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    Migrate to a better Personal Health Insurance plan
    (Portability of Health Insurance)

    If you already have taken Health Insurance in the past, you might have been tempted to shift insurers who offer better cover or lesser premiums.

    There is, however, one big issue : waiting periods will start again under the new policy.

    It is possible for an insured to switch insurers and have the waiting periods waived under the portability guidelines.

    • 1. 30 days waiting period waiver
    • 2. 1/2/3/4 years specific disease waiting period waiver
    • 3. Pre existing waiting period.

    The waiting period waiver is given to the extent of the claim free years he is present in the current policy and is limited to the current policy sum insured.

    Assume Raju took a health insurance policy for 5 lacs two years ago. He wants to change the insurer when the policy is due for renewal now.

    It is suggested that he apply to a new insurer 45 days before the renewal date of current policy.

    Assume he decides to take a policy from a new insurer for 10 lacs. He currently has a policy for 6 lacs (5 lacs of base sum insured + 1 lac of cumulative bonus).

    Under the new policy, the insurer will waive the 30 days waiting period, 1 or 2 years specific disease waiting period, and reduce the pre-existing disease waiting period by 2 years only for the first 6 lacs and not for the entire 10 lacs.

    It's not as simple as that, however.

    The New Insurer will make you sign the proposal form in which you need to declare your current Health Conditions.

    So let's say that Raju got diagnosed with diabetes six months back. So in his current policy policy, diabetes will be covered since it is diagnosed after taking his health insurance policy. However the new insurer may refuse the cover citing the reason diabaties as pre existing.

    If Raju forgets to declare the Diabaties information in the proposal form, the insurer might give him the cover now, but his claim will be rejected on the basis of misrepresentation of material facts”

    So in short, portability in a way is not portability in the true sense.

    • A policyholder desirous of porting his/her policy to another insurance company shall apply to such insurance company to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the premium renewal date of his/her existing policy.
    • Insurers may not be liable to offer portability if the policyholder (a) fails to approach the new insurer at least 45 days before the premium renewal date, or (b) approaches the new insurer more than 60 days prior to the premium renewal date.
    • Portability shall be opted for by the policyholder only as stated in (1) above and not during the currency of the policy.
    • In case the insurer is willing to consider the proposal for portability even if the policyholder fails to approach insurer at least 45 days before the renewal date, it is free to do so.
    • Where the outcome of acceptance of portability is still awaited from the new insurer on the date of renewal.
      • The existing policy shall be allowed to be extended, if requested for by the policyholder, for a short period of not less than one month by accepting a pro-rata premium for such short period and
      • The existing insurer shall not cancel an existing policy until such time as a confirmed policy from the new insurer is received or there is a specific written request of the insured
      • The new insurer, in all such cases, shall reckon the date of the commencement of risk to match the date of expiry of the short period policy issued based on the request of the policyholder. If for any reason the insured intends to continue the policy before the expiry of the policy or before the expiry of the short-period policy referred to under Clause (5) (a) above, with the existing insurer, it shall be allowed to continue by charging a regular premium and without imposing any new condition.
    • In case the policyholder has opted as in Clause (5) (a), and there is a claim, the existing insurer may charge the balance premium for the remaining part of the policy year provided the claims are accepted by the existing insurer. In such cases, the policyholder shall be liable to pay the premium for the balance period and continue with the existing insurer for that policy year. 6.
    • On receipt of the intimation referred to under Clause (1) above, the insurance company shall furnish the applicant with the Portability Form as set out in Annexure-I to these guidelines together with a proposal form and relevant product literature on various health insurance products which could be offered.
    • The policyholder shall fill in the portability form along with the proposal form and submit the same to the insurance company.
    • On receipt of the Portability Form, the insurance company shall seek the necessary details of the medical history and claim history of the concerned policyholder from the existing insurance company. This shall be done through the web portal of the IRDAI.
    • The existing insurer, on receiving such a request on portability shall furnish the requisite data for porting insurance policies in the prescribed format in the web portal of IRDAI within 7 working days of the receipt of the request.
    • In case the existing insurer fails to provide the requisite data in the data format to the new insurance company within the stipulated time frame, it shall be viewed as a violation of directions issued by the IRDAI and the insurer shall be subject to penal provisions under the Insurance Act 1938.
    • On receipt of the data from the existing insurance company, the new insurance company may underwrite the proposal and convey its decision to the policyholder in accordance with Regulation 4 (6) of the IRDA (Protection of Policyholders’ Interest) Regulations, 2002.
    • If, on receipt of data within the above time frame, the insurance company does not communicate its decision to the requesting policyholder within 15 days in accordance with its underwriting policy as filed by the company with the Authority, the insurance company shall not have any right to reject such proposal and shall accept the proposal.
    • In order to accept a policy which is being ported in, the insurer shall not levy any additional 18[***] charges exclusively for the purpose of porting.
    • No commission shall be payable to any intermediary on the acceptance of a ported policy.
    • Portability shall be allowed in the following cases
      • All individual health insurance policies issued by General Insurers and Health Insurers including family floater policies.
      • Individual members, including the family members covered under any group health insurance policy of a General Insurer or Health Insurer, shall have the right to migrate from such a group policy to an individual health insurance policy or a family floater policy with the same insurer. Thereafter, he/she shall be accorded the right mentioned in 1 above.
    • For any health insurance policy, waiting period with respect to pre-existing diseases and time-bound exclusions shall be taken into account as follows:-
    • Note 1: In case the waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment, the additional waiting period should be clearly explained to the incoming policy holder in the portability form to be submitted by the porting policyholder.
    • Note 2:For group health insurance policies , the individual members shall be given credit as per the table above based on the number of years of continuous insurance cover, irrespective of, whether the previous policy had any pre-existing disease exclusion/time bound exclusions.
    • The portability shall be applicable to the sum insured under the previous policy and also to an enhanced sum insured, if requested for by the insured, to the extent of cumulative bonus acquired from the previous insurer(s) under the previous policies.
      For e.g. - If a person had a SI of Rs 2 lakhs and accrued bonus of Rs 50, 000 with insurer A; when he shifts to insurer B and the proposal is accepted, insurer B has to offer him SI of Rs 2.50 lakhs by charging the premium applicable for Rs 2.50 lakhs. If insurer B has no product for Rs 2.50 lakhs, insurer B would offer the nearest higher slab say Rs 3 lakhs to the insured by charging a premium applicable for Rs 3 lakhs SI. However, portability would be available only up to Rs 2.50 lakhs.
    • Insurers shall clearly draw the attention of the policyholder in the policy contract and the promotional material like prospectus, sales literature or any other documents in any form whatsoever, that:
      • All health insurance policies are portable;
      • Policyholders should initiate action to approach another insurer to take advantage of portability well before the renewal date to avoid any break in the policy coverage due to delay in acceptance of the proposal by the other insurer.