The Ultimate Guide to Porting Your Health Insurance Plan

Choosing the right health insurance plan is crucial, but what happens if your needs change or you're unhappy with your current insurer? Thanks to health insurance portability you can switch your health insurance provider without losing any benefits you’ve earned. This is a lifesaver for those looking for better services, lower premiums, or enhanced coverage. In this blog, we'll walk you through the basics of portability in insurance, how it works, its benefits, and how to ensure a smooth transition. 

Porting Your Health Insurance: Everything You Need to Know

As per the 2011 circular from the Insurance Regulatory and Development Authority of India (IRDAI), the portability feature allows you to transfer your existing health insurance with return of premium to a different insurer. This includes both individual and family floater plans issued by non-life insurers.

With this you get to transfer your existing health insurance policy from one insurer to another without losing the benefits accumulated, such as waiting periods for pre-existing conditions. This means you can continue your coverage without having to start over with a new policy.

At a Glance

When Should You Consider Porting Your Health Insurance Policy?

Switching health insurance plans might seem daunting, but it could be beneficial in these situations:

> Need for Additional Cover: If your current policy doesn’t offer certain protections, like critical illness cover, and you require extra coverage, it may be the right time to switch insurers.

> Claim Settlement Issues: Facing trouble with claim settlements or dealing with a provider with a low claim settlement ratio is a strong reason to look for a more reliable insurance company.

> Price Difference: With increased competition in the insurance market, you may find policies offering better benefits at lower premiums. This could prompt you to consider switching to a different provider.

> Hidden Clauses: If you come across terms that weren’t clear at the time of purchase, and these hidden clauses affect your coverage or claim process, it’s worth exploring more transparent insurance options.

> Better Products and Offers: Insurance companies regularly launch new products and services. If you find more suitable or advantageous options, consider switching.

> Poor Service: When the service from your insurance provider doesn’t meet your expectations or isn’t aligned with the initial promises, moving to another provider might be the best solution.

> Need for Specialized Services: If you require specific health services or coverage that your current general insurance provider lacks, it’s a good time to port to a specialized insurer.

Guidelines for Health Insurance Portability

Before you proceed with porting your health insurance policy, here are the important IRDAI guidelines:

a) Portability at Renewal: You can only port your health insurance during the renewal of your policy.

b) Acceptance Timeline: The new insurer must acknowledge your portability request within 3 days and decide on your application within 30 days after receiving all necessary documents.

c) Types of Policies: Both individual and family floater policies are eligible for porting.

d) Waiting Period: The waiting period covered under your previous policy will be deducted from the new policy's waiting period. If you’ve already completed the waiting period for pre-existing diseases, you’ll receive immediate coverage from the new insurer.

e) Policy Continuity: Ensure your current policy does not lapse before porting. Continuity is crucial for a successful porting process.

f) 45-Day Notice Period: You must apply to port your policy at least 45 days before your current policy expires and inform your current insurer.

g) Underwriting Rules: The new insurer can evaluate your application based on their underwriting norms. If you don’t have pre-existing conditions or claims, the premium may remain low. Otherwise, they may increase the premium or deny the portability request.

h) Insurance Companies: You can transfer your policy between general or specialized insurance providers.

i) Rejection of Portability Request: Portability is not guaranteed. If the new insurer rejects your proposal, you can continue with your current policy.

j) Like-to-Like Policies: Only similar types of policies can be ported. For instance, a basic reimbursement plan can be ported to another reimbursement plan, but not to a critical illness plan.

Steps to Port Your Health Insurance Policy

The following steps are require to port your policy are: 

> Apply to port your policy 45 days before the expiry of your current plan.

> Complete the portability and proposal forms, and gather all required documents.

> The new insurer will check your details and process the porting request within 7 days.

> Your current insurer will submit your data to IRDAI.

> The new insurer will frame the new proposal as per their norms.

> The portability request should be approved within 15 days. If there is a delay, the new insurer must accept your porting request.

Documents Required for Porting Health Insurance

The following are the documents that are generally required for porting health insurance: 

1) Portability form issued by the current insurer 

2) Proposal form duly filled and signed ( Health history of all the insured are to be disclosed)

3) Previous policy copies 

4) Claim history in the previous policies 

5) KYC documents, with following attached:

a) Health declaration form

b) Address proof Aadhaar card or any valid Address proof 

c) Age proof PAN card

Other documents may be required by the new insurer depending on the policy terms.

Benefits of Porting Health Insurance

Here’s why porting your health insurance can be beneficial:

(i) Increased Sum Insured: The sum insured, plus any accrued bonuses from your previous policy, will transfer to your new policy, increasing your coverage.

