Introduction
Remember when Superman went out into the sun and got a cool energy restoration instead of a sun tan?
(Sigh) Sounds fun, right?
But, hey! That’s superhero stuff - cool to read, watch & dream about, but difficult to actualize! After all, we are mere Earthlings, not exactly a superpower born on the planet Krypton with superhero strengths and no worries about health issues except Kryptonite! Plus, if you can own the power to restore something, wouldn’t that be your bank account?
While the restoration superpower in banks is also a matter of fiction, one crucial financial balance can be restored - your health insurance plan and its coverage, provided you choose a plan that offers this feature.
When it comes to restoration in health insurance, you can imagine it as something like this:
- There is a glass of water = Your total sum insured
- You gulp down some of it = You raise a claim
- The glass is filled again = The restoration is made
So, the restoration of your sum insured after a claim is raised is called restoration benefit in health insurance. Now, based on the variant of restoration provided by your health insurer, this restoration can happen once a year/ multiple times a year when you have exhausted the sum insurance completely/partially and can be used for different/same illness treatment coverage.
The perk seems somewhat of a myth, too, right? I mean, boost up your sum insurance after you have raised the claim so that you have access to dependable funding again - that does sound unreal! But, well, the restoration benefit in health insurance is a very non-fictional feature for most of the best health insurance policies.
Subsequently, restoration has become a determining factor when choosing a policy from the best health insurance providers across India. However, before banking on this perk as a determining factor when choosing your plan, you must understand restoration in its minute details -
What is Restoration Benefit in Health Insurance?
Restoration in health insurance is a perk that boosts the sum insured by a pre-specified % after a policyholder has raised a claim. The
- % of the amount restored
- The time when the sum is restored
- The number of times the sum insured is reinstated across a single year
- The illnesses that are covered by this restored amount
-are all determined by the restoration variant that is in use.
So, to better understand how restoration in health insurance works, consider its multiple variants -
What are the types of Restoration in Health Insurance Plans?
The restoration perk in health insurance has become crucial while determining the best health insurance products across the industry. However, as the years have progressed, multiple variants of the perk have emerged in an endeavor to cater to the tailored medical requirements of policyholders.
The restoration benefit in health insurance can thus be categorized in 3 ways -
- Based on the number of times the restoration is offered across a year:
- Based on when the restoration benefit kicks in:
| Restoration on Partial Exhaustion | This suggests a case where restoration kicks in upon partial exhaustion of the sum insured. Say, Health insurance sum insured = INR 10 lakhs After 1st hospitalization, the Raised claim = INR 6 lakhs. Now, your balance sum insured should have been INR 4 lakhs (INR 10 lakhs - INR 6 lakhs). However, with the restoration perk in your policy feature, the sum insured becomes INR 14 lakhs (INR 4 lakhs + INR 10 lakhs). But the entire 14 lakhs is not available for your next hospitalization. So, you can raise claims only up to your original sum insured, i.e., INR 10 lakhs. The rest 4 lakhs can only be used if you are hospitalized again. |
| Restoration on Complete Exhaustion | In this variant, the policyholder needs to exhaust his/her entire sum insured before the restoration claim can kick in. This variant often is a bit tricky. Let’s take, for example, you have a Health insurance policy sum insured = INR 10 lakhs. 1st hospitalization claim = INR 7 lakhs. Balance sum insured = INR 3 lakhs 2nd hospitalization claim = INR 5 lakhs. [Insurer pays only INR 3 lakhs (the residual sum insured), out-of-pocket payment = INR 2 lakhs] Now that the entire sum insured has been exhausted, your restoration perk will kick in. However, you already have INR 2 lakhs out of your pocket in the mix, defying the very reason why you opted for a health insurance policy with restoration benefits. |
| [P.S. In complete exhaustion, the policyholder has to wait for the base sum insured to be exhausted before the restoration benefit kicks in. This leaves him/her financially vulnerable and at high risk of paying out of their pocket (as cited above). Thus, partial exhaustion is the restoration variant that potential policyholders lean towards. | |
3. Based on what the restoration can be used for,
| Say Amit is admitted to the hospital with a renal ailment. He has health insurance coverage of INR 10 lakhs with an in-built restoration benefit. What happens if the perk carries a small clause describing how it can be used? | |
|---|---|
| Same Illness | Some health insurance providers restrict the use of the restored amount for just renal issues (the primary condition under which the 1st claim was raised and restoration was activated) |
| Different Illness | The restored amount can be used for any other disease apart from the renal issue and any complications arising from it. |
| [P.S. The ideal restoration variant, in this case, would be the one that offers the freedom to the policyholders to use the restored amount for either the same or a different ailment based on his/her medical emergencies. | |
Now, PLEASE NOTE that each health insurance provider prepares their policy using a variety of permutations and combinations of the aforementioned variants.
