Experience: After porting from group health insurance to a family floater

Published: August 8, 2016 at 10:47 am

Last Updated on

Last week, Mr. Srinivasan Sundarajan shared with us how he had converted his company group health insurance to a family floater as per IRDA’s portability rules.  In this follow-up post, he describes his experience after porting from the group cover to a family floater. I believe his account would be quite useful for anyone with or without an individual health cover.

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Well, as the proverbial saying goes, the proof of the pudding lies in eating it. For an insurance policy, the proof of the quality of your risk cover is known only when your claim has to be processed.

In my earlier blog, Health Insurance: Switching out of my job current – My experiences I had outlined the porting of my policy from my employer’s group scheme to a personal floater policy.

Now, I would like to share my experience after that – and the learning that I had from that.

Thank God, for in the ten year period prior to my switching out the policy, I never had to make a claim, barring once for my mother’s cataract.

However, in the very first year, after I had ported to my family floater policy, I took ill and had to get hospitalized.

It was a good, and not a flamboyant hospital near where I live. There was a TPA available in the hospital premise. However, he made it clear, that I will have to notify them about the hospitalization and thereafter I have to make a reimbursement claim.

Having stayed in the corporate world, and having seen many earlier claims in my organization, this was a little surprise. Even though the same hospital had a cashless settlement if I was in a corporate group cover, now I had to first put in my money and then only claim a reimbursement.

Well before my departure from the company, I had acquired a super top-up policy from another health insurance company. So when I left the company, I took the base cover for 3 Lakhs only, since my super top-up had a 3 Lakh deductible. Sounded very sensible, when I took the cover.

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Since (always thank God for that) we had not got hospitalized for over a decade, I had “my own” idea of the room rent in a hospital. So when I went to this neighbourhood hospital (good and not flamboyant), I did not expect that the room rent would cross 1% of the sum assured. But that turned out to be a poor judgement.  Well, many of us know that when we are in the corporate policy – you normally don’t have sub-limits. So this would never have been a concern in that case.

So, now when I had a 20% excess over the permitted room rent, the insurer – would not only not pay the excess room rent, but also all the other hospital charges were pro-rata reduced by that amount, barring the medicines. So I landed up paying a little over 20% of the claim from my pocket!

As you know, Murphy’s Law always works! I had to be re-hospitalized for the same again, a few weeks later. So we submitted our claims paper for that. A few days later the TPA came back – asking me for a copy of my policy for the prior years!  I don’t want to hazard any guess about their intentions, though I have my own hunch.

After all, this was the first year of my personal family floater policy.  So the prior years, I never had my own policy – it was through my corporate. A strange quirk of mine, made the day easy for me. Every year, the company would ask us to confirm the personal details. After doing the same, there would be a message from the TPA, stating confirming the data for the period.

I had retained the copy of the confirmation from the TPA for most of the years in a personal e-mail folder, including a year – when the TPA had goofed up and the correction thereafter. I had also sensibly “ported out” this data of mine when I moved out of the company! So, I had to dig this out, and flash it all to the TPA before they started the claims processing. In this process, it took another 10 more days to complete the claim processing. I know, from many of my fellow colleagues that very rarely anyone has bothered to keep the data. Imagine trying to chase your old employer for ancient data that you need!

So let me summarize my learning here:

  1. When you move away from a corporate group policy to individual policy, the number of cashless hospitals comes down significantly. So even with an insurance policy, you may need to plan for this additional emergency cash (to tide over the situation till your claims are reimbursed). The same hospital may be cashless for corporate but not for the individual.
  1. While many of the corporate policies, even at a small cover (I am defining that as less than 5 Lakhs), could allow you to have no sub-limits… your individual policy may not give that luxury. So it will be worthwhile to have some understanding of the room rent – and ensure that your basic policy would take care of it – even with sub-limits!
  1. It may be worth preserving the documentation on your earlier group insurance with you (at least for the prior 4 years). My quirk saved the day, but from what I know, many do not bother about it!

While the porting definitely helped, there are a few things that one has to know and plan beyond that.

On a later day, I will share my perspective on how I have chosen my base cover and top-up.

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