Health Insurance Portability in India

Facts you need to know about Health Insurance Portability in India.

The demand for healthcare facilities has been gradually growing in recent years. And so, the number of insurance companies in India has increased in response to the rising demand for health insurance.

These days, if you are unhappy with the policies, you have chosen and want to switch insurance providers, The health policy portability helps you to do so without losing any of the benefits you have received with your new insurer.

What You Should Know About Health Insurance Portability in India:

In 2011, the Insurance Regulatory Development Authority of India (IRDAI) introduced the idea of health insurance portability. An Individual policyholder is offered for switching health benefits options from one insurer to another or from one plan to another plan within the same company. However, in the case of group health insurance portability, you cannot move insurance companies. You can only port health insurance within the same business.

Reasons for porting your health insurance:

1. The current health insurance provider offers poor service.
2. The ongoing plan does not have enough coverage for such specific diseases.
3. The current health insurance provider has a complicated claim settlement history.
4. Medical bills were either not reimbursed on time or not at all.
5. In the case of a lawsuit, you'll have to pay higher premiums or a secret co-payment.
6. There is a better option in the market which is less expensive and has more coverage than the current health insurance.

Every Policyholder should be aware of the following Rights:

Although there are many specific details to consider when porting your health insurance plan, there are a few things that any policyholder should be aware of:

• You can switch your current health insurance policy from and a specialized/general health insurance provider.
• You can switch individual or family policies.
• The new insurer must cover you up to the previous policy's assured amount.
• The new insurer is obligated to give you credit on the waiting period for pre-existing conditions you accrued with the previous insurer.

Guidelines for transferring health insurance policies -

According to IRDAI guidelines, moving to a new health insurance company does not deprive you of benefits such as a shorter waiting period for covering a pre-existing illness as specified in your previous health insurance plan. All benefits earned during your previous policy would be available for you. However, the two insurers must complete the porting phase within the IRDAI's defined timelines.

The following are the criteria for transferring health insurance policies:

1. 45 days prior notice is mandatory

To ensure a seamless health policy transition to a new health insurer, you must notify the new insurer at least 45 days (but no more than 60 days) before the next policy renewal. Otherwise, your appeal for portability will be denied by the insurer.

1. Non-eligibility for porting in case of a break-in existing policy

According to the IRDA, for a policyholder to be eligible for switching, he or she must not have missed any premium payments and the existing policy must not have been broken.

1. New insurance company’s liability to respond within 15 days

The new insurer is required to respond within 15 days of receiving the application form and all required documents. Otherwise, after 15 days, they forfeit the right to refuse it. In other words, if the new organization does not deny the application within 15 days, it must be accepted.

Health insurance portability clause with a waiting period-

According to the waiting period clause, Policyholders can switch to the current insurance provider's benefits without having to go through the initial cycle of waiting periods. The policyholder's waiting period is reduced by the number of years he or she has already served.

Portability Applications Rejection Grounds -

IRDAI has given insurers the authority to deny a portability request on the following grounds:

• Incomplete information about the applicant
• An adverse claim history, such as multiple health claims
• Non-availability of the applicant's previous (at least three years) policy documents
• Delays in meeting document submission deadlines
• Policy renewal break
• If the applicant is a senior citizen

How do I change my health insurance plan?

You can only apply for portability when your current policy is about to expire. You must submit a request for portability to the insurance company. The new insurance company will then send you a portability form, a proposal form, and information about the various products and plans available.

After receiving the applicant's forms, the new insurance company will contact the existing insurer to obtain the claim history and medical history. Within 7 working days, your current insurer must submit all required information to the IRDA's web portal. The data should be submitted within seven days, it is a violation of IRDA rules.

Only after receiving all pertinent information new insurer will begin the process of underwriting the existing policy within 15 days and must inform the insurer about its decision during that time. If it fails, the application must be accepted.

Required documents for health insurance portability -

• A copy of your current health insurance policy with the most recent renewal notice.
• Portability Application Form
• Previous year's policy certificates
• Insured's self-declaration of no claims in the previous year (if there are no claims)
• If a claim is made, copies of the discharge summary, investigation, and follow-up report are required.

Any insurance customer can benefit from porting because it allows them to switch to a better product. Better service expectations from the new insurance company are one of the advantages of health insurance portability. As a policyholder, you can get a better deal and more features on the plans. Furthermore, you will be able to customize a policy according to your future needs. As a result, portability supports in bridging the gap between the current plan's coverage and other plans in the market.