Home > Money > Question
Need Expert Advice?Our Gurus Can Help
Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 10, 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
THANGAVELU Question by THANGAVELU on Jun 10, 2022Hindi
Listen
Money

My family is covered under Ex-serviceman Contributory Health Services (ECHS). She is having health insurance coverage from three other insurance entities. Still continuing. So, there was no pre-existing conditions.

Two and half years back, we have opted for claim re-imbursement only for blood transfusions during the pre-diagnosis period.

Later, her medical condition was diagnosed and the same was falling under IRDA exclusions. She was treated once in-patient and afterwards as outpatient. All claims for admission and medicine re-imbursement were availed from ECHS. (Once I have opted for enhancement of insurance coverage from one insurer and the TPA has refused under these clauses).

Now, after two and half years, she has recovered better (Even Doctor's perception). But she is continuing medicine with lessor dosage. Presently, her condition is fine.

My questions are:

1. Can I avail insurance facilities from insurance companies for the same issue in future? 
2. Can I avail insurance facilities from the insurance companies, for other issues than the specifically excluded?
3. Can I prefer ECHS for any eventualities for the specified issue to the extent admitted, and remaining expenditure from other insurance companies?

Please guide.

Ans: Hi Thangavelu, good to know that your wife is doing better. Coming to your questions, yes you can avail the insurance facilities for the same ailment in future from your existing insurance companies. However, if you purchase a new insurance policy from another company, then whether you get the coverage or not will depend on the ailment and the insurer.

For other ailments, at the time of issuance an insurer analyses the risks, given the ailment of the insured. Accordingly, the insurer takes a decision whether the policy can be issued or not, there are few insurers in the market that will keep the pre-existing diseases excluded or will have a waiting period for it. However, if your ailments have developed after the policy issuance then you can avail insurance facilities for those ailments.

Answering your third question, yes you can prefer ECHS for this specific issues and the remaining expenditure can be claimed from other insurers.

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 Jun 21, 2022

Listen
Money
My family (aged 54 years) is covered under ECHS (Ex-servicemen Contributory Health Service) for the last thirty years. I have family floater health hospitalisation policy in two different insurance companies. Three years back, she had some issues related to her blood disorders. During the blood transfusions, we have made claims in the insurance cover. It took few months to diagnose the issue. Finally it was diagnosed as 'a type of blood disorder'. I have availed the hospitalisation and treatment facilities from ECHS. Now she has recovered (and under medication) for the last two years. She is leading normal life. My query is: Can I declare and have Critical illness included coverage in the health insurance? (Earlier I was denied as permanent exclusion -IRDA). Can I continue the existing health coverage from the insurance from other than Critical illness? (I can get ECHS facility, but there are limitations). Since she is alright, will the insurance companies accept? We are ready for relevant medical tests as required. We seek your advice.
Ans: Hi Thangavelu, good to know that your wife is doing well. To answer your first query, yes you can declare your critical illness and avail the rider for it. Another option is to purchase a new plan for critical illness from an insurer of your choice. The insurer will ask a set of questions and based on that the coverage will be provided. However, most of the insurers will keep the PED in the Permanent exclusion list. As far as your query on continuation of policy is considered, you can continue with the existing health policies you have.

Any medical condition which arises after the waiting period of the policy will be covered in the health policies. Which is why check for the waiting periods associated with different ailments in your policy document.

(more)
Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Nov 24, 2022

Listen
Money
I was customer of Oriental Bank of Commerce. Being a customer of Oriental Bank of Commerce, Oriental Insurance Company provided Group Health Insurance Policy and inception date was 04-05-2015. My policy with them continued till 03-05-2021 without any break. Because Oriental Bank of Commerce merged with Punjab National Bank, Oriental Insurance Company discontinued that policy from 03-05-2021 onward. Being a customer of Punjab National Bank, I approached them, and they migrated my Group Health Insurance Policy of Oriental Insurance Company to Star Group Health Insurance Policy for customers of Punjab National Bank from 04-05-2021 to 03-05-2022.  As All my policy periods were continued from 04-05-2015 till 03-05-2021 with Oriental Insurance Company, Star Health Insurance given me the benefit of pre-existing disease waiting periods being waived because of continuity (They mentioned it in Policy Document too). They reimbursed my 1st claim of 15 July to 22 July 2021 (Non Empaneled Hospital) and Cashless claim of 16 December to 19/12/2021 but denied reimbursement of 19/12/2021 to 26/12/2021 with the excuse of pre-existing disease even I directly shifted from cashless hospital to non-Empaneled Hospital for same problem because Empaneled hospital having been less facilities.  Here I want to address that I was discharged from Cashless Hospital, on request, to get treated in Higher Hospital and treatment was in continuation of previous cashless hospital to new hospital. So, sir, please guide me accordingly as my correspondence with them is not fruitful.
(more)
Latest Questions
Sushil

