Health insurance: Porting from group to individual plan

Today, many organisations provide group medical coverage (GMC) to their employees under employee benefit programs. It has emerged as a critical component of the overall compensation package of the companies.

GMC policy is an effective way for salaried people to have basic health insurance protection; however, you can avail the benefits of GMC only as long as you are employed with the company.

Have you ever wondered what happens if your next employer is not offering a GMC or is offering limited cover? How will you manage if you decide to take a career break or start a stint as a freelancer or an entrepreneur? Do not worry; you have the option to port your health insurance coverage under GMC to an individual health policy; this is called ‘continuity benefit,’ let us see how it works. 

How to port?

First and foremost, if the GMC policy covered your dependents, you can port the policy to a family floater plan. If the policy only covers you, you can shift to an individual health insurance plan.  

To initiate the process, inform the insurance company offering GMC about your intention to port the policy to an individual plan. For a smooth transition, it is recommended that you inform the insurer at least 45 days before your last day with your organisation. Study their retail health insurance products, evaluate your requirements and choose a plan that best suits you. Once you have identified the right product for you, request the insurer to provide you with the required documents like the proposal, portability forms etc. Fill out the forms, share the details of the existing GMC policy, medical history, claims history etc., as the form asks, and submit it to the insurer. Once the form is submitted the insurer will review your request and if accepted, you can pay using net banking, debit/credit card or UPI. The insurer may offer you some change/modifications of terms depending on your claim experience or health declaration. Evaluate the offerings and proceed.

What are the benefits of porting?

One of the most significant benefits is that the waiting period under the GMC will be adjusted against the waiting periods for certain ailments of the retail policy. For example, the retail policy you plan to buy has a waiting period of 4 years for a particular ailment, and you had a GMC cover for 3 years. In this case, the time served under GMC will be considered. So, you will have to serve the waiting period of only 1 year for those ailments. The second benefit is GMC policies are designed to provide coverage to a group of individuals with similar insurance needs. By porting to a retail policy, you have the opportunity to customise your coverage to suit your specific requirements. GMCs often have sub-limits under various ailments like cataract, maternity etc. that may not be sufficient. While porting to a retail policy, you can choose a higher sum insured in line with your requirements. Lastly, porting to a retail policy allows you to maintain the policy independently, irrespective of any change in employment.

Things to keep in mind: Continuity benefits have many advantages; however, you must know a few things before starting the process. You can port a GMC to a retail plan only with the same insurer, and porting is subject to the insurer’s underwriting guidelines. Usually, GMC policy does not require you to undergo a medical check-up; however, while porting, you may have to undergo a routine medical test. Many people prefer to increase the sum insured during the transition to get better coverage. However, it is important to note that the waiting period benefit will apply only to the amount of the GMC sum insured. Suppose the GMC sum insured is Rs 3 lakh, and you decide to increase the sum insured in your new policy to Rs 5 lakh. The waiting period benefit will be available for INR 3 lakh; for the additional Rs 2 lakh, you will have to serve the waiting period. Lastly, understand the exclusions and limitations of the new policy. Familiarise yourself with the terms and conditions of the new policy to know the extent of the cover. More importantly, you have to keep track and renew your policy timely to keep the policy active.

Porting your GMC policy to a retail policy offers greater flexibility, personalised coverage, and enhanced benefits. By keeping the mentioned details in mind and making an informed decision, you can ensure a smooth transition and continued financial protection for you and your loved ones during medical emergencies.

(The writer is Head – Health Administration Team, Bajaj Allianz General Insurance)