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How Many Times Health Insurance Can Be Claimed in a Year?
If you have a health insurance policy, you must file a claim to get your insurer to pay for your medical expenses. Fortunately, you can file multiple claims during a policy year, provided your sum insured is not exhausted. Moreover, if you have the restoration benefit, you can raise claims even if your sum insured has been exhausted. Know more about how many times you can claim health insurance in a year and how the restoration benefit works.
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- How Many Times Health Insurance Can Be Claimed in a Year?
How Many Claims are Allowed in Health Insurance?
In health insurance, you can make multiple claims in a policy year, provided your sum insured is not exhausted. This means you are free to claim your medical expenses as many times as required if you have a balance sum insured. Once you have claimed your entire sum insured amount, you cannot raise any further claims and will have to pay your medical bills out of pocket.
However, if your sum insured has been exhausted, you can still file health insurance claims with the restoration benefit.
What is Restoration Benefit in Health Insurance?
The restoration benefit in health insurance restores your sum insured by 100% if the original coverage amount is fully or partially exhausted due to claims filed during the policy year. It allows you to claim your medical expenses without buying another policy, even if the base sum insured has been exhausted. Restoration benefit is especially useful for families covered in a floater policy, as they can file claims even if one family member fully utilizes the original sum insured.
Let's understand restoration benefit with the help of an example:
Neerav purchased a ₹5 lakh family health insurance plan with the restoration benefit. When Neerav underwent bypass surgery, he filed his first claim for ₹3.5 lakh. A few months later, his wife filed a health insurance claim of ₹1.5 Lakh due to some other medical emergency, leading to complete exhaustion of the policy sum insured.
Later, in the same year, Neerav had a heart attack, and his treatment generated a hospital bill of ₹4 lakh. Thanks to the restoration benefit, his policy coverage amount was restored by ₹5 lakh, allowing him to claim ₹4 lakh for the treatment of his heart attack.
How Does Restoration Benefit Work?
Restoration benefit may work differently for different mediclaim policies. Here are a few things to consider while claiming the restored sum insured amount:
- Number of Permitted Restorations - While some mediclaim policies may restore your sum insured amount unlimited times a year, others may restore it once a year.
- Type of Illness Covered – Many medical insurance plans may allow the restored amount to be used for claims arising from the same and unrelated illnesses. On the other hand, some plans may not allow you to use the restored coverage amount for ailments that you have already claimed.
- Activation of Restoration Benefit – The restoration benefit under most plans gets activated only after you file the first claim in the policy year. However, under a few plans, you can utilize the restored sum insured from the first claim itself.
- Partial or Complete Exhaustion – While some health insurance plans restore the coverage amount after partial exhaustion, others may activate the restoration benefit after complete exhaustion of the sum insured.
After How Many Days Can You Claim Health Insurance?
You can claim your health insurance policy after serving the initial waiting period of 30 days. During this period, no claims are allowed, except for accidental injuries. Once this waiting period is over, you can file a claim with your insurance company. Similarly, you may have to serve a waiting period of 1-2 years to file a claim for specified diseases and procedures.
If you have any pre-existing diseases (PED), you will have to serve a PED waiting period of up to 3 years. However, some mediclaim policies offer PED coverage from day 1 of the policy.
Do Health Insurance Premiums Increase with Multiple Claims?
Usually, your health insurance premiums do not increase if you file multiple claims. However, you may lose your No Claim Bonus (NCB) every time you file a claim. Hence, if you do not file claims frequently, you may reduce your premium amount.
FAQs
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Q1. Can I claim insurance multiple times in a year?
Ans: Yes. You can claim your health insurance policy multiple times a year, provided your sum insured is not exhausted or you have the restoration benefit. -
Q2. Can I claim health insurance twice in a year?
Ans: Yes, you can claim your health insurance twice in a year, as long as your policy sum insured is not exhausted. If the sum insured is exhausted with the first claim, then you can file the second claim only if you have the restoration benefit. -
Q3. How many health insurance claims can you make in a year?
Ans: There is no limit to the number of claims you can make in a policy year, provided the combined claim amount stays within your sum insured amount. If your sum insured amount has been exhausted, you can still file claims if you have the restoration benefit. -
Q4. What is the maximum limit for health insurance?
Ans: The sum insured is the maximum limit for your health insurance policy. You cannot claim an amount beyond your policy sum insured. -
Q5. Can I claim health insurance every year in India?
Ans: Yes, you can claim your health insurance policy every year as long as it is active. However, you cannot build your No Claim Bonus if you file a claim every year. -
Q6. Can insurance be claimed twice?
Ans: No. You cannot claim the same medical expenses twice in your health insurance policy.
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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
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*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.
*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.
*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases
*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.
*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.
*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
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