How could Restoration Benefit in Health Insurance Policy become an Advantage?

May 26, 2021 (0) comment , , , , ,


In the previous article, we discussed the necessity of opting for add-ons. Riders in the health insurance plan can provide us all the needed advantages in times of medical crisis, making the treatment process less problematic. In addition, these add-ons make health insurance comprehensive and complete.

Now, realizing the need of each insurance rider makes it essential before diving into buying all of them together. It would only increase the premium rate, even if it were of no use to customers in their insurance plan. Parallel to this knowledge of need, one should not forget that individuals or their families could get sick more than once in a single policy period. It is one of those unprecedented circumstances that must be involved in the list of all inevitable incidents. It is more than possible that an individual’s total sum insured covered by their insurance policy comes to an end in the first time of its use. The rising cost of the healthcare facility or covering the hospitalization expense makes the policy reach its sum insured limit.

Hence, the restoration benefit is just the right thing for a person to include in their health insurance plan and make it satisfactory. The rider can solve the medical crisis twice a year. It now depends on the individual’s insurance brand, whether or not they can provide the facility of refilling the coverage of sum insured in a single policy period. People are now even more aware of their rights and benefits when spending a few pennies out of their pocket.

In this article, experts from the Secure Cover team will discuss the benefits of restoration policy and how it works.


What is Restoration Benefit?

Restoration Benefit is the must-have rider required to be added to a health plan. An insurance policy is of no use if one cannot use it every time there is a medical emergency to a person or their family member. Restoration benefit is a facility provided by the insurer to refill the sum insured coverage if it exhausts or reaches its limit in a single policy period. This feature of reinstating the total sum insured, if used up for the first time by an individual for themselves or their family, enables the security and assurance to afford healthcare treatment.

The second hospitalization becomes a less-worrisome moment, even if the insurance plan’s coverage has exhaust at the beginning of the year. However, many people still are unaware of the restoration benefit, so if the coverage exhausts in a single policy period, they might have to think about taking a loan or empty their savings to treat themselves or their family members for the second time.

Restoration benefit is capable of helping the most when an individual has opted for a Family floater plan. For example, suppose the policyholder gets hospitalized for treatment of an illness during a policy period. The coverage of the entire hospitalization and medical expense exhausts the policy’s sum insured amount. In the same year, the policyholder’s child gets hospitalized due to severe sickness. If the policy owner has been able to add a restoration facility in his/her health plan, their child’s medical expenses would be covered too in the same policy year. It would mean that the insurer’s company reinstated their sum insured amount after it was exhausted for the first time.


Types of Restoration Benefit

There are two kinds or categories of restoration benefit depending on how much it has been exhausted.

  1. Complete Exhaustion:

    This restoration benefit would become active when a person has utilized their sum insured coverage entirely for a single policy period. For instance, if a person has 4 lakh sum insured coverage in his/her insurance plan, and a claim of 3 lakh is made by him/her. Post the payment is made for the claim, only about 1 lakh remains under the policy sum insured amount. During the second claim made in the same year, restoration benefits will not be considered into play. Whatever sum insured remains   (i.e., 1 lakh) would only be paid up irrespective of the policyholder’s claim amount. Hence, the exhaustion of the entire amount would only activate restoration benefit under this category.

  2. Partial Exhaustion:

    This category of restoration benefit would become active when a person has utilized their sum insured partially. For example, if a claim is made for the second time in the instance explained above, a complete 4 lakh would be reinstated as restoration benefit is applicable in partial exhaustion of the sum insured.


What to keep in mind or check while opting for a restoration benefit add-on?

Specific pointers must be kept in check while looking to add a restoration benefit to your health insurance plan. Most insurance brands currently offer stand-alone health insurance policies that already include restoration benefit in them. So it saves a customer from the extra hard work of going through a relevant add-on rider that reinstates their sum insured if it gets exhausted at the first time of use.

Here are few points that are necessary to look for while opting for the correct restoration benefit plan.

  1. Remember that the same restoration benefit could not be continued for the next policy year, even if the benefit has not been utilized in the previous policy year. Therefore, the benefit is only applicable in the year for which it is taken.
  2. One person at a particular time can avail of the restoration benefit.
  3. Restoration benefit could be added for any sum insured amount and not just for a higher sum insured in an insurance policy.
  4. Restoration policy is meant to be active for future claims. Hence, it will not be applicable while making the first claim in a policy period.
  5. Some insurance plan covers the same illnesses in a single policy period. At the same time, other allow the restored sum to be used by only others member of the family with the same disease.
  6. Most insurance brands have laid the guidelines of only restoring the sum insured for hospitalization expenses, only when the disease is unrelated/not similar. However, few other brands may agree to reinstate the sum insured for the same disease in a single policy period, with a gap of about 30-45 days. For this, they charge an extra price at the premium rate.
  7. Look for insurance brands that could offer unlimited coverage in the case of an accident.


Let’s Wrap Up!

It is essential to keep restoration benefit an option in an insurance plan because no one knows whether they could get sick in a single year twice or not. People who have opted for family floater health policy especially should consider adding restoration benefits. It would help the family members even if the policyholder has already exhausted the base cover. The benefit practically floats from one member of the family to the other.

Knowing what an insurer can give more to you and benefit you is the prime agenda of opting for health insurance. However, unfortunately, if it is not fulfilling the same, the policy itself has a loophole. So remember to read your restoration benefits thoroughly before finalizing them.

{To know how to choose the best health insurance plan, or learn more about several other add-on benefits, contact us @ 9315720732, or email us your queries at:}

Disclaimer: The content of this blog is based on the personal research of the writer. Reader’s discretion is advised. Neither Secure Cover nor the writer will be held responsible for any wrongful interpretation of the content of this blog.

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