk, and partied. This means that they would be staying at each other's place as well. This is something super old but bothers me a lot. Specifically the fact that she would be drunk partying with someone for an year and sleeping with him, with no feelings. Secondly, I found some posts where she has liked a post about this guy on fb/insta from mid-2021. I have already confronted her twice to share everything and we shall never discuss this again but this bothers me a lot. Secondly, now that I know the timelines I can figure out what photos have been taken by her ex. There's even a photo of her sitting on a messy bed, where she's cutting her bday cake. They celebrated it together. I found my cousins page and some other pages from which I knew it's the guy's room/flat. I know everyone has a past. She has come clean to me but somehow my brain is so split. Sometimes her nature and behaviour with me make me not care about anything. And then I know the bed, flat, and her actions with some guy. Then there is this angle where the ex's flatmate is my distant cousin and knows about her well.
Ans: Dear Anonymous,
I understand that it is important for you to need to know her past and you mentioned that you merely want to know, and would not judge. But judging is exactly what you are doing. A lot of people have exes, a lot of people have occasional drinks- we can't judge people based on their past. She has opened up to you and all you are doing is snooping around. To be honest, it seems like you are really more concerned about her ex and past than about how amazing a person she is. I have only one piece of advice, if you think you can't get past her past, let her go. No one deserves to be judged by their past.

And think of it this way- you asked, and she told you. She was not obliged to, but still understanding your 'need' to know 'everything,' she confided in you. And this is how you are paying her back. Moreover, so what if she had an ex, or dated casually? How does that affect you right now? Ask yourself the same question and I think you will know the answer to your own dilemma.

Having said it all, marriage is a big decision. If you think her past can hamper your future, please rethink this relationship. It is best for both of you.

Best Wishes

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Ramalingam

Ramalingam Kalirajan  |7596 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 21, 2025

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I am 49 and plan to retire in 2 years time.. I currently have a MF corpus of about 1.8 Cr, a PF of about 1 Cr and properties worth 2 Cr. I have been investing in MF's since 2014 through SIP's and currently have 70K monthly SIP. Please advise if I would be comfortable in 2 years, my estimated monthly expense post retirement would be approx 2 Lakhs per month
Ans: Your current corpus of Rs. 1.8 crore in mutual funds and Rs. 1 crore in PF is significant. The additional Rs. 2 crore in properties adds to your wealth but doesn’t provide immediate liquidity. Let us evaluate if your corpus will sustain your post-retirement expense of Rs. 2 lakh per month.

Estimating Post-Retirement Corpus Requirement
You plan to retire in 2 years, at age 51.

Assuming a life expectancy of 85 years, the corpus needs to last for 34 years.

An expense of Rs. 2 lakh per month means Rs. 24 lakh annually.

Adjust this amount for inflation to calculate future needs.

Current Investment Contributions
Your Rs. 70,000 monthly SIP builds your corpus over the next 2 years.

SIPs offer rupee cost averaging, reducing market volatility impact.

Assess the fund performance regularly to maximise growth.

Diversification of Investments
Your corpus is spread across mutual funds, PF, and properties.

PF provides a stable, fixed return but lacks flexibility.

Properties offer wealth accumulation but are less liquid for immediate needs.

Mutual funds remain a primary source of liquidity and growth post-retirement.

Evaluating Monthly Withdrawals Post-Retirement
Withdrawals should balance your monthly expenses and ensure corpus longevity.

Avoid withdrawing large amounts in the early years of retirement.

Consider a mix of equity and debt mutual funds for withdrawal strategies.

Role of Inflation and Healthcare Costs
Factor in inflation’s effect on expenses over 30+ years.

A 6% inflation rate doubles your monthly expense in 12 years.

Allocate for increasing healthcare costs with age.

Importance of Emergency and Medical Coverage
Keep at least 6 months' expenses in a liquid fund for emergencies.

Ensure you have comprehensive health insurance for unexpected medical costs.

Tax Efficiency in Withdrawals
Equity mutual funds' LTCG above Rs. 1.25 lakh is taxed at 12.5%.

Debt fund returns are taxed as per your income tax slab.

Plan withdrawals to minimise tax liability on gains.

