Restoration Benefit in Health Insurance

What is Restoration Benefit?

The restoration benefit restores the sum insured of your health insurance policy up to the maximum limit as soon as it gets exhausted after a claim. This benefit is offered under health insurance plans available for individuals as well as families. Commonly known as the refill benefit, it is also available as an add-on cover to your existing policy and comes in handy in case of a second hospitalisation within a single policy year. You can consider it as your backup plan in times of need.

How Does Sum Insured Restoration Benefit You?

Restoration benefit is an ideal choice for policyholders opting for the family floater plan. This is because, in the case of the family floater health insurance plan, the same sum insured floats between all the insured family members.

If you want to buy an individual health insurance plan, having a restoration benefit for higher coverage would let you cover an existing illness and/or accident more than once in a policy year.

Types of Restoration Benefit

The two major kinds of restoration benefit are categorised according to the sum insured exhaustion level:

• Complete Exhaustion- Once the entire sum insured is exhausted, this type of restoration benefit comes into play. Most health insurance policies offer a restoration benefit for the complete exhaustion of the sum insured.

For example, a claim of ₹4 lakh is made on a health plan with a sum insured of ₹5 lakh. Post claim payment, the remaining sum insured will be ₹1 lakh. In the case of a second claim made in the same policy year, the restoration benefit will not be applicable. Instead, the restoration benefit will get activated only when the remaining sum insured is also exhausted and your sum insured will be fully restored.

• Partial Exhaustion- With this option, the restoration benefit comes into play even when only partial exhaustion of the sum insured takes place. When it comes to choosing a beneficial mediclaim policy, this type of restoration benefit should be your pick.

For example, if you have a sum insured of ₹5 lakh and you make a claim of ₹4 lakh, then ₹1 lakh would be left. Nonetheless, the restoration benefit would apply and the sum insured would be restored to ₹5 lakh, which will be available for any future claims.

How to Buy a Restoration Benefit Plan?

You can opt for the restoration benefit at the time of buying or renewing your health insurance policy. If the restoration benefit is available as an add-on cover, it will be available for an extra premium. However, there are many conditions associated with the restoration benefit that you must go through at the time of purchasing the policy. Take a look at some of those features below:

1. Keep in Mind the Conditions Related to Restoration Benefit

   • The restored sum insured cannot be carried forward to the next policy year, even if you do not consume it in the policy year when it was restored.
   • The total sum insured is reinstated even if you exhaust it in a single claim within the policy term.
   • Restoration benefit applies to any given sum insured and not only the higher sum insured.
   • Restoration benefits exist only for future claims. It is never applicable to the first claim made in a policy year.
   • It is one of the most valuable benefits to have under a family floater plan. Once you exhaust the base cover, your family members can just continue to avail the coverage.
   • Only one person at a time can avail of the restoration benefit.

2. Consider Medical Emergencies that May Arise in the Future

   • To get maximum coverage at a low premium, you need to add the restoration benefit to your health insurance policy. Although certain health insurance plans come with built-in restoration benefits, you may have to buy it as an add-on cover under a few plans. Buying it as an add-on cover will increase your premium by a slight margin depending on the policy term, plan type, etc.
   • Your restoration benefit will trigger for an unrelated medical condition. For 2 members of the same family, the trigger point of the disease must be at different time intervals.
   • Some health insurance policies might cover the same illnesses during a policy year while others only allow the restored sum insured to be used by other members for the same disease.
   • Few health insurance companies may offer to restore the sum insured on a gap of 30-45 days in case of the same illness. You may have to pay an extra premium in that case.
   • Some insurers offer unlimited restoration of the sum insured in a policy year.

Pros of Buying a Health Insurance Plan with Restoration Benefit

Restoration Benefit is quite valuable and beneficial under a health insurance policy. Some of the benefits of buying a health plan with the restoration benefit are as follows:

• You get to enjoy an additional sum insured under your policy within the same policy year.
• In the case of health insurance plans with in-built restoration benefits, you get to enjoy extra coverage without paying an additional premium.
• Having a restoration benefit helps you to stay prepared for any medical emergencies and you never fall short in meeting a health insurance claim.
• Restoration benefits in family floater plans cover all family members with a sufficient sum insured for all.

Summing It Up

Having a health insurance policy with the restoration benefit comes with multiple benefits. Make sure to compare various health insurance plans before choosing a particular policy. Do keep your budget and medical history in mind when deciding to opt for the restoration benefit.