Mediclaim portability kicked off on 1st October, but will you land up in no-man’s land if you switch insurers?

The IRDA portability circular says that the prospective insurance company will lose the right to reject a proposal if there is a delay of more than 15 days in receiving all relevant information from the existing insurer. How can the insurance watchdog implement this circular?

The Insurance Regulatory and Development Authority's (IRDA) mediclaim portability circular intends to protect the insurance policyholders' interest and it also sets strict timelines for existing and the prospective insurance company to comply with the guidelines for smooth portability implementation. However, the ground reality may lead to the insured being booted out by the existing insurer-and not being accepted by the prospective insurer.

This will effectively mean that an insured person opting for mediclaim portability may end up in no-man's land.

Industry sources told Moneylife, "Getting the medical & claims history from an existing insurer within seven days itself will be a big challenge. How will IRDA implement the default acceptance of an insurance proposal if the prospective insurer does not respond within 15 days of receipt of information from the existing insurer? It is not valid in a court of law. If the insurance company (to whom the insured wants to shift) has not issued a policy, nobody can hold it liable to pay any claim. There is no way an insured can say that he has a claim against the prospective insurance company in this case. There has been a court judgment in the past, which states that paying premium and having receipt of the same is not evidence of an insurance contract. Only a policy document is evidence of an insurance contract.

"If push comes to shove, the insurer can always ask for a hefty premium or policy terms having high co-pay and sub-limits, which will dissuade the customer from porting. Moreover, the prospective insurer can always deny the portability proposal within the IRDA timeline under the power of 'right to underwrite'. Therein lies the problem. Portability will remain an illusion-it won't work out on the ground."

Though IRDA's intentions are noble, what will an insured person do if he is faced with such a situation? The problem will be more pronounced especially for senior citizens, who have neither the time, energy nor the resources to run from pillar to post for a valid mediclaim policy. And there are more glitches that could crop up.

"On a case-to-case basis, the existing insurer may not be too keen to continue, once the policyholder has shown an interest to port. The policyholder will not have the new premium quote as the procedure for porting has to start 45 days before the expiration of the policy. Without the knowledge of new premium to make a sound portability decision, the policyholder is shooting in the dark. If the prospective insurer rejects the proposal, the policyholder will have to run around to get a quote from the existing insurer… just before the policy expiration date."

So if you are planning to switch your insurer, be prepared for a bumpy portability ride. The need for portability is real and IRDA's recognition of the same is a step in the right direction. It will work in simple and straightforward cases, especially for the young with no pre-existing diseases (PED).

Obviously, insurers will lure this target segment. The sections that will be the most affected will be the elderly and those with PED-ironically, both these categories need comprehensive mediclaim policies.

So will insurance portability have a smooth take-off? Or will it be bogged down by the issues detailed above? Moneylife will keep a close watch and keep you posted on the developments in this crucial front. 

Comments
Hoshang Nekoo
1 decade ago
Mr. Panjwani Ji perhaps you are not knowledgeable and experienced on the different types of Medi-Claim Policies floated in the market by PSU and Private Insurers. The way the Insurance Industry especially in Medi-Claim business operates is well known to IRDA. Insured only comes to know whether he is insured with a good insurance company or not, till such time settlement of claim is experienced with T.P.A. Nothing is wrong with IRDA to bring in Portability of Med-Claim Policy. The harassed policy holders are very happy as the good news now is only on papers. You will make a special survey as to how many policy holders could port their policy with ease. Policy holders’ good time starts from 1.10.2011 and your time to gather statistic starts from 15.11.2011. Looking forward to read your survey reports in November, December 2011 Money Life magazine issue.
Prem Panjwani
Replied to Hoshang Nekoo comment 1 decade ago
Mr Hoshang Nekoo>>>>I am envolved into the insurance from 23years and very much professionally envloved into the insurance profession...Rgrdg problems faced by the policy holders when it was realised by IRDA how a common man is suffering in health insurance segment, hence IRDA have come out with these new portability of health insurance....Since now IRDA have come out with some protection to policy holders money life being the magaize and articles to be printed to utilised the space on pages...You seems to be worried about the how it will be benefited to policy holder>>>>>sir ji to avoid harresment of one insurance company or even if client want to change the agent also he can change and select the agent and company of his choice...regarding the PED now client have option to switch over with all his adverse medical history....C the changes in positive angel, as it is very difficult to digest to except the changes...but positive changes should be welcome....Rgds
Hoshang Nekoo
Replied to Prem Panjwani comment 1 decade ago
Mr. Panjawani Ji- I am in insurance profession for the past 37 YEARS. I did write “Nothing is wrong with IRDA to bring in Portability of Med-Claim Policy.” Raj Pradhan in no way is giving negative picture to the readers. In fact he writes to caution the Insured Person before taking a leap and is right. Why will any insured person port to change the Insurer? Or for the matter an Insurance Agent? In the bargain the loser is a Good Service Oriented agent who has initially made all effort to canvass Medi-Claim Policy to convince people the advantage of having Medi-Claim Policy and bring in business. He may lose a good client who will port the policy to other insurer not for the reason that the agent was bad, but having a policy with the insurance company who showed unconcerned attitude to settle the claim. Agents business is lost. The same agent cannot carry his client to port to other insurance company as he is not attached to the Insurance Company with whom the policy will port. Agent with the other insurance company will eat the cake served on a silver platter. It is said that it takes months to get a business but a day to lose a business. Why is IRDA silent on the issue and has done no thinking of opening up agent’s agency to be associated with other Insurance Companies rather than restricting to do business with only one General and One Life Insurance Company? Why the same rule does not apply to brokers? Insurance brokers are also bias in doing the business by promoting insurance business of the Insurance Company who gives them more incentives etc. The harassment by T.P.A. and also by the Insurance Company is well known to IRDA. Perhaps you must have read an advertisement in the Newspapers some years back when Cash Less Benefit was announced to the benefit of Medi-Claim Policy Holders that” You only have to pay for the ambulance or taxi fare to go to the hospital”. With what good intension Cash Less Hospitalisation benefit was introduced to the benefit of insured person. What is the situation today? Only those have asked for cashless sanction only knows the sick way of getting the sanction from T.P.A. As such many agents are on the look out to snatch away only the Medi-Claim business of other agents will have good opportunity to expand their business.
prem panjwani
1 decade ago
Mr Raj Pradhan ji...how come if you can not understand the decision of IRDA for portability of health insurance for policy holders, instead of reviewing and understanding the concept u write or raise the question in Money life,,,,Threating the policy holders as if it is something wrong which IRDA have come out with....It clearly says proceess of 45 days...u better go thru the process details and u will get the full knowledge and do n dont and how it will be benefit to policy holders.
Raj Pradhan
Replied to prem panjwani comment 1 decade ago
Mr Panjwani, the views are from industry experts. If there is anything inaccurate in the article, please challenge on specific issue.
prem Panjwani
Replied to Raj Pradhan comment 1 decade ago
Mr Pradhan Ji...My views are not to hurt anyone...but to bring the awarness that yes IRDA have come to protect the intrest of Health Insurance policy holders by portability...I was referring with your sentence or headlines (Mediclaim portability kicked off on 1st October, but will you land up in no-man’s land if you switch insurers?) is this a ethical way to address the message? we should have positive msg to public ...No intenstion should be their only to print the pages in magazine for selling with number of pages....on stand...it should have msg to public...
Sundaram
1 decade ago
Thanks,Raj,you are indeed keeping a hawk-like watch on the insurance portability issue.
Raj Pradhan
Replied to Sundaram comment 1 decade ago
thanks, Mr. Sundaram
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