Active Funds vs. Direct Funds
Actively managed funds optimise returns by responding to market changes.

Direct funds lack professional support, affecting long-term efficiency.

Work with a Certified Financial Planner to select regular funds.

Disadvantages of Relying on Real Estate
Properties are illiquid and may take time to convert to cash.

Rental income may not cover Rs. 2 lakh monthly expenses reliably.

Maintenance and property taxes further reduce returns.

Recommendations for Portfolio Restructuring
Increase Allocation to Growth Assets

Continue SIPs in equity mutual funds for growth potential.

Review funds for consistent performance and portfolio alignment.

Add Balanced and Debt Funds for Stability

Include balanced advantage and debt funds for steady income.

Debt funds reduce overall portfolio risk.

Plan a Withdrawal Strategy

Use the SWP (Systematic Withdrawal Plan) for predictable income.

Withdraw from equity funds after 3 years for tax efficiency.

Avoid Over-reliance on PF and Real Estate

PF offers safety but limited returns.

Use properties strategically for potential downsizing or sale.

Final Insights
You are on track to retire comfortably, provided you optimise your investments. Plan your withdrawals carefully, factoring in inflation and tax efficiency. Work with a Certified Financial Planner to refine your portfolio and achieve your goals.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

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

...Read more

Ramalingam

Ramalingam Kalirajan  |7596 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jan 21, 2025

Asked by Anonymous - Jan 21, 2025Hindi
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I like to know which MF to be selected for investing in a SIP among same types of funds with equal performances and risks but with different NAVs.
Ans: When selecting a mutual fund for SIP among funds with similar types, performances, and risks but different NAVs, consider the following aspects:

1. Net Asset Value (NAV) Does Not Reflect Fund Performance
A lower or higher NAV does not indicate better returns.

NAV reflects the fund's per-unit value and changes daily.

Investment growth depends on percentage returns, not NAV values.

2. Expense Ratio and Fund Costs
A lower expense ratio can improve net returns.

Actively managed funds with skilled fund managers may charge slightly higher fees.

Ensure you evaluate the cost-to-benefit ratio before making a decision.

3. Fund Manager's Track Record
Review the fund manager's expertise and past performances.

A consistent manager with strong market knowledge can add value.

Avoid funds with frequent management changes.

4. Fund House Reputation and AUM
Choose funds from a reputed fund house with a strong track record.

A large Asset Under Management (AUM) ensures better stability and liquidity.

Avoid funds with excessively low AUM, as they may face liquidity issues.

5. Tax Implications of the Fund
Assess how long-term and short-term capital gains will affect returns.

Equity mutual funds have specific tax rates: LTCG above Rs 1.25 lakh is taxed at 12.5%.

Debt funds follow your income tax slab, affecting post-tax returns.

6. Investment Goals and Time Horizon
Align the fund choice with your financial goals.

Longer-term goals may benefit from equity-focused funds.

Short-term goals may require hybrid or debt-focused funds.

7. SIP Benefits in Any NAV
SIPs help average out purchase costs over time, reducing the impact of NAV differences.

Avoid basing decisions solely on NAV, as SIPs work on rupee cost averaging.

8. Focus on Portfolio Composition
Examine the fund's portfolio mix and sector allocation.

Ensure diversification aligns with your risk appetite and goals.

Avoid funds with concentrated exposure to risky sectors.

9. Assess Consistency of Returns
Look at rolling returns and consistency across market cycles.

Funds with stable returns in volatile markets are preferable.

Avoid funds with high volatility in performance.

10. Disadvantages of Index Funds
Index funds passively track benchmarks, lacking flexibility in volatile markets.

Actively managed funds can outperform by leveraging market opportunities.

A Certified Financial Planner can guide you to suitable active funds.

11. Benefits of Regular Funds Over Direct Funds
Regular funds offer ongoing advice and monitoring by a Mutual Fund Distributor (MFD).

Direct funds lack professional support, which is crucial for long-term goals.

Certified Financial Planners provide insights and manage your portfolio efficiently.

Final Insights
Choosing the right mutual fund involves evaluating beyond NAVs. Focus on long-term potential, cost efficiency, and alignment with goals. SIPs, combined with expert advice, will help you achieve financial stability.

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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