One term that often stands out in health insurance is restoration benefit. This can significantly increase the value of your health insurance policy by providing additional coverage when you need it the most!
Imagine this – You have a health insurance policy with a sum insured of ₹10 lakhs. One day, you need to undergo a major surgery that costs ₹8 lakhs. Just a few months later, you are hospitalised again for a different illness, and this time, the expenses amount to ₹4 lakhs. Under a health insurance policy without restoration benefits, you would be left with only ₹2 lakhs to cover the second hospitalisation, leaving you to pay the remaining ₹2 lakhs out of your pocket.
This is why the restoration benefit in your health insurance policy can be a lifesaver, which gives you additional coverage with you need it the most.
Best Health Insurance Policies with a Good Restoration Benefit
| Best Health Insurance Plans | Restoration Perk Details | Other Features | Drawbacks |
|---|---|---|---|
| HDFC ERGO Optima Secure | 100% restoration of base cover amount. Once a year on partial exhaustion for any illness. |
|
While Optima Secure is a good policy, it has very high premiums. |
| Care Supreme | Restoration up to the base cover amount. Unlimited times a year on partial exhaustion for any illness. |
|
Operational metrics could be slightly better. |
| Niva Bupa ReAssure 2.0 | 100% restoration of the cover amount. If triggered once, it stays active forever. |
|
Operational metrics could be slightly better. |
| Aditya Birla Activ One Max | Restoration up to the base cover amount. Unlimited times a year on partial exhaustion for any illness. |
|
10% co-payment at non-network hospitals. Insurer metrics can be improved. |
Note: PED WP stands for pre-existing disease waiting period.
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Restoration benefits in health insurance policies are designed to replenish your cover amount if it gets exhausted within a policy year. Imagine you have a glass of water that represents your health insurance coverage. The glass starts to empty when you drink the water (when making a claim). If you finish the water, you will not have more to drink.
But what if that’s not the case?
Let’s say another glass refills your glass when it starts to empty. This is precisely what restoration is.
Once your glass is empty or partially empty, it gets refilled automatically so you can continue drinking (making claims) without waiting for a new glass (policy year).
What are the Different Types of Restoration Benefits in Health Insurance Plans?
Restoration benefits can be categorised into four main types, each with different restrictions and terms of use. Restoration in most modern health insurance policies is a combination of the four factors:
- Restoration on Partial / Complete Exhaustion of the base cover amount
The restoration benefit is triggered when the sum insured is partially or entirely exhausted. Think of your glass of water being refilled when it's half-empty or completely empty.
2. Restoration for Any illness / Different Illness
Some policies restore the sum insured for any illness, allowing multiple claims for the same condition. Others might only restore it for a different illness, meaning the restored sum cannot be used for the same condition for which the original cover amount was used. This is like the insurer refilling your glass of water but with oil (which doesn’t mix with the water, but floats on top of it). You can still use the water for your initial disease, but you can use the oil (restored amount) only for a new disease.
3. Restoration Unlimited Times / Once
Some policies offer unlimited restoration of the sum insured within a policy year, while others allow restoration only once. Unlimited restoration is like using a jug to refill your glass every time it’s emptied or partially empty, ensuring you never run out of coverage within the policy year. On the other hand, restoration only once is like pouring water from another glass into your glass, where you can only refill it once per policy year.
4. 100% Restoration of Cover Amount / Restoration up to Base Cover Amount
100% restoration of the cover amount means that once you make a claim, the insurer will restore your entire cover amount for that year. For example, you have a health insurance policy of ₹ 10 lakhs, and you make a claim of ₹2 lakhs. Your insurer will add the original ₹10 lakhs to your sum assured. Therefore, your total cover amount will be ₹ 10 lakh (Base Sum Assured) - ₹ 2 lakh (Claim) + ₹ 10 lakh (Restoration). This brings the total cover to ₹ 18 lakhs. However, it is important to note that you can use only up to the base cover amount for any one hospitalisation. The insurer will cover your claims if you get admitted 4 times in a policy year, with each claim of ₹ 4 lakhs. But will not cover you if it is one claim for ₹ 16 lakhs.
On the other hand, if your restoration is up to the base amount, the insurer will add back the amount after each claim so that the coverage is always equal to the base sum assured.
For example, you have a policy of ₹ 10 lakhs and made a claim of ₹ 2 lakhs. The base cover amount is ₹ 8 lakhs now. The insurer will add back ₹ 2 lakhs to your policy, making the effective cover ₹ 10 lakhs once again. This is done either once, multiple times or unlimited number of times in a policy year, depending on the policy. Most of the best health insurance policies in India offer restoration multiple times.
The restoration benefit in your health insurance policy is a combination of the above four factors.
Why Do You Need A Health Insurance Policy with Restoration Benefits?
A health insurance policy with restoration benefits provides an added layer of security. It ensures that you and your family are not left without coverage after making significant claims.
This is particularly beneficial in family floaters, where multiple family members are covered under a single policy and may need to make separate claims within the same year. It is also beneficial for people with chronic conditions, where they may have to be hospitalised or treated multiple times a year.
What are the Best Health Insurance Plans with Restoration Benefits?
Several health insurance plans offer restoration benefits, each with unique features, advantages and disadvantages. Here are some of the top plans to consider:
- Niva Bupa ReAssure 2.0
Niva Bupa ReAssure 2.0 is a comprehensive policy with a unique restoration benefit called ReAssure Forever. Once the restoration is triggered, it will stay active until you stop renewing the policy. This can be used for any illness in a policy year.
ReAssure 2.0 also covers a wide range of pre-existing diseases and provides comprehensive coverage for various medical expenses.
2. HDFC ERGO Optima Secure
HDFC ERGO Optima Secure is a comprehensive health insurance policy with a good restoration benefit. The policy restores 100% of the sum insured automatically after the first claim, ensuring you have continuous coverage throughout the policy year.
It also offers a wide range of additional benefits, including good coverage for pre- and post-hospitalization expenses, no claim bonus, etc.
3. Aditya Birla Activ One
Aditya Birla Activ One offers comprehensive health insurance tailored to your needs. This policy has no copayment, room rent limits, or disease-wise sub-limits, ensuring comprehensive coverage without any unexpected costs.
What makes this policy even more robust is its excellent restoration benefit, which offers unlimited refills on partial exhaustion during the policy year for any illness. This makes it an excellent choice for those seeking extensive and flexible health insurance coverage for their elderly parents.
4. Care Supreme
Care Supreme is an affordable policy that provides extensive coverage. The policy restores the sum insured up to the base amount for any illness, making it a robust option for individuals as well as families. It also covers various medical conditions and treatments, ensuring comprehensive protection.
Things to Keep in Mind About Restoration in Health Insurance
- Even if you have unlimited restoration, at any given point of time, you can only make a maximum claim of the base cover amount.
- The restoration benefit usually comes with four different variables:
- Restoration on partial/complete exhaustion
- 100% restoration/restoration up to the base cover amount
- Restoration for any illness / different illness
- Restoration unlimited times / multiple times / once
(The most ideal type has been highlighted.)
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Choosing a health insurance policy with a good restoration benefit offers peace of mind and financial security during medical emergencies. This ensures that your coverage is not limited to a single claim and provides an additional layer of protection for you and your family.
If you're considering a health insurance policy, here are some of the features to consider and choose a plan that aligns with your healthcare needs and financial situation.
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