Take a look to understand how the restoration feature works across some of the best health insurance plans in the market -
What are the best health insurance plans offering restoration benefits?
| The best health insurance plans with restoration benefit | Frequency of Restoration | Nature of Restoration | Restoration Coverage |
|---|---|---|---|
| HDFC ERGO - Optima Restore | One-Time Restoration | Restoration on Partial Exhaustion | The restored amount can be used for the same illness. |
| CARE - Care Plus | Unlimited Restoration | Restoration on Partial Exhaustion | The restored amount can be used for any illness. |
| NIVABUPA ReAssure | Unlimited Restoration | Restoration on Partial Exhaustion | The restored amount can be used for the same illness. |
However, here’s something else that you should consider - what if you find the perfect health insurance plan that addresses your medical and financial goals and has a single drawback - no restoration feature or a less beneficial restoration feature?
Well, restoration for your health insurance policy can be availed in two ways -
What are the ways to avail of Restoration benefits in Health Insurance Policies?
- In-built in your Base Policy: This is the most common way - choosing a health insurance plan with a restoration benefit as an in-built feature.
- As a Health Insurance add-on: In case your existing health insurance plan offers a queue of the best perks available in the market (No-Claim Bonus, minimal waiting period, domiciliary coverage, pre, and post-hospitalization expense coverage, no room rent restrictions, no disease-wise sub-limits, no copayment, and more) and offers a weak restoration feature or no restoration perk at all, you can always opt for a Restoration add-on. This health insurance add-on comes at a minimum premium and offers a huge financial cushioning to safeguard your savings.
[Take a look at Care - Care health insurance plan that also offers the add-on for restoration.
- On the one hand, the base health insurance plan is affordable, offers extensive coverage, and more.
- On the other hand, the Restoration add-on covers its only drawback of one-time restoration by offering unlimited restoration opportunities.
- The only problem is that this restoration can be used multiple times, only if it's used for different ailments]
Frequently Asked Questions
Are Restoration benefits available in all health insurance policies?
Restoration benefits are available in most of the best health insurance plans from reputed insurers. However, the type of restoration that comes with each policy differs - one-time, unlimited, partial, or complete exhaustion.
Are there any hidden terms & conditions attached to the restoration benefit?
Yes, restoration benefits in health insurance do come with certain terms and conditions. These terms and conditions vary as per the type of restoration offered. So, before availing of a plan with restoration benefits, do make sure to ask your insurer about these conditions associated with the perk.
What is the advantage of having a restoration benefit in health Insurance?
The advantage of having a restoration benefit in health insurance is that policyholders can enjoy extended coverage beyond his sum Insured. With the right restoration benefit, you can get an unlimited sum insured benefits by paying premium for a base coverage of as low as 10 Lakh.
Is there an additional cost for the restoration benefit?
No additional cost is charged for your in-built restoration benefit. The insurer has it covered in your premium itself.
Is there any waiting period for the restoration benefit?
No, There is no waiting period for the restoration benefit to kick in.