(ii) Retained Benefits: All benefits from your old policy will continue with the new one.

(iii) Potentially Lower Premiums: Due to market competition, the new insurer might offer a lower premium with the same benefits.

(iv) Improved Transparency: You can port to an insurer with clear and transparent policies, avoiding hidden terms.

(v) Customized Plans: Portability allows you to tailor the new policy to your current health needs by adding optional covers or modifying the nominee.

(vi) No Additional Waiting Periods: You won’t need to restart the waiting period, especially for pre-existing conditions.

(vii) Better Claim Settlement: If your current insurer has slow claim processes, switching may help you receive faster settlements with a new provider.

(viii) Enhanced Overall Service: Researching better options allows you to switch to an insurer known for their high-quality services.

Challenges of Porting Health Insurance

Though porting has numerous advantages, it’s important to be aware of the potential downsides:

(i) Limited Time for Porting: You can only port during the renewal window, not at other times.

(ii) Higher Premiums: Some new insurers may charge higher premiums for additional benefits, which might offset any cost-saving advantages.

(iii) Policy Type Restrictions: You can only port between similar policy types. Significant policy changes are not allowed, for example, porting a top-up plan to a hospital cash policy.

(iv) Loss of Group Policy Benefits: If you switch from a group policy to an individual plan, you may lose some benefits offered under the group plan.

When can new insurer reject portability request

A new insurer can reject a health insurance portability request under the following circumstances, including reasons related to underwriting risks:

1. Incomplete Documentation

If the required documents (such as policy history, medical records, claim history, etc.) are incomplete or not provided within the stipulated time frame, the insurer may reject the portability request.

2. Non-Disclosure or Misrepresentation

If the policyholder has not disclosed material facts (like existing health conditions) or provided inaccurate information during the proposal, the new insurer may reject the portability request based on misrepresentation or non-disclosure of crucial details.

3. Pre-existing Medical Conditions

If the policyholder has certain high-risk pre-existing diseases (like cancer, heart ailments, or severe diabetes), the new insurer may reject the portability request after assessing the medical history.

4. Underwriting Risk Assessment

If, after a detailed risk assessment, the insurer determines that the policyholder represents a high underwriting risk, such as:

a) Age: Older individuals are often considered a higher risk due to potential health complications.

b) Chronic Illnesses: Long-term chronic diseases (e.g., hypertension, liver/kidney diseases) could be viewed as higher risk.

c) Previous Claims History: Frequent or high-value claims could make the policyholder an unattractive risk to the insurer.

d) Lifestyle Factors: Risky lifestyle habits, such as smoking or excessive drinking, may lead to rejection due to a heightened risk of future claims.

5. Pending or Ongoing Claims

If the policyholder has a pending claim at the time of requesting portability, the insurer may consider this a risk factor and reject the application.

6. Exceeding Time Limits

The portability request must be made at least 45 days before the policy renewal date. If this timeline is not adhered to, the insurer may reject the request.

7. Product Mismatch

If the new insurer does not offer a product that aligns with the features and coverage of the existing policy, they may reject the portability request.

8. Non-compliance with Insurer’s Underwriting Guidelines

Each insurer has its own underwriting guidelines, which include acceptable risk levels. If the policyholder falls outside these criteria due to specific health or lifestyle factors, the portability request may be denied.

Other Important Things to Remember When Porting: 

Here are some final key points to consider before porting your policy:

a) You can return to your old insurer at any point during the porting process.

b) Your previous insurer will reinstate you without any penalties or premium increases.

c) There are no charges for porting; you only pay the premium for the new policy.

d) A 30-day grace period is allowed for renewing your policy while porting is underway.

e) The new insurer must offer a minimum coverage equal to your old policy’s sum insured, though you can opt for a higher sum insured.

f) You can switch between different plans within the same insurer.

g) You can port from a group policy (offered by an employer) to an individual policy, starting with the same insurer. After a year, you may switch to a different insurer.

Bottomline

Health insurance portability is an essential tool for policyholders who want to switch insurers without losing their accumulated benefits. Whether you’re looking for better coverage, lower premiums, or improved claim settlement services, portability offers the flexibility to upgrade your insurance without starting from scratch. By following the IRDAI guidelines and applying at least 45 days before your policy renewal, you can ensure a smooth transition to a new insurer while retaining benefits like waiting period credits and accrued bonuses.

The key advantage of porting is that it allows you to continue enjoying coverage for pre-existing conditions without any additional waiting periods. It also opens the door to more customized plans that better suit your needs. With careful planning, porting can give you the freedom to select the best health insurance plan for your changing needs.

Take the first step today and explore your options with OneAssure. Your family’s future is worth it!