Changing from Group Mediclaim to Personal Cover

Changing from Group Mediclaim to Personal Cover

Several issues need to be addressed once you decide to shift from a group mediclaim scheme to a personal policy. These include the norms of porting, carrying forward the waiting period, and whether you can shift to a different insurer

When 37-year old Akash, working with a top IT company in Bengaluru decided to change jobs, he was concerned about shifting his group health insurance from his present company, to an individual policy. He knew this can be done but was largely unaware about the portability norms regarding health insurance in India. There were many questions in his mind and he did not know where to hunt for answers.

Several issues need to be addressed once you decide to shift from a group mediclaim scheme to a personal policy. These include the norms of porting, carrying forward the waiting period, and whether you can shift to a different insurer.

If you are in the same boat as Akash, scratching your head in the dark about what to do, here is a quick glance of the facts involved in the switch over and the steps you need to follow.

The basic conditions

Group mediclaim policies are offered by all leading insurance companies in India, both in the public and private sector. These schemes underwrite a group and hence the norms are more relaxed. It allows you to carry forward the waiting period which you accumulated for your pre-existing health conditions when you decide to switch over to a personal policy. However, one of the most important points to remember is that it is allowable only with the same insurance company. You can of course switch insurers, but only after the completion of at least one year of having a personal policy with the present insurance company. You can also switch policies even if your family is covered under it, and have the flexibility to choose personal policies for each of your family members or go for a family floater cover.

But group mediclaim schemes are undeniably more lenient regarding terms of coverage. Some schemes, for instance, extend facilities like family floater plans and maternity health benefits that are often excluded under personal policies.

What about the waiting period?

A group mediclaim cover, usually, has no waiting period and you can get coverage on all your pre-existing conditions right from day one. However, according to IRDA guidelines, you may carry over the credit gained on your pre-existing health conditions in the form of a waiting period. A big advantage of shifting policies these days is that the waiting period is not wasted. But if the group insurance scheme at your present company has a waiting period and you have served a part of it, the balance would be carried over to the new individual policy under the same insurer.  

So what is the procedure?

First, you have to fill up a form to change from group insurance to individual cover. While filling up the form, you have to disclose the details about your existing policy, medical history and declarations, and other relevant information. Some insurance companies may ask you to take some medical tests. It is also important that you submit the form for changing at least 45 days before the date of renewal.

After your application for portability has been successfully processed, the insurer will underwrite a new policy and specify the terms and conditions along with it, besides stating the new premium. The form is typically processed within 15 days. The new policy begins as soon as you pay the premium.

It is important to note that you can avail the portability benefits only if your previous health insurance policy is carried forward sans any interruption.

Understood, but why should I shift?

A personal health insurance scheme often gives people a more exhaustive coverage, as against a group policy. You have the flexibility to choose a policy which is tailored to your needs. At the same time, there are no worries about the expiry of the waiting period, which makes the switch over much easier. You can also forward the benefits from your existing policy to the new one.

While changing, you may increase the policy cover as well. But in such cases, the benefits of the waiting period would be applicable only on the present sum assured and not on the new one.

What the IRDA says:

Market regulator IRDA protects mediclaim customers by giving them rights to change their health insurance policies from one insurer to another. The new insurer, according to IRDA, must allow for all credit acquired by the insured for all pre-existing conditions in terms of the waiting period. This is applicable not only while switching over from one insurer to another company, but also when you change between plans under the existing insurer.   

IRDA rights to customers

The market regulator has extended the following rights to all health insurance subscribers.

  • You can change your mediclaim between any specialised mediclaim provider or general insurance company.
  • You can change any individual or family policies.
  • The new insurance company must extend the credit related to the waiting period regarding any pre-existing health condition that you acquired with your present insurer.
  • The new insurer must assure you the sum assured under the present policy as the minimum. Under no circumstances it can give you a lesser sum assured.
  • Both the new and existing insurers must carry out the switch over according to the timeframe prescribed by IRDA under its Protection of Policyholders' Interest regulation and guidelines.

IRDA conditions

Changing from a group health insurance cover to a personal policy is subject to the following conditions.

  • The policy is portable only at the time of renewal of the existing one i.e. the next period will commence with the new insurer
  • All terms and conditions of the new scheme along with the premium, except the waiting period credit, would be at the sole discretion of the new insurer
  • Before the 45 days of your switch over date, you have to write to your existing insurance company to request the change. You must also specify the new company.
  • You have to renew the policy with a break. IRDA, however, extends a 30-day grace period if the changeover is under process.

Column by, Naval Goel- Founder and CEO