Important Questions on Portability of Health Insurance Policy

Important Questions on Portability of Health Insurance Policy answered by Mr. S. K. Sethi, Director, RIA Insurance Brokers Pvt. Ltd., a Reputed Firm Specializing in the Health Insurance Portfolio

Q. What are the advantages and disadvantages of health insuranceportability?

Ans. Portability of Health Insurance Policy is permitted and its advantages are:

·        No loss of benefits: The waiting period for pre-existing diseases already served in the previous policy is carried forward to the new policy.

·        Better features: You have the option to switch to a policy which is offering better coverage, additional riders, improved services and may be better premium terms.

·        Customer satisfaction: Portability motivates insurers to provide better service to retain the customers or to attract new customers.

There are few Disadvantages of the Portability are:

·        Premium changes: The premium may increase depending on your age, medical history, and other risk factors.

·        Limited portability options: Some insurers may not offer policies exactly matching your current policy's features.

·        Approval risk: Portability requires approval from the new insurer, who may deny it based on the medical conditions or other underwriting guidelines.
It is to make clear that new insurer has right/option to access your expiring health insurance policy details and Claims history.

Q. What should be kept in mind while porting insurance?

Ans. The following points should be kept in mind:

·        Policy renewal timing: As per procedure it is desired that you start the portability process 45 days before the policy renewal date. In the event of refusal by new insurer you will have the option to continue with your existing insurer.

·        Disclosure of health conditions: Provide complete and truthful information about medical history to avoid claim denials at later date.

·        Coverage comparison: Ensure the new policy covers all essential benefits you need.

·        Insurer reputation: Choose a reliable insurer known for good claim settlement ratios and customer service.

Q. When should we choose this option?

Ans. Portability is a good choice if:

·        You are not satisfied with service being provided by your current insurer or agent or the claim settlement process of the insurer.

·        You find better features, wider coverage, or attractive premiums with another insurer.

·        Your healthcare needs have changed, requiring enhanced coverage.

Q. Is it better to take a new plan instead o porting insurance? What are the other options?

Ans.

·        Portability is preferable if you have already served waiting periods for pre-existing conditions in the existing policy.

·        Taking a new plan can be beneficial if your current policy offers limited coverage, but you will need to restart waiting periods.

·        Enhancing your current policy with add-ons or riders is another option to consider.

Q. According to a recent IRDAI report, health insurance rejections have increased significantly. What rights does a policyholder have if a claim is rejected? What precautions should be taken to avoid rejection?

Ans. It pays to move step by step in the right direction for settlement of your claims:

·        Appeal to the Branch Manager: After finding the reason for claim rejection and checking of the facts at your end, you should take up the matter with branch manager.

·        Appeal to the grievance cell: Every insurer has a grievance redressal system to handle disputes. in case of no favorable decision at branch level, you should write to Grievance cell of the insurance company.

·        Escalation to IRDAI: If unsatisfied with the insurer’s response, you can always escalate the issue to IRDAI or approach the Insurance Ombudsman or consumer forum of your district.
We personally feel that going to Insurance Ombudsman is a better option. Full facts are to be presented to Insurance Ombudsman of your region/state.

You should take following precautions to Avoid Rejection:

·        Full disclosure: Provide accurate and complete information about medical history when purchasing or porting your health insurance policy.

·        Policy understanding: Read the policy document carefully to know the inclusions, exclusions, and claim procedures.

·        Timely premium payment: Ensure continuous policy coverage by renewing on time before its due date as claim lodged during the grace period will be rejected by the insurer.

·        Timely Intimation: As and when hospitalization is required intimation has to be sent to the insurer. Documents are to be submitted to insurer within required time frame.

·        Proper documentation: Submit all required documents accurately and in their original form when filing a claim.

Keep in mind Pre-hospitalization and post-hospitalization expenses are also payable to you therefore you should start keeping prescription/Doctor receipts/Diagnostic tests receipt /reports/chemist bills in a file for submission.