Health Insurance Portability
Health Insurance Portability
What is Portability right?
This is the right accorded to an individual health insurance policy holder (including family cover) to transfer the credit gained by the insured for pre-existing conditions and time bound exclusions if the policyholder chooses to switch from one insurer to another insurer or from one plan to another plan of the same insurer, provided the previous policy has been maintained without any break.
Portability allows you to switch from one insurer to another without making you lose your waiting period benefits earned by you in your existing policy. The waiting period is generally classified into three types:
- General waiting period
- Waiting period for pre-existing diseases
- Time bound exclusions (2 & 3 years waiting period for listed conditions)
for example, if you own a health insurance policy issued by insurer A (for example), which has a waiting period of 4 years (for a pre-existing disease) and you want to switch from insurer A (with whom you have been insured for 3 years) to Royal Sundaram, then enough if you just serve one more year of waiting period, to avail the benefit of pre-existing diseases with us.
How to apply for portability?
Step 1: An applicant desirous of porting his health insurance policy along with all the members of the family to another insurance company is required to apply/approach the new insurance company at least 45 days before the premium renewal date of the existing policy.
Step 2: On receipt of an application for porting, the insurance company shall furnish the applicant, the portability form, proposal form & declaration form and product literature.
Step 3: On receipt of duly filled portability form, insurance company is required to seek the necessary details of medical and claims history of concerned applicant through the web portal of IRDA within 7 working days of the receipt of such request. The underwriting is required to be done in accordance with the underwriting policy of the company and decision to accept or reject the proposal is required to be taken within 15 days from the receipt of complete information of the applicant from the existing insurer.
Can an employee migrate from the employee Group Health Insurance policy to a retail policy?
From Group Health Insurance policy to a retail health policy, Portability can be applied with the same insurer only. During subsequent years it can be ported to other Insurers
Will I get Cumulative Bonus under portability?
The cumulative bonus will the clubbed with the Sum insured and premium will have to be paid for the sum insured plus cumulative bonus, for which amount portability rights will be given.
To give an example,
If a person has a Sum insured of Rs. 2 lakhs and accrued bonus of Rs. 50, 000 with Insurer A. When he shifts to us and the proposal is accepted, we will offer him SI of Rs. 2.50 lakhs by charging the premium applicable for Rs. 2.50 lakhs. If we have no product for Rs. 2.50 lakhs, we will offer the nearest higher slab say Rs. 3 lakhs to insured by charging premium applicable for Rs. 3 lakhs sum insured. However, portability would be available only up to Rs 2.50 lakhs.
Documents required for Porting
a. Application form - Please note: In case of application for portability it is mandatory to answer questions requiring the details of previous or current Insurance Plans as “Yes” with all required details.
b. Portability form - All questions in the portability form are mandatory
c. Documents - Copy of the last years Policy Schedules issued by the previous Insurer OR Renewal Notices, Declaration by customer regarding claims made / past medical history.
When can I avail the benefit of Portability?
You can apply at least 45 days prior to the renewal date of your earlier policy in order to avail portability benefit.