In 2025, medical costs are soaring, making quality healthcare increasingly expensive. While it's impossible to predict when a medical emergency might strike, it is essential that you stay prepared. A comprehensive health insurance plan serves as a reliable safety net, shielding you from unexpected medical and financial burdens.
However, with the inflation rates driving up medical costs to unprecedented levels, how much coverage is truly enough? More importantly, how do you make the most of your health insurance plan without increasing your premiums?
This is where the restoration benefit comes in as a powerful feature that automatically replenishes your sum insured once it's exhausted, giving you additional coverage without needing you to pay a single extra penny.
Curious about how it works and how it can enhance your coverage? Let’s dive in. This article explores what the restoration benefit in health insurance entails, its types, key advantages, and the top health insurance plans that provide this feature.
| Top Plans | Waiting Periods | Features | Insurer Metrics | Drawbacks |
|---|---|---|---|---|
| HDFC ERGO Optima Secure | SI WP: 2 years PED WP: 3 years (add-on can reduce it) |
Pre & post hospitalization cover: 60 & 180 days Restoration: 100% of base SI, once a year (Cost-effective addon to make it unlimited) Renewal Bonus: 50% pa, up to 100% (irrespective of claims) Secure benefit - 2X Coverage from day 1 |
Network Hospitals: 13k + CSR: 98% ICR: 86% |
While Optima Secure is a comprehensive policy, it is slightly more expensive. |
| Care Supreme | SI WP: 2 years PED WP: 3 years (add-ons can reduce it) |
Pre & post hospitalization cover: 60 & 180 days Restoration: Up to Base SI, unlimited times Renewal Bonus: 50% pa, up to 100% (add-on can increase it to 100% pa, up to 500% irrespective of claims) |
Network Hospitals: 11.4k+ CSR: 90% ICR: 59% |
Operational metrics could be slightly better. |
| Aditya Birla Activ One Max | SI WP: 2 years PED WP: 3 years (add-ons can reduce it) |
Pre & post hospitalization cover: 90 & 180 days Restoration: 100% of base SI, unlimited times Renewal Bonus: 100% pa, up to 500% (irrespective of claims) |
Network Hospitals: 12k+ CSR: 95% ICR: 68% |
Relatively newer insurer with a lower track record as compared to HDFC & Care. |
| Niva Bupa ReAssure 2.0 Titanium+: | SI WP: 2 years PED WP: 3 years (add-ons can reduce it) |
Pre & post hospitalization cover: 60 & 180 days Restoration: Up to Base SI, unlimited times No-claim Bonus: Carry forward unutilized cover up to 10x of base cover. |
Network Hospitals: 10k+ CSR: 91% ICR: 58% |
Operational metrics could be slightly better. |
| ICICI Elevate | SI WP: 2 years PED WP: 3 years (both can be reduced with add-ons) |
Pre & post hospitalization cover: 90 & 180 days Restoration: 100% restoration of the base cover, unlimited times Renewal Bonus: 20% pa, up to 100% (Add-on can make it 100% per year with no capping on maximum amount) |
Network Hospitals: 10.2K+ CSR: 85% ICR: 83% |
Operational metrics could be better. Need to take a variety of add-ons to truly make the plan comprehensive. |
Pro tip: The health insurance market can be a labyrinth. Instead of spending hours navigating through the hundreds of policies out there, why not book a 30-minute call with our expert IRDAI-certified advisors? We don’t spam or pressure you to buy. Just honest insurance advice.
What is the restoration benefit in health insurance plans?
Say you have 10 leaves left for the year and you take a much-needed trip, using up 5. Now, you’re left with only 5 for the rest of the year.
What if your company replenished your leave balance and gave you 5 more days off? Sounds perfect, right?
That’s exactly what a restoration benefit in health insurance does, but for your sum insured.
For example, if your sum insured is ₹20 lakhs and you use ₹10 lakhs for a claim, some insurers will restore ₹10 lakhs to your coverage. This means your total coverage for the year becomes ₹20 lakhs again, without paying anything extra.
A few months later, you make another claim for a different illness, with expenses amounting to ₹20 lakhs. If your health insurance policy doesn’t have a restoration benefit, you’d only have ₹10 lakhs left from your original ₹20 lakh sum insured. This means you’d have to pay the remaining ₹10 lakhs out of pocket.
