IRDA Health Insurance Portability Rules

There are some rules and regulations that must be followed when porting a health insurance policy to a new health insurance plan. The switch is not governed by the health insurance portability act. As a result, there are IRDA rules that must be followed by both policyholders and insurers. The list is as follows:

• An insurance company - Policyholders should choose a similar type of insurance company when switching insurers. 
• Can't switch policy if it lapsed - If you are looking to port your health insurance policy, there should be no gaps in renewals. No insurer will accept your proposal if you have gaps in your policy renewals and your policy has lapsed.
• Fees for porting - It is prohibited for any insurer existing or new to charge a fee for porting a health insurance policy under the IRDA rules.
• A change in premiums - Health insurance premiums are determined by the insurance company based on a variety of factors. When switching from your old insurance company, you may have to pay an additional premium. The new insurer may charge a different premium for the same type of policy. 
• Waiting period - Depending on the extent of coverage, you may have to serve an additional waiting period. In the case of an increase in coverage approved by the company, the policyholder is required to serve the waiting period according to the terms and conditions of the new insurer.

Benefits of Porting Health Insurance Policy

Porting to a new health insurance company has the following benefits:

1. Continuity of Waiting Period Benefits - The biggest advantage of porting is that you don’t have to serve waiting period like pre-existing disease waiting, maternity waiting, or specific illness waiting as it get carried forward to the new insurer in which you are porting your policy. This means you don’t have to start from zero again.

2. Better Coverage With Enhance Features - If your current policy has limited benefits or outdated features, porting allows you to upgrade to a better health insurance plan with modern features and feature that meets your today’s requirement.

3. Escape Poor Claim Experience - If you’ve faced issues like claim rejections, delays, or bad customer support, porting helps you shift to an insurer with a higher claim settlement ratio and smoother claim process.

4. Access to Modern Benefits & Add-ons - Older policies often lack features like, limitless rider that allows you to claim over and above your sum insured once in a lifetime, waiting period modification, day 1 PED cover, OPD related expenses. Porting lets you move to a plan that is 2026 ready and aligned with today’s medical costs

5. Competitive Premium for Better Coverage - In many cases, you can get better coverage at a slightly higher premium, But by porting your policy you will get better coverage with less premium now a days and it offers much more value for money compared to continuing with an inefficient plan.

6. Flexibility to Increase Sum Insured - While porting, you can increase your sum insured. The waiting period continuity applies to the old cover amount, while the increased portion follows fresh waiting periods.

 7. Have Option Choose Company With Wide Network Hospital - If your current insurer has a limited cashless network hospital, porting allows you to choose a company with wider network hospitals, and reducing your out of pocket stress during medical emergencies.

Disadvantages of Porting Health Insurance Policy

Porting a health insurance policy have lots of benefits, but it is not risk free at all. Below are the some disadvantages of porting your health insurance policy:

1. Porting does not have guarantee that it will get accepted by new insurer - Many people assume porting is a guaranteed but New insurer can reject your porting request after underwriting especially if you have health issues, past claims, or high medical risk. Until approval comes, nothing is final.

2. Fresh Medical Underwriting Needed - Even if you’ve been insured for years, porting means re-evaluation of your health. Medical tests may be required in some cases if person have higher age or have any medical issue, and conditions that were earlier accepted might be loaded, excluded, or capped by the new insurer.

3. Partial Waiting Period Continuity - Waiting period benefits are carried forward only up to your existing sum insured. If you increase coverage during porting, the extra amount will come with new waiting periods, which many policyholders misunderstand.

4. Risk of New Policy Term & Conditions - Every health insurance company has different term and conditions. After porting, you may face sub-limits, restrictions, co-pay rules. So always check the details before porting.

5. Higher Premium or Loadings on Health Issues - If your health profile is considered risky, the insurer may approve porting but with, Higher premium, Permanent exclusion, loading. So always go through the terms and condition of the new insurer if you are thinking to port your policy.

