What is Restoration Benefit in Health Insurance?

8 min read Posted on 19 May 2023

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A restoration benefit in health insurance is when the health insurance company restores the entire sum insured amount once it gets completely exhausted in treating a disease. Therefore, even if you utilise the entire sum insured, you need not be concerned since if you have this benefit, your health insurance company can restore the entire sum amount so that you can use it in the future.

Restoration benefit is one of the attractive features of health insurance. The restoration benefit is valid only once for the policy year, allowing you to get the coverage benefit after the coverage amount is exhausted due to hospitalization. Restoration benefit is a great add-on to health insurance that acts as a safety net in case of medical emergencies.

Types of Restoration Benefits in Health Insurance

There are two different types of restoration options available, and policyholders can choose one of them based on their needs and we advise you to read the terms and conditions of your health insurance policy carefully:

Complete Exhaustion: In Complete Exhaustion Restoration Benefit, you will get the benefit once your entire sum insured is completely exhausted.
Partial Exhaustion: In Partial Exhaustion Restoration Benefit, you will get the benefit once your sum insured get partially exhausted.

Who Should Buy Restoration Benefit in Health Insurance?

It is optional to choose the restoration benefit in your health insurance. But this benefit is a great deal for people having certain types of health insurance plans. The following persons will find the restoration benefit helpful.

Restoration benefit can be beneficial for those who have a family floater health insurance plan, but you can buy it for any health insurance policy. The restoration benefit provides the same comprehensive coverage that is provided in the basic policy.
People having a health plan with low sum insured amount can opt for this restoration benefit as a backup in case of exhaustion of sum insured amount.

Policy Features, Riders & Add-ons

Importance of Restoration Benefit in Health Insurance

Restoration benefit in health insurance reduces your additional expenses for multiple claims. This benefit allow your health insurer to bear the cost of treatment above the basic sum insured of your health plan.

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Things to know before purchasing Restoration Benefit

Most of the health insurance companies restore the sum insured only after the sum insured and the cumulative benefits of the policy are exhausted. But some health insurers restore the sum insured in case of partial exhaustion of the sum insured amount.
The restoration benefit cannot be carried over to the next year. This means that if you do not use the restoration benefit during the current policy term, then it cannot be availed in the next policy tenure. The policyholder should ensure that they can use the restoration benefit for the treatment.
In family health insurance, if a member has used the amount for specific ailments like; Heart attack cannot be used again for the same disease within the current period of the health policy. But other family members included in the family floater plan can use the restoration benefit amount for the same illness.
Some health insurance plans have built-in restoration benefit, so you don't have to pay additional premiums to get this benefit. The policyholder has to check the policy documents to see whether restoraiton benefit is embedded in the health policy, whereas in some health insurance policies, it is available as an add-on cover. One needs to pay extra to avail this benefit in their health insurance plan.

Policy Features, Riders & Add-ons

Conclusion

Restoration benefit is a very useful add-on cover to your health insurance plan, especially if you have a family health insurance plan. If a family member is hospitalized and uses up the entire sum insured, in that case the restoration benefit restores the sum amount and covers the remaining family members for the rest of the year. Also, while purchasing the restoration benefit for health insurance, read the offer policy document carefully to understand the inclusions and exclusions of the health policy so that you do not face any issues at the time of claims.