{"id":1968,"title":"HEALTH INSURANCE PORTABILITY PORTABILITY FORM","purpose":"service","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/resources/health-portability-form.pdf","sha256":"de65dcea576245bec4c930e4a96c8dbc91dd874b575deb177e0be7df44959e88","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders who wish to port their health insurance policy from one insurer to another or from one plan to another within the same insurer. The policyholder fills this form to provide details required for portability.","notes":["Portability rights cannot be enjoyed if there is a break in policy (premium not paid on or before renewal date or within 15 days thereafter)","Attach photocopy of the existing policy documents","Use the form as per instructions and timelines to ensure portability"],"title":"HEALTH INSURANCE PORTABILITY PORTABILITY FORM","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Part I","fields":[{"help":"Enter the date of filling the form","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Part II","fields":[{"help":"Select YES or NO","type":"choice","label":"Whether the PED exclusions / time bound exclusion have longer exclusion period than the existing policy: YES NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Write your consent agreeing to observe the additional waiting period for specified diseases/treatments","type":"text","label":"If yes, please give written consent to the declaration below","options":[],"required":null,"pdf_field":""},{"help":"Sign here to confirm consent","type":"signature","label":"Signature of the Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Policyholder and Policy Details","fields":[{"help":"Enter full name of the policyholder or insured person","type":"text","label":"Name of the Policyholder/insured(s)","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth or age","type":"date","label":"Date of Birth/Age","options":[],"required":null,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address of the Policy Holder","options":[],"required":null,"pdf_field":""},{"help":"Fill details: i) Name of the Product, ii) Sum Insured, iii) Cumulative Bonus, iv) Add-ons/riders taken, v) Policy Number","type":"table","label":"Details of Existing Insurer","options":[],"required":null,"pdf_field":""},{"help":"Fill details: i) Name of the Product proposed/intended to take, ii) Sum Insured Proposed, iii) Whether Cumulative Bonus to be converted to an enhanced sum insured","type":"table","label":"Details of the Proposed Insured","options":[],"required":null,"pdf_field":""},{"help":"Explain the reason(s) for porting the policy","type":"text","label":"Reason(s) for Portability","options":[],"required":null,"pdf_field":""},{"help":"Enter the number of family members to be included","type":"number","label":"No. of family members to be included in the policy to be ported","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Apply to the new insurance company at least 30 days before, but not earlier than 60 days from the due date for renewal","Decision to accept or reject the proposal to be taken within 7 days from receipt of complete information from the existing insurer"],"applies_to":"health insurance policy portability","attachments":["Photocopy of the existing policy documents"],"declarations":["The policyholder agrees to observe the additional waiting period for specified diseases/treatments if the new policy has longer exclusion periods","Insurance is the subject matter of solicitation and policy documents should be read carefully before concluding a sale"],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"contactus@universalsompo.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"ms\nClaim Status\nCrop Insurance Claim Details\nTPA’s Servicing Group Health Insurance\nDownload Pulz App\nConnect with Us\ncontactus@universalsompo.com\ncontactclaims@universalsompo.com\nHealth Insurance :\nComplete Healthcare Insurance\nA Plus Health Insurance\nSaral Suraksh","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-200-4030","label":"Customer Care","level":null,"hours":"24/7","applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"s or investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.\nCustomer Care\n1800-200-4030\nCrop Helpline\n14447\n,\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout Us\nContact Us\nGrievance Redressal\nLogin\nI am a C","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"14447","label":"Crop Helpline","level":null,"hours":null,"applies_to":"crop","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"Public receiving such phone calls are requested to lodge a police complaint.\nCustomer Care\n1800-200-4030\nCrop Helpline\n14447\n,\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout Us\nContact Us\nGrievance Redressal\nLogin\nI am a Customer\nI am an Agen","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-200-5142","label":"Crop Helpline","level":null,"hours":null,"applies_to":"crop","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"receiving such phone calls are requested to lodge a police complaint.