Portability Form Reason(s) for Portability: factors, terms and conditions, please read sales brochure carefully before concluding a sale • IRDA Registration. , FORM – IRDA – 5 – AF, Surveyor and Loss Assessor, APPLICATION FOR RENEWAL OF A LICENCE TO ACT AS SURVEYOR AND LOSS. the Insurance Act and Section 14 read with section 24 of the IRDA Act .. On receipt of the Portability Form, the insurance company shall address.
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In Octoberwebsites of health insurers flashed the new portability menu that promised customers the moon. Many considered it an easy way to end the bitter relationship with their health insurer.
The switch, it turns out, is not so simple, or podtability. You cannot port a policy as and when you wish. The regulator, the Insurance Regulatory and Development Authority, or Irda, has given insurers the right to accept or reject port-in requests. This implies that if the other insurer finds your application ‘unfavourable’, it can decline your request, and you’ll have to stick with your insurer. All portability proposals are treated as new and put through the underwriting guidelines afresh.
The underwriter portabilitj the right to reject any proposal. Underwriting involves measuring risk exposure and determining the premium that needs to be charged to insure that.
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That is, basic reimbursement to basic reimbursement or top-up to top-up. It will depend on the product plan you want to port to. You only have to pay the premium applicable for the plan chosen by you. The insurer may decline the proposal if it is not suitable as per its underwriting policy. The details are shared through the common Irda portal. Employer group health policies can also for ported to an individual cover. In this case the current insurer will have to extend the policy term by accepting a pro-rata premium of one-two months.
There should be no break in policy. They don’t accept portability proposals if the insured has a higher age and poor health. In fact, they put a lot of clauses and restrictions which are not encouraging for customers, who may drop the idea to port,” says Divya Gandhi, head of general insurance and principal officer, Fotm Global Financial Services.
The application may also be rejected on grounds of insufficient information, delay in submitting documents and poor claim history. Are you insured enough? We look at these impediments and things that must be kept in mind while porting health insurance policies. Customers hate reimbursement limits for different medical procedures, age caps for renewal, increase in premium in case of a claim, hassleprone claim settlement, limits on room rent, co-payment clauses, etc.
However, rules give insurers the right to reject your application on the basis of their underwriting guidelines. You may not get the improved plan you want simply because the other insurer considers you overweight and so more likely to fall ill.
Each insurer uses own principles to assess customers’ risk profile. So, the other company’s norms may differ from portabjlity existing insurer’s. If the new underwriter finds your case unsuitable, the insurer has the right to reject your application.
Huge differences between exclusions and inclusions and other features between the policies of the two insurers may also lead to rejection.
That’s why you got it easily. Now, if you have aged, joining a new insurer may not be easy. Senior citizens already have limited options in terms of availability of policies that cover old age-specific diseases. But the biggest problem is that since the irdda of falling ill is much higher in old age, few insurers want to cover the elderly.
The general guidelines given by insurers to insurance brokerage firms are to submit the proposal well is advance, that is, 45 days before the renewal date of the existing policy.
Also, they have instructed against submitting proposals where any claim has been lodged in last two years and the sum insured has been requested to be increased substantially say from Rs 2 lakh to Rs 10 lakh. Cases with pre-existing and chronic illnesses are to be shunned as well.
Some companies may accept people in the age band of years. However, they are choosy foem use strict underwriting guidelines in such cases,” says S K Sethi, chief executive officer, Ria Insurance Brokers.
Also, the premium will most probably be abnormally high. There may be high loading increase in premium in case of a claim as well, besides a co-payment clause. You may have been healthy when you bought your existing policy, but if you later contract a disease not covered by the other insurer, your application may be rejected. Even a minor illness that may affect your health in future may affect your chances.
Moreover, your current insurer cannot refuse to renew your policy if any chronic ailment was detected after you bought the policy. However, the other insurer may reject your request in such a case. If you have a pre-existing disease or suffer from an ailment that requires regular treatment, your case will definitely be rejected. Those with a history of cancer or renal failure, where recurrent costs are high, fall in this category.
This is because major illnesses mean high risk. The ongoing treatment and regular medication and other expenses result in multiple claims,” says Shreeraj Deshpande, head, health insurance, Future Generali. A poor claim history can also spoil your chances.
Though the policy is bought to pay your medical bills, insurers look suspiciously at portability requests where multiple claims have been lodged recently. Till this point every insurance company is good to the insured. If there is no claim, there cannot be any dispute,” says Dahiya. However, this will be subject to acceptance by the insurer’s underwriter.
The insurer can be sceptical if you request a very high increase in sum assured, for instance, per cent. So, he tries to increase the cover while porting.
