Health Insurance Portability

HEALTH INSURANCE PORTABILITY

CIRCULAR
NO. IRDA/HLT/MISC/CIR/209/09/2011, DATED 9-9-2011

The IRDA, vide
Circular, dated 10-2-2011, had issued guidelines on portability of health
insurance policies which was to be introduced from 1-7-2011. Subsequently, on
24-6-2011, it was felt necessary to put in place a system to enable collection
of data on the history of health insurance and monitoring the transfer of
records of the porting policyholder. In that context, it was decided that the
implementation of portability of health insurance policies would be mandated to
commence no later than 1-10-2011. In continuation of the above guidelines, the
detailed procedure on health insurance portability shall be as set out in these
guidelines.

1. In these guidelines, the following terms shall carry the
meanings as assigned to them :

1.1
Portability: Portability means the right
accorded to an individual health insurance policyholder (including family
cover) to transfer the credit gained by the insured for pre-existing conditions
and time-bound exclusions if the policyholder chooses to switch from one
insurer to another insurer or from one plan to another plan of the same
insurer, provided the previous policy has been maintained without any break.

1.2 Break
in policy: A break in policy occurs when
the premium due on a given policy is not paid on or before the premium renewal
date or within 30 days thereof.

2. All policyholders are hereby vested with the right of
portability, i.e., policyholders have the right to purchase a Health
Insurance Policy from another insurer from amongst the products such insurer is
marketing and the right will be limited to transfer of the period gained in the
existing policy(ies) which
would account towards PEDs and the time-bound exclusions of the new policy.

3. A policyholder desirous of porting his policy to another insurance
company shall apply to such insurance company at least 45 days before the
premium renewal date of his/her existing policy.

3.1 The Insurer may not be liable to offer portability if policyholder fails
to approach the new insurer at least 45 days before the premium renewal date.

3.2 The insurer may consider a proposal for portability even if the
policyholder fails to approach the insurer at least 45 days before the renewal date, it may be free to do so.

3.3 Where the outcome of acceptance of portability is still waiting from the
new insurer on the date of renewal:

3.3.1 the existing policy shall be allowed to
extend, if requested by the policyholder, for the short period by accepting a
prorate premium for such short period, which shall be of at least one month and

3.3.2 shall not cancel existing policy until such
time a confirmed policy from new insurer is received or at the specific written
request of the insured

3.3.3 the new insurer, in all such cases, shall
reckon the date of the commencement of risk to match with date of expiry of the
short period, wherever relevant

3.3.4 if for any reason the insured intends to
continue the policy further with the existing insurer, it shall be allowed to
continue by charging a regular premium and without imposing any new condition.

4. On receipt of an application for porting, the insurance company shall
furnish the applicant, the Portability Form as set out in Annexure 'A' to these
guidelines together with a proposal form and relevant product literature on the
various health insurance products which could be offered.

5. The policyholder shall fill in the portability form along with proposal
form and submit the same to the insurance company.

6. On receipt of the Portability Form, the insurance company shall address
the existing insurance company seeking necessary details of medical history and
claim history of the concerned policyholder. This shall be done through the web
portal of the IRDA within 7 working days of the receipt of the Portability
form.

7. The insurance company receiving from another insurance company a request
for relevant data shall furnish the requisite data in the data format for porting
insurance policies prescribed in the web portal of IRDA within 7 working days
of the receipt of the request.

8. On receipt of the data from the existing insurance company, the new
insurance company may underwrite the proposal in accordance with its
underwriting policy as filed by the company with the Authority in accordance
with clause 6 of IRDA Form R2 of IRDA (Registration of Indian Insurance
Companies) Regulations, 2000 and clauses 14-15 of F&U Guidelines (Circular
No. 021/IRDA/F&U/Sep. 06 dated, 28-9-2006), and convey its decision to the
policyholder in accordance with the Regulation 4(6) of the IRDA (Protection of
Policyholders’ Interest) Regulations, 2002.

9. If on receipt of complete information and data within the above time
frame, the insurance company does not communicate its decision to the
requesting policyholder within 15 days then the insurance company shall not
retain the right to reject such proposal and shall have to accept the proposal.

