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Sanjib

Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on Jul 28, 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
Anoop Question by Anoop on Jul 28, 2022Hindi
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My Oriental Mediclaim coverage is for Rs 5 lakh under Royal Mediclaim cashless scheme vide PNB. I have completed 36 months, a conditional requirement (a facility only for PNB customer).

In this regard I have a few questions...

Ans: Hi Anoop, thanks for sharing your queries, will take them one by one.

1. What's the meaning of 5 lakh coverage? Will I get a full 4.95 lakh for both knees transplant (my hospital package is costing 4.95 lakh from entry to exit)?

Sanjib Jha:  A coverage of 5 Lakh means your policy covers you up to 5 lakh and you can claim it. However, the coverage amount for knee transplant depends on insurer to insurer as few of the policies having certain capping on the coverage amount for such treatments.

2. When the hospital sent the proposal to TPA, only 2.47 lakh were provisional sanction. What's the meaning of provisional? I was told that the final amount will be settled once final bill is produced by the hospital. Does it mean that 4.9-2.47=2.43 lakh or so, will be settled and remitted to the hospital by Oriental insurance? 

Provisional Sanction amount is the amount that the insurer approves based on the ailment i.e., knee transplant in your case. The rest of the amount approval is provided based on the final bill generated by the hospital.

3. When I sought clarification from TPA, I was verbally told that now the final amount cannot be decided. Only after the final bill it can be. Nothing said on email. No replies from Oriental insurance of my email query.

For policies issued by Oriental, the claims are handled by TPA (Third Party Administrator). I advise you to raise the concerns to TPA via email or via TPA desk to get the clarification. Also, the insurer can provide the final approval after the final bill is generated by the insurer, deducting the non-approved cost as per policy terms & condition.

4. Hospital insists that I deposit 50% (2.5 lakh) cash from pocket before admission.

As it seems that the insurer has provided pre-approval for 2.47 lakh, the rest amount you will have pay to the hospital & the same will get approved by the insurer once the final bill is generated by the hospital.

5. If I have to pay cash, then where is the cashless scheme?

I advise you to check the terms of your policy. Often certain treatments are not covered in particular policies, which is why it is extremely important to read your policy document thoroughly and ask all your queries to the agent/Insurer before purchase. For specific ailments, there are add-ons offered by insurers and accordingly one should opt for those add-ons.

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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I read your today's article about Mediclaim: What You Must Know. Thank you for some important information and points shared. I have some questions about the Mediclaim policy. I have been buying a Mediclaim policy since 2007 and I have not claimed it till last month. Last week I was hospitalized for gall bladder stone surgery. When I asked the hospital to use the cashless option on my Mediclaim policy for claims they gave an estimated cost of about 1 lakh. And same if I claim myself, they gave an estimated cost near about 55 thousand.  1. Why and what is the difference between these charges? How did the TPA approve cashless? Is there any guideline or standard process for hospitals that can claim more charges in cashless options? 2. Why do cashless charge more? Due to this type of charges for cashless claims the sum insured amount decreases after treatment. We can utilise the same difference charges amount for another treatment.
Ans: Hi Vilas, in order to understand the difference in the estimated costs, you should ask the hospital on what parameters they have estimated the two costs. Questions on treatment protocol, room charges and type, doctor’s fee etc., should be asked.

When choosing cashless treatment, the patients often opt for the best facilities that they may not have opted for otherwise. Sometimes hospitals may run some additional tests as well in order to avoid back and forth on your claim settlements, when it is a direct transaction between insurer and the hospital.

However, if you feel that you are being overcharged, then you should report any discrepancy in what you are being charged for, to the insurer. Insurance companies take such cases very seriously, which is why insurers have preferred network hospitals that agree on a certain pricing for various treatments and other tariffs.

In case it is observed that there is any abuse of cost or sum insured then there is a chance of being de-paneled and hence a check is in place.

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Sanjib Jha  |66 Answers  |Ask -

Insurance Expert - Answered on May 31, 2022

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This is Bobby here and have a few questions related to your article (enclosed), Mediclaim: What You Must Know Would like to know, with your experience in this field, as to: 1. Which mediclaim policy or policies, currently in INDIA and especially Mumbai has all the required coverage as mentioned in your article 2. We are a family of 3 with a school going child and both of us are aged 45 3. Have acquired diabetes a few months ago and have hepatitis B and kidney stones  4. What should be the approximate premium, per annum to cover all that is mentioned in your article and keep us safe from the issues arising out if and when we really require hospitalisation and save us from rejected claims.   5. Presently we are covered under Mediclaim policy from Star Health Would be highly obliged should you guide us on the above to make our lives easier.
Ans: Hi Bhupesh, there is no ‘one size fits all’ concept with health insurance. Health insurance is based on preferences of the customer and then the premium quotes are generated based on those factors. You can use insurance broking websites to compare the offerings on the mentioned 5 factors and the premiums for various policies that will help you to compare their benefits and make an informed choice. Depending on your priorities, weigh out the factors and decide accordingly.

