Health Insurance Portability In India- All You Need To Know

By
Hemant Beniwal
30

These days Health Insurance is equally important as Good Health – IRDA has announced the Health Insurance Portability In India and accountability act of 1996 – HIPAA to make the product even better in India. In this article, You can read

  • What does the portability of health insurance mean for you?
  • What are the Benefits of health insurance portability?
  • How does health insurance portability work?
  • What is the process of health insurance portability?
  • What about pre-existing conditions?
  • Group insurance portability is possible or not?
  • And rules, requirements, reviews…

Health Insurance Portability In India- All You Need To Know

Read –How Much Health Insurance Do I Need?

Health Insurance Portability In India – Joy for People

Expenses are one of the biggest reasons but there is one more reason – What if funds of your insurance company are not performing. You have to stick to a single company as it is a long contract & keep losing on returns.

Similarly, in the case of health insurance, it was not a win-win situation if you moved to the new insurer – as gains were lower than losses you incurred on shifting. But from 1st October 2011, if the person is not satisfied with the services or product offering of the existing health insurer, he can change the company without losing policy benefits.

Health Insurance Portability In India- All You Need To Know

Must Read – What is Insurance?

Why Health Insurance is so important

My daughter was asked in her HKG class “How does car run?” – and you can guess what she answered in a single word. But let me ask it another way round to you “Why car will not run?” – and now there can be a number of reasons – no fuel, engine chocked, windshield got broke, puncture, the bumper is down, its night but headlamps not working & some external factors like strike, roadblock, lost keys of garage…. So when something cannot happen there are internal and external factors enabling (or not enabling) for this.

What is Health Insurance Portability in India and Their Process & Benefits? Click to Tweet

Now if I ask you a similar question “How Man Runs?” – again a single word answer but “Why Man will not Run?” and you will again have a long list from a small thing as a headache to a bigger one like a cardio stroke which is internal factors. And you have some external factors also attached to this question like an accident. Internal & external factors related to the human body can be covered financially through mediclaim. (to some extent) So if you are in good health that does not mean you don’t need Insurance – what about external factors on which you don’t have any control. insurance aims that one can access the best health care without fearing the financial strain, it helps people to have peace in mind rather than to have fear.

What is the Health Insurance Portability?

What does health insurance portability mean for you? Portability means transferring your existing health insurance policy to a new insurer – without losing any of the benefits that your current health insurer provides. Credit Gained that can be transferred from one insurer to another includes waiting periods; waiting periods of pre-existing diseases or time-bound exclusions. Portability is allowed to all individual and family floater health insurance policies issued by all general insurance & health insurance companies.

Check – Religare Care versus Apollo Optima Restore Health Insurance

Health Insurance Portability Benefits for existing policyholders

  • You can expect good services from all insurers.
  • Better claim settlements from all companies.
  • New upgraded insurance products.
  • Definitely lower or competitive premiums.
  • Portability will ensure that accrued benefits (including waiting periods; waiting period of pre-existing diseases or time-bound exclusions) are transferred at par to the new insurer at the time of porting and you do not lose on these benefits while switching insurers.
  • The direction is given by IRDA to insurers that it is essential to protect the policyholders against the discontinuity and consequential loss of pre-existing disease cover by making the insurance plans portable across the insurance companies.
  • Another benefit for the pre-existing disease is waiting period to be carried forward i.e. if a pre-existing disease is being covered by a company is three years and the policyholders are with the company for two years, then for the new insurance company, the waiting period will cover the pre-existing period within one year. (If New insurance company also cover the same disease in three years)
  • Earlier there was a compulsory waiting period of 30 days to get benefits from the insurance policy – which is gone now in case if you shift the policy.
  • A cumulative bonus can also be transferred in health insurance portability.
  • In group health insurance portability – after seeing the medical history & claims the insurer can provide the individual health insurance and this will be available for portability after one year. (Now you don’t have to worry much about – “Should you buy mediclaim even if your employer is covering you”)

Read- Best Medical Insurance for Parents

Process of Health Insurance Portability

  • You have to apply to a new insurance company at least 45 days before the policy renewal date of a current insurance policy.
  • You have to fill new insurance company proposal form along with the portability form.
  • New insurance company within 7 Days will ask the old health insurance company about the policyholder’s details that include medical history & claim Benefits.
  • New Insurance Company has the right to reject the proposal of a policyholder seeing the medical history & claim, but if in case of the health insurance company do not reject the proposal within 15 days it means that the proposal has been accepted.

