Health Insurance Portability in India: Your Rights When Switching Insurer

Changing your health insurer — whether for better premiums, better service, or a wider hospital network — should not cost you the waiting period credit you have accumulated for pre-existing conditions. Under IRDAI's health insurance portability regulations, it does not have to. Portability is a mandatory right that all health insurers must honour — but exercising it correctly requires attention to timing and process.

What portability means in practice

When you port a health insurance policy, the new insurer must:

• Accept your application (subject to medical underwriting, but cannot apply stricter criteria than for a new customer with similar risk)
• Grant credit for the waiting period already served under your previous policy for pre-existing diseases and specific diseases
• Provide at minimum the same sum insured as your previous policy (you can request an increase, but the insurer may apply fresh waiting on the incremental amount)

Portability does not mean the new insurer must offer the identical product — they offer the equivalent cover from their own product range. But the waiting period credit must transfer.

The 45-day application window

Portability applications must be submitted to the new insurer at least 45 days before the current policy's renewal date. This gives the new insurer time to underwrite the application, request any medical information, and issue a policy that takes effect from the date your old policy would renew. Missing this window gives the new insurer valid grounds to decline — not because of any fault in your application, but because they did not have time to process it.

If your policy renews on the 1st of the month, initiate portability by the 15th of the previous month at the latest. Starting 60 days out gives you a buffer if the new insurer asks for additional documents or medical tests.

What waiting period credit you are entitled to

Pre-existing disease waiting period

This is the main benefit of portability. If your old policy had a 4-year PED waiting period and you have been continuously insured for 3 years, you carry a 3-year credit — meaning your PED waiting period with the new insurer is only 1 year. Once you have served the full waiting period with any insurer, PED is covered from day one in all subsequent portable policies.

Specific disease waiting periods

Many health policies impose separate waiting periods for specific conditions such as joint replacement, hernia, cataracts, and similar. The waiting period credit for these specific disease clauses also transfers with portability. If you have served the full waiting period for these conditions with your previous insurer, the new insurer cannot re-impose a fresh waiting period on them.

Initial waiting period

Most policies have a 30-day initial waiting period for any illness (excluding accidents) from the policy start date. This initial waiting period does not apply on portability — you are a continuing policyholder, not a new one.

Medical underwriting on portability

The new insurer has the right to underwrite your application medically. They can request medical reports, test results, or require a medical examination. Based on the underwriting, they may:

• Accept the application at standard rates
• Load the premium for specific conditions
• Add exclusions for specific conditions not covered by the previous insurer
• Decline the application (with written reasons)

Critically, the new insurer cannot apply underwriting criteria that are stricter than they would apply to a fresh applicant of the same age and health profile. If they would accept a new customer with diabetes at standard rates, they cannot load or decline a porting customer with the same profile. Any difference in treatment between a porting and a new customer for the same risk profile is grounds for a complaint.

Group insurance portability

If you are leaving an employer-sponsored group health policy, you have the right to port to an individual policy with any insurer, carrying the same waiting period credit. The group policy's coverage history counts for portability purposes. Apply before your last day of employment to ensure the portability window is met.

Documents needed for portability

• Portability application form of the new insurer
• Current insurance policy certificate and renewal notice
• Claims history for the last 3–5 years from the current insurer
• Proposal form of the new insurer (with medical disclosures)
• Medical reports requested by the new insurer (if any)

The current insurer must provide your claims history and policy details within 7 working days of a request for portability purposes. Refusal or delay in providing this information is a IRDAI regulatory breach.

How to challenge a wrongful portability refusal

1. Obtain written reasons for the refusal from the new insurer's Grievance Redressal Officer. If the refusal is for medical underwriting reasons, request the specific underwriting basis.
2. Compare the refusal criteria against what the insurer would apply to a fresh applicant. If there is differential treatment, document it.
3. File on IRDAI IGMS. Portability refusals are a specific complaint category and IRDAI takes them seriously.
4. Escalate to the Insurance Ombudsman if the IGMS complaint is unresolved within 30 days.