Health

What is Restore Benefit in Health Insurance?

Over the years, health insurance has evolved significantly. Today, insurers offer a wide range of policies with numerous features and benefits. One such feature that has gained immense popularity among insurance buyers is the restoration benefit.

Imagine a situation where you exhaust the sum assured and the cumulative bonus of your health insurance and have zero coverage. In such a case, if a family member gets hospitalised, you will not get any compensation from the insurer, and you must pay the bill from your pocket. But you can avoid this situation if you have a plan with restoration benefits.

What is the restoration benefit in health insurance?

As the name suggests, the restoration benefit in a health insurance plan restores the entire sum assured along with the accrued cumulative bonus after you have exhausted it within a calendar year. You can avail the restoration benefit irrespective of whether you have an individual or family health insurance policy.

The restoration benefit, commonly known as refill benefit, is an add-on cover. You can purchase this add-on along with your existing healthcare plan by paying an additional premium. While it may cost you a little extra initially, it may come in handy if you need multiple hospitalisations in a single policy year. It essentially acts as a financial backup during an emergency.

How does the restoration benefit in health insurance work?

Let us understand the working of this benefit with an example.

Miss. Archana Singh purchased a family floater health insurance policy with a sum assured of Rs. 7 lakhs. Now, when her father was diagnosed with a liver ailment, Miss. Singh used up the entire sum assured for the hospital expenses in one go. Now, in the same year, Miss. Singh herself gets hospitalised and incurs an expense of 1.5 lakhs.

Since she has already used the entire sum assured amount and does not have the restoration benefit add-on, she must pay for the second hospitalisation from her pocket. However, if she had the restoration benefit, the insurance company would cover the cost up to the base sum insured limited.

Types of restoration benefit

Most health insurance plans offer two types of health restoration benefits: complete exhaustion and partial exhaustion.

Complete exhaustion: This type of restoration benefit comes into play when you use up the total sum insured amount within a policy year. Generally, most health insurance plans come with full or complete exhaustion restoration benefits.

Partial exhaustion: If your health insurance policy offers partial exhaustion benefit, you can get the sum insured restored after using up a part of the sum insured amount.

Important things to know about restoration benefit

  • You cannot carry forward the restoration benefit to the next policy year.
  • You cannot use this benefit for the first claim in a policy year.
  • Many health insurance buyers believe that restoration benefit applies only for policies that have a high sum insured. However, the truth is it can be applied to any policy, irrespective of the sum insured amount.
  • Restoration benefits are applicable only for future claims.
  • It is a valuable add-on to have for family floater plans. If one family member uses the entire sum insured amount, others can continue to enjoy the cover with this benefit.

Conclusion

Now that you know the benefits and features of restoration in health insurance plan, it is a healthy practice to keep your medical insurance, whether individual or floater (family) at the maximum limit.

Your and your family’s health is of utmost concern; so, do not let hospitalizations and medical expenses take a toll on your mental health.

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