Health Insurance Portability Requirements (differ from company to company)

  • Copy of the Last year’s Policy Schedule issued by the previous Insurer OR Renewal Notice.
  • Self-declaration by the customer regarding no claims made.
  • Question regarding previous and existing health insurance details in the Proposal Form should be mandatorily filled.
  • If there is a claim in the existing policy, then discharge summary, investigation, and follow-up report copies.
  • If there is past medical history, then consultation papers, prescription, investigation, treatment, and report copies.

Grey areas in Health Insurance Portability In India 

  • Features of Insurance companies are very different.
  • There is a cooling-off period of 1 year.
  • You can shift to another company only at the time of renewal.
  • In case you want to shift your group mediclaim – you have to compulsorily move it to the same insurance company. After 1 year you can transfer it to any other insurance company.
  • For the preexisting disease, the new company can charge loading on the premiums.
  • Maternity benefits that are normally available in group health insurance policies may not be available if switched to an individual policy.
  • Loss of no claim bonus will be there for the policyholder who opts for portability – as some companies don’t provide any claim bonus or cumulative bonus.

What you should do now?

If you are not satisfied with the existing insurance policy or premiums – go & fire the existing company. Health insurance portability in India procedure is now smooth – take maximum benefit of it.

Please share if you have already decided to move to some other health insurance company. Where & Why?? If you have already done that add health insurance portability reviews in the comment section.

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30 COMMENTS

  1. A good one.

    Its good that portability has come in India now.Although company like Apollo Munich were offering it since their launch but in a limited manner.However, a rush should not be there as there are certain conditions which will affect your new policy.

    My guess is that this is good for individuals who have completed certain period with existing insurer and employees in group insurance schemes.Reason, the benefits you are receiving from existing will be intact.But someone with one or two year with an insurer would not benefit much from this except better services.Also there is drastic difference in features of companies like star health and apollo munich due to which it will not the new company might have high premiums or certain limitations.

  2. I am happy to learn about portability.
    Thank you Hemant.

    Recently i came to know about buying health policy through PSU banks. The premiums seem to be very less. Can you please tell me what will be disadvantage of buying these products.

  3. Hi hemant,
    The best part of the article is:
    “””””””
    Health Insurance Portability looks a great idea but my suggestion is wait & watch. Don’t jump on first day first show – I did it in case of mobile portability (reliance to airtel) & my mobile was out of service for 20 days. Let insurance companies work on it & develop smooth process – meanwhile you try to choose the best health insurance for you. May be your existing company upgrades their products or reduce the premiums soon.
    “””””””

    Do not jump the gun at it very sight……finally if you are already insured then no need to worry and if you are not then go and get one today, don’t wait for premium to come down because you never know what may happen to you (or your loved ones) before that policy comes into effect if you wait too long.
    Regards,

  5. hi paritosh,
    It is already there……..surprised
    1) Within same fund you just need to switch between growth, dividend or dividend re-investment plans. NO charges by most fund houses if within the limits prescribed by them.
    2) Within same fund house you need to give a switch request….If your investment is more than 365 days old, then NO charges by any fund house, other wise charges applicable as per SEBi rules.
    3) To another fund house…redeem your units from existing portfolio and start SIP or buy units of the new fund house…..
    bye

  6. Hi Hemant, this looks like good option,but need more clear information, like fro ex: i have 1 insur. with riders, if i wwant to change i have to go the other comp. which offers riders, or i shlud get premium less paid, there is lot of Q in mind, when we try to Jump. as you said is correct lets wait n watch how companies will work on it.

    thanks for postining this topic…..

  7. I am back, finally. Work kept me off for quite some time. 🙂
    Once again, great article. I think there are way too many catches (or grey areas as you have mentioned). It looks like the NPS brought out few years back. One thing for sure, health insurers will strive for better service. Or atleast, lets hope for it. Thanks for sharing.

  8. Plz comment on Policies like “Health Cash” as one offered by SBI Life. I would like to hear the grey areas and benefits in India.