10. Portability shall be allowed in the following cases:

10.1 All individual health insurance policies issued by non-life insurance
companies including family floater policies.

10.2 Individual members, including the family members covered under any
group health insurance policy of a non-life insurance company shall have the
right to migrate from such a group policy to an individual health insurance
policy or a family floater policy with the same insurer. One year thereafter,
he/she shall be accorded the right mentioned in 10.1 above.

11. For any health insurance
policy, waiting period with respect to pre-existing diseases and time-bound
exclusions shall be taken into account as follows:-

S. No.	No. of years of continuous insurance cover with previous insurer(s)	Waiting period to be served with new insurer in number of days/years
		YY Days	1 Year	2 Years	3 Years	4 Years
I.	XX Days at inception (XX-No. of days as per the policy document)	(YY-XX) Days	N/A	N/A	N/A	N/A
II.	For 1 year period exclusion:
	1 year	N/A	NIL	1 Year	2 Years	3 Years
III.	For 2 year period exclusion:
	1 year	N/A	NIL	1 Year	2 Years	3 Years
	2 year	N/A	NIL	NIL	1 Years	2 Years
IV.	For 3 year period exclusion:
	1 year	N/A	NIL	1 Year	2 Years	3 Years
	2 years	N/A	NIL	NIL	1 Years	2 Years
	3 years	N/A	NIL	NIL	NIL	1 Year
V.	For 4 year period exclusion:
	1 year	N/A	NIL	1 Years	2 Years	3 Years
	2 years	N/A	NIL	NIL	1 Year	2 Years
	3 years	N/A	NIL	NIL	NIL	1 Year
	4 years	N/A	NIL	NIL	NIL	NIL

Note 1: In case the waiting period for a certain disease or treatment in the
new policy is longer than that in the earlier policy for the same disease or
treatment, the additional waiting period should be clearly explained to the
incoming policyholder in the portability form to be submitted by the porting
policyholder.

Note 2: For group health insurance policies, the individual member’s shall be
given credit as per the table above based on the number of years of continuous
insurance cover, irrespective of, whether the previous policy had any
pre-existing disease exclusion/time-bound exclusions

12. The portability shall be applicable to the sum insured under the
previous policy and also to an enhanced sum insured, if requested by the
insured, to the extent of cumulative bonus acquired from the previous insurer(s)
under the previous policies.

E.g. - If a person had a SI of Rs. 2 lakhs and
accrued bonus of Rs. 50,000 with insurer A; when he shifts to insurer B and the
proposal is accepted, insurer B has to offer him SI of Rs. 2.50 lakhs by charging the premium applicable for Rs. 2.50 lakhs. If insurer B has no product for Rs. 2.50 lakhs, insurer B would offer the nearest higher slab say
Rs. 3 lakhs to insured by charging premium applicable
for Rs. 3 lakhs SI However, portability would be
available only up to Rs. 2.50 lakhs.

Portability Form

Part-I

(1)	Name of the Policyholder/insured(s)
(2)	Date of Birth/Age
(3)	Address of the policyholder/insured
(4)	Details of existing insurer
	(i) Name of the product
	(ii) Sum Insured
	(iii) Cumulative Bonus
	(iv) Add-ons/riders taken
	(v) Policy number
(5)	Details of the proposed insurance
	(i) Name of the product proposed/intend to take
	(ii) Sum Insured Proposed
	(iii) Whether Cumulative Bonus to be converted to an enhanced sum insured
(6)	Reason(s) for Portability
(7)	No. of family members to be included in the policy to be ported:
	Enclosure: Photocopy of the existing policy documents
Date:
Signature of the policyholder
PART –II
1. Whether the PED exclusions/time-bound exclusion have longer exclusion period than the existing policy: (Please indicate Yes/No):
2. If yes, please give written consent to the declaration below:
"I am aware that the waiting period for the following disease(s)/treatment(s) is ….. days/years more than the previous policy terms. I hereby agree to observe the additional waiting period for the following disease(s)/treatment(s)
Signature of the policyholder