Restoration Benefit in Health Insurance

It is 2025 and in this new decade, the world is amidst dealing with a pandemic situation. Health that took a backseat in our daily hustle managing work and personal lives, has suddenly gained prominence. The adage, health is wealth has strengthened its foundation again. Keeping all of this in mind, availing a health insurance policy is of prime importance. When buying a health insurance policy, the first thought that strikes is what if it gets exhausted. But modern-day policies come equipped with a host of features, one among which is the restoration benefit.

How Does Restoration Benefit Work?

The restoration of sum insured in health insurance is activated only after the sum insured is fully or partially exhausted, depending on the type of benefit chosen. Here’s how it works:

1. Full Restoration

The sum insured is restored to its original value once completely used. For instance, if your INR 10,00,000 policy is entirely consumed, Bajaj Allianz General Insurance Company will reinstate INR 10,00,000 for subsequent claims.

2. Partial Restoration

The policy restores a portion of the used sum insured even when only part of it has been utilised, ensuring uninterrupted coverage for future claims. This restoration benefit in health insurance is particularly useful for families with a floater plan, where multiple members can benefit from the restored coverage.

What is the Restoration of Cover in Health Insurance?

Restoration benefit is a facility where the insurance company restates the sum assured of your insurance cover to its original amount once it is exhausted. With this feature, you need not worry even if you end up exhausting the sum assured of your health cover. Let us understand the restoration benefit in health insurance with an example. Mr Kishan has a family health cover of ₹8 lakhs with restoration benefit. Due to his critical heart condition, he had to undergo an operation where this entire amount of sum assured got exhausted. Now in the following months, he suffered from a stroke and had to again get operated for which the treatment cost was ₹4 lakhs. Since a restoration benefit is available for the insurance policy of Mr Kishan, the second treatment is also covered by his insurance company.

Why is it essential to have a restoration benefit in health insurance plans?

With the growth of lifestyle diseases and soaring treatment costs, it often happens that the sum assured amount may seem inadequate after a few years. At this time, having a backup plan in the form of restoration benefit will act as a safeguard, thereby providing additional coverage if required. Thus, make the right choice and opt for a recovery benefit in your health insurance policy.

Types of Restoration Benefit

There are two main types of restoration in medical insurance, catering to different needs:

1. Complete exhaustion

This applies when the entire sum insured is used. For example, a policyholder with an INR 10,00,000 sum insured will have it restored only after the full amount is utilised.

2. Partial exhaustion

The policy activates the restoration benefit when a portion of the sum insured is used, without requiring complete exhaustion of the coverage. This ensures continuous protection for future claims. For instance, if INR 6,00,000 of an INR 10,00,000 policy is used, Bajaj Allianz General Insurance Company restores a portion of the used amount, such as INR 4,00,000, offering continued protection. Both options have their advantages, and choosing the right type depends on individual medical requirements and financial planning. Also Read: Everything About Health Insurance for People with Heart Diseases

Features of Restoration Benefits in Health Insurance

The restoration benefit in health insurance is a valuable add-on that enhances the utility of your policy, ensuring financial protection during unexpected medical emergencies. Here are the key features that make this benefit indispensable:

1. Applicable for Future Claims

The restoration benefit applies exclusively to new claims that occur after the original sum insured has been exhausted. It cannot be applied retroactively to ongoing treatments or claims. This ensures that policyholders have additional financial backup for subsequent medical expenses within the same policy year.

2. One-Time Activation Per Policy Year

Bajaj Allianz General Insurance Company allows the sum insured to be reinstated only once in a policy year. This limitation ensures the fair usage of the feature, providing a safety net for emergencies without increasing policy costs excessively.

3. No Carry Forward to the Next Year

The restored sum insured is strictly valid for the current policy year and cannot be rolled over to the next year. This ensures that the benefit serves its intended purpose of addressing immediate, unforeseen medical expenses rather than creating a surplus for future years.

4. Available as an Add-On Feature

Restoration in medical insurance can be purchased as an additional rider at a nominal premium, making it accessible to a wide range of policyholders. This flexibility allows individuals to customise their coverage according to their financial and medical needs. These features highlight the practicality and effectiveness of the restoration of sum insured in health insurance, making it a cost-effective solution for managing multiple hospitalisations or recurring medical expenses.

Benefits of Buying a Health Insurance Plan with Restoration Benefits

The restoration benefit in health insurance is a powerful add-on that offers a host of advantages to policyholders, enhancing their financial security during medical emergencies. Here’s a closer look at the key benefits:

1. Increased Coverage

One of the most significant benefits of the restoration feature is the ability to reinstate the sum insured once it is exhausted. This ensures continuous financial protection for multiple hospitalisations within the same policy year, making it particularly useful in the event of severe illnesses or repeated treatments.

2. Cost-Effective Solution

While purchasing a new health insurance policy for additional coverage may be expensive, opting for a restoration benefit is a cost-effective alternative. For a nominal additional premium, policyholders can enjoy enhanced financial protection without the need for a second policy.

3. Peace of Mind During Emergencies

The restoration benefit eliminates the stress of depleting the sum insured, offering reassurance that additional coverage is available for unforeseen circumstances. This peace of mind can be invaluable, especially during prolonged or unexpected medical treatments.

