Ref: IRDAI/HLT/REG/CIR/003/01/2020
01.01.2020
To,
CEOs
of all General and Standalone Health Insurance Companies
Re: Guidelines
on Migration and Portability of health insurance policies
Reference
is invited to Regulation 17(iv) and clause 16 of Schedule I of IRDAI (Health
Insurance) Regulations 2016. In terms thereof, following guidelines are issued:
A:
NORMS ON PORTABILITY:
1.
Portability shall be allowed under all
individual indemnity health insurance policies issued by General Insurers and
Health Insurers including family floater policies.
B:
NORMS ON MIGRATION:
2. In
addition to the migration option to be provided to the policyholders as specified
under Regulation 17(i) of IRDAI (Health Insurance) Regulations 2016:
i.
Every individual policyholder (including
members under family floater policy) covered under an indemnity based individual
health insurance policy shall be provided an option of migration at the
explicit option exercised by the policyholder;
a.
to an individual health insurance policy or a
family floater policy, or;
b.
to a group health insurance policy, if the
member complies with the norms relating to the health insurance coverage under
the concerned group insurance policy.
3. Every
individual member, including family members covered under an indemnity based group
health insurance policy shall be provided an option of migration at the time of
exit from group or in the event of modification of the group policy (including
the revision in the premium rates) or withdrawal of the group policy:
a.
to an individual health insurance policy or a
family floater policy.
4. Migration
shall be applicable to the extent of the sum insured under the previous policy
and the cumulative bonus, if any, acquired from the previous policies.
5. Only
the unexpired/residual waiting period not exceeding the applicable waiting
period of the previous policy with respect to pre-existing diseases and time
bound exclusions shall be made applicable on migration under the new policy.
6. Migration
may be subject to underwriting as follows:
a.
For individual policies, if the policyholder is continuously covered in the
previous policy without any break for a period of four years or more, migration
shall be allowed without subjecting the policyholder to any underwriting to the
extent of the sum insured and the benefits available in the previous policy.
b.
Migration from group policies to individual policy will be subject to
underwriting.
c.
Where underwriting is done, the insurance company shall convey its decision to
the policyholder within 15 days as per Regulation 8(6) of IRDAI (Protection of
Policyholders’ interests) Regulations 2017.
7. A
policyholder desirous of migrating his/her policy shall be allowed to apply to
the insurance company to migrate the policy along with all members of the
family, if any, atleast 30 days before the premium renewal date of his/her
existing policy. However, if the insurer is willing to consider even less than
30 days period, then the insurer may do so.
8. Insurer
shall not levy any charges exclusively for migration.
9. Insurers
shall clearly draw the attention of the policyholder in the policy contract and
the prospectus that:
i.
Migration is allowed as per these Guidelines
as amended from time to time.
ii.
Policyholder should initiate action to
approach the insurer to exercise migration option well before the renewal date
to avoid any break in the policy coverage.
10. Individual
members, including the family members covered under an indemnity based group
health insurance policy shall have the right to migrate from such a group
policy to an individual health insurance policy or a family floater policy,
thereafter Portability shall be allowed as per Clause (1) above and in
accordance to the norms specified under IRDAI (Health Insurance) Regulations,
2016.
11. These
Guidelines are issued under the powers vested with Section 34 (1) of the
Insurance Act, 1938 and will come in to force with immediate effect.
12. This
has the approval of the competent authority.
(Suresh
Mathur)
Executive
Director