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Sanjib

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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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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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What is comprehensive auto insurance policy? What are its benefits? What are the inclusions and non-inclusions if I want to know before buying a comprehensive auto insurance policy?
Ans: A comprehensive auto insurance policy in India offers the most extensive coverage for your car and any third-parties involved in an accident. It's like a two-wheeler for your car's security, providing protection for both your vehicle and your wallet.

Benefits of a Comprehensive Policy:

1. Peace of mind: Covers a wide range of situations, so you'll be financially protected in case of many unforeseen events.

2. Own Damage Cover: Pays for repairs or replacement of your car if it's damaged in an accident, by fire, theft, natural calamities, riots, or even falls victim to vandalism.

3. Third-Party Liability Cover: Takes care of any legal or financial liabilities you incur if your car causes injury, disability or death to a third party, or damages their property.

4. Personal Accident Cover (Optional): Provides financial assistance to you or your family in case of injury or death due to a car accident (depending on the policy terms).

What to Consider Before Buying:

Inclusions:

a. Most accidents (collision, hit and run)

b. Theft (partial or complete)

c. Fire damage

d. Natural disasters (floods, earthquakes, etc.)

e. Riots, strikes, and other man-made calamities

g. Third-party property damage and bodily injury

h. Personal accident cover (if opted for)

Non-inclusions:

a. Damages due to wear and tear

b. Driving under the influence of alcohol or drugs

c. Mechanical or electrical breakdown

d. Depreciation on parts replaced during repairs

e. Using the car for illegal purposes

Additional Tips:

1. Add-on Covers: Enhance your policy with optional extras like engine protection or zero depreciation cover for a more comprehensive safety net.

2. Compare Quotes: Get quotes from different insurance companies to find the best coverage and price for your needs.

Remember, a comprehensive policy offers superior protection compared to third-party only insurance, which is mandatory by law but only covers your liability towards third parties. For a secure ride on Indian roads, a comprehensive policy is the way to go.
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My daughter did her graduation in November 2023 from a top-ranked university in Canada - University of British Columbia, Vancouver (QS World Rank within 35). She is interested in a job in the fields of Artificial Intelligence and related software domains. She graduated with an interdisciplinary BSc in Cognitive Systems, including several courses from Computer Science, Artificial Intelligence and Machine Learning, Neuroscience, etc.. Unfortunately, unlike in US universities, there's no Campus Placement facilities available in UBC and most Canadian universities. Please advise how to get into a job in this gloomy economic scenario, in Canada (USA is ruled out because OPT is not available for non-US university graduates).
Ans: Hello Indranil. Thanks for reaching out to us. Given your daughter's background in cognitive systems with coursework in computer science, Artificial Intelligence, Machine Learning and Neuroscience from a prestigious institution like the University of British Columbia (UBC), she has a strong base for having a career in AI and related fields. Although no campus placement is challenging, there are ways to find a job while keeping in mind the gloomy economic condition.

1. Encourage your daughter to leverage her professional network, including alumni, professors, and industry contacts. Attending industry events, seminars, and meetups can provide valuable networking opportunities and help her connect with potential employers or mentors in the field of AI and software development.

2. An online presence, such as having an account on LinkedIn, is important. She can showcase her skills and achievements—both academic and extracurricular—so far, reach out to professionals,etc

For further assistance, you can get in touch with us
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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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