In India, the cost of healthcare is rising rapidly, making it crucial for individuals and families to have comprehensive medical insurance coverage
. Health insurance provides a safety net against unforeseen medical expenses and ensures access to quality healthcare services.
However, even with a well-designed health insurance plan, individuals may find themselves in a situation where the sum insured is exhausted due to multiple claims within a policy year. Claims are subject to terms and conditions set forth under health insurance policy.* This is where the restoration benefit proves to be a true game-changer. In this article, we will learn more about this benefit.
What Is Restoration Benefit?
The restoration benefit, also known as a recharge benefit, is a valuable feature offered by select health insurance providers in India. It serves to replenish the exhausted sum insured during a policy year, thereby allowing policyholders to avail of continued coverage for subsequent medical expenses within the same year.*
It is important to note that restoration benefit is not similar to loading in health insurance. As mentioned above, the restoration benefit restores the exhausted sum insured during the policy tenure to provide uninterrupted health insurance coverage
. On the other hand, loading is related to adding extra cost to the premium of the existing policy. If an insured individual is deemed to be high-risk by the insurance company, the additional premium is ‘loaded’ to the current premium at the time of renewal. This is done to cover the additional risk underwritten by the insurance company for the policyholder.
How Does The Restoration Benefit Work?
The functioning of the restoration benefit is quite simple yet effective. Let's consider a scenario where you have a health insurance policy with a sum insured of ₹5 lakhs. During the policy year, unfortunate circumstances lead to a medical emergency that requires hospitalisation where the treatment consumes the entire sum insured of ₹5 lakhs. Without a restoration benefit, your policy would typically cease to provide coverage for any further medical expenses during the same policy year.
However, if your policy includes a restoration benefit, it will automatically kick in and restore your sum insured back to the original amount, allowing you to avail of continued coverage for subsequent health issues within the same policy year, up to the sum insured limit.*
Why You Should Opt For It?
The restoration benefit has numerous advantages for policyholders. The benefits are:
- Provides Continuous Coverage
It provides a sense of financial security, ensuring that policyholders are not left unprotected after exhausting their sum insured. This feature is especially crucial in a country like India, where the cost of advanced medical treatments and hospitalisation can often be exorbitant. Even if you have accident insurance coverage
, you might get worried about exhausting its amount. The restoration benefit allows individuals to focus on their recovery rather than worrying about the financial burden. Claims are subject to terms and conditions set forth under health insurance policy. *
- Benefits Family Plans
Additionally, the restoration benefit proves beneficial for policyholders with family floater plans, such as health insurance with maternity cover
. In a family floater policy, the sum insured is shared among family members. If one member exhausts the sum insured, others may be left without insurance coverage. However, with the restoration benefit, the sum insured can be replenished, ensuring that all family members continue to receive coverage for subsequent medical expenses within the same policy year.*
- Accessibility To Healthcare Services
The restoration benefit encourages individuals to seek timely medical attention without any hesitation. Often, individuals insured by health insurance with OPD coverage may delay or avoid seeking medical help due to concerns about exhausting their sum insured. However, with the restoration benefit in place, individuals can promptly address health issues, leading to early diagnosis and better outcomes.
How To Include It In The Policy?
It is important to note that the restoration benefit is an add-on offered by the insurer. It is not offered by default with the policy. The cost and benefit may vary across health insurance policies and providers. Some policies may offer automatic restoration, while others may require the policyholder to request the restoration manually.*
Additionally, there may be certain conditions and limitations, such as a waiting period before the restoration benefit becomes applicable, or restrictions on the number of times it can be utilized within a policy year. Therefore, it is crucial for individuals to carefully review the terms and conditions of their health insurance policy to fully understand the extent and applicability of the restoration benefit.*
The restoration benefit has emerged as a significant advantage in health insurance policies. It serves as a lifeline for individuals and families, ensuring continued coverage even after the sum insured is exhausted. If you are considering buying a new policy or wish to switch to another insurer that provides this benefit, take the assistance of the health insurance premium calculator
to get a quote and see if it matches your budget.
*Standard T&C apply
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.