Ref: IRDAI/HLT/REG/CIR/003/01/2020
CEOsof all General and Standalone Health Insurance Companies
Re: Guidelineson Migration and Portability of health insurance policies
Referenceis invited to Regulation 17(iv) and clause 16 of Schedule I of IRDAI (HealthInsurance) Regulations 2016. In terms thereof, following guidelines are issued:
A:NORMS ON PORTABILITY:
1. Portability shall be allowed under allindividual indemnity health insurance policies issued by General Insurers andHealth Insurers including family floater policies.
B:NORMS ON MIGRATION:
2. Inaddition to the migration option to be provided to the policyholders as specifiedunder Regulation 17(i) of IRDAI (Health Insurance) Regulations 2016:
i. Every individual policyholder (includingmembers under family floater policy) covered under an indemnity based individualhealth insurance policy shall be provided an option of migration at theexplicit option exercised by the policyholder;
a. to an individual health insurance policy or afamily floater policy, or;
b. to a group health insurance policy, if themember complies with the norms relating to the health insurance coverage underthe concerned group insurance policy.
3. Everyindividual member, including family members covered under an indemnity based grouphealth insurance policy shall be provided an option of migration at the time ofexit from group or in the event of modification of the group policy (includingthe revision in the premium rates) or withdrawal of the group policy:
a. to an individual health insurance policy or afamily floater policy.
4. Migrationshall be applicable to the extent of the sum insured under the previous policyand the cumulative bonus, if any, acquired from the previous policies.
5. Onlythe unexpired/residual waiting period not exceeding the applicable waitingperiod of the previous policy with respect to pre-existing diseases and timebound exclusions shall be made applicable on migration under the new policy.
6. Migrationmay be subject to underwriting as follows:
a.For individual policies, if the policyholder is continuously covered in theprevious policy without any break for a period of four years or more, migrationshall be allowed without subjecting the policyholder to any underwriting to theextent of the sum insured and the benefits available in the previous policy.
b.Migration from group policies to individual policy will be subject tounderwriting.
c.Where underwriting is done, the insurance company shall convey its decision tothe policyholder within 15 days as per Regulation 8(6) of IRDAI (Protection ofPolicyholders’ interests) Regulations 2017.
7. Apolicyholder desirous of migrating his/her policy shall be allowed to apply tothe insurance company to migrate the policy along with all members of thefamily, if any, atleast 30 days before the premium renewal date of his/herexisting policy. However, if the insurer is willing to consider even less than30 days period, then the insurer may do so.
8. Insurershall not levy any charges exclusively for migration.
9. Insurersshall clearly draw the attention of the policyholder in the policy contract andthe prospectus that:
i. Migration is allowed as per these Guidelinesas amended from time to time.
ii. Policyholder should initiate action toapproach the insurer to exercise migration option well before the renewal dateto avoid any break in the policy coverage.
10. Individualmembers, including the family members covered under an indemnity based grouphealth insurance policy shall have the right to migrate from such a grouppolicy to an individual health insurance policy or a family floater policy,thereafter Portability shall be allowed as per Clause (1) above and inaccordance to the norms specified under IRDAI (Health Insurance) Regulations,2016.
11. TheseGuidelines are issued under the powers vested with Section 34 (1) of theInsurance Act, 1938 and will come in to force with immediate effect.
12. Thishas the approval of the competent authority.
(SureshMathur)
ExecutiveDirector