  9. Hi Hemant,
    Nice article, as always :). Thanks for that.
    One question – From last two years I am maintaining two insurance policies. One which comes from my employer and another purchased by me. Both have almost same coverage which is 3 lakhs. The reason to maintain two was that I am not sure if my employer changes the rules for coverage in future or stops this facility in future. When portability was not picture then there was no option but to have my own because there is always a risk that in future if I have any health issues then they will go into pre existing ones.
    My questions is that with the portability which I think also allows to port from a group insurance policy, is it recommended to stop my own policy and then port the group policy to my own in case my employer decides to stop coverage or if I change my job etc. etc. Do you think at this stage the portability of group insurance is mature enough so that I can rely on it. One advantage is I can sure save on the premium of my own policy which I can then use either for critical insurance policy or top up policy.
    Please share your thoughts on it.

    Thanks,
    Manoj

    • hi manoj,
      it is good that you took your own health policy about two years ago. having an extra cover in theform of personal mediclaim is always better in addition to the group policy offered by the employer.
      As for your question, I would like to point out a few things:
      1) Usually all the dependants are covered by the group health insurance policies – depending ofcourse on the terms of your employer and the insurance co. – therefore if your policy covers only you (and your spouse/child) only then you get to cover your dependent parents, brothers an sisters too from the group policy.
      2) In case of group policies pregnancy of female employees and spouses of male employees – no individual pollicy covers this, except for a couple from probably max bupa and star health, which are very expensive.
      3) in case when you switch your job – or as you have mentioned that the employer might change the group policy terms, or may want to plunge into an enterprise of your own – then you will benefit most from the policy you have taken and not the policy that you get ported. it is because when porting from group to individual policy you cannot choose a new company and will have to stick with that for one year even if you do not get a good coverage (in terms of exclusions and illnesses).

      Now, my suggestion is that you continue your individual policy and increase the cover if it is a family floater. if it is not a family floater you should go for additional riders to include your dependents in it. Also take a critical illness rider on the same policy.

      in the end I stringly wish that “nobody shall remain without a cover…but GOD bless…. nobody shall ever need it”.
      regards,

  11. Hi Hemant,

    I am regular reader of your articles. This article force me to write something with my previous experience.
    I am 28 years self employed person. I am nonsmoker,Pure vegetarian person.Unfortunately last year ( 10th Oct 2010) I had undergone angioplasty treatment for my heart attack problem.
    Now I have following Doubts, which i think you should clarify with your vast experience in this field.
    1) Is it possible to get medical policy even after this. Because I think Mediclaim companies are now reluctant to issue any medical policy due to this previous medical history. ( For my satisfaction I have done all my medical test in June 2011 , which are completely normal.) If,Yes then which medicalim policy is suitable for my case?
    2) Even after giving all my correct information to any company,Is it creates problem in further hospitalization?
    3) I am also want to insured with good Term Insurance policy with 50 to 70 lacks insurance amount. Which is best suitable Term Insurance policy in my case?

    Waiting for your Experienced and valuable reply.

    Rajendra

    • Hi Rajendra,
      Hope you are doing good now.
      Yes ,Mediclaim Policy is suitable for you but the disease will be covered after three year.
      No it wont create any problem when you are further hospitalized but you should inform the company within a week’s time.
      I will suggest you to have ICICI i care online term plan.

    • Hello Rajendra,
      The replies by tinks are all corect. Let me put them point-by-point once again for you:
      Q1) Yes, some companies, especially pureplay health insurance companies my give you medical cover. As tinks had mentioned, there will be an exclusion period which may range from 3-4 years. Obviously, the premium would be higher than a regular policy, and if the company is not excluding you pre-existing ailment, then it may charge even higher premium for higher risks. by the way, angioplasty itself is not an ailment, and you ight have required if because of many reasons – tension, high cholesterol, high BP, or even genetic reasons. You get from your doctor the specific reason that warranted the procedure and probably only that disease may be excluded.
      Q2) During the exclusion period if you are required to undergo treatment due the the earlier reason, then you may be denied claim. But it should not deter from getting yourself covered. As in many cases after angioplasty the patient’s heart comes much more stronger and with regular exercise and diet control you can even avert such a situation for not only 3-4 years but forever.
      Q3) Even if you go for a term cover, there will be chances of your premium being higher because of the perceived risks. If you do not have dependents or too much liabilities that could not be met out using your existing assets, then I would recommend you to wait for a couple of months as LIC is launching its own online term plan and that will probably create further avenues for you. Meanwhile you can fill in the online application of all online term covers by all companies, to see if they reject your application or to see the premium they are charging right now. Whenever you go for it, DO INSIST ON A COMPLETE MEDICAL CHECK-UP BY COMPANY DOCTOR AND ASK FOR A COPY OF THE MEDICAL REPORT. This will save your survivors, in the unfortunate event, any hassles.
      regards,

  13. I would prefer to thanks for ones efforts that you written this kind of nice document. This is this kind of great resource you will be providing in addition to sharing with us.

