What is Restoration of Cover in Health Insurance?

 How Restoration of Cover Works in Health Insurance

A restoration benefit allows you to claim additional financial support from your health insurance provider after utilising the full insured amount within a single policy year. Moreover, this vital add-on feature provides you with premium healthcare facilities when your insurance coverage has already depleted due to unexpectedly high medical costs.

Understanding Restoration Benefits Clearly

Restoration benefit is a useful feature for health insurance policyholders as it offers an extra insured amount after the initial coverage is utilised. Particularly, this aspect is convenient for those who require regular health checkups or are currently afflicted with a specific health condition.

For instance, suppose a policyholder obtains a Rs. 10 lakh health insurance policy and eventually accrues medical bills totalling that amount. In such a case, if he had the restoration benefit, the health insurance policy provider would readily restore the insured sum for the same year. It allows the person to avail high-quality medical facilities and services without worrying about out-of-pocket expenses. 

Two Main Types of Restoration Benefit

Two primary kinds of health insurance restoration benefits are available in India:

●Fixed Restoration Benefit
This add-on feature enables you to effectively double your initial sum insured by the medical insurer. However, to benefit from this, you must first exhaust the entire amount allocated by the insurance company as coverage. 

Let's assume you purchased a medical insurance plan with a coverage of Rs. 12 lakhs. Suppose, unfortunately, you had to undergo surgery within the policy year, completely utilising the coverage amount. In such a situation, you can request your insurance company to restore the total coverage within the same year. It empowers you to meet any subsequent hospitalisation needs without much difficulty.

●Partial Restoration Benefit
Partial restoration is preferable when compared to the fixed restoration benefit. It allows one to claim a top-up without fully utilising their insured amount.
For instance, if a policyholder has Rs. 7 lakh insurance with Rs. 2 lakh restoration, they can access this additional amount only if the main insured sum is substantially used in a sudden medical emergency. Thus, he is entitled to receive a total of Rs. 9 Lakhs within a single policy year. 

Limitations to Keep in Mind

While restoration benefits provide extended financial protection, they come with certain restrictions:

●Unrelated Conditions: Restoration benefits typically apply only to claims arising from unrelated illnesses or conditions. If the same illness requires treatment again, the restoration may not be applicable.

●Exclusions for Family Members: In family floater plans, the restoration benefit may not apply to the same family member within the same policy year, even for unrelated conditions.

Knowing that you own a medical insurance plan with a restoration add-on provides peace of mind. You can approach other aspects of life more confidently, knowing that you are fully equipped to tackle unexpected medical expenses effortlessly.

Also read:-

→ What is the Recovery Benefit of Health Insurance

→ What Is the Sum Insured In Health Insurance

→ What is Top Up in Health Insurance

→ What Is TPA In Health Insurance

→ What Medical Tests are Required for Health Insurance