On the other hand, if you have a plan with the restoration benefit, you’d have to pay nothing out of pocket. Let’s use a table to understand this better:
| Particulars | Coverage without Restoration Benefit | Coverage with Restoration Benefit |
|---|---|---|
| Initial sum insured | ₹20 lakhs | ₹20 lakhs |
| First claim (₹10 lakhs) | Coverage left: ₹10 lakhs | Coverage left: ₹10 lakhs + ₹10 lakhs (restored) = ₹20 lakhs |
| Second claim (₹20 lakhs) | Insurer pays ₹10 lakhs → You pay ₹10 lakhs out of pocket | Insurer pays ₹20 lakhs → Coverage left: ₹20 lakhs - ₹20 lakhs = 0 |
| Out-of-pocket payment | ₹10 lakhs | ₹0 |
Note: All the events have occurred in the same policy year. Additionally, this is an example of restoration up to base cover upon partial exhaustion for different illnesses. (We’ll learn about the types in the next section). Not all health insurance plans provide restoration this way. Please refer to the policy document of your plan to understand how restoration will work for you specifically.
This is how the restoration benefit automatically refills your sum insured if you exhaust it, giving you more coverage at no additional cost. This feature becomes especially valuable in family floater plans, where multiple hospitalizations can quickly drain your coverage. By restoring your sum insured every time you need it, the benefit ensures you’re always protected, no matter how many claims you make in a year.
Types of restoration benefit in health insurance plans
Not all plans offer the restoration benefit in the same way. There are four different types of restoration, with some types being preferable to others. Let’s learn about them in this section:
Restoration on partial or complete exhaustion of sum insured: Some insurers restore your sum insured only when it’s completely exhausted, while others do so even after a partial claim. Restoration on partial exhaustion is better than restoration on complete exhaustion as the restoration benefit kicks in after a single claim, regardless of how much base coverage you have left.
For example, if you have a ₹20 lakh sum insured and claim ₹10 lakhs, some policies will instantly restore the full ₹20 lakh coverage immediately by adding back the partially used amount. Others might restore it only after you’ve used up the entire ₹20 lakhs through a single claim or multiple claims.
Restoration for the same or different illnesses: Some policies restore your sum insured for hospitalizations or claims related to any illness, even if it’s the same condition or related conditions. On the other hand, there are policies that only restore coverage for a different illness. The former is better as you can avail the benefit for any illness, which reduces out-of-pocket expenses of treating an ongoing medical condition that requires multiple hospitalizations.
For example, if you claim ₹10 lakhs for heart surgery and then need another ₹10 lakhs for follow-up procedures, some insurers won’t restore your coverage for the follow-up procedures as it is a related ailment. However, others will, allowing you to use the restored amount for multiple claims in the same year, regardless of the condition.
Restoration unlimited times vs once per year: Some insurers offer unlimited restoration within a policy year, refilling your sum insured every time it’s exhausted. Others allow restoration only once per year, regardless of exhaustion. Obviously, unlimited restoration is preferable to restoration once per year. However, some insurers put a waiting/cooling off period between 2 restorations; ensure that you avoid those plans.
If you have a ₹20 lakh cover and make multiple claims of ₹10 lakhs, unlimited restoration ensures your coverage keeps refilling so you’re never left uncovered.
100% Restoration or restoration up to base cover: In health insurance, 100% restoration means your full sum insured is restored after a claim. For example, if your base cover is ₹20 lakhs and you claim ₹10 lakhs, the insurer adds back ₹20 lakhs — giving you a total cover of ₹30 lakhs.
However, some policies only restore up to the base amount. So, if you claim ₹10 lakhs from a ₹20 lakh cover, the insurer adds back ₹10 lakhs, keeping your total coverage capped at ₹20 lakhs.
100% restoration is always better as it provides more coverage than restoration up to base cover. However, most insurers will only allow you to use a sum up to your base cover (i.e., ₹20 lakhs) for a single claim, even though you have a total cover of ₹30 lakhs available.
Note: The best kind of restoration is 100% unlimited restoration upon partial exhaustion for any illness.
Benefits of restoration in health insurance
Choosing a health insurance plan with a restoration benefit can significantly strengthen your financial safety net. Let’s explore how this feature enhances your coverage and safeguards your finances:
Enhanced coverage without additional premiums: The restoration benefit replenishes your sum insured after it is fully or partially exhausted, providing extended coverage at no extra cost.
Support for multiple claims in a year: Restoration ensures you remain covered even after making multiple claims in a single policy year — a critical feature for chronic conditions or frequent hospitalizations. For severe or long-term illnesses that may require repeated hospital visits, restoration ensures uninterrupted coverage, preventing financial strain.
Protection against rising healthcare costs: With medical inflation driving treatment costs higher, restoration helps you avoid significant out-of-pocket expenses when your base coverage is depleted.
Ideal for family floater policies: In family floater plans, if one member exhausts the sum insured, the restored amount remains available for other family members, ensuring continued protection for the entire family.
Why do insurers offer the restoration benefit?
