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Sanjib

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Insurance Expert - Answered on Sep 08, 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
Pannkaj Question by Pannkaj on Sep 08, 2022Hindi
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I have an individual health policy with Nivabupa. The current renewed policy document mentions:

1. Base Sum Insured Rs 5 lakh

2. Loyalty Additions Rs 2 lakh 

3. Next Column Sum Insured (Base Sum Insured + Loyalty Additions + Refill amount ^) (in Rs) 12,00,000

My 2 claims totalling Rs 6.25 lakh for Angiography and Bypass Surgery were settled only for Rs 500,000. 

Is this in line with norms? 

Ans: Hi Pannkaj,to answer your question we need to understand the plan details and the type of deduction done by the insurance company during the claim.

I suggest you speak with your insurer on why only Rs 500,000 was settled against your bills.

Also as a rule, do read all the terms and conditions on your policy document and the claim settlement process followed by your insurer.

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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Sanjib

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Insurance Expert - Answered on Jun 21, 2022

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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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Sanjib

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Insurance Expert - Answered on Jun 21, 2022

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I have mediclaim policy from Oriental Insurance Co since 1992 for 5 lakhs and other from New India Assurance for 7.5 Lakhs under SCUM scheme with my spouse. However both the policies have set a limit of Rs. 40,000 for Cataract surgery even though I have been diagnosed with 1) Cataract Phaco with Panoptix IOL, 2) Pupilloplasty, 3) CTR Implantation for which a renowned hospital billed me as below for separately for each eye. 1) Cataract Procedure Cost. Rs. 27000/- which is approved by Oriental in their contract with Hospital 2) IOL Cost Rs. 49000/- 3) Pulilloplasty Rs. 6950/- after discount 4) CTR Implantation Rs. 1600/ after discount Now in Claim No. 1 Oriental approved. Rs 36,000/- Only and balance Rs 48500 I had to pay Claim No. 2 Oriental approved Rs.73,300/- Only and balance Rs.11250/- I had to pay Surgery was done 1 week apart. In my case I was advised Cataract with multifocal IOL + Pupilloplasty + CTR Implantation So, I need your advice on: How can Insurer Oriental approve and give different claim amount for each eye and how can I claim for reimbursement of balance amount I had to pay. Appreciate your guidance and help.
Ans: Hi Jyoti, hope you are doing well. As you have mentioned that the claim amount for each eye has been different, to understand the reason behind this disparity, you will have to check the documentation submitted to the insurer for both the surgeries. Request you to contact your insurance advisor and discuss the same with the insurer to understand this gap further and help you resolve this issue. 

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Sanjib

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Insurance Expert - Answered on Oct 12, 2022

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 I am an employee of central govt. PSU. My family consists of myself, spouse, two minor children and mother. I am covered by a corporate group medical insurance policy for Rs 2 lakh with an additional emergency coverage of Rs 4 lakh by the employer. I also have a personal Family Floater policy for Rs 3 lakh and a Sr. Ctzn. Policy for Rs 1 lakh. I have not used the personal policies till date for any hospitalisation claim. I am aware that a claim exceeding the corporate policy limit can be claimed in the personal policy. Recently I was made to know that any planned hospitalisation exceeding the corporate claim limit, cannot be done using the second policy. I also know that there is a product called as top up policy which can be used in such cases. I have 8 years of remaining service where there is a medical insurance cover during the period. After retirement, the employer provides a basic policy of 1.5 lakh for the family. The same feels to be insufficient in today’s times. What would be your advice with regards to the existing medical insurance policies and their amounts? Should I need to undertake any tweaking of the policy amounts or switch to a top up policy?
Ans: Hi Pradeep, yours is a legit concern. It would be best if you take advice from a professional person or company – having the necessary qualifications -- after discussing your issue with them.

Insurance is each to its own. Depending on your concerns and requirements a professional service provider will be able to give you the best advice, whether to tweak policy amount or switch to top up.

