Many health policyholders may not have had the smoothest experiences while dealing with their insurance companies. These challenges may relate to both the claims themselves as well as operational/process difficulties while waiting for settlement. Consider the following numbers and events:

Data from insurance regulator IRDAI show that in FY24, claims – disallowed and repudiated – worth ₹26,037 crore were rejected, a 19.1 per cent increase over the amount rejected in FY23.

In the aforementioned data, disallowed claims totalled to ₹15,100 crore. These claims are those related to improper/missing documentation, lapse of policy, incorrect procedure, errors in filing forms and so on. If there is a genuine mistake/lapse that could be rectified, there is scope for resubmission of claims if they are disallowed, though there is no certainty.

Repudiated claims accounted for the remaining ₹10,937 crore. These rejection decisions are made after a thorough investigation. Factors contributing to the rejection include claims made during waiting periods, disease not being covered, pre-existing medical conditions not disclosed and so on.

In August this year, the Association of Healthcare Providers-India (AHPI) suspended cashless services across hospitals for three insurers. The decision was to have taken effect from September 1. The issues were low reimbursement rates from insurers, arbitrary claim rejections/deductions and delayed payments.

Fortunately, the issue was resolved late in August after talks between APHI, hospitals and the insurance companies.

More recently, we had at least a couple of cases where policyholders had to fight a stiff battle in social media just to grab the attention of the concerned health insurance companies about frivolous rejections/deductions.

As a policyholder, you could be at the rough end of claim rejections, unsubstantiated deductions, shoddy processing by the insurance company and so on. After a point, you just decide enough is enough.

The one step you could take to secure your medical needs is to port your policy to another health insurer.

We walk you through reasons that should make you port to a new health cover provider, the process involved and some key aspects to remember to make the process smooth.

Making the move

There are several reasons why you could consider a new insurer for your medical needs.

First, of course, is the poor experience you may have had with your current insurer across many claims over the years. Your claims may have been delayed/rejected, the process could have been cumbersome with too much back and forth with the insurer, deductions for consumables may have led to much lower amounts being settled than the original hospital bill.

Second, you may find that your current insurer is increasing premiums every year for the same sum insured, quite arbitrarily. It is not uncommon for premiums to surge 40-50 per cent over the previous year’s figures when minor or even no claims are made. Often, no explanation is given for premium hikes.

Third, you may want a higher sum insured which your current insurance company is not offering/willing to give. In the current times, when ₹25 lakh or higher family covers are quite common, you wouldn’t want to be stuck with low covers of, say ₹2-3 lakh, especially when medical inflation is in double digits. Even when a higher sum insured request is accepted, the premiums quoted could be way too high with your current insurer.

Fourth, and an important reason is the non-availability of a more comprehensive coverage of a wide range of ailments with your existing provider.

Some of the features you could be seeking include maternity cover, treatment of ailments relating to mental wellness being allowed, no room rent capping (hospital bills are settled based on room rents on a proportional basis), consumables being allowed as a part of the main policy itself and so on.

Fifth, the list of hospitals that your current insurer has for cashless treatment may be too narrow. If you are shifting cities or are a frequent domestic traveller relating to your work, you may want a much wider list of hospitals across cities.

Overall, you want additional features, a smooth claim process and full amounts settled with no nasty surprises on deductions and so on. If you aren’t getting these features from your current insurer, you should consider porting.

Porting out

When you port to a different insurer, some key benefits are retained. These include the waiting period. For example, if a pre-existing illness has a waiting time of two years and you have already completed the period with your current insurer, you will have coverage for the ailment with your new insurer from day one; if you have completed one year of waiting period, you will have to wait only for one more year for a pre-exiting ailment’s treatment in your new policy.

Any cumulative bonus accumulated with your current insurer would also be transferred to your new insurer.

Portability is allowed for individual and family floater policies. Your new insurer must offer you a sum insured that is at least as much as what your current insurer does.

Then there is the actual porting process. You are allowed to port your current policy only closer to the renewal date and not at any other time.

Once you have chosen a new insurer, send a porting request at least 45 days before the expiry of your current policy. This can be done online via the selected insurance company’s website.

The new insurer will send all the required forms (proposal, portability and so on.) required for completing the process. You must submit the form fully filled and make complete disclosures while doing so.

Along with the filled-up forms, you must also choose a plan from the list available with the insurer.

When all the details are received by your new insurer, the company will then begin processing your request. The insurer will seek details relating to your medical history from your current insurer. IRDAI also has a web-based data-sharing facility that your new insurer can access securely to get all relevant details. Data sharing could take seven working days.

Once your new insurer gets all the details from your current health provider/IRDAI, a decision is made on the basis of all the available information. Usually, portability requests are processed within 15 working days after all the details become available.

You will need to have suitable address and identity proofs – Aadhaar, PAN and so on.

It would also be helpful to have all your medical records, discharge summaries from hospitals, claims filed, policy documents etc. of the past few years.

One key aspect to note here pertains to claims made during the period when you make the portability request. In such cases, only your current insurer should be approached for fresh or pending claims arising before the date of expiry of the current policy.

Talk to friends, relatives and colleagues to check which health insurance providers have a solid track record in settling claims. Go through IRDAI’s annual report for claim details of various insurers. You can talk to insurance agents as well. However, one issue with agents who are registered with only a single insurer is the lack of choices.

Published on September 13, 2025