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Health Insurance Portability

Health insurance portability is a feature introduced by the Insurance Regulatory and Development Authority of India (IRDAI). Through which you can switch from one health insurance plan to another with the same insurance provider. Alternatively, you can also use the health insurance portability feature to switch to a new insurance provider. 

 

When you port your health insurance policy using this feature, you continue to enjoy benefits of your previous plan, such as a no-claim bonus and free medical checkups. Also, if you’ve already gone through the waiting period for pre-existing conditions in the old plan, the same will also be transferred over to the new plan.

 

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How to Port Health Insurance Policy

You can apply for health insurance portability only when your existing plan is due for renewal. The transfer has to be initiated at least 45 days before the policy renewal date. Your request will either be accepted or rejected in 15 days. If the insurer doesn’t accept or reject your application within that time frame, your request has to be approved mandatorily. Both the accumulated bonus and the sum insured can be transferred.

 

 Here’s how you can port your current health insurance plan to a new one:

  • Step 1: Fill out the health portability form with the existing policy details.

  • Step 2: Then, fill out the proposal form with the details of the new health insurance policy.

  • Step 3: Submit the supporting documents and make the premium payment.

Health Insurance Portability Concept With Illustration

Mr Khurana was not pleased with the insured coverage offered under his existing health insurance plan. Thus, he decided to port his policy from his current provider to a new one. He has been associated with his existing insurer for four years and the sum insured is ₹2.5 lakh. Moreover, he has earned a cumulative bonus of ₹50,000.

 

After getting in touch with his current provider, he was informed that health insurance portability was possible with the same sum insured without having to lose the earned benefits. However, Mr Khurana was not pleased with the process. Hence, he got in touch with the new insurer to gain a better idea about health insurance portability.

 

Unlike his current insurer, they did not offer the same sum insured. So, he would have to opt for the nearest higher sum insured that was available. Now, let us assume the closest sum insured offered by the new insurer is ₹3 Lakhs.

 

Thus, Mr Khurana will get a full continuity benefit for ₹2.5 Lakhs to the extent of the waiting period served under the previous policy but no benefit under the enhanced sum insured. In simple words, he can avail of a higher sum insured with the new provider, but won’t get any additional benefits on the increased amount. For Mr Khurana, it turned out to be one of the disadvantages of health insurance portability.

 

The above example proves that the answers to questions like ‘should I port?’, and ‘what is better? Porting to a new insurer or a new plan’, etc., are subjective. You need to understand your needs, gain an understanding of the pros and cons of porting, and then make a decision.

Common Reasons Behind Health Insurance Portability

Let’s check out a few common reasons why an insurance holder might choose to port health insurance:

  • Poor services

  • Inadequate coverage for certain health issues

  • Slow claim settlement process

  • Hiked premium once a claim is made

  • Co-payment clauses

  • Lack of transparency

  • Room rent limits affecting the claim amount

  • Better deals from a different health insurance company

  • The desire to seek services from a specialised health insurer that offers personalised services in sync with the individual’s needs.

What are the Benefits of Porting a Health Insurance Plan?

Porting to a different health insurance plan offers a multitude of benefits. And they are:

 

  • Protects Continuity Benefits -

 We all want a way out of our existing plan to a better insurance policy, but without having to forgo our earned benefits. Health insurance portability enables you to avail the continuity benefits of the existing policy. It means you do not lose your accumulated benefits by changing the health insurance policy or insurer. For example, if you have earned a 40% NCB under the existing policy, you can enjoy the same percentage of NCB with the new insurance provider.

  • Carrying the Waiting Period Credit Forward -

 The waiting period completed or covered under the current health policy is carried forward to the new plan. Let us assume that your existing policy has a waiting period of 2 years for critical illnesses. And you will complete the waiting period by the end of the policy tenor. However, as per the new policy, the waiting period is 3 years. Here, your completed waiting period shall be deducted, thereby reducing the waiting period to 1 year.

  • Better Services - 

One of the reasons why people port their health plans is poor services. So, if you are not happy with your current insurer’s claim process, coverage, customer support, etc., you can look for a company that meets your needs. However, do your research to ensure that the new insurance company provides better services.

  • Lower Premium -

 Changing the plan or the insurer enables you to get the same services at a more feasible price. It is especially beneficial for you if your health insurance premiums have gone up simply because you raised a claim during the policy tenor.

Pros and Cons of Health Insurance Portability

Check out the below table to understand the pros and cons of porting your health insurance. This will help you answer a question–to port or not to port?

Pros

Cons

It allows policyholders to change their health coverage according to their current medical conditions/requirements and lifestyle. For instance, it enables you to switch from a group health insurance policy to a family floater health plan.

You can choose portability only when the health insurance plan is due for renewal. So, if you purchased a plan on June 9, 2022, and the plan expires on June 8, 2023, you cannot apply for portability before you have completed 10 months. The window offered for application is 45 to 60 days before the due date.

