I am working with a multinational corporation (MNC), where I am covered under group health insurance, but will be leaving the firm in two months. Can I port my group policy into an individual policy? My current benefits include coverage for all hospitalization immediately without any waiting period. The plan provides OPD benefits too. Please advise.
—Name withheld on request
Similar to the provision allowing portability between individual health insurance policies, there is also a provision for portability from group plans to individual plans. Under this provision, an employee covered by a group plan with an insurer can switch to an individual plan with the same insurer upon leaving the group.
The primary benefit is a reduction in the waiting period that would be applied under the individual retail plan. The duration for which the employee was continuously covered under the group plan with the same insurer is subtracted from the waiting period of the individual plan.
However, several points should be noted regarding the porting from group to individual plans. Firstly, porting can only occur within the same insurer as the group insurer; an employee cannot switch to a new insurer upon leaving the group. Once the retail plan is issued, the policyholder can port to the retail plans of other insurers in subsequent years. Secondly, the plan features will align with those of the individual plan, not the group plan. Therefore, if the retail plan includes OPD benefits, those benefits will be available. If there are no OPD benefits in the retail plan, they cannot be added or customized.
Thirdly, the residual waiting period after the set-off is still applicable for the employee. For example, if the original waiting period in the retail plan was four years and the person stayed in the group for two years, the set-off would be only for two years. Fourthly, the waiver of the waiting period applies to the same sum assured as prevalent in the group. If the person opts for a higher sum assured, the original waiting period will apply to the incremental sum assured. Fifthly, the waiting period is accrued based on continuous coverage with the same insurer. In cases where companies switch their group health insurer, only the continuous coverage period with the last insurer will be counted towards portability. And, finally, the premium applicable will be for the retail plan.
Employees, especially those without personal health insurance coverage, can utilize group-to-individual portability to obtain an effective health insurance cover. The waiting period is substantially reduced, making health coverage effective much sooner. However, it’s important to note that this provision is not a tool to mirror group benefits in a personal plan. It is generally recommended to initiate the portability process 45 days before the exit date. The insurer will require a retail proposal form, a portability form, and premium to initiate the process.
Abhishek Bondia is principal officer and managing director at SecureNow.in
Unlock a world of Benefits! From insightful newsletters to real-time stock tracking, breaking news and a personalized newsfeed – it’s all here, just a click away! Login Now!
Download The Mint News App to get Daily Market Updates.
More
Less
Published: 18 Jan 2024, 11:15 PM IST
