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Sanjib

Sanjib Jha  | Answer  |Ask -

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

Sanjib Jha  | Answer  |Ask -

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.   

..Read more

Sanjib

Sanjib Jha  | Answer  |Ask -

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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Ramalingam

Ramalingam Kalirajan  |10902 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 11, 2024

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I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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Anu

Anu Krishna  |1749 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Dec 17, 2025

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one of my friend who is married from past 14 years having 2 kids (elder son 12 and daughter 8)...he was out of home deputed to site on project work by company for more than 4 months. During this period he did not visit the home but regularly available on call and in touch with his w... when he returned to home his wife was behavior was not normal as like earlier ... later he found out that his wife got involve with her college friend during this period ..... and they had physical 01 time during this period... now my best friend he is very caring and not able to forget this betrayed act by his wife... after all this he is not able to concentrate and focus on his work.. he love his wife so much and want to forgive her but how to handle this situation in decent way... he is not willing to divorce or parting his ways... request you to suggest some way out to get out of situation and lead a normal life as like earlier
Ans: Dear Navya,
He loves her
He wants to forgive her
BUT
He is not able to forget what his wife has done
Sadly, both these work in opposite directions...
If he is willing to rebuild his marriage, he does not need to forget what his wife has done BUT he can work on how to process what she has done. This is difficult to do...but he will need to understand what happened, the reasons for it, if the wife is still interested in the marriage and if both are willing to work together towards the future. If this seems a bit difficult to work out by themselves, I suggest that they see an expert who can guide them aptly.

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

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Anu

Anu Krishna  |1749 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Dec 17, 2025

Asked by Anonymous - Sep 26, 2025Hindi
Relationship
hello mam, My son 19 year old from last 4 year his behavior change not listing not having food properly whole day watching mobile after 10th i put him diploma in electrical engineer he completed his 1 year but from 2nd year he stop going to college we both are working parent so nobody is there at home to force to go for college his teacher every day calling me to send him to college but he is not listing i ask him did teacher scold you or any student is troubling you he said no one is troubling me i don't want to study i want to do voice dubbing i want to give my voice for cartoon and for dubb movies in july 2025 he told me in 2028 i will leave both of you i have my dream i leave the home i ask him what is your dream he said 1st 2 dream i cant tell you but 3rd dream is to go to japan for tour i thought he is joking. In August 2025 he started going for voice dubbing classes in 1st week of August 2025 he told me my planning is change next month only i will leave both of you again i thought is just pulling my leg but on 15 September its regular Monday we both parent went for job and he called me around 12 pm and said daddy left the home not a single rupees he had with him and he left the home in full of rain he keep walking and talking to me i ask him where you are going but he said that's secrete i took his mom in conference and try convince him but he not listing with 1 hour talking with him on phone i ask him tell me the landmark where you are he told me one landmark while talking him i left office to reach the landmark he told i forcibly sit him in car and take back home with his mother after reaching home with his mother we are trying to convince don't do like this its your home we have only one child that is you but he said no today is the i want to go let me go don't fail my planning whole standing at home he said want to go without having water or food just crying and saying i want leave the home in evening at 7pm i told him give me three month i will send to japan for tour after hearing this he little bit convince but said repair my mobile which was shutdown due rain water get inside arrange visa and passport within three month and give new laptop for playing game but after three i will leave both of you and left the home in december 2025 he told me he will the home. he is very superstitious at home not having bath use same cloth he said if change cloth and have bath all my power will go after that incidence leaving home he become more superstitious each and every moment he whispering himself after asking why you doing this saying this is my power i will get what i want if i scold him he said i will leave home right now please help me what to do he not having bath not changing cloth not having afternoon food not cutting his nails from last 15 days i am very much in stress due to his behavior and stress about his future also he is not behaving like a normal child whole day and night watching mobile. Please help
Ans: Dear Anonymous,
Please take him to a professional who can evaluate him. There are a lot of gaps in what you haev shared and a professional will be able to ask the right questions and be of better guidance to your son and your family.