With this feature, the current sum insured and any bonus earned under the old health policy are combined to give you a new sum insured.

As a policyholder, you can only move to a similar type of health plan and not to something completely different. For example, you cannot go from a top-up plan to a cancer insurance policy.

Porting health insurance enables you to avail a plan for lower premiums.

You have to pay higher premiums to enjoy additional benefits under a new health plan.

The benefits of the existing policy stick with you even after switching to a different plan. Moreover, you do not have to worry about exclusions like the waiting period.

You may lose a few benefits from the existing policy if you choose to go from group insurance policies to individual plans.

When Should You Opt for Health Insurance Portability?

Questions such as whether you should port health insurance policies in India can be quite confusing. To make it easier for yourself, ensure that you evaluate the reason why you need to switch to a different insurance provider.

 

It would help if you considered porting in case the new insurer is offering a better restore benefit compared to your existing plan. It can also be because the new insurer has a large number of network hospitals under them, or maybe they offer a customised plan for specific medical issues.

Things to Consider While Porting Health Insurance

We understand that porting your health insurance plan to a new insurer for better services and benefits is a wise decision. However, there are a few things that you should keep in mind before switching:

  • Benefits Offered by the New Insurer -

Transferring from your existing insurer to a new one would make sense only if you receive better features and benefits. Hence, before you submit your health insurance portability application, check the features, benefits, coverage, and exclusions offered by the new insurance provider.

  • Age Limit -

Some insurers have set a limit on policy renewal, i.e. individuals beyond a certain age cannot renew their health insurance plans. Hence, do your research and confirm that the new insurance provider offers lifelong renewal.

  • Network Hospitals - 

Cashless claims can only be availed at network hospitals. Therefore, it is wise to choose an insurance provider that has a large number of empanelled hospitals for your convenience.

  • Premiums - 

When switching, it is crucial to know the premiums charged by the new insurer. There are a few insurance providers that offer low premiums, but the coverage offered by them is also limited. Hence, choose a plan that offers adequate coverage and fulfils all your health-related needs.

Porting From Group Health Insurance or Family Floater to an Individual Health Cover

People covered under group health insurance policies or family floater policies eventually move out and choose individual health insurance plans. However, it is imperative to make sure that you switch to an individual plan and not a new insurer. If you want to change your insurer, you might have to hold your horses…for a year. As someone covered under a group/family plan, you must first switch to an individual medical cover offered by the current insurer. The next step would be to complete an entire tenor with the new plan and only then switch to a new insurer.

Before you make the final switch, do not forget to check the features, coverage, add-on covers, and other benefits offered by the new insurer. Compare the plan offered by your existing and prospective insurer based on their terms, conditions, sum insured, age limit, waiting period, network hospitals, co-payment clause, room rent capping, and so on.

Health Insurance Portability Rules and Regulations by IRDAI

  • When an individual ports their health insurance plan, they must ensure that their new insurance company is similar to the current one. They cannot port their insurance plan from a health insurance company to a general insurance company.

  • One can port their health insurance to a similar insurance plan. Switching to a completely new plan with different coverage and benefits is not allowed under health insurance portability.

  • You can opt for porting of a health plan only when the renewal date of the existing plan is nearing and not at any time during the policy term. This way, the new tenor of your policy begins with the new insurer.

  • For hassle-free transfer, you have to apply for portability at least 45 days before the policy is due for renewal. You have to submit a written application with your existing insurer, mention the new insurance provider that you plan to transfer to and renew the plan without any break in the tenor.

  • The insurance company can take around 2-3 business days to acknowledge and respond to your request about health insurance portability.

  • Health Insurance companies cannot charge processing fees, foreclosure, or penalties to port your health insurance plan. 

  • Insurance companies have the right and freedom to determine premium amounts taking various factors into consideration like benefits, validity, etc. In such a scenario, the policyholder might experience a hike in the premium amount compared to the current insurance plan.

  • The policyholder is eligible to enjoy a grace period during the portability procedure, however, the number of days of the grace period depends upon the norms and policies of the insurance company.

  • The policyholder can also apply for an increase in the insured sum amount or negotiate about it with the new insurance company.

  • The new insurer will provide you with a waiting period benefit. But other features such as the premiums charged and underlying terms and conditions will vary according to your new insurer.

Rights of the Insured

  • You can switch your current insurance plan from one insurer to another

  • Health insurance portability is possible for the individual, as well as family health insurance plans 

  • The new insurer, is liable to provide you with the credit for the waiting period and bonuses that you may have accumulated over the years

  • The new insurer is also liable to provide you with a sum insured amount that is equal to or possibly near to the existing sum insured

  • Once the portability request has been raised, both the old and new insurance providers have to complete the necessary formalities as per the specified guidelines by IRDAI

Rejection of Health Insurance Portability Requests

IRDAI has given us the power to port health insurance plans. However, it has also provided health insurers with the right to reject portability applications. It means every request is treated as new, and thus, it shall go through the verification process.