From a probability standpoint, restoration benefits make sense for the insurer because the likelihood of multiple policyholders exceeding their benefit limits is very low. Only a small percentage of insured individuals use the restoration feature, and even fewer experience multiple high-cost claims for the same ailment that exceed thresholds like ₹3 to ₹5 lakhs.
Example: Consider an insurance company with 1,000 policyholders. Suppose only 10 (1%) need the restoration benefit. Moreover, within these 10, the chance that one individual has several claims for the same ailment—each costing over ₹3 to ₹5 lakhs—is extremely low. The premiums collected from the majority (990 policyholders) effectively cover the minimal additional cost from those few rare, high-cost cases. This careful balance of risk helps keep the overall financial impact low for the insurer.
Top 4 plans with restoration benefit in health insurance
Choosing a health insurance plan with a restoration benefit can be a game-changer, but not all policies offer the same value. Let’s break down some of the top plans in 2025 that provide this feature, so you can pick the one that best suits your needs.
- HDFC Ergo Optima Secure: Optima Secure has loading charges but provides extensive coverage and benefits to its policyholders. It is a robust health insurance plan offering coverage from ₹5 lakh to ₹2 crore. This policy has comprehensive coverage with no room rent limits, disease-wise sub-limits, or mandatory copayment. It also includes extensive pre and post-hospitalization coverage, daycare procedures, and domiciliary treatments. With features like 100% restoration once during the policy period and a cumulative bonus of 50% per year up to 100% of the base sum insured, it provides significant financial protection. Unique benefits like the Secure Benefit, which doubles the base coverage from day one, and the Protect Benefit, which covers consumable expenses, make this plan an attractive choice. Additionally, home healthcare services are covered on a cashless basis. Notable add-ons include Unlimited Restoration and OPD coverage through Optima Well-being.
- Aditya Birla Activ One Max: Aditya Birla Activ One Max provides coverage from ₹5 lakh to ₹6 crore and includes wellness benefits like HealthReturns, which offers premium discounts for maintaining good health. It offers comprehensive coverage with loading charges based on your risk assessment. The plan has no restrictions on room rent and includes pre and post-hospitalization coverage of 90 and 180 days, respectively. It also covers daycare procedures, AYUSH treatments, and domiciliary care.
The Claim Protect feature ensures inbuilt coverage for consumables, while the Super Reload feature provides unlimited restoration benefits after the first claim. The Super Credit Bonus increases the sum insured by 100% annually up to 500%. Additional optional covers include Chronic Care, which provides day-one coverage for pre-existing conditions like diabetes and hypertension, a Cancer Booster for enhanced cancer-related expenses, and Durable Equipment Cover for medical devices like wheelchairs and ventilators. - Care Supreme: Care Supreme offers comprehensive coverage without additional loading charges for pre-existing conditions. It provides extensive coverage ranging from ₹5 lakh to ₹1 crore, ensuring flexibility without disease-wise sub-limits or room rent capping. The plan includes 60 and 180 days of pre and post-hospitalization coverage, daycare procedures, AYUSH treatments, and domiciliary care. The restoration benefit is available an unlimited number of times during the policy period, and policyholders can benefit from a cumulative bonus of 50% per year up to 100% of the base sum insured. Notable add-ons include Instant Cover, which reduces waiting periods for pre-existing conditions like hypertension and diabetes to just 30 days.
- Niva Bupa ReAssure 2.0 Titanium+: Niva Bupa is known for its robust coverage options and industry-first features. Keeping up with this trend, this policy offers unlimited restoration, booster benefits for the unutilized cover amount, and several useful add-ons. This plan also includes loading charges for higher-risk individuals. As an insurer, Niva Bupa has more than 10k+ hospitals under its network and a claim settlement ratio (CSR) of over 91%.
- ICICI Lombard Elevate: Elevate is a highly customizable health insurance plan offering flexible coverage, including an option for unlimited sum insured. It provides extensive benefits like no mandatory co-payment, full coverage for pre and post-hospitalization expenses (90 days before and 180 days after), and domiciliary treatments. The plan includes unlimited restoration benefits, allowing multiple claims for the full sum insured within a year. Policyholders can enhance coverage with unique add-ons like reduced waiting periods for pre-existing diseases, OPD and maternity cover, and even surrogate and oocyte donor expense coverage up to ₹5 lakh. While the claim settlement ratio could improve, the plan’s tailored features and extensive add-on options make it a versatile choice for those seeking comprehensive protection.
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Conclusion
In 2025, a restoration benefit isn’t just a luxury, it’s a necessity. It ensures you never run out of coverage, even after multiple claims, without paying extra. Whether you’re protecting yourself or your entire family, this feature provides invaluable peace of mind. By choosing a health insurance plan with robust restoration benefits, you safeguard your future against rising medical costs and unexpected emergencies. And if you need expert guidance to find the best policy, Ditto advisors are just a call away!
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