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Restore Option in Health Insurance Policy – Why to Buy?

Health Insurance Guidelines

Sum insured restoration option is a feature offered by many health insurance companies to make sure that the policyholder is covered adequately even after the coverage amount is exhausted. This option is allowed once a policy year and is known as the restore option.

Since the cost of healthcare has soared up in the last decade or so, the importance of having a good and all-inclusive health insurance has become pertinent. If you are looking at the best health plans for you and your family, make sure to get a comprehensive policy with sum insured restore benefit.

So, what is the restoration benefit in health insurance?

By restoration benefit in health insurance, it means that the insurance company will restore the sum insured (SI) to the original amount if you have used up your SI due to claims. For instance, suppose you have a family floater health insurance plan with SI INR 20 lakh. Now, you were diagnosed with a critical illness and had to be hospitalized for the treatment. The entire hospitalization bill came to around INR 20 lakh. So, your sum insured for the policy year was exhausted with that one treatment. However, 6 months later, your wife falls sick. Now, she also went through hospitalization and you faced a bill of INR 5 lakh. However, you have already used up the entire sum insured for the policy year while undergoing your treatment. So, how can you raise a claim for your wife’s hospitalization expenses?

Here, the restoration benefit comes to your rescue. Since, you have opted for a 100% sum insured restore option in your health plan, your insurance company restores the entire amount of INR 20 lakh back in your policy SI. This makes it a total cover of INR 40 lakh that is paid by your insurer within one policy year under the restore benefit option.

Hence, it is advisable to buy a policy offering 100% sum insured restoration benefit to avail the feature when you actually need it. Restore option is an add-on that one can avail with a health insurance policy by paying an extra price. The Restore option is also termed as 'Refill' option by some insurance companies.

Types of Restore Options

Restore option are of two types - Complete exhaustion and Partial exhaustion

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Complete exhaustion

This option of restore benefit can be availed by the insured only when the entire amount of your sum insured together with bonus and all are exhausted.

Partial exhaustion

Partial restoration benefit is a feature that can be availed by the insured even if the person has exhausted a partial sum insured. Thus, this option is regarded as more beneficial for policyholders.

For example, suppose your health policy has an SI of INR 3 lakh. Now, you have exhausted INR 2 lakh for a treatment and INR 1 Lakh is remaining. However, you had to raise another claim within the policy year of an amount that is more than the remaining SI. Here, the partial exhaustion option would allow you to get complete SI restored under the plan.

Pros of availing restore option

The restoration of cover offered as an add-on with health Insurance policies comes with different pros and cons. Hence, a policy seeker has to look into these fine points in detail by reading their policy document before availing the benefit of this option.

Here are some restoration benefits of health insurance:

  • The restore benefit allow the policyholder to enjoy added SI within the same policy year if it gets exhausted
  • If your plan comes with an in-built restoration benefit, you can avail the option of additional coverage even without paying an extra premium
  • A restoration benefit allows the policyholder to stay prepared against any kind of medical emergencies, while ensuring that you are never short of funds to raise a health claim
  • If you have a family floater plan, the restoration benefit would ensure that all family members are covered or they receive the required sum insured within a policy year 

Conditions under the restoration benefit

There are certain conditions that are applicable under the restoration benefit, which vary from policy to policy:

  • You can receive the restoration benefit only for different illnesses
  • You are not eligible for the restoration benefit in case of your first claim during the policy term
  • You cannot carry forward your restoration benefit to the next policy year if the add-on is not used in the current year
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To Sum Up

The restoration benefit offered under health insurance comes with several advantages. However, it is important to do a comparison of different plans before choosing a particular policy. Think about the premium price and the medical conditions that you are suffering from while opting for the restoration benefit.

Frequently Asked Questions

The restore benefit supports a policyholder to restore the sum insured of his/her policy once it gets exhausted after a claim. The benefit is available with both individuals and family floater plans

No, it cannot be availed on the same claim for the same treatment. For instance, suppose your policy Sum Insured under your health insurance is INR 5 lakh and the claim amount of a certain medical treatment you went through is INR 7 lakh. In that case, the extra IN 2 lakh needs to be paid from your own pocket. But if you get hospitalized again and for a different illness, you can avail the restoration facility for that treatment.

You can raise claims of health insurance multiple times during your policy term, until your sum insured is exhausted.

Automatic Restoration in Health Insurance is the feature that restores the SI of your policy to the maximum when it gets exhausted.

Though most health insurance policies offer a restoration benefit in case the sum insured under your policy gets completely exhausted. However, it is better to confirm the same with the insurance company before buying the plan.

The sum insured (SI) of your basic health plan gets fully recharged after you have utilised it by raising claims. This is called restoration of cover in health insurance.

* Rs. 245/month is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*! Rs. 334/month is the starting price for a 10 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*@ Rs. 12/day is the starting price for a 5 lac family health insurance for an 25-year-old male and 22-year-old female, with no pre-existing diseases.
*# Rs. 12/day is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*$ Rs. 600/month is the starting price for a 20 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*^ Rs. 12/day is the starting price for a health insurance that covers coronavirus for an 25-year-old male, with no pre-existing diseases.