Health Insurance Portability
Health Insurance Portability
Adequate and uninterrupted health insurance coverage is essential for easy access to quality healthcare services. However, when an individual’s existing health insurance coverage is not enough or his preferences have changed with time, health insurance portability offers flexibility to the policyholder to switch to another insurer without losing existing benefits and waiting periods. In case you are looking to port your health insurance policy, here is everything you should know about health insurance portability.
What is health insurance portability?
Health insurance portability is transferring your health insurance policy from one insurer to another without losing any benefits that you have accumulated in your existing policy. IRDAI introduced the concept of portability in health insurance in 2011, which allows a policyholder to switch to another insurance provider if he is not satisfied with the services of the existing insurance provider. This facility lets the policyholder retain the benefits of existing policy like no claim bonus, waiting periods or pre-existing disease coverage.
Why port?
How Does Grace Period in Health Insurance Work?
The concept of health insurance portability was introduced to address certain common issues faced by the policyholders. Changing circumstances and rising medical costs often require an individual to evaluate his healthcare needs and coverage. Portability gives a policyholder, the freedom to adapt to these changes.
- A policyholder can explore a wide range of plans and can get everything he needs in one plan.
- A policyholder can change to a plan with no room rent limits that can help him get access to the best healthcare.
- If the sum insured in the existing policy is not sufficient, a policyholder can switch to a plan with a sum insured restoration.
Benefits of health insurance portability
Health insurance portability offers a range of benefits to a policyholder allowing him to get the best healthcare without any hassles.
- Continued benefits
The primary advantage of health insurance portability is the continuity of benefits accumulated from the existing insurer. This means that porting allows you to carry forward benefits from your current insurer to the new insurer without the need to start from scratch. For example, benefits like your accumulated No-claim bonus are retained even after switching insurers, thus resulting in lower premiums and better coverage. - Customisation
Portability allows you to modify features and coverage according to changing circumstances so that your health insurance coverage aligns with your changing needs. You can increase your sum insured, change your plan to include a particular disease, or even change your nominee. - The waiting period is credited to the new policy
If you have completed a certain part of the waiting period for pre-existing diseases in your current policy, it will be credited to your new policy during porting and you will be required to serve only the remaining waiting period. - Wider network of hospital
With portability, you can choose an insurer with a better network of hospitals. This helps in case when you are looking for specialised medical care or specific coverage features. - Better premium rates
A policyholder can get better premium rates for the same or enhanced coverage as the existing policy. Thus portability helps in saving money and gives you the option to get health insurance at a lower premium. - Applicable to all kinds of health insurance policies
Porting is allowed for all kinds of indemnity health insurance policies such as retail, group, individual, or family floater.
How to port: Process of porting a Health Insurance Policy?
IRDAI has laid down a standard procedure for porting a health insurance policy. Given below is the step-by-step process of porting health insurance portability.
- Communicate to your existing health insurer about portability to initiate the process and apply at least 45 days before the expiry or renewal of the policy.
- Reach out to the new insurer whom you want to port your existing plan. He will provide a portability form along with a proposal form. Fill out the forms and submit the details of your current policy, the personal details of the insured, and the medical reports to the new insurer.
- The new insurer will review your application and may accept or reject the application within 15 days.
- In case the application is rejected, you can renew your existing policy.
- If the application is accepted, the new insurer coordinates with your old insurer for the transfer of the policy. The waiting periods, no-claim bonus, and other accumulated benefits are credited to your selected new plan.
- Once the transfer process is complete, you pay the premium for the new policy to the new insurer.
List of Documents to be Submitted for Porting a Health Insurance Policy
The list of documents to be submitted for portability depends on the terms and conditions of the new insurer. This list of documents depends on the requirement of the insurer and may differ for every insurer. However, some common documents needed are;
- ID and address proof
- IRDAI portability form
- Proposal form
- Policy document
- Claim history (If applicable)
- No claim declaration (If applicable)
- Documents and reports related to medical history
What can you port in your Health Insurance Policy?
While porting a health insurance policy, a policyholder is allowed to port the following:
- All the members insured under the existing plan
- The sum insured of the existing plan. Your new plan should have at least your existing sum insured value.
- Your accumulated no-claim bonus
- Waiting period for pre-existing diseases
- Waiting period for specific diseases
Health Insurance Portability Rules and Norms: Rules as set by the IRDAI for Health Insurance Portability
To ensure a standard and fair process, IRDAI has set some guidelines to be followed by both the insurer and the insured. These guidelines are applicable not only when you are switching insurers but also when you are switching from one plan to another from the same insurer. These guidelines include the rights of the policyholder and the conditions applicable for portability.
Rights of the policyholder:
- A policyholder can port individual or family floater plans.
- A policyholder can port his policy from and to a general insurance company or a specialised health insurance company.
- The new insurer should give the policyholder the credit of the waiting period for pre-existing diseases already served by him.
- The new insurer should insure the policyholder at least up to the sum insured of the old policy.
- The new and the old insurer should follow the timelines prescribed by IRDAI to complete the porting process.
Conditions applicable to health insurance portability:
- The policyholder should fulfil the eligibility criteria:
○ Portability is allowed between similar types of policies.
○ There shouldn’t be any gaps between two consecutive renewals of the policy that you wish to port. Note that, during porting, a grace period of 30 days is given. - Portability is allowed only at the time of renewal of the policy.
