All About Restoration Benefit in Health Insurance

Much ado has been made about Restoration Benefits. Insurance companies are serving it on a platter to woo the customer but are they really worth all the fuss? Let’s find out.

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    What exactly is Restoration Benefit, you ask? You might believe your comprehensive health insurance policy will take care of everything once the need arises. While you feel confident to tackle any medical emergency – come what may – would your insurer be able to pay you if you need to make a claim for the second time in a policy period? The very real possibility of having more than one medical emergency at hand is forgotten by us all. So how to add coverage to your plan once you overuse the entire SI amount for a year?

    Herein comes the oft-misunderstood benefit of Restoration Cover that helps you stride through when your insurer stops short at right up to the amount entitled to you under the plan. Instead of dipping into your savings or taking out another loan – let Restoration Benefit take care of you.

    What is the Restoration Benefit?

    The refill option of Restoration Benefit is a benefit offered with comprehensive health insurance plans for individual plans as well as Family Floater Plans. Most commonly available as an add-on to your existing policy, it comes in handy in case of a second hospitalisation within one single policy year. It helps the original sum insured to be restored as soon as your original cover gets exhausted. Consider it your back-up plan in times of need.

    Does this Benefit You?

    If you are looking for a family floater policy, a restoration benefit add-on lets you make the most of the benefits available in the policy. Restoration benefit makes for an ideal choice for a family floater plan in place of enhancing the worth of your insurance – it ‘floats’ between the various members of your family covered under the family floater plan you opted for. 

    If it is but an individual health insurance plan that you’ve been eyeing, having a restoration benefit for higher coverage would let you cover an existing illness and/or accident.

    Types of Restoration Benefit

    The two major kinds of restoration benefit are categorised according to the level of exhaustion of sum insured:

    • Complete Exhaustion– Once the entire sum insured is exhausted, the benefit comes into play. This kind is what is offered by most Health Insurance Policies.
      Example: A claim of 4 lakh is made on a health plan with 5 lakh as an insured sum. Post claim payment, the remaining sum insured is 1 lakh. In case of a second claim made in the same policy year, restoration benefit is not applicable. Only the remaining sum insured shall be paid irrespective of the claim made.
    • Partial Exhaustion – With this option, the benefit comes into play even with only partial exhaustion of the sum insured. When it comes to being more beneficial to the insured individual, this restoration benefit should be your pick.
      Example: In the first example, 1 lakh would be left after the claim is made. But, the restore benefit would apply and the sum insured would be restored to 5 lakh which will be available for any future claim.

    How to Pick a Restoration Benefit Plan?

    A Restoration Benefit is an “Add-on” benefit that one can buy at the time of picking their insurance policy. All it takes is a nominal extra cost. A lot of features must be borne in mind as you compare health insurance before zeroing in on just the right one for you and your family.

    There are many conditions associated with any restorative benefit add-on that you need to go through at the time of purchase as also at the time of availing it. Some features are generic and common across all insurers whereas others are insurer specific.

    • Keep in mind these Conditions related to Restoration Benefit

      • The restoration sum insured cannot be carried forward to the next policy year, even if you did not consume it in the same policy year of restoration.
      • The total sum insured is reinstated once you exhaust it in a single claim within the policy term. 
      • Restoration benefit applies to any given sum insured, and not only the higher sum insured.
      • Restoration benefits exist only for future claims. It is never applicable to a first claim made in a policy year. Only subsequent claims fall under the purview. 
      • It is the most valuable add-on to have on a family floater plan. Once a member exhausts the base cover, other members can just continue to enjoy the cover.
      • Only one person at a time can avail of a restoration benefit.
    • For Medical Situations that might Arise in the Future

      To get maximum coverage at the least cost, one needs to add the restoration benefit to their health insurance policy. Although certain health insurance plans come with built-in restoration benefits. Add-ons will increase your premium by a slight margin but depends on policy term, plan type, etc. Thus, make sure to compare health insurance plans from different insurers before taking a pick. 

      • Your restoration benefit will trigger for an unrelated medical condition. For 2 members of the same family, the trigger point of the disease must be at different time intervals.
      • Some health insurance policies might cover the same illnesses during a policy year while others only allow the restored sum to be used by other members with the same disease. 
      • The industry practice is to let the restoration benefit be availed only in case of hospitalisation for unrelated diseases. Few companies may offer to restore the benefit with a gap of 30-45 days in case of the same illness. One will have to pay an extra price in that case.
      • Some insurers offer unlimited coverage in case of accidents.

    Pros of Having Restoration Benefit Cover

     The additional coverage provided by Restoration Benefit is most valuable and quite beneficial. Some of the benefits are as follows:

    • You get to enjoy an additional sum insured under your policy – an increase in available coverage.
    • For many health insurance plans with in-built restoration benefits, you get to enjoy extra coverage benefits without paying an additional premium.
    • Having a restoration benefit helps keep emergencies at bay and you never fall short in meeting a health insurance claim. 
    • Restoration Benefits in family floater plans cover all family members through sufficient sum insured.

     So, the pros of having a restoration benefit are manifold. Make sure you consider comparing health insurance plans before landing on a particular policy. A thorough research will help you get the ideal deal.

    Written By: PolicyBazaar - Updated: 23 July 2021

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