6. No Rollback Once New Policy Starts - Once porting is completed and the new policy begins, you cannot revert to the old policy. If you later realize the coverage is weaker or claims are stricter, the decision becomes irreversible.

7. Not Ideal for Elderly or Chronic Patients - For senior citizens or people with long-term illnesses, porting can be more risky than beneficial. Insurers tend to be conservative, and you will face issue at the time of claim.

What Can You Port In Your Health Insurance Policy?

It is stated in the IRDA provisions that you can port credits that are subject to time-bound exclusions and no-claim bonuses. Upon acceptance of your proposal, the new insurer must give you the waiting period credit you gained with the old insurer. Keep in mind that your existing policy features cannot be transferred. It is only possible to port so much as you had insured with your previous insurer (including a no-claim bonus). In order to renew your coverage, he must at least insure you up to the amount insured under your previous policy. When should you port your health insurance policy?

You may want to consider porting your health insurance policy for the following reasons:

• The service and claims experience you are currently having with your insurer may be unsatisfactory
• If you believe there is a better health insurance policy with better benefits, let us know
• In the event that your existing health insurance provider does not offer sufficient coverage or does not cover specific health issues concerning you (such as maternity coverage)

Reasons For Rejection of Portability Request?

• Portability claims can be denied when the new insurer's underwriting risk does not align with the customer's medical condition. Migrating from a group policy to an individual policy is possible.
• In the event that the policyholder provides incorrect, inaccurate, or mistaken information, the new insurer may reject the application. If there are discrepancies between the information you provide and your medical test results or your claims history with your previous insurer, your application may be rejected.
• A health insurance portability request can be declined for several reasons, and most of them are linked to risk assessment and compliance rather than policyholder rights.
• One of the most common reasons is adverse medical history. If the new insurer feels that existing illnesses, chronic conditions, or past surgeries increase the probability of frequent or high-value claims, the request may be rejected during underwriting.
• High or frequent claim history is another key factor. Multiple claims or recent large claims can signal higher future risk, making the insurer cautious about accepting the policy.
• Portability can also be denied due to non-disclosure or incorrect information. Any mismatch between medical records, proposal form details, and past policy data can lead to immediate rejection.
• If the portability request is submitted before 45 days of renewal or after expiry of renewal insurers are not obligated to process it, which can result in rejection.
• Some requests fail due to age-related underwriting limits. Senior policyholders may face stricter evaluation.

Document Required For Health Insurance Policy Portability

Porting a health insurance policy requires certain documents. Health insurance policies can be ported in different ways depending on the insurance company's terms and conditions. For the purpose of porting the policy. To begin the process, you may need to submit the following documents:

• Proof of identity
• A copy of your address
• An insurance policy copy
• Detailed claim history, if applicable
• Documents pertaining to the medical history of the patient

Things to Know Before Porting Health Insurance Policy

Porting your health insurance policy can be a smart move but only if you do it with the right understanding and with having proper knowledge. Many people switch policies in a hurry and later realize they missed important details. Before you decide to port your health insurance, here are some crucial things you must check before porting your health insurance policy:

• Porting is allowed only at the time of renewal - Health insurance portability is not an anytime option. You can port your policy only during policy renewal, or 45 days before the renewal date. Missing this time period means you’ll have to continue with your existing insurer for another year.
• Waiting period benefit is limited to existing coverage - One of the biggest advantages of health insurance portability is waiting period continuity, but it comes with a condition. The waiting period benefit is transferred only up to your current sum insured. If you increase your sum insured while porting your policy, the extra increased sum insured will have a fresh waiting period.
• Claim settlement ratio matters more than brand name - Before porting your health insurance don't just look at the brand name, do check network hospital, claim settlement ratio, room rent limits, sub limit and copayment as well.
• No claim bonus does not transfered - Your no claim bonus does not get transferred as it is. Once you port your health insurance policy your bonus will get lose.