- The terms and conditions of the new policy including the premium, bonuses, and the extent of coverage are at the discretion of the new insurer.
- The process of portability should be initiated at least 45 days before the renewal date.
- To start the process, the policyholder should submit a written application to the existing insurer requesting portability, mentioning the details of the new insurer.
- The application should be acknowledged within 3 working days.
- There are no porting fees applicable in the portability process.
- A policyholder may opt for a higher sum insured and enhanced coverage features subject to approval from the new insurer. Note that with new coverage, waiting periods may change.
Disadvantages of Health Insurance Portability
There are some disadvantages also that come with health insurance portability.
- Porting is allowed only during the time of renewals. You can not port your policy in between the policy year.
- Portability allows only limited changes in your existing plan because you can port to similar types of policies only.
- An increase in coverage will also increase your premium accordingly.
- Porting can be a time-consuming process with extensive paperwork and coordination.
Top Reasons Your Health Insurance Portability Requests are Rejected
IRDAI has given insurers the right to reject portability requests for the following reasons;
- Documentation
A portability request may get rejected by the insurer if the policyholder fails to submit the required documents on time. Also, if there is missing information, inaccuracies, or gaps in the documents, it may also result in rejection. - Age
If a policyholder is more than 70 years old, chances are high that his request will be rejected. The insurers charge high premiums or add a co-pay clause for portability requests from senior citizens. - Underwriting risk
If your medical condition and the new policy’s underwriting risk do not match, the portability request is most likely to get rejected. - Incorrect information
If the policyholder provides incorrect information or misses some crucial information, the portability request will get rejected. Ensure that you share your full medical history to avoid rejection of portability requests.
Common Reasons to Apply for Health Insurance Portability
Following are some of the major reasons for opting to port a health insurance policy;
- Poor service offered by existing health insurer
When the services offered by a health insurer do not meet a policyholder’s expectations such as limited coverage or poor customer service, porting the health insurance policy to another insurer is a good option. The policyholder can look for an insurer offering better services and features like maternity benefits, coverage without sub-limits, better claim settlement or a wider network of hospitals depending on his requirements. - Relocation
A change of location can be another reason when a policyholder may need to port a policy to another insurer that has a better hospital network in his new location. - Inadequate coverage in the existing policy
When the coverage offered in your existing health insurance is not sufficient or is restricted, you may port your existing policy to a better option that suits your healthcare needs. There are a variety of health insurance policies available in the market with better coverage at a reasonable premium and better benefits compared to your current policy. - Cost-saving
Sometimes renewing a policy comes at an additional premium. A policyholder can switch to a health insurance policy that fits his budget and provides optimum coverage at a lower premium. Hence when premiums are revised, it is crucial to review your existing coverage costs and consider porting for cost-saving.
Factors to Consider Before Porting a Health Insurance Policy
There are certain factors to be considered before you decide to port your health insurance policy
- New policy features: Check the policy features that you are going to switch to. Ensure that it offers coverage that matches your requirements. Review the policy terms, limits, co-pay clause, waiting periods, etc. before you port.
- Premiums: Compare the premium of the new policy with the existing one and ensure that it is financially viable.
- No-claim bonus: Ensure that the accumulated no-claim bonus of your existing policy is added to the sum insured by the new policy.
- Network hospitals: Check the network of hospitals of the new insurer. See that you have easy access to network hospitals near you.
- Claim settlement process: Find out the claim settlement record of the new insurer. Check the claim settlement process and timeline before you finalize anything.
Conclusion
Health insurance portability is not just a technical process but it is a way that empowers a policyholder to adapt to changing medical expenses and growing healthcare needs. However, it is crucial to understand the process, rules, and its advantages and disadvantages to make informed decisions. If you seek better coverage, better services, affordable premiums or just relocating, health insurance portability gives you the freedom and flexibility to access quality medical care.
Frequently Asked Questions
As per IRDAI, the policyholder should apply for portability at least 45 days before the renewal of the existing policy. He should submit a written application to the current insurer mentioning the new insurer. He should fill out a probability form and proposal form and submit them to the new insurer with relevant documents.
A policyholder can port individual or family floater policy. He is entitled to get the credit of accumulated benefits and waiting period from the existing policy to the new policy. The new insurer should at least give him the sum insured equal to his existing policy.
You can port from group health insurance to individual health insurance if you change jobs, retire or the employer has discontinued the group insurance. The process is the same as the process of health insurance portability. Notify the insurer, apply for an individual plan, and submit the relevant documents.
You can ask the insurer for the reason for the rejection and check if it can be rectified. If there is any incorrect or missing information, it can be corrected. If the documents are not submitted on time, you will have to wait till the next renewal to reapply.
Yes, the older you are the more are the chances of rejection or you will be charged a higher premium.
If your portability request is accepted. You get the continuity for all waiting periods, all time-bound exclusions, and an accumulated no-claim bonus.
It depends on the underwriting guidelines of the new insurer.
The transfer of data is done through the IRDAI portal which maintains data about all health insurance policies issued by the insurance companies.
No, porting does not involve any charges. You only pay the premium for your new health insurance policy.
Yes, you can port your health insurance policy online by visiting the website of the new insurance company.
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