  14. Hi,
    I am planning to buy the Health Insurance for my parents. My parents are above 60yrs. I came to know about the “Star Red Carpet for Senor Citizen”. Does anybody has idea about this policy ? should I go for this policy or does anybody has other better option.

    Regards,
    Prem

  15. Hi, I hv an additional family floater health insurance policy other than the one provided by my employer.

    This plan was taken as part of my financial planning last year. Now my family and I are moving outside india for atleast a year(During which time the Health Insurance from my employer will continue). I had asked my financial Planner if I should discontinue my other health insurance till we return. His suggestion was to hold the plan to avail seniority benefits.

    what is a seniority benefit and is his suggestion correct?

  16. Hi,
    I am planning to buy the Health Insurance for my parents.
    My mom is 52 and dad is 59. Dad is all fit by god grace up till now but there is one thing that my mom went through the angioplasty last week, Aug 2012.

    Will I be able to buy any plan/mediclaim/critical care (or whatever it is)??
    If yes then what would be the condition for my mom’s policy?? and what all things will be included and excluded in that??? and if something related to angioplasty is excluded, will it be included after 3/4 years???

    I am free to pay high premium rates on yearly basis. But the claim settlement for hospitalization should be smooth.
    Thanks in advance and would highly appreciate if you could contact me and have a word that could give me clear Idea.

  17. Hi,

    I am 29 yrs old and married. I want to have family floater health insurance plan which covers my spouse as well as my dependent parents.

    Can anyone suggest suitable plans?

    Thanks,
    Jigar

  19. If I resign from a previous company( Suppose Reliance Securities Ltd ) , can I go for Portability .

    What is the procedure & document required for the same

    Regards
    Rajshekar
    932100000

    • Rajsehkhar,

      Yes you can port your group insurance policy to an individual policy but with same company for one year.
      Contact your insurance company they will guide you with exact process and documentation.

  20. Recently I went for health insurance portability and switched from New India Assurance to Apollo Munich with same amount insured. Most of the things remained same but in New India Assurance I got a cumulative bonus of Rs. 60000 but in Apollo Munich, the cumulative bonus reduced to 50% i.e. Rs. 30000. The reason for swithcing was higher premium by New India Assurance as compared any other insurance company. The question is can I get 100% Cumulative bonus transfer? If yes, then what should i do to get it? Because for Rs. 1000 saving in premium I have lost Rs. 30000 in cumulative bonus. Please reply ASAP as I have to notify new company within 15 days for any discrepecency. Thanks in advance.

  21. Angel,

    These are the issues which are arising in portability. The major reason is the non standardization of products which you can port. Its difficult to say where you can get all the features port to new company as this decision rest with company you are availing the new policy and you come to know only when your proposal goes for underwriting. The company decide it based on various factors premiums difference being one. In our view if you are porting your policy due to dissatisfaction with current insurer or better features in the new company then you can go ahead with Apollo Munich. Else you will have to analyze few companies before you decide to opt for portability.

  22. Hi
    My existing health policy is with Allianze Bajaj , the policy taken in the year 2005 , since then there is no claim. As the policy with Bajaj there is no family floater benefit , so I want to transfer my policy to other company . Can you guide me which company is more beneficial to me , I am giving my details :
    1 My age is 50, My wife is 43 and my daughter is 15.
    2. We need family floater benefit .
    3.Cost of premium should be less.
    4.If any claim in future which company has a good track record.
    And pls guide me how to transfer the policy i.e. what is the process, my renewal due date is 25.08.2015

    Thanks
    Jayanta

  23. My company has a group health insurance policy which covers parents too. We have made a request to port to individual policy when an employee retires. The insurance company is willing to do so for employee & spouse but not for the parents who obviously are now in the age bracket of 80+. This sounds unfair as the company was giving a higher premium for such employees who had aged parents. Is there any IRDA guideline on this subject?

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