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

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Ramalingam

Ramalingam Kalirajan  |10902 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 17, 2025

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Hi Vivek, I am 43 year old. I am currently working in private organization. Having an Investment of 8.0 Lac in NPS, 27 Lac in PF, 4 Lac in PPF and 2.5 Lac in FD. My child is in 11th Science. I have my own house and no any loan. I need to Invest around 80.0 Lac for Child Education, Marriage and Retirement.
Ans: Your discipline and clarity deserve appreciation.
You have built strong foundations early.
Many people reach forty without such assets.
You already reduced major future stress.
That itself gives you an advantage.

» Current Financial Snapshot
– You are 43 years old.
– You work in a private organisation.
– You own your house fully.
– You have no loans.
– This gives financial stability.

– Retirement focused savings already exist.
– Long term instruments form your base.
– Your money is spread across safety products.
– Liquidity is limited but acceptable.
– Growth exposure needs attention.

» Existing Investment Review
– Retirement related savings are meaningful.
– Mandatory savings have helped discipline.
– These instruments protect capital well.
– However growth potential is limited.
– Inflation risk exists over long periods.

– These assets suit long term security.
– They suit retirement stability well.
– They are not designed for high growth.
– Child goals need higher growth.
– Marriage expenses need liquidity planning.

» Child Education Time Horizon
– Your child is in 11th Science.
– Higher education expenses are near.
– Time available is limited.
– Risk capacity is lower here.
– Planning must be conservative.

– Education costs grow faster than inflation.
– Professional courses cost significantly more.
– Overseas options cost even higher.
– Partial funding support is important.
– Loans should be minimised.

» Child Marriage Planning Window
– Marriage expenses are medium term.
– You still have some time.
– Cultural expectations increase costs.
– Planning early reduces stress.
– This goal needs balance.

– Too much risk can hurt plans.
– Too little growth causes shortfall.
– Phased investing works best.
– Gradual shift towards safety helps.
– Liquidity must be ensured.

» Retirement Planning Horizon
– Retirement is long term.
– You have nearly two decades.
– This allows growth oriented approach.
– Inflation is biggest risk here.
– Passive savings alone will not suffice.

– Retirement expenses last many years.
– Healthcare costs rise sharply later.
– Regular income post retirement matters.
– Corpus must be inflation protected.
– Growth assets become essential.

» Understanding Rs 80 Lac Requirement
– Rs 80 Lac is a combined target.
– All goals have different timelines.
– One strategy will not suit all.
– Segmentation is essential.
– This avoids misallocation.

– Education needs immediate planning.
– Marriage needs medium planning.
– Retirement needs long term planning.
– Each goal must be ring-fenced.
– Mixing goals creates confusion.

» Asset Allocation Importance
– Asset allocation drives outcomes.
– Not product selection alone.
– Time horizon decides allocation.
– Risk appetite decides allocation.
– Discipline maintains allocation.

– Safety instruments protect capital.
– Growth instruments fight inflation.
– Balance avoids emotional mistakes.
– Rebalancing keeps strategy aligned.
– This is a continuous process.

» Role Of Equity Exposure
– Equity creates long term wealth.
– Equity is volatile short term.
– Time reduces equity risk.
– Retirement horizon suits equity.
– Education horizon needs limited equity.

– Selective equity exposure is essential.
– Quality matters more than quantity.
– Active management adds value.
– Market cycles require judgment.
– Discipline ensures success.

» Why Not Depend Only On Safe Instruments
– Safe instruments give predictable returns.
– They struggle to beat inflation.
– Purchasing power erodes slowly.
– Long term goals suffer silently.
– Growth becomes insufficient.

– Your current assets are safety heavy.
– Growth allocation needs improvement.
– This change should be gradual.
– Sudden shifts create stress.
– Planned transition works better.

» Education Goal Strategy
– Use conservative growth approach.
– Capital protection is priority.
– Avoid aggressive exposure now.
– Phased investing works best.
– Gradual de-risking is necessary.

– Education funding should be ready.
– Avoid dependency on future income.
– Avoid last minute borrowing.
– Keep funds accessible.
– Liquidity is key.

» Marriage Goal Strategy
– Marriage expenses are emotional.
– Costs are difficult to predict.
– Planning gives confidence.
– Balanced approach is ideal.
– Growth plus safety mix works.

– Start allocating gradually.
– Increase safety closer to event.
– Avoid locking money long term.
– Keep flexibility.
– Avoid speculation.

» Retirement Goal Strategy
– Retirement planning needs growth focus.
– Inflation is the silent enemy.
– Long horizon allows equity.
– Volatility should be accepted.
– Discipline ensures compounding.

