4 Reasons Why Your Health Insurance Porting Request Can Be Rejected

Suma Rajendran (name changed) is a 52-year-old school principal who has an existing health insurance policy that she has held over the last four years. The sum insured is Rs 2.5 lakhs, and this policy has a cumulative bonus of Rs 50,000. She felt it was more beneficial to port this policy to a fresh insurance company before retiring in a few years.  The article is about “Health Insurance Porting Request”.

However, her porting request was rejected by the new company.

Table Content

  • What Is Health Insurance Porting Request?
  • Pros and Cons of Portability
  • Rules of Health Insurance Porting Request
  • Permitted Policy Types
  • Company Type
  • Renewal
  • Intimation
  • Acknowledgment
  • Premiums & Bonuses
  • Why Health Insurance Porting Request May Be Rejected
  • Related posts:

What Is Health Insurance Porting Request?

Porting refers to a policyholder’s options to switch their policies to another provider without losing any of the benefits in their present policy.

The IRDA mandated guidelines in 2011 on Migration and Portability, which states that portability can be allowed under all indemnity health insurance policies issued by general and health insurers. This includes floater policies. No charges are to be levied exclusively for migration. The new insurer must allow for credit gained by the policy-holder for any gains in pre-existing conditions in terms of the waiting period.

This also means that when you move your health insurance policy from one company to another, you need not lose the benefits accrued.

You may decide to port because:

  • Poor service
  • Do you want additional coverage
  • Better offerings
  • Compelling differential benefits
  • The new insurer has a larger network of hospitals under their coverage
  • Better customization for a specific or chronic illness
  • Tardy claim settlement
  • Lack of transparency
  • Specialized services available

Pros and Cons of Portability

Portability provides certain advantages: On the flip side, portability:
New sum assured. Can be only to a similar policy.
Continuation of existing benefits such as no-claim bonus and time-bound exclusions. Can lose benefits if moving from a group insurance policy.
More customization. May result in a higher premium
Time-bound exclusions don’t exist. Can be undertaken only at a specified time limit.

 

Rules of Health Insurance Porting Request

There is a certain rule of everything and if we have to do anything it should be under the rules because rules define the limits of a particular service. If you want to port your health insurance policy, you need to know the rules of portability cause it will make things smooth for you in terms of the portability of the insurance policy. You will have to complete everything as per the rules, only then your policy will be ported or it will be rejected if things do not go as per way.

Permitted Policy Types

A common rule that we all know, and is the key rule of portability is if you are insured with a reimbursement plan, you can only port your plan in a reimbursement plan. You can get ported in the same policy from which you are insured earlier. Just like when the goods get damaged in the guarantee period, they are replaced with new ones. If you want to change the plan under portability, then it’s not possible and sometimes just because of this, your porting request gets rejected.

Company Type

If you are insured with any specialized or any general insurance company then you can only port your insurance policy in specialized or any general company. It’s just continuing the first rule of portability in their own way, if you really want to port your insurance policy then you also take the decision that with which plan you want to port and must have a good performance ratio in recent times in comparison of your current policy. Policyholders can port policies from any general or specialized insurance company to another specialized or general insurance company.

Renewal

Talk about portability, so we can port our policy at the same time when the time comes to renew the policy. We can only express our desire to port the policy; if you wish to port it during the policy period, it’s impossible. Renewal is the only time you can port your insurance, and if there is any discontinuity in renewing the policy, it’ll make things challenging for you. And if there is a discontinuity in your policy because your “Insurer Company,” then it will not consider as discontinuity, and it won’t affect your portability.

Intimation

Before porting the insurance, we have to inform our current insurance company that we want to port; we have to give this information in writing. We also have to mention in which insurance company we are going to the port. As per IRDA norms, if you are planning to port your insurance, you have to inform your insured company precisely 45 days before the renewal of your current policy.

Acknowledgment

Within three days of receiving the port application, the insurance company must have told that they have acknowledged this application and they are working on it. It’s necessary that they have acknowledged the port application in 3 days.

Premiums & Bonuses

Whether the decision to port the insurance is right or wrong is decided by the premium of the insurance because you choose to get the port done, and you also decide which insurance to choose. In this case, the insurer you wish to join is free to fix the premium according to its specific underwriting criteria. You may have to pay the amount according to the type of coverage service you take with your plan.

Why Health Insurance Porting Request May Be Rejected

IRDAI gives insurance companies the right to reject claims for certain reasons:

  1. Documentation: A company may reject your portability application if documents are not submitted in time. There may be inaccuracies in the document, gaps, and missing information, or non-availability of previous policy documents that can lead to rejection.
  2. Underwriting: When the new insurer’s underwriting risk is not aligned with the customer’s medical condition, portability claims can be rejected. This is possible, especially when migrating from group to individual policy.
  3. Age: If the policyholder’s age is higher, in the 60-70 age bracket, there are chances of rejection. People above 70 have very high chances of rejection because the insurer can apply very strict underwriting rules. Insurers may include co-pay clauses, charge very high premiums, or ultimately reject the request.
  4. Incorrect information: If the policyholder provides mistaken, inaccurate, or incorrect information, the new insurer can reject the request. It’s important to ensure complete disclosure of your medical history, and any discrepancy between the information you provide and medical test results or your claims history with the previous insurer can attract rejection.

Your request may be rejected on certain technical grounds laid down by the new insurer. This can include non-compliance with porting timeline, failure to answer their phone calls, not making yourself available for medical check-ups, and more.

Suma Rajendran could have avoided rejecting her request if she had consulted experts such as Insurance Agencies.com.

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