Health Insurance Portability:Change your Health Insurer With Caution
Three years ago, Mumbai-based Ashish Shah bought a family floater health cover for Rs 5 lakh. This year, he was in for a shock when his insurer decided to raise the premium from Rs 5,415 to Rs 26,719 despite the fact that he had made no claims.
But Shah did not want to let go of the policy because he had completed three years, the period after which specific diseases, such as hernia, cataract, dysfunctional uterine bleeding, are covered. He was also just one year short of getting a cover for other pre-existing conditions. What was Shah to do?
He needn't have worried. With health insurance portability likely to come into effect from 1 July this year, there may be respite for people like Shah. Portability allows you to carry over the pre-existing disease (PED) benefits in your previous policy to the new service provider.
This was one of the biggest deterrents for switching because the customer had to serve the waiting period all over again and PED claims were covered only after a waiting period of 2-4 years. However, Irda has waived this condition, making for a smooth shift to a new insurer provided the previous policy has been maintained without a break.
When to move
You can look for a new insurer not only because of a sudden jump in premium but because a job shift has landed you in a place where the coverage of the existing insurer is inadequate. "People shifting from one place to another face problems due to lack of policy servicing at the new location," states Irda. Service standards, network of hospitals, lack of coverage in areas such as dental treatment, maternity benefits, etc, could also prompt you to shift.
Portability can be carried out only at the time of renewing a policy, not at any time during the year. However, it is advisable to approach the new insurer at least 45-60 days before the renewal date in order to ensure a smooth transition. Says Sanjay Datta, head of customer service, ICICI Lombard General Insurance Company: "A smooth sharing of data between insurance companies is a must to facilitate portability. For this, the industry wants to move to an IT-based platform for exchange of information regarding waiting period, existing claims, etc. The glitch is that all insurance companies don't have data that is online and in a standardised format."
If you don't start the procedure well in advance, there is a chance that you could go coverless for a certain period. "To avoid such a situation, one can look at a short-term extension of the policy. Besides, a 60-day period is given before a break in cover is considered," says Arun Mehrotra, head, retail underwriting & product development, Iffco Tokio General Insurance.
Insurance companies have been advised by Irda to acknowledge all applications for portability within three working days. Also, the previous insurer has been advised to share the policyholder's claim history with their counterparts within seven working days.
Look before you switch
While portability may seem like a welcome development, exercise the option with caution. So if you are motivated by lower premium to move to a new insurer, remember to check for all services, including the coverage of pre-existing diseases. As the waiting period for companies usually differs, you may have to serve a longer period even if you have completed the term with your existing insurer.
BK Sinha, managing director of Unison Insurance Brokers, says, "You should make sure that you are getting continuity benefits since the year you started the policy with the initial insurer. Any diseases contracted after you started the first policy should not be treated as pre-existing."
"As per Irda guidelines, all insurance companies will have the flexibility to offer a waiver of waiting period as per their terms and conditions with a maximum of four years for pre-existing disease coverage," says Antony Jacob, CEO, Apollo Munich Health Insurance.
The exclusions will also differ from one company to another, which is why you must check all the parameters before you decide to switch. To help compare, log on to websites such as www.click2insure.in and www.myinsuranceclub.com.
It is also likely that your premium will increase or decrease depending on the insurance provider, the policy that you opt for, and on the risk assessment done by your new insurer. B Subrahmanyam, vertical head, health insurance, Bharti AXA General Insurance Company, says, "Policyholders are advised to study the coverage provided by the new insurer before they take a final decision on portability. At the moment, there is no standardisation across the industry in terms of coverage or pricing as each insurer decides on these matters according to his respective underwriting philosophy."
But Shah did not want to let go of the policy because he had completed three years, the period after which specific diseases, such as hernia, cataract, dysfunctional uterine bleeding, are covered. He was also just one year short of getting a cover for other pre-existing conditions. What was Shah to do?
He needn't have worried. With health insurance portability likely to come into effect from 1 July this year, there may be respite for people like Shah. Portability allows you to carry over the pre-existing disease (PED) benefits in your previous policy to the new service provider.
This was one of the biggest deterrents for switching because the customer had to serve the waiting period all over again and PED claims were covered only after a waiting period of 2-4 years. However, Irda has waived this condition, making for a smooth shift to a new insurer provided the previous policy has been maintained without a break.
When to move
You can look for a new insurer not only because of a sudden jump in premium but because a job shift has landed you in a place where the coverage of the existing insurer is inadequate. "People shifting from one place to another face problems due to lack of policy servicing at the new location," states Irda. Service standards, network of hospitals, lack of coverage in areas such as dental treatment, maternity benefits, etc, could also prompt you to shift.
Portability can be carried out only at the time of renewing a policy, not at any time during the year. However, it is advisable to approach the new insurer at least 45-60 days before the renewal date in order to ensure a smooth transition. Says Sanjay Datta, head of customer service, ICICI Lombard General Insurance Company: "A smooth sharing of data between insurance companies is a must to facilitate portability. For this, the industry wants to move to an IT-based platform for exchange of information regarding waiting period, existing claims, etc. The glitch is that all insurance companies don't have data that is online and in a standardised format."
If you don't start the procedure well in advance, there is a chance that you could go coverless for a certain period. "To avoid such a situation, one can look at a short-term extension of the policy. Besides, a 60-day period is given before a break in cover is considered," says Arun Mehrotra, head, retail underwriting & product development, Iffco Tokio General Insurance.
Insurance companies have been advised by Irda to acknowledge all applications for portability within three working days. Also, the previous insurer has been advised to share the policyholder's claim history with their counterparts within seven working days.
Look before you switch
While portability may seem like a welcome development, exercise the option with caution. So if you are motivated by lower premium to move to a new insurer, remember to check for all services, including the coverage of pre-existing diseases. As the waiting period for companies usually differs, you may have to serve a longer period even if you have completed the term with your existing insurer.
BK Sinha, managing director of Unison Insurance Brokers, says, "You should make sure that you are getting continuity benefits since the year you started the policy with the initial insurer. Any diseases contracted after you started the first policy should not be treated as pre-existing."
"As per Irda guidelines, all insurance companies will have the flexibility to offer a waiver of waiting period as per their terms and conditions with a maximum of four years for pre-existing disease coverage," says Antony Jacob, CEO, Apollo Munich Health Insurance.
The exclusions will also differ from one company to another, which is why you must check all the parameters before you decide to switch. To help compare, log on to websites such as www.click2insure.in and www.myinsuranceclub.com.
It is also likely that your premium will increase or decrease depending on the insurance provider, the policy that you opt for, and on the risk assessment done by your new insurer. B Subrahmanyam, vertical head, health insurance, Bharti AXA General Insurance Company, says, "Policyholders are advised to study the coverage provided by the new insurer before they take a final decision on portability. At the moment, there is no standardisation across the industry in terms of coverage or pricing as each insurer decides on these matters according to his respective underwriting philosophy."
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