Health Insurance Portability: IRDAI 2024 Regulations on Switching Insurers Without Losing Waiting Period

Health insurance portability is the legal right to switch from one insurer to another at renewal without losing the credit you have built up for waiting periods, the cumulative bonus, and the moratorium clock. The right has existed since the IRDAI Health Insurance Portability circular of 9 February 2011, but the rules were rewritten on 20 March 2024 in the IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024 and reinforced by the IRDAI Master Circular on Health Insurance Business dated 29 May 2024. Together they compress timelines, narrow the grounds on which a new insurer can refuse a porting request, and allow a switch into a competitor product even mid-term where the policy is cancelled by either side.

This deep dive walks through the new rule book, the credits that travel with you, the worked premium and waiting-period maths for a 42-year-old porting between insurers, and the policy-wording traps that quietly shrink the cover you thought you bought. Use it alongside the Health Insurance Premium Calculator before signing the new proposal.

The Rule / Product

Health insurance portability in India sits on three layers of regulation you should be able to cite if a new insurer drags its feet. The base statute is the Insurance Act 1938 read with the IRDAI Act 1999. The operative subordinate legislation is the IRDAI (Protection of Policyholders' Interests, Operations and Allied Matters of Insurers) Regulations, 2024, notified through F. No. IRDAI/Reg/3/204/2024 and published in the Gazette on 20 March 2024. Regulation 17 of these 2024 regulations defines portability and binds the new insurer to tight time windows. The IRDAI Master Circular on Health Insurance Business dated 29 May 2024 (Ref: IRDAI/HLT/CIR/MISC/95/05/2024) operationalises the regulation, including the cashless settlement timelines that now sit alongside portability.

A few definitions matter. Portability means transferring credits from one general or health insurer to another, or between products of the same insurer, without losing waiting-period and cumulative-bonus credit. Migration is the same idea inside one insurer when you move from a group or older individual policy to a new product. Continuity is the umbrella term the 2024 regulation uses for both.

The 2024 framework changed five concrete things from the 2013 portability circular it replaced.

Every Indian health insurer connects to a common back-end called the Insurance Information Bureau of India (IIB) portability portal. When you submit Form IRDAI-Port-1 to the new insurer, that insurer raises a request on the IIB portal which pulls your claim history and credits from the old insurer. The old insurer has 7 days to respond, failing which the new insurer must underwrite on the proposal alone. Bookmark the IRDAI consumer site policyholder.gov.in for the standard portability proposal form, and confirm that the new insurer accepts the IIB-generated electronic continuity certificate before paying the first premium.

Why It Matters

The economic value of portability is the difference between buying a fresh policy at age X with X years of waiting-period credit retained, versus buying it with the clock reset to zero.

Take a 42-year-old who has held a Rs 5 lakh family floater since age 35. Seven years of clean renewals mean every waiting period under the policy has expired and the cumulative bonus is at its product cap, typically 50 per cent of sum insured. If she moves to a competitor without portability, she loses:

• 30-day initial waiting on every illness except accidents
• The 24-month specific-disease waiting (cataract, hernia, joint replacement, ENT surgeries, kidney stones)
• The 36-month pre-existing disease waiting if she has hypertension, diabetes, asthma, or thyroid disorder
• The accumulated cumulative bonus, often Rs 2 to 2.5 lakh of additional cover
• The remaining moratorium credit (60 months minus elapsed months) after which the insurer cannot deny a claim for non-disclosure

In a market where the IRDAI Annual Report 2023-24 records general and health insurers paying retail health claims at an incurred claim ratio of 88.7 per cent — meaning premiums and claims roughly track — losing seven years of waiting-period credit can convert a covered hospital bill into a six-figure cash outflow during the first three post-port years.

The 2024 regulation also matters for older policyholders. Earlier most insurers refused portability above 65 years; Regulation 17(7) read with the Master Circular bars rejection solely on the ground of age, including for senior citizens. The Master Circular separately removed the entry-age cap for fresh health insurance proposals from 1 April 2024.

The 2024 cashless timelines layer on top of portability and matter at the next admission. The Master Circular dated 29 May 2024 sets a 1-hour decision window on cashless authorisation requests and a 3-hour discharge window once final billing is uploaded. Pick a new insurer with a cashless network that includes your usual hospital and confirm the network status in writing before porting.

Worked Numbers

Take the family floater above and run the porting maths in two scenarios. We use the Health Insurance Premium Calculator base assumptions and benchmark indicative premiums against the IRDAI Annual Report 2023-24 (released January 2025), which puts retail health average premiums for a Rs 5 lakh floater at Rs 18,500 to Rs 26,000 at age 40 to 45.

Scenario A — Same Rs 5 lakh sum insured

Policyholder: 42-year-old proposer + 41-year-old spouse + two children aged 11 and 8.

Annual saving in cash terms: Rs 3,068. Over 10 years at 6 per cent post-tax that compounds to roughly Rs 41,000. The bigger win is the preserved Rs 2.5 lakh cumulative bonus and the credited waiting periods.

Scenario B — Sum insured upgraded from Rs 5 lakh to Rs 10 lakh on porting

Regulation 17(5) of the 2024 regulations is explicit: continuity credit applies only up to the sum insured on the previous policy. The incremental Rs 5 lakh is treated as fresh cover with the full 30-day initial wait, 24-month specific disease wait, and 36-month PED wait. Premiums change as follows.

If a covered specific disease such as cataract surgery is performed in months 1 to 24 after porting, the insurer will pay only on the credited Rs 5 lakh slab; the incremental Rs 5 lakh remains in the waiting period. Plan the upgrade timing carefully — most policyholders are better off porting at the same sum insured first, then triggering the upgrade only at the second renewal once the topped-up portion has cleared its waiting periods.

