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What happens to group health insurance when I leave the organisation?

Author: Team Finpage
Employee Group Health Insurance
Monday, May 27, 2024

Embarking on a new professional journey often involves a transition not only in employment but also in health insurance coverage. This article unfolds the benefits of migrating from an employer's group health insurance plan to an individual health insurance policy, providing insights to make informed decisions during this crucial phase.

1. Understanding Group Health Insurance

Many organisations extend group health insurance as part of their employee benefit packages, offering standardised coverage to all members. This coverage encompasses medical benefits, including hospitalisation expenses, maternity coverage, and more.

2. Conversion Option

Contrary to the common assumption of insurance coverage ceasing along with employment, some insurers provide a conversion option. This allows employees to convert their group health insurance coverage into an individual policy when transitioning out of their job.

3. IRDAI Guidelines

The Insurance Regulatory and Development Authority of India (IRDAI) sets guidelines governing the migration from group health insurance to an individual policy. According to these guidelines, individuals can switch to individual health insurance with the same insurer. While the premium rates may increase, certain advantages accompany this transition.

4. Advantages of Conversion

One notable advantage is the porting of waiting periods from the employer's health insurance to the individual health cover. This means that the waiting period for pre-existing conditions is carried over, allowing individuals to enjoy full benefits from day one of converting to an individual policy. IRDAI mandates that the new insurer recognizes the credit gained for pre-existing conditions.

5. Tailored Health Coverage

Group health insurance lacks the customization available in individual policies. Individuals may have specific health needs, such as vaccination coverage for their children, which may not be addressed by group policies. The migration to an individual health insurance policy allows for tailored coverage that aligns with the unique health requirements of the individual and their family.

6. Mandatory Steps:

To initiate this migration, individuals must inform the insurer at least 45 days before resigning. This window can be extended to five days after the last working day in case of oversight. However, the migration process is subject to underwriting, where the insurer assesses new risks. Necessary documentation, including the resignation or retirement letter, is required for the underwriting process.

7. IRDAI's Role

Under IRDAI guidelines, the insurer must communicate its decision within 15 days of receiving the migration request. The policy becomes active upon payment of the premium. Successful migration opens avenues for further exploration, including porting to a similar health policy offered by a different insurer.

Conclusion: Empowering Individuals in Health Insurance Transitions

Understanding the option to migrate from group health insurance to an individual policy empowers individuals during employment transitions. The benefits, guidelines, and steps outlined by IRDAI provide a roadmap for informed decision-making. By recognizing the advantages of tailored coverage, seamless transition, and credit for pre-existing conditions, individuals navigate this insurance landscape with confidence.

Team Finpage

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