Sushil Sukhwani  |254 Answers  |Ask -

Study Abroad Expert - Answered on Mar 29, 2024

Sushil

Sushil Sukhwani  |254 Answers  |Ask -

Study Abroad Expert - Answered on Mar 29, 2024

Sushil

Sushil Sukhwani  |254 Answers  |Ask -

Study Abroad Expert - Answered on Mar 29, 2024

Listen
Career
Hi Sushil. My daughter is planning to do MS from US. She has got acceptance from two universities and waiting from one more. Meanwhile, I have approached bank for loan. Their list of documents require I20, whereas for I20 I have to show finance. How to solve this? Secondly, the fee estimate of University shows only for one year ( spring and fall), How can I show the requirement for two years to Bank? No.3: Whether cash in account to be shown while applying for VISA or bank loan also will do? Sorry I have asked lot of questions.
Ans: Hello R. It is great that your daughter has been accepted by a couple of universities in the US. To answer your question first, generally, banks do ask for I-20 to process the loan application; however, a few banks or NBFCs, e.g., HDFC Credila, could issue a loan sanction letter on the basis of the offer letter issued. You could use this sanction letter to call for the I20, provided the university is accepting the letter, or show the required funds in your savings account, provide a bank certificate, and then call for the I20.Expenses to be shown in the bank certificate or savings account to call for the I20 are for a year, which includes the total of tuition, food, accommodation, and miscellaneous [if any]. I20 will show expenses for 9 or 12 months; however, it will also clearly mention the start and end dates of the course, which would help the bank know the total duration of the course and accordingly sanction the loan amount will be sanctioned. Yes, both the savings account and the education loan letter could be used during the visa interview.

For further assistance, you can get in touch with us
(more)
Krishna

Krishna Kumar  |177 Answers  |Ask -

Workplace Expert - Answered on Mar 29, 2024

Asked by Anonymous - Mar 29, 2024Hindi
Listen
Career
I was doing Business for past 23 years and have been succesful in that.. After COVID my business fell apart and I am trying to regain the foothold. Although I have created a good brand, I am not able to make the Money I was making earlier. However the buisness is picking up and I knew If I could have little more patience, I will make it. However the situation demands lot of financial requirements for my lifestyle and family. They are insisiting me to go for a Job now. My business is stagnent for past few years and it is slowly showing the signs of growth now.. I do not want any waiting time due to pressing needs. I am 49 Now.. I am not sure if applying for work at this age will help as I have no idea on the Job market.. I am getting very good offers on selling my Business. Kindly advice.
Ans: Dear

There are two parts.

Emotional...how you feel attached to your business.

Rational: your financial needs and the revenue that your business is generating.

Any advise us a function of both the above aspects. Unless one knows the current revenue numbers, growth potential of the business, competition and several such factors it's not possible to share any guidance.

Hence may I suggest you talk to your CA and other colleagues of yours, look at the numbers in hard way and then take a call.

Emotional aspect can be both strength and liability... strength because it will inspire you to make business grow... liability because you may be overtly attached to your business without looking at the financial realities.

All the best.
(more)
Dr Shakeeb Ahmed

Dr Shakeeb Ahmed Khan  |34 Answers  |Ask -

Physiotherapist - Answered on Mar 29, 2024

Asked by Anonymous - Mar 28, 2024Hindi
Listen
Health
Sir im 36 yrs of age weighing 107 kgs and I regularly walk which helps in maintaining my weight but im unable to reduce belly fats. I walk approx 4 kms daily within 30 minutes .
Ans: Thank you for your inquiry. I appreciate your dedication to maintaining a consistent walking routine for weight management. However, if you're specifically aiming to reduce belly fat, it might be beneficial to incorporate additional methods into your regimen.

While walking is great for overall health and weight control, integrating strength training exercises can be instrumental in building muscle mass and boosting metabolism, thereby facilitating greater fat loss, including targeting belly fat. Incorporate exercises such as squats, lunges, push-ups, and abdominal workouts like crunches or planks.

To enhance the effectiveness of your walking routine, consider adding intervals of higher intensity. This might entail alternating between periods of brisk walking and intervals of more vigorous effort, such as walking uphill or increasing your pace to a jog for brief durations. This approach can elevate calorie expenditure and promote fat burning.

In terms of nutrition, it's crucial to pay close attention to your dietary habits, as they significantly impact fat loss. Prioritize a well-rounded diet rich in whole foods such as fruits, vegetables, lean proteins, and whole grains, while minimizing intake of processed foods, sugary beverages, and excessive calories, which can contribute to belly fat accumulation. Additionally, consider reducing carbohydrate intake and increasing protein consumption in consultation with a registered dietitian for personalized guidance.

Overall, by incorporating these strategies alongside your walking routine, you can optimize your efforts towards reducing belly fat and improving overall health.
(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.

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