Health Insurance – Restoration benefit: Know how it works | The Financial Express

Health Insurance – Restoration benefit: Know how it works

The restoration benefit in the policy will be valid only once for the entire policy year and cannot be carried forward to the next year.

Health Insurance – Restoration benefit: Know how it works
For instance, if the sun insured is exhausted for an heart ailment, then the restored sum insured cannot be used for another heart-related claim in the same policy year.

With rising healthcare expenses, individuals must look for a health insurance plan with restoration benefits. In such a plan, if the sum insured is exhausted in the policy year due to hospitalisation of the insured, then the insurer will replenish the sum insured along with the accrued cumulative bonus. The restoration benefit in the policy will be valid only once for the entire policy year and cannot be carried forward to the next year.

The restoration benefit will make the cover expensive, unlike a top-up plan. Moreover, the restoration benefit is mostly not applicable for related claims. For instance, if the sun insured is exhausted for an heart ailment, then the restored sum insured cannot be used for another heart-related claim in the same policy year.

Works well in family floater
In case of a family floater plan, the reinstatement of the sum insured will be on floater basis for all insured persons. In fact, experts say the restoration benefit works well in case of a family floater plan as the entire sum insured is shared by all the members in the family. For instance, a family has a floater plan of `5 lakh and the entire amount is exhausted in the treatment of two members of the family. If another family member is hospitalised, then the restore benefit will trigger and the medical expenses will be covered up to the sum insured. Experts say if a policyholder wants maximum coverage, then he should ensure that the restoration benefit is added to his health insurance policy.

Also Read: What goes into porting a health insurance plan? Everything you need to know

Insurers offer two types of restoration benefits — complete exhaustion or partial exhaustion. In the former, the benefit will be applicable only when the entire sum insured is exhausted. In the latter, it kicks in even after a part exhaustion of the sum insured.

Points to check
Check the terms and conditions on the restoration of the sum insured for related as well as non-related illness for the same cover, before deciding on the restoration benefit. See if it is an add-on which you can buy with the policy, and if two or more members of your family suffering with the same disease can claim for restoration benefit.

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First published on: 31-10-2022 at 12:15:00 am
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