Health Insurance Portability

Health insurance portability was introduced by the Insurance Regulatory and Development Authority of India (IRDAI). It allows you to switch from one health insurance plan to another within 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 the benefits of your previous plan. This includes a no-claim bonus and free medical checkups, among others Also, if you’ve already completed the waiting period for pre-existing conditions in the old plan, the same will be transferred over to the new plan.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Health insurance portability applications can be submitted online only when your existing plan is up for renewal. The transfer process must be initiated at least 45 days before the policy renewal date. Within 15 days of submission, your request will either be accepted or rejected by the insurer. If the insurer fails to respond within this timeframe, your request must be approved mandatorily. Notably, both the accumulated bonus and the sum insured can be seamlessly transferred during the portability process.

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

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

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

3. Submit the supporting documents and make the premium payment.

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 offering personalised services in sync with the individual’s needs

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?

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. It is recommended to 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.

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're considering changing your insurer, you might need to exercise some patience for up to 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 making 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.

• 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.

• You can opt for the 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.

• Top 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 considering various factors 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 for 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.

• 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

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