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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 -

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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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Ramalingam

Ramalingam Kalirajan  |8615 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 31, 2025

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Hi sir, My age is 45 years. I am currently investing in SIPs in mutual funds, ICICI Prudential Bluechip Fund Growth (RS 2500) and Motilal Oswal Large and Midcap Fund Growth (Rs 3000), Quant mid cap (RS 3000), Kotak equity emerging (RS 3000) and Parag Parikh flexicap (RS 4000). My risk profile is high and my investment horizon is up to the age of 55 years. I will require approx 1cr for my kid's education after 10 years and for retirement (1 cr) after 10 years. I have stopped SIPs in Axis small Cap fund and Mirae Asset Emerging Bluechip Fund Growth and their amount of 56000 and 264000 has not yet been redeemed. My total investments in till date is approx 9.85 lakhs. Also I can invest up to Rs 25000/pm in SIPs. I also want to do rebalancing of Axis small Cap and Mirae Asset Emerging Bluechip Fund Growth fund amounts in small caps and hybrid fund, pls suggest. Is my porfolio suitable as per my goal. Pls suggest.
Ans: Your discipline towards mutual fund investing is admirable. You already have a good head start with your current investments. But let’s assess your portfolio, rebalance it smartly, and align it with your goals clearly.

Here is a complete 360-degree assessment of your mutual fund portfolio.

 

Portfolio Suitability as per Your Goals
You are 45 years now. Your key goals are after 10 years.

 

You want Rs. 1 crore for your child’s education.

 

You also want Rs. 1 crore for your retirement corpus.

 

These goals are achievable. But your portfolio needs alignment.

 

Your SIPs are currently Rs. 15,500. You can go up to Rs. 25,000.

 

This gives you room to restructure and grow your wealth.

 

Your risk profile is high. This supports growth-oriented funds.

 

Your investment horizon of 10 years is very reasonable.

 

So, equity-oriented funds can play a major role here.

 

You also need to reduce overlapping and duplication in categories.

 

Based on your age and goals, a proper category mix is important.

 

Also, monitoring performance is key to long-term success.

 

Evaluation of Current Portfolio
You have invested in large cap, large & mid cap, mid cap and flexicap.

 

This is a good mix across market cap segments.

 

However, some schemes have overlapping exposure.

 

You had SIPs in two good schemes that are now discontinued.

 

The Axis small cap fund has Rs. 56,000 invested.

 

The Mirae Asset emerging bluechip has Rs. 2.64 lakhs invested.

 

These are idle now. They must be rebalanced as per your strategy.

 

Total investment till now is approx Rs. 9.85 lakhs.

 

Your ongoing SIPs are across 5 different categories.

 

Portfolio rebalancing is needed to avoid overexposure.

 

There is no allocation to hybrid or balanced advantage funds.

 

You can add those for stability, especially as you age.

 

You need a mix of growth and risk control over the next 10 years.

 

Recommended SIP Structure
You are willing to invest Rs. 25,000 per month in SIPs.

 

That gives you Rs. 9.5 lakh of new investment in the next 3 years.

 

For proper diversification and balance, follow this structure:

 

Large Cap Fund – Rs. 4,000 monthly

 

Large & Mid Cap Fund – Rs. 4,000 monthly

 

Mid Cap Fund – Rs. 5,000 monthly

 

Flexicap Fund – Rs. 5,000 monthly

 

Hybrid Aggressive or Balanced Advantage Fund – Rs. 5,000 monthly

 

Small Cap Fund – Rs. 2,000 monthly

 

This structure ensures broad diversification and better returns.

 

It also provides smoother journey with balanced allocation.

 

Rebalancing of Existing Idle Investments
Axis Small Cap fund holding is Rs. 56,000.

 

Mirae Asset Emerging Bluechip Fund holding is Rs. 2.64 lakhs.

 

These amounts should not lie idle or underperform.

 

You can redeem these and reinvest as follows:

 

Rs. 1.5 lakh to hybrid aggressive fund or balanced advantage fund

 

Rs. 1.2 lakh to a small cap fund of your choice

 

Use STP if you are shifting full amount to equity funds again.

 

Spread the switch over 6 to 9 months to reduce volatility risk.

 

This will bring back discipline and better long-term compounding.

 

It will also bring stability and growth into one basket.

 

How to Align Portfolio with Education and Retirement Goals
Your education and retirement goal both need Rs. 1 crore each.

 

So you need Rs. 2 crore in total after 10 years.

 

You already have Rs. 9.85 lakh invested.

 

You plan to invest Rs. 25,000 per month now.

 

This disciplined investing with proper fund mix will help.

 

Small cap, mid cap and flexicap will deliver long-term growth.

 

Hybrid and large cap will bring portfolio stability.

 

Rebalancing and yearly review will help you stay on track.

 

Avoid reacting to short-term volatility and stay invested.

 

Key Adjustments to Improve Returns
Avoid duplication in similar category schemes.

 

Select only one strong fund from each major category.

 

Shift idle lump sum into hybrid and small caps via STP.

 

Avoid sector funds, thematic funds or international funds now.

 

Increase SIP by 5% every year if income allows.

 

Review SIPs yearly. Drop laggards. Replace only after 3-year review.

 

Stick to 5-6 funds maximum in total.

 

Keep your funds manageable and meaningful.

 

Regular vs. Direct Funds
You should always invest through regular plans via a trusted MFD.

 

A Certified Financial Planner (CFP) can guide you better.

 

Direct funds may save some cost but give no advisory support.

 

They are for experts who understand the markets deeply.

 

Wrong selection in direct mode leads to poor returns.

 

In regular plans, your MFD with CFP gives continuous support.

 

This is key when markets are volatile or during fund underperformance.

 

Proper advice leads to better overall results than cost savings.

 

SIP Discipline and Risk Management
Continue SIPs without breaks. Markets may fluctuate.

 

But long-term SIPs deliver strong results with compounding.

 

Rebalance every year. Shift part of equity to hybrid over time.

 

In final 2 years before goal, reduce equity to protect capital.

 

Keep emergency fund in liquid mutual fund for peace of mind.

 

Review your portfolio performance every 6 months.

 

Track progress towards Rs. 2 crore goal.

 

Tax Considerations for Mutual Fund Investors
Equity fund long term capital gains (LTCG) over Rs. 1.25 lakh taxed at 12.5%.

 

Short term capital gains (STCG) taxed at 20%.

 

Debt and hybrid fund gains taxed as per your income slab.

 

Plan redemptions smartly to reduce tax outgo.

 

Use STP or SWP to manage taxes near goal maturity.

 

Insurance and Emergency Cover
Ensure you have health insurance and term life cover.

 

Keep 6 months’ expense in liquid fund as emergency buffer.

 

Do not mix insurance with investment.

 

No ULIPs, no endowment or money back plans.

 

Your focus must remain on mutual funds only.

 

Final Insights
Your investing habits are strong. You are consistent.

 

Your fund categories are well selected but need tweaking.

 

You must act on idle investments to improve overall returns.

 

Add hybrid and small cap exposure smartly.

 

Avoid over-diversification and direct plans.

 

Keep a long-term view and follow up every year.

 

Increase SIPs when possible and do goal-based planning.

 

You are on the right track. Some rebalancing will take you faster towards your goals.

 

Keep emotions out. Let data and strategy guide your investment path.

 

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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