Health Insurance Portability: How & Why
This is obviously not favourable for the insurer idra indicates a bigger claim in the next onetwo years,” says Sethi of Ria Insurance Brokers.
For, helps a customer only as long as the health insurance policy is portabilitg for the company, that is, the poryability has been paying premium regularly and has not filed any claim. If there is no claim, there cannot be any dispute. This case becomes even more difficult for senior citizens, who are already seen as a high-risk category. This generally happens in poftability where an individual with an adverse health declaration wants to enhance the cover,” says Shreeraj Deshpande of Future Generali.
However, in the draft guidelines on health insurance, the regulator has asked rida to accept such requests at the renewal of the policy or the end of the specified exit age by irxa suitable credits for all previous policy years, provided the policy has been maintained without break.
Know the process of portability thoroughly to avoid these pitfalls. According to the guidelines, insurers have to be informed 45 days before renewal of the existing policy.
A portability request made after 45 days may be rejected. Therefore, it is important that you remember the expiry date of your policy and get your documents in place in time. So, it is better to initiate the process well in advance, say, around 60 days, to be on the safe side.
Decide the insurer you want to port your policy to and have the required papers in place. Also, fill the forms carefully and be honest about poratbility existing and earlier claims.
If your current insurer delays sharing fkrm claim information, the other insurer may keep acceptance of the porting request in abeyance. In such a case, apply to your insurer for paying premium for one-two months on a pro-rata basis and extend the cover till you get a nod from the other insurer. The draft guidelines say the insurer cannot force you to pay the whole year’s premium in such a case.
Plus, the insurer has to convey the decision in 15 days; otherwise, the application is understood to have been accepted. Hence, it is important for the customer to fully understand the benefits under his existing policy and match them with the plan he wishes to port to,” says Antony Jacob of Apollo Munich. Therefore, before switching, know the product you are buying and its differences portabiltiy your existing plan such as flexibility and slabs for sum insured, pricing, restrictions on entry age, renewal limits, waiting period, capping and co-payment clauses, ailments covered, rules about preexisting diseases and the list of hospital network.
The other insurer may also decide to underwrite the policy with some loading on table premium. This may not suit everyone. Similarly, the new policy may have restrictions such as lower sub-limits, capping and co-payment. So, while your old policy didn’t put any restriction on ailment-based claims, the new insurer may be willing to accept your proposal only with a cap of Rs 50, on heart ailments or apply 20 per cent copayment on each claim.
Cumulative bonus is usually not carried forward. Instead, the additional cover which you got in the old policy against the bonus you have collected is added to the basic sum insured in the new policy on which premium is charged. Also, for any increase in cover you ask for, the complete waiting period for pre-existing diseases will have to be served. So, let us say you have a health policy that has been continuously renewed for the last four years and whose sum insured is Rs 2 lakh.
You now want to port it to another insurer with a higher cover of, say, Rs 3 lakh. The portability sum insured applicable for pre-existing diseases and other time-bound exclusions in the new policy will only be Rs 2 lakh, while the sum insured available otherwise will be Rs 3 lakh. That is, if the waiting period in the new policy is four years, and you are hospitalised in between for a pre-existing ailment, you’ll be eligible to claim only up to Rs 2 lakh. The additional Rs 1 lakh will only be available after you’ve spent four years with the new policy.
For any other hospitalisation, the whole Rs 3 lakh will be available to you. Similarly, if the previous insurer has a waiting period of three years which you have served while the insurer you are porting your policy to mandates four years, you will have to serve one additional year for coverage of pre-existing diseases under the new policy.
There can be differences in inclusions, exclusions and other features between the existing and the new policy. For instance, while the old policy covered 13 critical illnesses, including maternal benefits, the new policy might have a shorter list or have a waiting period before certain ailments are included in the cover.
If it fails to take portabiloty view within this time frame, it is bound to accept your application. Samir Dave, 42, a resident of Ahmedabad Dave wanted to port his nine-year-old family mediclaim policy from New India Assurance last November when his son was hospitalised and the insurer didn’t pay the full claim as the policy had sub-limits on room charges which he was unaware of.
He portabi,ity to switch to Apollo Munich, which had a ‘no-sub-limit’ policy. His existing policy gave a cover of Rs 2 lakh each to him, his wife and child for an annual premium of around Rs 7, He had earned a cumulative bonus of Rs 70, on this policy. When he approached Apollo Munich, the company appointed one of its sales representative to assist him.
As per the guidelines, he was promised that he was eligible for all the accrued benefits – will not have to serve the waiting period for covering pre-existing diseases and will be eligible for a cover of Rs 2. However, he was shocked when he got the policy document from Apollo Munich as none of the continuity benefits were passed on to him.
He was to serve the waiting period for coverage of pre-existing ailments.