Thanks to the rules of the Insurance Regulatory and Development Authority of India (IRDAI), it is possible to shift or migrate your membership of a group medical health insurance policy to an individual health insurance policy. If your family members were also covered under the group health insurance scheme, there is also the option for all your family members to migrate to a family floater policy together.
One is often faced with this challenge on two occasions:
- When you change your job
- When you retire or resign
It is quite usual for corporates and large organisations to offer their employees coverage under a group medical insurance scheme. However, during a job switch, job loss or retirement, one is forced to deal with the issue of medical insurance coverage personally. Since most individual and family floater health insurance policies come with a waiting period, it is crucial to find ways to ensure continuous coverage for any hospitalisation or serious medical issue once you are no more covered by a group medical insurance scheme.
In order to insure yourself from Day 1 of your retirement or transition, you could migrate your policy from the group medical insurance policy to an individual health insurance scheme. You could also opt for a family floater plan – this will allow two or more family members to be covered under a single premium. While the sum insured is shared by all the individuals under the plan, many medical insurance service providers will also offer you a reload facility of up to 100% of the base sum insured.
However, here are some safeguards to protect yourself from unpleasant surprises and ensure seamless coverage:
Adopt These Ways to Transition to an Individual or Family Floater Plan
1. Make a Transition with the Same Insurance Provider
It is usually the same medical insurance provider you need to keep in order to avoid the waiting period while shifting from a group medical insurance policy to an individual one. But then, it will also depend on that insurer. So, enquiring about the same before transitioning does no harm to you. However, after having been a member of an individual/family floater policy for at least a year, you could consider changing the service provider to one that offer’s better value for money.
2. Compare Plans
There are a variety of plans offered by each health insurance company. These can be confusing. Some plans may cap room rates as per the total amount insured. Some exclude specific diseases from coverage. Some may exclude pre-existing conditions. Compare health insurance plans offered by the service provider carefully and choose the one that best represents the needs of everyone covered under the individual or family floater plan.
3. Look for the Reload Facility if Shifting to a Family Floater Plan
You may ask - What does this reload facility mean? Sometimes, it can happen that after filing a health insurance claim for one of the insured family members throughout the year, there is not enough money left over to pay for any other claims filed by the other insured family members during the same year. To allow you to submit a second claim during the same year, several insurers today offer to reset/reload the sum insured up to 100% of the base figure.
Read more- Individual Health Insurance Vs Family Floater Health Insurance Plan
4. Begin the Dialogue Early
It is good to start the dialogue with the medical insurance service providing company between 45 to 60 days in advance in order to ensure a seamless migration. There may be a mandatory medical check-up before acceptance on the individual or family floater policy. You could be required to pay for this yourself at the hospitals that the insurance provider has recommended. However, there are many companies that offer the check-up facility at no extra cost.
5. Clarify Regarding The Waiting Period
Generally, there is no waiting period in a group medical insurance policy and so the same clause is likely to apply when you convert to an individual policy or family floater plan. But insurance companies may apply the same on conversion, more so when you do that at a different insurance provider.
Read more - Waiting Period In Health Insurance
6. Fill in the Necessary Forms
Make sure you fill up all necessary forms. A simple conversation will definitely not do. The acceptance of the proposal will be subject to the guidelines of the insurance company.
7. Get the Terms and Conditions Offered by the Medical Insurance Plan in Writing
Ask for a brochure regarding the plan you hope to take so that there is no misunderstanding. Clarify all doubts.
So yes, while it is possible to migrate from a group insurance plan to an individual or family floater plan, you need to plan ahead, choose carefully and submit your application on time in order to ensure seamless coverage.
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