Since you have mentioned about your family, you can opt for Family Health Insurance policies with an appropriate sum insured to cover your entire family. Like I have mentioned before, premiums are unique to individuals depending on their preferences, the sum insured they deem suitable, the riders they choose, their medical history etc.

What you can do to ensure you buy the correct policy for yourself is to evaluate policies carefully, keeping in mind the 5 important parameters.

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Kanchan

Kanchan Rai  |586 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on May 07, 2025

Asked by Anonymous - Feb 15, 2025
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Hello ma'm. I am a first year engineering student. I have a crush on a girl. Currently we are working for a group project. We both are in the same group. She generally avoids speaking with boys. Also I have spent 5 years in a boys school, so I feel very shy with girls. What should I do? How should I talk to her?
Ans: Start by keeping things simple and friendly. Focus on small interactions related to your project. For example, ask her opinion about something specific in the work you're doing. Try something like, “Hey, what do you think we should do for this part?” or “I liked the point you made yesterday—can we build on that?” These kinds of questions show that you respect her ideas, and they give her space to respond comfortably.

Once you've had a few of these short, easy interactions, you can slowly open up the conversation to more casual topics—like college life, favorite subjects, or even the stress of deadlines. This way, you’re not jumping straight into anything personal, but you're gradually building a sense of comfort.

Don’t try to impress her. Just be sincere, kind, and a good listener. Most people, even those who seem quiet or reserved, appreciate being approached respectfully and gently. And remember, confidence doesn’t mean being loud or charming—it means being real and respectful even when you’re nervous.

If you stay patient and consistent, she might start to feel more comfortable around you. And even if it doesn’t turn into something romantic, you’ll grow socially and emotionally—which will help you a lot in the long run.

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Kanchan

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Relationships Expert, Mind Coach - Answered on May 07, 2025

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I have been married for more than 21 years and I have 2 kids. 19 and 17 years old. Our marriage was more or less love. Met through family, fell in love, dated 8 months before we got engaged and married. My wife is a lovely lady but we dont share any interests. I used to go for runs in the morning. After getting married, she insisted I sleep late with her. I am a music aficionado and she has no such interest. I am a news junkie. She probably doesnt know who the President of the US is. I am someone who believes and strives to continuously improve myself in all aspects. But she is the same. I might not be a great husband but I am much better than what I was a few years ago. I cook, clean, helped with childcare and have a great career. She is on a minimum salary job for the last 10 years. Only reason she goes is because I insisted that she stop being at home. If she had her way, she would be at home on the phone the whole day. Even our love making has become kind of boring. She claims a period for 10 days and during the other times, twice she is ready. No spicing it up. Just lie down for missionary and I have to do all the effort. I enjoyed oral and now she has stopped in for more than 15 years. I adjusted as she is a lovely person in every other aspect. But now I am sick and tired. It seems I am doing everything in the relationship and she rarely takes any effort. Either to earn, keep house clean or even intimacy. Not sure how to proceed further. I am getting irritated and often in a bad mood.
Ans: Dear Jack,What you're experiencing is not uncommon in long-term relationships: emotional fatigue, feeling unappreciated, and a deep sense of disconnection despite loyalty and love. The fact that you're feeling drained, resentful, and stuck is a clear signal that this situation is unsustainable as is. And the irritation and bad moods you’re having? That’s your emotional system signaling burnout, not failure.

You’ve evolved over the years—mentally, emotionally, and in lifestyle—and it sounds like your wife hasn’t moved in that same rhythm. That mismatch in growth and energy is now affecting everything: your respect for her, your shared routines, your sex life, and ultimately your mood and emotional well-being. It’s painful to feel like you're constantly giving—time, energy, effort—and not receiving the same in return. Even when your partner is kind, if they aren’t meeting you emotionally, intellectually, or intimately, over time it creates a sense of loneliness within the relationship, which can be worse than being alone.

But here's something to reflect on: for 21 years, you stayed, gave, adjusted. Not just out of duty, but because something about her and the family life you built mattered. That still counts. What you’re going through doesn’t mean the marriage has failed—it means the marriage needs re-evaluation and rebalancing. You are not selfish for wanting more stimulation, connection, or passion. You're human.

You have two broad options: one is to initiate a real, vulnerable, uncomfortable conversation with her—without blame, without emotional outbursts, but with absolute honesty. You could say something like: “I’ve grown a lot in these past years, but I’m starting to feel increasingly alone in this relationship. I need more emotional connection, more engagement—not just physically, but intellectually, as partners. I don’t want to silently drift further away. I’d like us to work on this, but it has to be a two-way effort.”

