S, an individual has a health insurance policy with 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 2017 and has been current

CS Professional · Insurance - Law & Practice · PYQS · June 2022
S, an individual has a health insurance policy with 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 2017 and has been current from them with S paying the renewal premium by due dates. In the currency of the policy with X, S 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, 2021. S has been approached by Z, an agent of a different company, Y Health Insurance Company Ltd. with a proposal that sounds attractive to S. He wants to change over to Y from X. Indicate the option to S and the process involved. Does 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 terms 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 claims 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, S obviously is a long standing customer of X health insurance co. ltd. He apparently has accumulated some credits because of the longevity of the policy and his claims profile. Obviously he is not happy with X health insurance co. ltd and wants to move to Y health insurance co. ltd. S possibly feels that his needs may be taken better care by the agent of Y. In the circumstance, S has the freedom to ask X health insurance co. ltd. to port his policy to Y health insurance co. and Y's agreement within the time schedule as prescribed, it can be done whereby all the accumulated credits and benefits under the policy with X will continue to be enjoyed from Y under the scheme. Neither X or Y or the agent will be entitled to any fees or charges for the portability. S can be advised to follow the prescribed procedure and seek portability of his health cover from X to Y.

Topics: Health Insurance

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