Health insurance portability: Important clarifications

8 Common Health Insurance Portability Doubts Clarified

With the onset of health insurance portability, people now have the freedom to switch from one insurer to another while 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 is portability? Is portability applicable for all the health products?

Under health insurance portability, the 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 for hospitalization policies, popularly known as mediclaim policies.

What continuity do I get under portability?

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 as well.

What is the recommended process for portability?

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

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?

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 and conditions would be informed to the customer. If the illness is not pre-existing exclusion, the terms would not be applicable. However, the insurer has the discretion to either accept or reject the proposal.

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

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

What about the Portability with regard to individual floater policy?

Portability is applicable from individual to floater family health insurance policy and vice versa.

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

Yes, you can apply for revised SI with the new insurer. However, acceptance would be at the discretion of the new insurer.

If an insured has an earlier policy from 1-Jan- 11 until 31-Dec-12, Can he port from 1-Mar-11, i.e. can he port midyear?

Portability can be applied at the renewal only, he cannot apply for portability mid term of the policy.

Educate yourself about your needs before you buy a health insurance policy.