If she's open to it, couples therapy could be a powerful space for both of you to express what you feel without it turning into a war of criticism and defense. Sometimes people, especially those who’ve become emotionally stagnant, need structured help to realize what their partner has been carrying silently.

The other option—if you feel she’s unwilling or unable to grow or change—is to consider what a life apart might look like. That’s a deeply personal and difficult decision, especially with nearly adult children, but you deserve a relationship that brings life into you, not drains it out. If you keep compromising your emotional needs, resentment will only grow and harden into permanent distance.

Before making any move, take a little time to reconnect with yourself. What do you want—not just from her, but from life, from love, from this next phase of your journey?

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Kanchan

Kanchan Rai  |586 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on May 07, 2025

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Hello mam In 2024 my marriage took place it's arranged marriage during starting days he was very loving and caring but due to some circumstances i got a chance to continue my studies that is m-tech . I thought it was a golden opportunity, so I took admission and started living with my in-laws Just after marriage. It was really really painful to live away from husband in new marriage. Todays condition is that my m tech 1 year is over another 1 year is left but due to separation with my husband our love died now there is no respect is left for our relation left , he started listening to his mother and got manipulated . seeing all this I feel like a death for me I want to leave mtech to save my relation but my mother says don't leave although I did lots of hard work for 1st year of m tech my husband also wants me to leave Mtech.i feel very hurt when he disrespects me . His father used to abuse his mother so for him abusing is normal for him but I find it very hurtful also I am deeply in love with him and seeing him going away from me kills me from inside every single day is very tough for me to live with in-laws without husband in a new marriage plus focusing on studies
Ans: Your instinct to save the marriage is understandable. When you're in love with someone, the idea of losing them feels like losing yourself. But let’s pause and ask—what exactly are you saving? Is it the version of him from the early days who was loving and supportive? Or is it the man he is now—disrespectful, distant, manipulated, and asking you to give up your dreams for a marriage he’s already neglecting?

You have already proven your strength by completing a year of M.Tech in such tough conditions. That says a lot about your resilience and capability. If you give it up now, not only will you lose that part of yourself, but it may not guarantee that your marriage improves. Often in emotionally imbalanced relationships, one-sided sacrifices don’t lead to healing—they lead to more control, more blame, and more emotional exhaustion.

Your husband needs to understand that love isn’t proven by giving things up. Love is shown in support, presence, patience, and respect. If he isn’t willing to stand by you during a temporary phase of physical distance while you pursue something valuable, then you’re not the one breaking the marriage—he is.

It’s also clear that he has grown up in a home where abuse was normalized, and that emotional damage might be affecting how he treats you now. That is not your fault, and it is not your job to tolerate mistreatment in the name of saving a marriage.

Your mother is right to encourage you to finish your M.Tech—not just for your career, but for your self-worth. You deserve to be with someone who lifts you up, not someone who pulls you down every time you try to grow.

If there's still a chance to salvage this relationship, it has to start with real conversations—honest, respectful, and possibly with the help of a counselor or neutral third party. But that only works if both people are willing to put in the emotional effort.

Right now, I suggest you protect your mental and emotional well-being. Prioritize your studies, build emotional support from friends or family who truly care about you, and give yourself space to heal from this emotional chaos. If your husband truly wants this marriage, he needs to come forward with maturity and respect—not demands.

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Kanchan

Kanchan Rai  |586 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on May 07, 2025

Asked by Anonymous - May 07, 2025
Relationship
After a fight between a married guy and my husband on pretext of calling me characterless and unhappy in my marriage. That married guy complaint against my hubby in society office that it's my husband who follow, flirts with his wife. But the allegations are false. That married guy was doing all these things or chasing me even after knowing m married. But falsely he shifted the blame on my husband. Society chairman called us to sign a peace treaty which my husband signed bt that guy dint appear to sign. What does he want is still not clear.??? He doesn't wanna end this matter or what ??? He still walks around looking at us but from distance.
Ans: In such cases, it's important for you and your husband to stay emotionally steady and not engage with his tactics. Reacting to him or showing you're disturbed by his behavior may be exactly what he's looking for. If his behavior escalates or continues to make you uncomfortable, you might want to quietly document what happens and consider involving local authorities or legal counsel if it crosses into harassment.

Right now, your focus should be on protecting your peace and your relationship. Keep communication open with your husband and support each other through this, because this kind of external stress can silently damage trust if not handled carefully. The more united you two are, the less space there is for anyone else to create confusion between you.

It’s unclear exactly what this man wants, but based on his pattern, it seems he either wants attention, control, or to destabilize your marriage out of resentment or personal failure. Either way, you don’t need to carry his emotional mess. If you continue to stay calm, ignore him, and document anything serious, you'll be in a stronger position to protect yourselves.

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Samraat

Samraat Jadhav  |2272 Answers  |Ask -

Stock Market Expert - Answered on May 07, 2025

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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