Suresh, has a health insurance policy with M/s X Health Insurance Company Limited. The sum insured is ₹ 15 lakh and the policy has a floater option of ₹ 5 lakh. The policy was first taken in 2019 and has been current fro
CS Professional · Banking and Insurance - Laws and Practice · PYQS · December 2024
Suresh, has a health insurance policy with M/s X Health Insurance Company Limited. The sum insured is ₹ 15 lakh and the policy has a floater option of ₹ 5 lakh. The policy was first taken in 2019 and has been current from then with Suresh paying the renewal premium by due dates. In the currency of the policy with M/s X Health Insurance Company Limited, Mr. Suresh has made some claims, small and big but all these have been rejected by the insurer. The policy is due for renewal on 15th December, 2024. Suresh has been approached by Gopal, an agent of a different company, M/s Y Health Insurance Company Ltd. with a proposal that sounds attractive to Suresh. He wants to change over to M/s Y Health Insurance Company Limited from M/s X Health Insurance Company Limited. Indicate the option to Suresh and the process involved. Does M/s X Health Insurance Company Ltd. have any role to play in this move? Discuss.
Answer & Explanation:
One of the facilities offered to a policy holder under the health insurance policies is the right accorded to a policy holder to transfer the credit gained, for pre-existing conditions and time bound exclusions from one insurer to another insurer or from one plan to another plan of the same issuer. It is called portability of an insurance policy. It is the right conferred on a Policyholder who decides to move from one General or Health insurer to another or to another plan of the same General or Health insurer. Such portability is not applicable to fixed benefits payable under health policies issued by a life insurer. The advantage of portability is the carry forward of the credit accrued on account of having a policy with the previous insurer. Long term benefits gained under the terms of a policy will not be denied by a switch over to another insurer by the policy holder. The application for portability will have to be given to the existing insurer who will send it through a portal to the new Insurer who may request for the claim's history and other details from the old insurer who shall give them to the new insurer within a period of 7 days from the date of receipt of request. An insurer may reject the request for portability if the policy holder approaches 60 days before or within 45 days of the date of expiry of the insurance policy. However, an insurer may at their option consider the request for renewal even outside the stated period. The new insurer is under obligation to accept or reject within a period of 15 days from the date of receipt of the Portability form. If the new insurer does not convey any decision with the aforesaid 15 days, the new insurer is deemed to have accepted the request for portability. No charges for portability can be levied either by the previous insurer of the new insurer. No commission shall be paid to any Agent or Intermediary for the policy which is ported from one insurer to another insurer. In the present case, Mr. Suresh obviously is a long-standing customer of M/s X Health Insurance Company Ltd. He apparently has accumulated some credits because of the longevity of the policy and his claims profile. Obviously, he is not happy with M/s X Health Insurance Company Ltd and wants to move to M/s Y Health Insurance Company Ltd. Mr. Suresh possibly feels that his needs may be taken better care by the Agent of M/s Y Health Insurance Company Ltd. In the circumstance, Mr. Suresh has the freedom to ask M/s X Health Insurance Company Ltd. to port his policy to M/s Y Health Insurance Company Ltd. and M/s Y Health Insurance Company Ltd. agreement within the time schedule as prescribed, it can be done whereby all the accumulated credits and benefits under the policy with M/s X Health Insurance Company Ltd. will continue to be enjoyed from M/s Y Health Insurance Company Ltd. under the scheme. Neither M/s X Health Insurance Company Ltd. or M/s Y Health Insurance Company Ltd. or the agent will be entitled to any fees or charges for the portability. Mr. Suresh can be advised to follow the prescribed procedure and seek portability of his health cover from M/s X Health Insurance Company Ltd. to M/s Y Health Insurance Company Ltd.
Topics: Insurance Laws and Practice
Related Questions in this Topic
- Insurers are well advised to put in place a "whistle blower policy" whereby mechanisms exist for employees to raise conc...
- Describe the functions of Reinsurance Broker.
- What are the reasons that most of the insured prefer to choose an Individual Agent instead of Corporate Agent or Online ...
- Prakash effected insurance on his goods against loss or damage by fire. Prakash and his wife quarrelled and the excited ...
- A purchased a car getting it financed by XYZ Finance Limited. The car was being used for a company's executives only. Th...