 

When a health insurer receives an application to port healthcare plans, the underwriter first examines the risk exposure to determine the premium rate. The insurance company is allowed to reject your proposal in case it seems unfavourable. During such cases, continuing with the existing insurer would be your only option.

Reasons for Rejection of Health Insurance Portability Requests

IRDAI has allowed insurance providers to reject a portability application if it doesn’t meet their terms and conditions. Your portability request could be rejected on the following grounds:

 

  • Inadequate information

  • Delay in submitting the document

  • Poor claim history due to multiple claims

  • Unavailability of the previous policy document

  • A break in policy renewal

Other important grounds for the rejection of health insurance portability request:

  • Higher Age - 

Insurance companies generally refuse to cover senior citizens. The possibility of an individual falling sick increases with age. However, some insurance companies accept people within the age group of 60-69 years. These companies are like knights in shining armour for senior citizens. Most insurance companies may also impose stringent rules and charge high premiums.

  • Unfavourable Medical History - 

People with pre-existing diseases are often rejected during health insurance portability. In fact, even having a minor illness, which could later turn into a life-threatening disease could reduce the likelihood of your portability request being approved. Pre-existing diseases and other critical medical conditions require ongoing treatment, regular follow-ups and medication, which leads to high as well as recurring costs. This, in other words, means multiple claims. So, if a person with a history of hypertension, diabetes, cancer, or other major illnesses applies for portability, they shall be categorised as a ‘high risk’ applicant.

  • Porting Out of a Floater Cover -

Porting out of a family floater health plan raises multiple questions. So, if you choose to move from a family health insurance plan to an individual policy, the insurer could get doubtful. It is commonly believed that such requests come from people suffering from a chronic health condition, which requires better coverage. Hence, such portability applications are generally rejected.

Porting From Group Health Insurance or Family Floater to an Individual Health Cover

 

People covered under group health insurance policies or family floater policies eventually move out and choose individual health insurance plans. However, it is imperative to make sure that you switch to an individual plan and not a new insurer. If you want to change your insurer, you might have to hold your horses…for a year. As someone covered under a group/family plan, you must first switch to an individual medical cover offered by the current insurer. The next step would be to complete an entire tenor with the new plan and only then switch to a new insurer.

 

Before you make the final switch, do not forget to check the features, coverage, add-on covers, and other benefits offered by the new insurer. Compare the plan offered by your existing and prospective insurer based on their terms, conditions, sum insured, age limit, waiting period, network hospitals, co-payment clause, room rent capping, and so on.

Documents Required for Health Insurance Portability

Keep the following documents handy while submitting the health insurance portability application -

 

  • Identity proof

  • Address proof

  • Duly filled portability form

  • Duly filled proposal form

  • Insurance policy

  • Claim history (if applicable)

  • Declaration of no claims (if applicable)

  • Documents related to medical history

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FAQs

✔️What is health insurance portability?

Health insurance portability is a process that enables you to move from one health insurance plan/provider to another. It also ascertains that you do not lose your continuity benefits.

✔️What are the benefits of health insurance portability?

The health insurance portability benefits are as follows -

  • It allows you to choose a health insurance plan that fulfils your medical needs

  • It enables you to get better services

  • You can increase the sum insured at the time of portability

It allows you to carry forward the No Claim Bonus (NCB) benefits

✔️Which health insurance plans can be ported?

You can port individual as well as family health insurance plans.

✔️Why has my health insurance portability request been rejected?

Here are a few common reasons why health insurance portability requests get rejected:

  • You provided insufficient details

  • There was a delay in document submission or wrong documents were submitted

  • The rejection was based on your claim history, the difference in coverage, or due to some product discrepancy

  • There was a break in the health insurance renewal

✔️What happens to my continuity and waiting period benefits if I port my health insurance?

As per the Health Insurance Portability and Accountability Act and IRDAI guidelines, your continuity benefits and waiting period get carried forward to your new policy; that is, they remain intact and unaffected.

✔️When can I apply for Health Insurance portability?

You can apply for health insurance portability 60 days before the renewal date of the health insurance plan.

 

✔️Am I losing anything when I port health insurance policy?

With Health insurance portability you do not lose earned rewards, cumulative bonus points, etc.

✔️When should you think about transferring your health insurance policy?

If you find a better health insurance plan offering additional perks and benefits at a similar premium, then you must consider porting your health insurance.

✔️Can we port health insurance policy anytime?

Health insurance portability can be done at the time of the renewal period, however, you must place a request 45 days before the expiry of the policy.

✔️Can we transfer the health insurance policy mid-year?

No, you cannot undertake a health insurance portability procedure mid-year. The portability procedure can be done at the time of the renewal period.

✔️Does age matter while porting health insurance?

Yes, age matters during the health insurance portability procedure as the premium amount is influenced by your age.

✔️Can I change my plan with my current health insurance company without porting?

Yes. You can change your current health insurance with your insurance company without porting at the time of renewal.