\nCustomer Care\n1800-200-4030\nCrop Helpline\n14447\n,\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout Us\nContact Us\nGrievance Redressal\nLogin\nI am a Customer\nI am an Agent\nMy Transaction","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"gro@universalsompo.com","label":"Grievance Redressal Officer Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"e Co Ltd.\nUnit No. 601 & 602, 6th Floor,\nReliable Tech Park, Thane - Belapur Rd,\nNavi Mumbai, Maharashtra 400708\nEmail: gro@universalsompo.com\nContact Us for Grievance\n1800-200-4030 / 1800-22-4030\n(24/7 Assistance Services)\nVisit Branch\nGrievance Redressal Offic","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-200-4030","label":"Grievance Redressal Contact","level":1,"hours":"24/7 Assistance Services","applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"s or investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.\nCustomer Care\n1800-200-4030\nCrop Helpline\n14447\n,\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout Us\nContact Us\nGrievance Redressal\nLogin\nI am a C","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-22-4030","label":"Grievance Redressal Contact","level":1,"hours":"24/7 Assistance Services","applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"ne - Belapur Rd,\nNavi Mumbai, Maharashtra 400708\nEmail: gro@universalsompo.com\nContact Us for Grievance\n1800-200-4030 / 1800-22-4030\n(24/7 Assistance Services)\nVisit Branch\nGrievance Redressal Officer (GRO)\nWalk-into any of our nearest branches and req","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Grievance cell, Universal Sompo General Insurance Co.Ltd, Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane - Belapur Rd, Airoli, Navi Mumbai, Maharashtra 400708","label":"Grievance Cell Postal Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-critical-Illness-insurance-policy/policy-wording.pdf","quote":"ww.universalsompo.com\nToll free: 1800-22-4030 Senior Citizen1800-267-4030\nE-mail: contactus@universalsompo.com Courier: Grievance cell, Universal Sompo General Insurance Co.Ltd, Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane - Belapur Rd, Airoli, Navi Mumbai, Maharashtra 400708\nlnsured person may also approach the grievance cell at any of the company's branches with the details of grievance lf l","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"contactus@universalsompo.com","label":"Grievance Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-individual-accident-policy/policy-wordings.pdf","quote":"case You are aggrieved in any way, You may register a grievance or Complaint by visiting Our website or write to us on contactus@universalsompo.com. You may also contact the Branch from where You have bought the Policy or the Complaints Coordinator who can be reached","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1-800-224030","label":"Toll Free Number for Grievance (MTNL/BSNL Users)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-individual-accident-policy/policy-wordings.pdf","quote":"the Complaints Coordinator who can be reached at Our Registered Office. You may also contact on Our Toll Free Numbers: 1-800-224030 (For MTNL/BSNL Users) or 1- 800– 2004030 or on chargeable numbers at +91-22-41659800/+91-22-41659900 You can also visit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1-800-2004030","label":"Toll Free Number for Grievance","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-individual-accident-policy/policy-wordings.pdf","quote":null,"fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-22-41659800","label":"Chargeable Number for Grievance","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-individual-accident-policy/policy-wordings.pdf","quote":"lso contact on Our Toll Free Numbers: 1-800-224030 (For MTNL/BSNL Users) or 1- 800– 2004030 or on chargeable numbers at +91-22-41659800/+91-22-41659900 You can also visit Our Company website and click under links Grievance Notification If the issue still","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-22-41659900","label":"Chargeable Number for Grievance","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/assets/file/withdrawn-products/pos-individual-accident-policy/policy-wordings.pdf","quote":"ur Toll Free Numbers: 1-800-224030 (For MTNL/BSNL Users) or 1- 800– 2004030 or on chargeable numbers at +91-22-41659800/+91-22-41659900 You can also visit Our Company website and click under links Grievance Notification If the issue still remains unresolv","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/universal-sompo-general-insurance/1968-health-insurance-portability-portability-form"}