4. Multiple Claims in a Policy Year

This benefit is ideal for individuals or families with recurring medical needs. For family floater plans, where multiple members share the sum insured, the restoration feature ensures adequate coverage is available for all, even after substantial claims. Such benefits make this add-on feature a prudent choice for enhanced financial security. Also Read: Benefits of Health Insurance with OPD Cover

Importance of Restoration Benefit in Health Insurance

Medical emergencies can arise unexpectedly, and the restoration benefit in health insurance ensures that policyholders are not financially burdened. It acts as a safety net, providing additional coverage and safeguarding against rising medical costs. This feature is especially crucial for families or individuals with a history of frequent hospitalisations.

Who should opt for a Restoration Benefit?

Our advice shall be anyone and everyone who can afford this additional feature should opt for it. A case of multiple hospitalisations is rare, but so are medical emergencies. But if not for all, then at least health insurance plans for family should be loaded with a restoration benefit. When you purchase a recovery benefit in your health insurance plan, the entire sum assured that ‘floats’ between the beneficiaries can be restored for it to be available for other members of the policy.

Things to Consider While Opting for Restoration Benefit in Health Insurance

1. Eligibility Criteria: Understand the conditions under which restoration benefits are applicable, such as whether they cover all illnesses or are limited to unrelated claims.
2. Coverage for Same Illness: Most restoration benefits do not apply to the same illness or hospitalization in the same policy year. Verify if your insurer offers flexibility in this regard.
3. Type of Health Insurance Plan: If you're considering a family floater plan, ensure the restoration benefit applies to all members and offers sufficient coverage for multiple claims.
4. Cost of Premiums: While restoration benefits enhance your coverage, they may increase your premium. Compare the additional cost with the benefits provided to assess its value.
5. Number of Restorations Allowed: Check how many times the sum insured can be restored in a single policy year. Some plans allow multiple restorations, while others may limit it to one.
6. Nature of Claims: Determine if the restoration benefit applies only to inpatient treatments or if it includes day-care procedures and other medical expenses.
7. No Carry-Forward Provision: Restoration benefits are generally valid only for the current policy year and cannot be carried forward. Utilize the feature within the policy term if needed.
8. Waiting Period and Exclusions: Ensure that the restoration benefit is available from the first policy year and check for exclusions that might restrict its use.

Also Read: Benefits of Porting Health Insurance Policy

Conclusion

The restoration benefit in health insurance is an essential feature that enhances the overall utility of your policy. It provides financial protection against unforeseen medical expenses, ensuring uninterrupted coverage for you and your loved ones. Whether you’re an individual with recurring health concerns or a family sharing a floater plan, this benefit can offer peace of mind and financial security. When choosing a health insurance plan from Bajaj Allianz General Insurance Company, consider opting for one with restoration benefits. This small step can make a significant difference in times of need, ensuring that medical emergencies never become financial emergencies.

FAQs

What is the period of restoration?

The period of restoration refers to the timeframe within which the sum insured is reinstated after being exhausted due to medical claims. It is typically effective immediately after the insured amount is used up and remains valid for the remaining policy period.

What is the extended period of restoration?

The extended period of restoration allows for the restoration of the sum insured beyond the policy term in certain cases, such as when a claim is filed close to the policy expiration date. It ensures coverage for an additional period as specified by the insurer.

What is the time limit for restoration?

The time limit for restoration benefits is usually the same as the policy period. Restoration can be utilized only during the ongoing policy year and does not carry over to the next renewal period.

Can two members of the family suffering from the same disease claim restoration benefits?

No, most policies with restoration benefits do not cover claims for the same illness or disease under the restored sum insured. Restoration benefits are typically applicable to unrelated illnesses or accidents.

What is the restoration period in insurance?

The restoration period in insurance refers to the duration within a policy year when the sum insured is replenished after being completely utilized. It ensures continuous coverage for new and unrelated medical events during the same policy year.

Can you avail of restoration benefits in health insurance in the same claim?

No, restoration benefits only apply to future claims. They come into effect once the existing sum insured has been fully exhausted. This feature ensures additional coverage for subsequent medical expenses within the same policy year but cannot be utilised for ongoing claims that have already depleted the sum insured.

Are recharge and restore the same benefits in health insurance?

While they share similarities, restore benefits reactivate the full sum insured after complete exhaustion, whereas recharge benefits top up the sum insured when it reduces due to partial claims. Both features provide financial protection but differ in their applicability based on claim amounts and conditions in the policy.

Is recharge benefit useful in health insurance?

Yes, a recharge benefit is highly beneficial as it allows partial restoration of the sum insured. This feature ensures continued financial security by replenishing coverage, enabling policyholders to make further claims without out-of-pocket expenses for subsequent medical emergencies.

Can I carry forward the restored sum insured to the next policy year if I don't use it?

No, the restored sum insured is only valid for the ongoing policy year. If unused, it does not roll over to the next year. Restoration benefits are designed for immediate, unforeseen medical needs within the policy's active term.

Is restoration benefit available for pre-existing conditions?

Restoration benefits typically exclude pre-existing conditions unless explicitly stated in the policy terms. It’s crucial to carefully review the policy document or consult Bajaj Allianz General Insurance Company to determine whether the benefit applies to specific medical conditions covered under your plan. *Standard T&C Apply Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale. Claims are subject to terms and conditions set forth under the health insurance policy. The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional.