Home > Money > Question
Need Expert Advice?Our Gurus Can Help
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, 2022Translate
Listen
Money

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.
Money

You may like to see similar questions and answers below

Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 21, 2022

Listen
Money
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.   

(more)
Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Sep 08, 2022

Latest Questions
Moneywize

Moneywize   |66 Answers  |Ask -

Financial Planner - Answered on Mar 03, 2024

Asked by Anonymous - Mar 03, 2024Translate
Listen
Money
I'm contemplating a career change in my late 30s, earning Rs 14 lakhs annually. How can I navigate this transition while ensuring financial stability and working towards long-term goals such as retirement?
Ans: Transitioning to a new career in your late 30s while maintaining financial stability and planning for long-term goals like retirement requires careful consideration and planning. Here are some steps you can take to navigate this transition effectively:

1. Assess Your Skills and Interests: Reflect on your skills, interests, and values to identify potential new career paths that align with your strengths and passions. Consider seeking career counseling or taking career assessment tests to explore different options.

2. Research Potential Careers: Conduct thorough research on the industries and roles you're interested in pursuing. Look into job market demand, salary potential, and growth opportunities to ensure your chosen career path is financially viable.

3. Skill Development and Education: Determine if you need to acquire new skills or education to transition into your desired field. This could involve enrolling in courses, obtaining certifications, or pursuing higher education such as a degree or specialised training programme.

4. Financial Planning: Evaluate your current financial situation and create a budget to understand your income, expenses, and savings. Factor in any potential changes in income or expenses associated with your career transition. Consider setting aside an emergency fund to cover unexpected expenses.

5. Debt Management: If you have any outstanding debts, develop a plan to manage and pay them off efficiently. Prioritise high-interest debts like credit card debt while maintaining minimum payments on other loans.

6. Retirement Planning: Review your retirement savings accounts like the EPF, and assess whether you're on track to meet your long-term retirement goals. Consider consulting a financial advisor to develop a personalised retirement plan based on your age, income, risk tolerance, and retirement objectives.

7. Health Insurance and Benefits: Evaluate the health insurance and other benefits offered by your new employer, if applicable. Ensure you understand the coverage provided and any associated costs. If transitioning to self-employment or freelancing, research options for obtaining health insurance coverage independently.

8. Networking and Building Connections: Network with professionals in your desired industry to gain insights, advice, and potential job opportunities. Attend industry events, join professional associations, and leverage online networking platforms like LinkedIn to expand your network.

9. Side Hustle or Freelancing: Consider starting a side hustle or freelancing in your desired field while maintaining your current job. This can provide additional income, valuable experience, and a smoother transition into your new career.

10. Evaluate Risks and Rewards: Assess the risks and rewards associated with your career change, including potential income fluctuations, job stability, and work-life balance. Be prepared to adapt and make adjustments as needed throughout the transition process.

By following these steps and carefully planning your career transition, you can navigate the change while maintaining financial stability and working towards your long-term goals, including retirement.
(more)
Dr Karthiyayini

Dr Karthiyayini Mahadevan  |599 Answers  |Ask -

General Physician - Answered on Mar 03, 2024

Listen
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.

Close  

You haven't logged in yet. To ask a question, Please Log in below
Login

A verification OTP will be sent to this
Mobile Number / Email

Enter OTP
A 6 digit code has been sent to

Resend OTP in120seconds

Dear User, You have not registered yet. Please register by filling the fields below to get expert answers from our Gurus
Sign up

By signing up, you agree to our
Terms & Conditions and Privacy Policy

Already have an account?

Enter OTP
A 6 digit code has been sent to Mobile

Resend OTP in120seconds

x