Restoration Benefit in Health Insurance

Restoration Benefit in Health Insurance

How does ‘Restoration Benefit’ help in Health Insurance?

The very real possibility of unexpected medical conditions and their recurrence is often not foreseen by many of us. This may result in the entire Sum Insured and the bonus (if any) under one’s Health insurance policy getting exhausted mid-term, either due to a single hospitalisation or recurring illness or even due to the subsequent diagnosis of an entirely new medical condition. This exposes the policyholder to the risk of being without coverage for any further illness during the policy period.

Finding a way to replenish your Sum insured when entirely utilised would be a question then. In this scenario, the Restoration Benefit will help you with subsequent claims within the same policy year.

Let us understand the Restoration Benefit with an example.

Mr. Sameer purchased an individual Health insurance policy of Rs. 5 Lakhs of Sum Insured with Restoration Benefit. He was hospitalised for an ailment, the claim for which exhausted the entire Sum Insured of Rs. 5 lakhs.

A few months later, Mr. Sameer is diagnosed with another ailment (in the same policy period) which requires a medical expense of Rs. 4 Lakhs, whereas his basic Sum Insured is already completely utilised. In such a situation, 100% of the Sum Insured gets automatically restored (i.e. Rs. 5 Lakhs) without any additional Premium, which can be utilised for subsequent hospitalisation of the same illness or a different illness depending on the policy conditions.

What are the highlights of Restoration Benefit?

Restoration Benefit acts as a saviour in bringing back the exhausted Sum Insured and ensuring the financial backup for your subsequent hospitalisation.

  • Restoration Benefit is available in both individual and floater policies and  triggers upon partial or full utilisation of Sum Insured and Bonus (if any) depending upon the policy conditions.
  • Restoration Benefit plays a significant role in family floater plans, where the Sum Insured is shared by all the family members, and there is a higher chance of the entire Sum Insured getting exhausted amongst the family members.
  • Depending upon the policy types, Restoration Benefit is provided for the same illness in subsequent hospitalisations and even for the illness/disease for which claims were already made.

Key criteria related to Sum Insured Restoration/Reinstatement

  • Restoration Benefit is available for any given Sum Insured and is not limited to only higher Sum Insured options. 
  • Unutilised restored amount cannot be carried forward to the next policy period.

Exploring the types of Restoration Benefit

The restoration options are of two types. The Sum Insured will be restored either on partial or full utilisation of Sum Insured. It is advisable to read the prospectus of your Health insurance policy and understand the nature of the Restoration Benefit offered before opting for the same.

1. Complete utilisation of Sum Insured

Restoration of Sum Insured happens only on utilisation of the entire Sum Insured under the policy.

2. Partial utilisation of Sum Insured

Sum Insured is restored even upon partial utilisation of it. Hence this type of restoration proves to be more beneficial.

Star Health insurance offers the benefit of Automatic Restoration in various policies as follows:

Sl. No.Star Health Insurance PoliciesPercentage of Restoration in a Policy Year
1Star Comprehensive Insurance Policy100% – Once
2Family Health Optima Insurance Plan100% – 3 times
3Medi Classic Insurance Policy200% – Once
4Young Star Insurance Policy100% – Once
5Star Health Assure Insurance Policy100% – Unlimited

In conclusion

Health insurance offers coverage for medical and surgical expenses incurred by the insured during medical emergencies, either through the Cashless or Reimbursement claim process.

Choosing the best Health insurance policy in the Indian market can be tricky. Restoration Benefit is an important differentiator which gives a Health Insurance policy an edge over those which do not have it.

Every individual needs Health insurance that provides holistic coverage to meet the expenses of minor and major medical contingencies, including surgeries/treatment for life-threatening conditions. When you buy a Health insurance policy with Restoration Benefit, it gives additional support in case of exhaustion of existing Sum Insured, thereby giving the best value for the Premium you pay.

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