Health Insurance Portability

The Insurance Regulatory and Development Authority of India (IRDAI) is a body that works for the welfare of insurance policyholders and lays down guidelines for protecting their interests. Health Insurance Portability is one provision given by the IRDAI that allows policyholders to switch their policy from one insurer to another while retaining the benefits.

Buying good health insurance is a process that involves thoughtful planning and careful comparison of various plans available in the market. However, there could be some reasons that can compel a policyholder to move from one insurer to another. For instance, you might want to change your insurer if your insurer increases the premium or you shifted your location and are unable to find a network hospital, or you may just be dissatisfied with the services. Earlier, policyholders faced disadvantages in terms of losing their benefits such as the ‘waiting period for pre-existing diseases’ and no claim bonus when switching insurance companies and were regarded as new policyholders by the new insurer. However, the portability rules by IRDAI now enable policyholders to opt for their preferred insurer without worrying about losing the benefits.

There are certain rights available for the policyholders that include the right to:

• Port individual or family floater health policy
• Port policy from and to any general insurance company or specialized health insurance company
• Get benefits from the new insurer pertaining to the waiting period for pre-existing conditions gained with the old insurer
• Get insured by the new insurer at least up to the sum insured under the old policy. However, they can also opt for a higher sum insured, subject to terms and conditions.

Also, both the old and new insurer must complete the porting in accordance with the timelines specified in the IRDAI (Protection of Policyholders’ Interests) Regulations and guidelines.

When planning to port your health insurance policy, there are vital things to keep in mind to experience a hassle-free process. They are discussed below:

• The terms and conditions of the health policy may be different for different insurers. It is essential to understand them clearly.
• There are certain IRDAI rules to which one must adhere. For instance, a written application to the existing insurer must be submitted at least 45 days prior to the premium renewal date.
• Portability requests undergo scrutiny by the underwriters, and the prescribed guidelines are followed in order to gauge the risks and determine the premium costs. Higher age and health issues are some factors that insurers consider for rejecting portability requests. If they accept, they accept, they may apply some clauses and restrictions that policyholders must go through carefully.
• Policyholders should avoid giving incomplete information or delays in furnishing documents that can lead to rejection of requests. Poor claims history is another reason for the rejection of portability requests.
• Lower premium is a key point that encourages policyholders to consider policy portability. Yet, this may lead to the insurer reducing their coverage amount and policyholders might end up spending more. Hence, the premium and policy coverage are critical factors to consider when porting policies.

By opting for the portability of health insurance policy, policyholders can expect to gain numerous benefits in addition to their accrued benefits and bonuses getting transferred. These benefits come in the form of upgraded policies, attractive premium and enhanced services. With a track record of processing claims in a hassle-free manner, Care Health Insurance enables policyholders to port their health plans ‘Care’ and ‘Care Freedom’ based on their age segment and health status, and guided by the underwriting rules.

Introduced in October 2011, Health Insurance Portability refers to the right given to a policyholder of individual health insurance or family floater plans to get the credit gained for pre-existing conditions and time-bound exclusions transferred when he/ she decides to switch from existing insurer to another or from one plan to another with the same insurer. It is applicable under the condition that the previous policy has been maintained without any break. To be eligible for this, the policyholder who wishes to port his/her policy is required to apply to the old insurer at least 45 days prior to the premium renewal date of the existing policy. He must approach the new insurer at least 45 days prior to the premium renewal date. However, the insurer is free to consider the proposal even if the policyholder fails to adhere to this time limit. At the same time, insurers also have been given the right to accept or decline any request for porting health policy, after reviewing data, such as claims history of the policyholder.

The IRDAI has set up a web-based facility for maintenance of data of all health insurance policies issued by insurers in order to make it easily accessible by the new insurers.

Policyholders are required to comply with the health insurance portability rules, as specified here:

• Notifying the Insurer: A person can port the policy only at the stage of policy renewal. It implies that the new policy period shall be with the new insurer. As per IRDAI rules, the insured must inform the insurer 45 days before the policy renewal date.
• Waiting Period for Pre-existing Diseases: The new insurer will give the waiting period credit for pre-existing diseases gained with the old insurance company. Let’s suppose, you have a policy with a 4-year waiting period for pre-existing conditions, and you port a policy after completing 3 years. You need to wait for one additional year only if the new insurer has a similar waiting period.
• Premium and Bonuses: The health insurance premium, bonuses, and other terms of the new policy are at the discretion of the new insurer. The premium cost will be higher for those in the high-risk category.
• Renewal: A person desiring to port the policy must inform the old insurer in writing for a port-in request at least 45 days before renewal. One should mention the name of the insurer to which he wants to port the policy. It is also essential to renew the policy without a break.
• Grace Period: Policyholders are entitled to get a 30-day grace period when porting is under process. One can request to extend the existing policy for a short period by paying the premium on a pro-rata basis. They also have the right to continue the policy at a regular premium with the existing insurer.
• Sum Insured: The insured persons can opt for a higher sum insured when porting a policy, and it will be approved based on the underwriting guidelines of the new insurer. Also, the new insurance company must insure the policyholder at least up to the original sum insured under the old policy.
• Acknowledgement: Portability applications will have to be acknowledged by the insurers within 3 working days. Till the time results of acceptance of portability requests are awaited, the policyholder must not cancel the existing policy until he receives a confirmed policy from a new insurer or makes a specific written request.

Many people who want to skip hassles discard the idea of moving from one insurer to another. However, the portability procedures have been simplified, that makes it highly convenient for the policyholders.

Care Health Insurance offers an easy 3-step procedure to port health insurance policy.

1. Fill up the portability form with existing insurance details, including insured persons' name and age
2. Fill up the proposal form with complete details for the new insurance company
3. Submit the relevant documents

The requisite data will be furnished on the official web portal of IRDAI. The new insurer will underwrite the proposal and inform the policyholder within 15 days.

The IRDAI has set guidelines regarding the portability of the mediclaim policy that must be adhered to by the insurers and policyholders. It is a privilege given to the policyholders to change their insurer, due to some specific reasons, without losing the benefits. It is specifically convenient as far as a waiting period in case of pre-existing conditions is concerned. So, even if a policyholder ports his policy to the new insurer, he may not have to complete the waiting period all over again. However, this advantageous provision of mediclaim policy portability is subject to the continuity of the health policy. That is, there should not be any break in the existing policy.