What is Restoration Benefit and How Many Times Can you File a Health Insurance Claim in India?

If you are insured under a health insurance policy then you can file multiple numbers of claims during a policy term provided it is within the limit of sum insured. The coverage limit is pre-specified and the policyholder can get coverage up to that specified amount only. During a policy term, unlimited number of claims can be covered as per the scope of coverage mentioned in the policy wordings.

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    The cost of hospitalization has risen so much that in certain cases the sum insured might get exhausted in the initial two or three claims only. In such a scenario, a restoration benefit or refill of sum insured is provided by health insurance companies once in a year.

    When the limit of coverage amount gets exhausted or the limit of sum insured is used up during the policy period, the insurer recovers the cost of medical treatments by refilling the basic coverage amount either once in a year or as per the limits specified in the policy wordings. The idea is to ensure that the insured gets paid for the undergoing treatment and can live with the peace of mind.

    Here is a scenario to help you understand better

    Neerav purchased a mediclaim policy for family with sum insured amount of Rs 5 lakh with restoration benefit. When Neerav underwent bypass surgery he filed the first claim and the treatment costed him around Rs 3.5 lakh. A few months later a health insurance claim of Rs 1.5 Lakh was filed due to some other medical emergency. His policy sum insured got exhausted during the second claim and his insurer provided him with automatic restoration of the base sum insured. Neerav can avail claim benefit of up to Rs 5 lakh again during that year because of restoration benefit.

    Later, in the same year, Neerav had some health repercussions due to the previous open heart surgery. Although his policy was of Rs 5 lakh still the health insurance claim won’t be settled. The restoration benefit feature, does not apply to the same course of medical treatment. Unfortunately, Neerav’s health insurance claim process will not be initiated for the treatment he has undergone earlier, and he will have to pay the hospitalization expenses himself. Therefore, it is imperative to know the policy terms and features of the health insurance policy that you are purchasing.

    Therefore, you should opt for an adequate coverage amount and check the limit for restoration benefit when buying health insurance in India. Mostly, all private health insurance companies in India provide restoration benefit but you should still check with your health insurance company about the restoration benefit. With refill benefit your sum insured amount gets doubled and helps you meet all the medical expenses.

    If you have some more doubts then you can check-out the answers to some of the questions that you might have regarding health insurance claim process.

    After how many days can you file claim for your health insurance policy?

    This will totally depend on your health insurance provider. There might be a waiting period before you can file a claim and also on some specific illnesses. And once this waiting period is over, you can lodge a claim up to the sum insured limit during the policy term.

    Can you file medical insurance claim with two insurers at the same time?

    No, it is not possible to file health claim with two insurance companies simultaneously. You will have to file a claim with the first insurance company and if that is not enough then you can claim for reimbursement from your other insurance policy. It is usually done with top-up mediclaim policies that offer coverage over and above the deductibles in the existing health plan. Make sure that you maintain transparency and disclose all the essential details to avoid claim rejection from either of the insurance providers.

    Is it possible to purchase multiple health plans for the same person?

    Yes, you can purchase multiple health insurance policies on the same person. This will offer wide coverage and availability of different benefits from each of the insurance providers. Having access to two or more health insurance plans can be beneficial, especially during claims.

    Written By: PolicyBazaar - Updated: 30 June 2021

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