Group Health Insurance Portability

Health Insurance Portability:: Health insurance porting refers to the process of switching the health insurance policy from one insurance company to another without losing the accrued benefits such as waiting period credit, no claim bonus, free medical check-ups etc.

Health insurance porting provides the customers with freedom to switch to a better insurance company in case the customers are unhappy with the services, coverage, terms and conditions of the existing insurance company’s policy. Porting of health insurance is the right given by the insurance regulator of India, IRDA to the common public. 

It is important to note that the portability would be possible if there are no breaks in the continuity of the insurance policy. Enough time should be provided to the new insurance company to decide on the acceptability of the proposal. Group health insurance portability can be availed by all the members of an indemnity based group health insurance scheme offered to account holders of a bank.

The members of an indemnity based group health insurance scheme offered to account holders of a bank are allowed porting of their health insurance coverage to another indemnity based group health insurance scheme offered by a different insurer to the account holders of the same bank. 

For group health insurance portability, the members of an indemnity based group health insurance scheme shall exercise the option of portability at the time of renewal of the policy or withdrawal/ discontinuity of the policy. Upon health insurance porting, all the terms and conditions of the policy shall be as per the new policy. The policyholder should be clearly explained by the insurance company about the additional waiting periods, if any before the health insurance porting. 

Procedure for portability: For the port of group health insurance a certain process is stipulated by the IRDA which has to be followed for smooth portability of your health insurance policy. Let us understand the procedure of group health insurance portability:- 

Step 1: The first step in the portability process is to select the new insurance company which the customer wants to port. An application has to be made to the new insurance company for the portability request at least 45 days prior to the expiry of the existing policy. This is an important step that has to be followed for the port of group health insurance as sufficient time should be given to the insurance company to examine the proposal and decide on the acceptance of the proposal. 

Step 2: The next step in the group health insurance portability process is to receive a proposal form and portability form from the new insurance company which has to be duly filled and sent back to the new insurance company for consideration. The new insurance company would give details of all the health insurance plans available with them and the customer should select the plan as per the requirement. The new insurance company would explain all the details of the selected health insurance plan to the customer and also any extra waiting period in the plan. 

Step 3: After the new insurance company has received all the required forms such as policy copy, KYC documents and other medical history they will login to the IRDA’s common data sharing portal within 7 working days and process the application. The IRDA’s website would have all the details of the applicant such as medical history, proposal form, claim history etc. 

Step 4: Once the new insurance company has received all the necessary details, it will decide on the acceptance or rejection of the proposal within 15 days. If the decision has not been taken within the stipulated time, then they should accept the proposal without any other option. 

Documents required for portability: Once the group health insurance portability request is sent to the new insurance company, there are certain documents which needs to be shared with the new insurance company to carry out the portability process which is mentioned below:-

• Current year policy copy which contains the details such as No claim bonus, sum insured, claim details etc.
• Previous years policy certificates as requested by the new insurance company. Few insurance companies request only for the latest insurance policy whereas others request for at least 3-4 years policy copies. 
• Renewal notice, if any, received from the existing insurance company which clearly mentions the claim details, coverage, no claim bonus and other details.
• Self declaration from the policyholders in case of nil claims during the previous years. 
• If any claim has been intimated during the policy period, then all the claim related documents have to be shared with the new insurance company. 
• Duly filled and signed  proposal form from the new insurance company
• Duly filled and signed health insurance porting from the new insurance company. 

Rejection of portability request: Porting is a right given to the insured customer which cannot be enforced by the customer on insurance company. IRDA has not made it mandatory for the insurance companies to accept every porting request.

IRDA has empowered all the policyholders with the right of portability as well as the insurance companies the right to reject the portability requests. As a result, all the portability requests received by the insurance companies are treated as new policy requests and are subject to scrutiny by the underwriters of the new insurance company.

The insurance company has the right to reject the proposal if it feels the proposal is not favorable. There are certain reasons for rejection of portability requests such as furnishing inadequate information, delay in document submission, suppression of facts such as claim related information and health conditions, break-in policy renewal, not providing previous year documents etc.

If the group health insurance portability request is rejected by the new insurance company, then the insured would have no other option and continue with the existing insurance company. In case of health insurance porting the new insurance company may ask the customer to undergo certain medical tests as the proposal is considered as new.