स्वास्थ्य बीमा पोर्टेबिलिटी: अवसर, जोखिम और मुख्य विचार

Health insurance portability, introduced in India in 2011, provides policyholders with the option to transfer their health insurance policy from one insurer to another. This mechanism aims to enhance consumer choice and promote competition among insurance providers.

One key concept is the sum insured. This refers to the maximum amount an insurer will pay for covered medical expenses during the policy period. When porting a health insurance policy, the existing sum insured is typically carried over to the new policy. For example, if an individual has a policy with a sum insured of ₹5 lakh and ports to a new insurer, the new policy should also offer a sum insured of at least ₹5 lakh.

Another important aspect is the no-claim bonus (NCB). This is a benefit offered by insurers to policyholders for not making any claims during a policy year. The NCB usually translates into an increase in the sum insured or a reduction in the premium. When porting, the accumulated NCB should be transferred to the new policy. This ensures that policyholders are not penalized for their claim-free history. The article mentions that this benefit must be carried forward.

The concept of underwriting is also crucial. Underwriting is the process by which an insurer assesses the risk associated with insuring an individual. This involves evaluating factors such as age, medical history, and lifestyle. While portability is a right, the new insurer still has the right to underwrite the policy. This means that they can assess the risk and determine the premium accordingly. The article emphasizes that while porting is a right, underwriting remains the insurer's right.

For UPSC aspirants, understanding health insurance portability is important for both prelims and mains. In prelims, questions can be asked about the key features of portability, such as the transfer of sum insured and NCB. In mains, questions can focus on the benefits and challenges of portability, as well as its impact on the insurance sector. This topic is relevant to GS Paper III (Economy) and GS Paper II (Social Justice).