Restoration Benefit in Health Insurance - Restoring the Sum Insured

There are many aspects to health insurance that are not popular amongst the general public. People are usually not aware of different benefits that are packed within their health insurance, or those which can be bought as add-ons. These add-ons can help massively when required. Restoration benefit in health insurance is one such benefit that can be bought as an add-on when not included in the policy.

What is restoration benefit in health insurance?

With restoration benefit, if the sum insured gets fully or partially utilized, the insurance provider will restore it to the original amount. The amount is restored and the policyholder can it for future use during hospitalization and claims.

Often considered to be a backup plan, restoration benefit, also known as refill policy, can come in handy if treatment is required multiple times in a year.

Why is restoration benefit important?

Like everything else in life, it is important to have a backup plan. Similarly, in a health insurance policy, restoration benefit acts just like a backup option for your insurance. If by any chance you happen to utilize the entirety of your sum insured, the restore benefit will become useful. With this benefit, you need not worry about exhausting your insurance cover. It is beneficial in family floater plans as well because even if one member of the family exhausts the base amount of your chosen policy, the rest of the members can utilize the restored amount in case of medical emergencies.

For example - Suppose the family floater plan is for 5 Lacs and one of the family members’ get hospitalized. In case he or she utilizes the base amount, i.e, 5 Lacs, it will be refilled again upon exhaustion. This refilled amount can be used to curtail future medical emergencies by other family members.

Restoration benefit types

1. Complete exhaustion

If the total sum insured gets exhausted within a year due to multiple hospitalizations, then this type of restoration benefit comes into play. With complete exhaustion, you can get 100% of the sum insured restored in your policy. The majority of health insurance plans provide this benefit so that the patient does need not worry about the total exhaustion of his or her insurance policy.  This benefit is offered by a few insurers in an insurance policy, but it can be bought as an add-on.

For example - Ketan’s health insurance policy provides a cover of up to 5 Lacs. Due to some illness, he exhausted his cover within a few months only. If he has restoration benefit, upon exhaustion, the whole amount will be restored for his usage. He can use the full amount again if the necessity arises.

2. Partial exhaustion

With this benefit, even if your sum insured is not completely exhausted or utilized, you can still get the restoration benefit on partially exhausting your policy.

For example - If your original sum insured is 5 Lacs, from which you have exhausted 3 Lacs, you will be left with only 2 Lacs. But with a partial exhaustion policy in play, your amount insured will get fully restored to 5 Lacs, that is, the previously used amount will get refilled. The sum insured will be available for future medical requirements.

How to buy restoration benefit plan?

You can easily buy restoration benefits on your existing health insurance policy or while renewing one. It can also be bought as an add-on cover with a nominal increase in premium. It is important to know about the different benefits you can avail of while buying health insurance policies. One must go through the fine print beforehand to make optimum use of their insurance policy.

Also Read: Convalescence benefit in Group Health Insurance

Restore benefit in health insurance - Important points to note

There are certain things you need to be aware of before claiming the restoration benefit or restore benefit in health insurance policy

1. The restored amount can only be utilized in one policy year. The policyholder can not use the amount in the upcoming year.
2. Once the base amount is utilized, you can still benefit from the restored amount till the end of your policy year.
3. This benefit can be triggered for an unrelated medical emergency. That is, if you have utilized your base amount for heart-related uses, you cannot use the restored amount for heart-related issues for the second time.
4. It can be easily bought as an add-on policy with your existing insurance plan.
5. In the case of family floater plans, if one member has exhausted the base amount, the rest of the family can continue to enjoy the cover till the end of the policy year.