When comparing insurers at the porting stage, look up the company-level incurred claim ratio in the IRDAI Annual Report — anything below 75 per cent means the insurer has paid less than three quarters of premium back as claims and is typically harder on settlement.

Pitfalls

Portability is a right, but the right is narrow. The credits travel only on the legacy contract terms; everything outside that is fresh underwriting at the new insurer. Six trap doors recur in our review of 500-plus claims correspondence.

Sub-limits do not travel. If the old policy paid knee replacement at actuals up to the sum insured but the new policy caps joint replacement at Rs 2 lakh, the new sub-limit applies from day 1 of the ported contract. Pull the new product's exclusions and sub-limits schedule and compare against your old wording. Read the Sub-limit glossary entry before signing.

Room rent caps reset to the new product. A common clause is "single private room up to 1 per cent of sum insured per day". On a Rs 5 lakh floater this is Rs 5,000. If you admit into a Rs 12,000 room, the proportionate deduction clause then scales every associated bill — surgeon's fee, ICU charges, consumables — by the same ratio (5,000 / 12,000 = 41.7 per cent). The Supreme Court in Gurmel Singh v Branch Manager, National Insurance Co. Ltd (Civil Appeal No. 4071 of 2022) cautioned against using such clauses to defeat reasonable expectations, but where wording is clear, IRDAI grievance orders have upheld the reduction.

Co-payment clauses follow the new product. Senior citizen products commonly carry a 10 to 20 per cent co-pay even after porting. Some products also impose a zonal co-pay if you admit in a Tier 1 city above the policy zone. Co-pay applies on the eligible amount after sub-limit deductions, not on the gross bill.

PED list reset. While the 36-month PED waiting is credited, the list of conditions classified as PED is set by the new insurer from your fresh proposal form. A diabetic on Metformin is a clear PED everywhere; borderline thyroid may be PED at one insurer and not another. Disclose every condition, prescription, and prior admission. Non-disclosure remains the top reason for claim rejection at IRDAI ombudsman complaints (Annual Report 2023-24).

Moratorium credit is conditional. The new 60-month moratorium runs only on continuous coverage. A one-day lapse during handover restarts the clock. The 30-day renewal grace period preserves continuity only if the premium lands inside the window — confirm the NEFT date stamp.

Cumulative bonus on upgrades. Some products reset bonus to zero if you upgrade sum insured at porting. Others apply it only on the continuity slab. The 29 May 2024 Master Circular is silent on this, so the wording controls. Read the Cumulative Bonus entry and confirm in writing.

The IIB portal carries claims data for the past five years. If your old insurer flagged a claim for non-disclosure and rejected it, the new insurer can refuse to issue the policy under "adverse selection" without breaching Regulation 17. Ask for a copy of the IIB report before paying premium.

Compare across at least three insurers using the Health Insurance Premium Calculator. The Term Insurance Premium Calculator covers the parallel question for life cover (term life is not portable; a fresh proposal is needed). For drivers and frequent travellers, refresh quotes via the Two-Wheeler Premium Calculator and Travel Insurance Calculator at the same renewal cycle. The Oquilia explainer on Bima Sugam covers how portability requests will route through the unified marketplace from rollout, and our Motor Third-Party Insurance explainer covers the parallel statutory mandate.

FAQ

How many days before renewal should I apply for porting in 2026?

Regulation 17(2) of the IRDAI 2024 regulations fixes the window at 30 to 60 days before renewal. Apply earlier and the new insurer can decline as premature; apply later and it can decline citing insufficient time to underwrite. The window is hard.

What credits actually transfer when I port?

The elapsed 30-day initial waiting, the elapsed 24-month specific-disease waiting (cataract, joint replacement, hernia, kidney stones, ENT surgeries), the elapsed 36-month PED waiting, the cumulative bonus, and the elapsed months of the 60-month moratorium. Sub-limits, room rent caps, co-pays, and the list of PED conditions do not transfer — they follow the new insurer's product wording.

Can the new insurer reject my porting request?

Regulation 17(4) requires the new insurer to accept or decline within 5 working days of receiving complete proposal documents and the IIB continuity certificate. Rejection is permitted only on objective underwriting grounds backed by actuarial reasoning, communicated in writing. Silence beyond 5 working days is treated as acceptance. Rejection on age alone, or on a generic "underwriting policy" line, can be escalated to the IRDAI grievance cell at policyholder.gov.in.

Does porting reset the moratorium period?

No. The 60-month moratorium runs on continuous coverage. After 36 months at the old insurer you arrive with 24 months left. A one-day lapse during handover restarts the count.

What if I increase the sum insured at porting?

Continuity credit applies only to the lower of the old and new sum insured. The incremental cover is treated as fresh, with full 30-day, 24-month, and 36-month waiting periods running on it. Most policyholders are better served porting at the same sum insured and upgrading at the next anniversary.

Will Section 80D deduction continue after porting?

Yes, provided the policy is a notified health insurance contract under Section 80D of the Income Tax Act 1961. Deduction limits are unchanged: Rs 25,000 for self, spouse, and dependent children below 60, Rs 50,000 if any is 60 or above, and an additional Rs 25,000 (or Rs 50,000 if senior) for parents. Section 80D is available only in the old tax regime — Section 115BAC does not allow it.

What is the role of Bima Sugam in portability?

Bima Sugam, the IRDAI-mandated unified insurance marketplace, will route portability requests through a common interface from full rollout. You will see comparable products across insurers, generate the IIB continuity certificate inside the platform, and submit the porting request in a single workflow. Until full rollout, the existing IIB back-end and individual insurer portals remain operative.