What is portability in group health insurance and how does it work?

Portability in health insurance is the right of a policyholder to move from one insurer to another (or from group to individual cover) without losing accumulated benefits such as waiting period credit, pre-existing disease cover status, and moratorium period accrual. Under IRDAI regulations, portability applies to retail policies and, in a modified form, to employees moving from group cover to individual cover. The core requirement is intimation to the existing insurer at least 45 days before the renewal or shift.

What is portability under Indian health insurance rules?

Portability was introduced under IRDAI's health insurance regulations to prevent policyholders from being locked into an insurer by the cumulative waiting periods and continuity credits built up over the years. Under the IRDAI Insurance Products Regulations, 2024, portability lets a policyholder move to a new insurer while carrying forward the waiting periods already served, PED cover if the moratorium is complete, and other continuity benefits.

What benefits carry over during portability?

Three main benefits carry over when portability is exercised correctly:

• Waiting period credit: Time already served under the old policy counts toward the new insurer's waiting period. If the employee has completed 24 months of PED waiting period under the old policy, only 12 more months remain under the new policy (with a total cap of 36 months under the IRDAI Insurance Products Regulations, 2024).
• Moratorium status: Where the old policy has completed the 60-month moratorium (reduced from 96 months under the 2024 regulations), the new insurer cannot reopen non-disclosure disputes on pre-existing conditions covered under the moratorium.
• PED cover: Where PED cover is already active under the old policy, it typically carries over to the new insurer.

How does portability work for someone leaving group cover?

When an employee leaves an employer, their group health cover ends. If the employee wants to move to an individual retail policy with continuity of PED cover and waiting period credit, they can port the group cover to an individual policy from the same insurer or another insurer, subject to specific IRDAI rules. Portability at this transition is more limited than in retail-to-retail cases, since group underwriting is different from individual underwriting, but PED waiting period credit is typically preserved where the transition is handled within the allowed window.

What is the timeline for exercising portability?

The intimation to the existing insurer must be given at least 45 days before the policy expiry or the intended transition date. Intimation later than this can result in loss of continuity credit, though insurers may accept later intimations at their discretion. The formal portability process typically completes within 15 to 30 days of intimation, with the new insurer conducting fresh underwriting where required.

Can group-to-individual portability be denied?

Yes, on specific grounds. The new insurer can decline to port a policy where fresh medical underwriting reveals material adverse conditions, where the employee's age exceeds the new insurer's entry age limits, or where the policy requested is materially different from the group cover being ported (for example, a very high sum insured with no comparable history). The new insurer must state the reason for declining in writing.

What documentation is needed for portability?

The typical document set includes:

• Portability request form, submitted to the new insurer.
• Certificate of insurance from the current group policy, showing sum insured, tenure, and covered members.
• Claims history from the current insurer (helpful, though the new insurer can also request this directly).
• Fresh proposal form for the new individual policy.
• Health declaration or medical test results if the new insurer requires underwriting.

How Plum approaches this

Plum helps departing employees on Plum-managed group policies understand their portability options and initiates the process with the new insurer where possible. Across Plum's group book, claims NPS runs at 79 and cashless pre-authorisation clears in a median of 45 minutes on the live group cover. Plum places group cover from a minimum of 7 employees, working with partner insurers including ICICI Lombard, HDFC ERGO, Bajaj Allianz, Star Health, Niva Bupa, and Aditya Birla Health Insurance, each of which handles portability slightly differently.

Frequently asked questions

Is there a cost to porting a policy?

Portability itself does not carry a fee. The premium of the new policy is charged at the new insurer's rates.

Can the new insurer refuse to accept the port-in?

Yes, on stated underwriting grounds. Refusal must be given in writing with the reason.

Does portability apply to riders and top-ups?

Portability primarily applies to the base cover. Riders and top-ups may or may not be portable, depending on the new insurer's product structure.

What happens if the intimation is later than 45 days?

The insurer may accept later intimation but has the right to decline continuity credit. Employees should submit intimation as early as possible.

Can a family member be ported separately from the primary insured?

Yes. Individual family members can port their cover independently under the same rules.

Does portability preserve any premium discount?

Premium is priced at the new insurer's rates and their underwriting assessment. Discounts do not typically carry over from the old insurer.