Restoratio Benefits in Health Insurance

What is restoration of cover in health insurance?

Restoration of cover in health insurance refers to a feature that restores the sum insured to its original amount after it has been fully used. The restoration benefit in health insurance is increasingly seen as a key feature for consumers who want extended protection during multiple medical emergencies.

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. Many insurers promote this as a reset benefit in health insurance, where the sum insured resets automatically when the base amount is used up.

Let us understand the Restoration Benefit with an example.

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. Some plans also offer unlimited restoration in health insurance, allowing the sum insured to be replenished multiple times during the policy year.

What are the highlights of Restoration Benefit?

Restoration Benefit helps restore the exhausted sum insured, and ensuring the financial backup for your subsequent hospitalisation. With growing medical expenses, the restoration benefit in health insurance has become a deciding factor for individuals looking for comprehensive coverage.

• 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. Both partial and complete options ensure the restoration of sum insured in health insurance as per the policy terms, enabling uninterrupted coverage.

1. Complete utilisation of Sum Insured

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

Also Read: Best Medical Insurance for Parents

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:

These options help customers understand how the restore benefit in health insurance is triggered during repeated medical claims.

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 a 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. Understand the restoration benefit properly to choose a policy. 

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.