IRDAI Health Insurance Portability Guidelines

What is Health Insurance Portability?

Health insurance portability is the process to switch from your existing insurer to a new one if you are unsatisfied with their services. It allows you to port your health insurance policy to an insurer with better plans and improved services.

The Insurance Regulatory and Development Authority of India (IRDAI) introduced portability in health insurance in 2011 to protect policyholders from being stuck with an insurer that provides poor or unsatisfactory service. Since the introduction of the concept, regular amendments have been made to the health insurance portability rules to ensure a fair process and policyholders' maximum benefit.

IRDAI Health Insurance Portability Guidelines

Understanding the IRDAI rules regarding porting helps you to know your rights and navigate the process smoothly. Here are the important IRDAI guidelines for health insurance portability:

1. Same Policy Type

   You can port any individual or family health insurance plan, but only to a similar category as your existing policy.

2. Porting at Policy Renewal

   You can port to another insurer only at the time of policy renewal. Mid-term porting is not allowed.

3. Portability Application Timeline

   You must raise a portability request at least 45 days before the renewal of your existing health insurance plan.

4. No Policy Breaks

   To be eligible for porting health insurance, your existing policy must not have any breaks or gaps. This means the policy should be active and there should have been continuous coverage.

5. Type of Insurer

   You can switch from any specialized/general insurance company to another specialized/general insurance company.

6. Underwriting by the New Insurer

   The IRDAI allows the new insurer to evaluate your profile and claim history for risk assessment. They can accordingly accept or reject your portability request, propose loading premiums, request medical tests, or add specific exclusions or conditions.

7. Transfer of Waiting Period Credits

   The waiting period you have already served with the existing insurer is transferred to the new insurer. This means you do not have to serve the waiting periods from the start with the new health insurer.

8. Transfer of Bonus

   Your accrued no claim bonus is usually transferred fully to the new insurer when porting a policy.

9. Moratorium Period Transfer

   The moratorium period (of 5 years) does not start from scratch when you port your policy. Its continuity is maintained with the new insurer, and you must serve only the remaining period required to complete the moratorium.

10. Sum Insured Flexibility

    The new health insurance provider must insure you at least up to your existing policy's coverage amount. However, you have the option to increase the base sum insured if you wish to.

11. Portability Fees

    There is no additional fee charged to port health insurance policy.

12. Premium Amount

    The premium is determined by the new insurer. The new premium may be lower or higher than the current amount based on underwriting and the new insurer's policies.

13. Timeline for the Insurers

    The new health insurance company must acknowledge portability applications within 3 days of receiving.

    The existing insurer must share the requested policy information (to the new insurer) within 7 working days.

    The new insurer must make a decision within 15 days of receiving the required information.

14. Porting After Claims

    Filing claims does not make you ineligible to port health insurance. However, you must disclose previous health insurance claims honestly.

15. Grace Period

    A 30-day grace period is provided after the premium due date to ensure continuity benefits while your porting request is in process with the new insurer.

16. Data Sharing through IIB

    Your existing and new health insurers must share policy information through the Insurance Information Bureau of India (IIB) portal to ensure transparency and a smoother process.

What Does Not Apply to Portability?

Here are a few things you must keep in mind about health insurance portability:

• Automatic Approval: Raising a portability request does not mean the policy will be issued automatically. The insurer has the right to reject the portability request based on underwriting.
• Policy Types: Porting health insurance is not available for benefit-based policies, such as critical illness plans or hospital cash policies.
• Getting the Same Premium: It is not mandatory that your new health insurance policy will have the same premium as the existing one. The premium for the new policy is decided per the new insurer's regulations.
• Add-ons: The add-ons or riders you bought with the existing policy are not transferred to the new policy; you must decide the coverage accordingly.
• Missed Grace Period: If your policy lapses during the grace period, you cannot place a portability request.

When Should You Port Your Health Insurance Policy?

Although porting allows you to avail better coverage and services, it can also result in potentially higher premiums or stricter underwriting. Hence, porting health insurance should be a thoughtful decision.

Here is when porting your health insurance policy can be helpful:

If your current health insurer:

• Has higher claim rejections or a delayed claim settlement process
• Does not have sufficient nearby or top hospitals in its network list
• Has poor customer service
• Keeps updating their policy terms or premiums

If your existing health insurance policy:

• Has higher room rent or disease-specific limits
• Has a higher co-payment
• Is inadequate to cover rising medical costs
• Does not have specific coverage or benefits to meet your healthcare needs