– Retirement corpus must grow faster.
– Contributions should increase with income.
– Lifestyle expectations must be realistic.
– Healthcare buffer is essential.
– Regular review is necessary.

» Role Of Active Funds
– Markets do not move uniformly.
– Sectors rotate frequently.
– Index funds stay static.
– They reflect index weaknesses.
– Active funds adapt better.

– Active managers adjust allocations.
– They reduce exposure in weak sectors.
– They increase exposure in growth areas.
– This helps during volatility.
– Especially for long term goals.

» Why Avoid Index Based Approach
– Index funds mirror market direction.
– They cannot protect downside.
– They remain exposed during corrections.
– Investors feel helpless.
– Returns stay average.

– Active strategies aim to outperform.
– They manage risk dynamically.
– They suit Indian market inefficiencies.
– Skilled management adds value.
– This matters over decades.

» Regular Investing Route Benefits
– Regular route offers guidance.
– Behaviour management is critical.
– Panic decisions destroy returns.
– Professional handholding matters.
– Especially during volatile phases.

– Certified Financial Planner helps discipline.
– Goal tracking becomes structured.
– Portfolio review becomes systematic.
– Emotional bias reduces.
– Long term success improves.

» Liquidity Planning
– Emergency funds are essential.
– You currently have limited liquidity.
– One year expenses should be accessible.
– This avoids distress selling.
– It protects long term investments.

– Emergency planning gives peace.
– Unexpected events do not derail plans.
– This should be built gradually.
– Avoid using retirement savings.
– Keep it separate.

» Insurance As Risk Management
– Insurance protects your plan.
– It is not an investment.
– Adequate life cover is essential.
– Health cover avoids financial shock.
– Premiums are necessary expenses.

– Delaying insurance increases risk.
– Medical inflation is severe.
– Employer cover is insufficient.
– Family protection is priority.
– This secures your goals.

» Tax Efficiency Perspective
– Tax planning should support goals.
– Avoid tax driven decisions alone.
– Post tax returns matter.
– Simplicity reduces mistakes.
– Compliance avoids future stress.

– Long term equity taxation is favourable.
– Short term churn increases tax.
– Stability helps efficiency.
– Avoid frequent switching.
– Stay disciplined.

» Monitoring And Review Process
– Plans are not static.
– Life changes require adjustment.
– Income growth allows higher contribution.
– Goals may change.
– Reviews keep relevance.

– Annual review is sufficient.
– Avoid daily market tracking.
– Focus on progress.
– Ignore noise.
– Stick to strategy.

» Behavioural Discipline
– Emotions affect investment outcomes.
– Fear causes premature exit.
– Greed causes overexposure.
– Discipline balances both.
– Guidance helps immensely.

– Long term wealth needs patience.
– Short term market moves mislead.
– Consistency beats timing.
– Process beats prediction.
– Stay calm.

» Aligning Goals With Reality
– Rs 80 Lac goal is achievable.
– Planning must be realistic.
– Income growth will support it.
– Lifestyle control helps savings.
– Early planning reduces pressure.

– You already started well.
– Course correction is timely.
– Delay would increase burden.
– Action now simplifies future.
– Confidence improves.

» Family Communication
– Discuss goals with family.
– Shared understanding reduces conflict.
– Expectations become realistic.
– Decisions gain support.
– Stress reduces significantly.

– Financial planning is family planning.
– Transparency builds trust.
– It improves discipline.
– Everyone works towards goals.
– Harmony improves.

» Risk Capacity Versus Risk Appetite
– Risk capacity is strong for retirement.
– Risk appetite may vary emotionally.
– Planning must respect both.
– Overexposure creates anxiety.
– Underexposure creates regret.

– Balance is the answer.
– Gradual allocation changes work best.
– Avoid extreme decisions.
– Stay flexible.
– Stay focused.

» Final Insights
– You have built a strong base.
– Assets are safe but growth limited.
– Goals need segmented planning.
– Education needs conservative strategy.
– Marriage needs balanced approach.
– Retirement needs growth focus.
– Active management adds value.
– Regular guidance supports discipline.
– Insurance protects the plan.
– Liquidity avoids stress.
– Review keeps alignment.
– Patience creates results.

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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