Exhausted Health Insurance Sum Insured? Replenish It with the Restoration Benefit

When Sridhar Rao tested positive for Covid-19, he had to undergo extensive treatment in the ICU of a super-specialty hospital with severe complications. He had a health insurance policy of Rs 5 lakhs, with a restoration benefit clause. The full amount of Rs 5 lakhs was exhausted when he was discharged. Exhausted Health Insurance Sum Insured is just activated the service restoration benefit.

Exhausted Health Insurance Sum Insured

A few months later, he had a fall and had to undergo hip surgery, which cost almost Rs 2 lakhs. Fortunately for him, the restoration benefit clause came into operation, and the original amount of Rs 5 lakhs was restored on his policy. This is because Rao had opted for the restoration benefit while purchasing his health insurance policy.

What Is Restoration Benefit?

Over the last few years, insurance companies have introduced new products such as Recharge of Sum Assured and Restoration of Sum Assured. Though both these products are similar, they differ significantly. Restoration benefit will refill the policy up to the basic sum assured when the basic sum insured and accumulated benefits are no more . Exhausted health insurance sum insured is basically starting the restoration service which will restore your sum insured.

This benefit is available only for future claims and not for any other claims already paid during the specific year. It is also used only once during a specific year and cannot be carried forward if unused in a specific year.

Your family members can also use the restoration benefits within limits.

Types of Restoration Benefits

There are two types of restoration benefits and everyone has their specific role and each one has a certain benefit as per time.

Complete exhaustion: Here, the benefits come into play only when the complete sum insured is exhausted. Complete exhaustion is quite like a “one-time benefit”, cause the first time you used the whole amount of the sum insured and after that, you have to wait a long time till your sum insured is restored once again. And, that’s why it’s quite like a “one-time benefit”.

Partial exhaustion: Benefits can be accessed even with part exhaustion of the sum insured. Partial exhaustion is quite like a “grasping at straws”, the first time you used your sum insured amount, and after that, it’ll take time a restore the amount but when you need it most it helps you than when you was drowning in the river. So, that’s why it’s quite like a “grasping at straws”

Advantages of Restoration Benefit

When you purchase a health insurance policy, ensure that it offers 100% restoration. or  you can call refill policy. There are several important advantages to this type of policy:

  • Coverage: The plan is available for families and individuals, especially for families opting for family floater plans. The plan is best for family floater plans.
  • Add-on:  it is very useful if you have to undergo a second hospitalization in that specific year. It can also be taken when buying a health insurance plan at a nominal extra cost.
  • It can be due to  an unrelated health condition
  • Ideal for clients who cannot afford a higher sum
  •  insured policies
  • Reduces out-of-pocket expenses in case of medical emergencies
  • Some plans allow restoration unlimited times in the policy year.
  • In case of an accident, if you have a family floater plan, each injured person will have the benefits up to the maximum of the sum insured.
  • The plan keeps you financially protected

Keep in mind

  • Restoration is only available for future claims
  • It works on a tenure basis
  • Some companies offer restoration benefits for the same illness with a time gap and at an extra price
  • Benefits are not available for the first claim of the policy year

Consider Medical Emergencies that may arise in the future or nearby

Look, talking about the restoration benefit in health insurance, this is one of those services that you have to add to your health policy, it will be beneficial for you. No doubt that adding restoration benefits to your health policy will increase your premium amount.  But with the help of this service, you will get a lot of help in the future.

Although many health insurance companies provided “restoration benefits” with the plan, you should add them if it is not with your plan. Some health insurance policies may cover similar illnesses during a policy year, while others only allow the sum assured going to use by other members for the same illness.

Plans that Offer Restoration Benefits

Insurer CompanyPlanRestore Benefits
HDFC ErgoOptima Restore Family Floater PlanUp to 100% Sum assured
Niva BupaHeart Beat Family FloaterUp to 100% Sum assured
Star Health InsuranceStar Comprehensive InsuranceAutomatic restoration of up to 100%
Star Health InsuranceFamily Health Optima Automatic Restoration at 300% of sum insured

Pros of Buying a Health Insurance plan with restoration benefit

  • Restoration benefit is a valuable service that people looking for, and in health insurance “restoration” can help you financially.
  • You have an extra option of getting treatment under the single policy in the same year.
  • If you want to buy a health policy, then you should opt for that plan that provides you with restoration benefits. With this, you will never pay an extra penny for adding restoration service with the plan and it’s really beneficial for you.
  • Restoration benefits will also serve you in a family floater policy, it will cover the whole family with a sufficient sum insured.
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Sonia Nagpal

Sonia Nagpal is an Insurance Specialist. She has more than 25 Yrs of experience in sales, Marketing and Corporate Alliances.

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