PORTABILITY

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Portability

With the onset of health insurance portability, people now have the freedom to switch from one insurer to another carrying forward all the benefits of their previous health insurance policy. Portability will enable transfer of credit gained by the insured for pre-existing conditions and time bound exclusion if the policyholders choose to switch from one insurer to another or from one plan to another plan of the same insurer provided the previous policy has been maintained without any break. Insurers can be switched to only if the policyholder has held it for one year. Under the new guidelines, a policyholder will have to initiate the portability process 45 days before his policy with the old insurer expires or becomes due for renewal. No-claim bonus can be carried forward to the new insurer. All benefits of the waiting period will get transferred. Cumulative bonus comes under benefit of porting.


What's Portable...
Portability allows customers to carry forward continuity benefits accrued on their previous policy. These benefits are gained by being under continuous coverage for a certain period. This is essential for getting coverage for pre-existing diseases. Earlier, policyholders had to stick to a policy only to retain the waiting period benefit.

Those covered under employer group health insurance policies or family floater policies can also port to an individual health cover .

However, they will first have to switch to a plan offered by their existing insurer and will be allowed to switch to the insurer of their choice only after a year.

The Procedure...

  • The application to port your health insurance policy should reach the new insurer 45 days prior to the last date of renewal of your existing policy.
  • On receiving your request, the new insurance company will provide you a proposal form and a portability form along with details of various products offered by it.
  • Choose the product which suits your requirement, fill up the proposal and portability forms and submit them to the new insurer.
  • Once the insurance company receives both these forms, it will approach your existing insurer seeking details such as medical records and claim history .
  • The data will be received through a common data sharing portal developed by Irda for all insurers. The existing insurer will have to furnish all the details within seven working days.
  • After the new insurer has the requisite information, it has to take a decision on underwriting your policy within 15 days. If it fails to take a view within this time frame, it will be bound to accept your application.

What you can lose...
The premium may not stay the same even for a similar coverage as insurers are free to levy premiums according to their underwriting norms. This means that people in the 'high-risk' category may have to pay a higher premium after switching. If you have accumulated no-claims bonus, it will be lost in transition.

Though you can carry forward your enhanced coverage, you will not get a discount on the premium and will have to pay the full amount. The terms and conditions of the policy will differ from insurer to insurer. Therefore, know the inclusions and exclusions before switching.
IF YOU ARE NOT HAPPY WITH YOUR WITH YOUR EXISTING HEALTH INSURANCE COMPANY THEN click here.
Things to remember

The 45-day criterion
File your request to switch insurer at least 45 days before the expiry of your existing health policy to ensure that the application is accepted. Though the health insurance company is free to consider a proposal even if the policyholder fails to approach it 45 days before the renewal date of the current policy, it is not legally bound to offer portability if this criterion is not met. So, there is a chance your application will be rejected.

Policy Continuity
Portability may be denied if there is a break in the policy. So, ensure that you port the policy before the existing cover expires. In case the decision of acceptance is still pending on the last date of renewal of your existing policy, you can request your present insurer to extend the coverage for a month or more. You will have to pay a pro rata premium for this extended coverage. It can remain till the procedure is completed.

Maintaining Records
Maintain proper documentation such as previous policy certificates, renewal notices clearly stating continuity of coverage, etc., so that it is easier for the new insurance company to evaluate your proposal and underwrite the policy accordingly.


FREQUENTLY ASKED QUESTIONS on Portability in Mediclaim Policies

1. What is Portability? Is portability applicable for all the health products?

Ans. Under Portability the health insurance customer can switch from one insurer to another insurer, the credit on continuity of the coverage would be passed on from the previous insurance policy to the new insurance policy.

Continuity can be passed on from products with similar risk covered, for e.g Portability can be opted from Hospitalization policies popularly known as mediclaim policies to mediclaim policies.

2. What continuity do I get under portability?

Ans. After the UW process if the proposal is accepted continuity would be given for all the waiting periods under the policy , including the waiting period for pre-existing illnesses.

The continuity would also be given on the time bound exclusions, for e.g most of the policies exclude the joint replacement surgeries for a period of 3-4 years, with portability the continuity would be considered for these conditions also.

3. What is the recommended process for portability?

Ans:

  • Once you have decided to port the policy, look at the various insurance products
  • Visit the web sites & study the various policies
  • Understand your requirement & compare the products
  • Check the waiting periods, capping, co-payments & exclusions under the policy
  • Select the product which meets your requirements
  • Approach the insurance company at least 45 days prior to the policy expiry date
  • Collect all the details from the agent
  • Fill the proposal form completely without leaving any field blank
  • Disclose all the information correctly on the proposal form
  • Submit the proposal form with the insurance company
  • If any further information is required from the previous insurer the new insurer will request for the same on the IRDA portal
  • On receipt of data from the previous insurer the new insurer will process the proposal further & inform the decision to the customer within working 15 days.
  • If you agree with the proposed terms & conditions of the new insurer premium should be paid without any further delay
  • On receipt of the premium from the client the policy would be issued with continuity & dispatched
  • Please check for all the details on the policy schedule
  • Now you are successfully enrolled with the new insurer under portability

4: Will I need to undergo medicals again? After the medicals are conducted by the new insurer, there is a positive finding in the medical reports, what would be the decision of the new insurer?

Ans. This depends on the Underwriting guidelines of the new insurer, if so the insurer will inform you accordingly Please ensure the tests are conducted within the given time frame.

The new insurer would take the decision as per the UW guidelines decided by the company, if the proposal is accepted the terms & conditions would be informed to the customer. If the illness is not pre-existing exclusion would not be applicable. However the insurer has the discretion to either accept or reject the proposal

5. If I want to port my policy to your company what documents I need to submit?

Ans. The documents required are
a) Previous policies (The no. of years continuity will be subject to the policies submitted)
b) Claim experience in detail
c) Proposal form
d) Age proof
e) If any positive declarations – discharge card, investigation reports, latest prescriptions & the clinical condition

6. What about the Portability with regard to individual floater policy?

Ans: Portability is applicable from Individual to Floater policy & Vice versa

7. Can I change my Sum Insured while changing the insurance company?

Ans: Yes you can apply for revised SI with the new insurer, however acceptance would be at the discretion of the new insurer

Portability