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Financial Planner - Answered on Apr 26, 2024

Asked by Anonymous - Apr 25, 2024Hindi
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I am just two years away from my retirement. I had purchased a flat in 2019 but couldn’t service the loan EMI. Due to the Covid pandemic my salary was reduced by 40 per cent so I sold that flat on no-profit-no-loss basis and repaid the home loan. Now, I had also withdrawn a sizeable amount from my PF to purchase this home and now I am looking at just Rs 4 lakh in my PF account. I might accumulate another Rs 4 lakh in the remaining two years but will that be enough to take care of my retirement? My wife passed away last year and my son is financially stable and settled abroad. I don’t expect much financial help from my son. How shall I plan for my retirement?
Ans: It sounds like you've had to make some difficult financial decisions due to the challenges posed by the pandemic. Planning for retirement can be daunting, especially when unexpected events like reduced income or unexpected expenses arise. Here is a 10-point checklist you can follow to plan for your retirement given your current situation:

1. Assess your current financial situation: Take stock of all your assets, savings, investments, and any other sources of income. This includes your remaining PF balance, any other retirement accounts, investments, and savings.

2. Estimate your retirement expenses: Calculate your expected expenses during retirement, including housing, healthcare, daily living expenses, and any other costs you anticipate. Be realistic in your estimations.

3. Consider your sources of income: Apart from your PF, consider any other sources of income you may have during retirement, such as pension plans, rental income if you have any other properties, investments, or any other assets.

4. Review your investment strategy: Given your limited time until retirement, it's crucial to ensure that your investments are aligned with your retirement goals and risk tolerance. Consider consulting with a financial advisor who can help you optimise your investment portfolio for retirement.

5. Maximise your savings: Since you have two years until retirement, try to maximise your savings during this time. Cut down on unnecessary expenses and consider additional income streams if possible.

6. Explore retirement options: Look into various retirement options available to you, such as annuities, systematic withdrawal plans, or any retirement benefits you may be eligible for from your employer or government.

7. Consider downsizing: If your current living situation is not financially sustainable during retirement, consider downsizing to a smaller home or relocating to an area with a lower cost of living.

8. Plan for healthcare costs: Healthcare expenses tend to increase during retirement, so make sure you have a plan in place to cover these costs. This may include purchasing health insurance or setting aside funds specifically for medical expenses.

9. Create a contingency plan: Prepare for unexpected events by having a contingency plan in place. This could include building an emergency fund or having insurance coverage for major expenses.

10. Regularly review and adjust your plan: Life circumstances and financial markets can change, so it's essential to regularly review and adjust your retirement plan as needed to ensure you stay on track to meet your goals.

It's understandable to feel concerned about your financial security in retirement, but with careful planning and prudent financial management, you can work towards a comfortable and secure retirement. Consider seeking guidance from a financial advisor who can provide personalised advice based on your specific situation and goals.
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Kanchan

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Relationships Expert, Mind Coach - Answered on Apr 26, 2024

Asked by Anonymous - Apr 26, 2024Hindi
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My boyfriend's ex happens to be his sister-in law's sister (first cousin). That was his first serious relationship and she had dumped him. It has been quite a few years since, but it bothers me that he is indirectly still related to her. My boyfriend's sister-in-law has a daughter (his niece) whom he loves very much. But whenever he talks to his sister in law or plays with the kid, it makes me uncomfortable. I am broadly uncomfortable with the fact that he is the uncle to the same kid his ex is aunt to. Which means they are somewhat familialy related. I have seen his ex post videos of the kid playing around in his house, which means she still gets regular updates about his household through her sister (his sister-in-law). I really don't want to get into something this complicated, but I love my boyfriend very much. He also loves the kid a lot which makes me hate myself for projecting my hate on the kid/sister-in law because they're not at fault. But it really bothers me whenever I hear the kid's voice or his sister in law's because that reminds me of his ex. I feel extremely insecure and uncomfortable and I don't know how to deal with this, but I really want things to work out between my boyfriend and me. What is the solution?
Ans: It sounds like you're dealing with a complex situation that's bringing up a lot of emotions for you. It's completely natural to feel uncomfortable or insecure in a situation like this, especially when there are reminders of your partner's past relationship.

First and foremost, communication is key. Talk openly and honestly with your boyfriend about how you're feeling. Let him know that you're struggling with these emotions and that you want to find a solution together. It's important for him to understand where you're coming from and to be supportive of your feelings.

Additionally, try to focus on building trust and strengthening your relationship with your boyfriend. Remind yourself of the reasons why you love him and the bond that you share. Trust that he's committed to you and that his past relationship is just that – in the past.

It's also worth considering setting boundaries with your boyfriend's sister-in-law, particularly when it comes to sharing information about your household or your relationship with his ex. Let her know that while you appreciate her relationship with your boyfriend and her niece, you would prefer to keep certain aspects of your personal life private.

Remember, it's okay to feel the way you do, but it's important to address these feelings constructively and work towards a resolution that allows you to feel comfortable and secure in your relationship.
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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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