यह 2025 है और इस नए दशक में, दुनिया एक महामारी से निपट रही है. कामकाज और व्यक्तिगत जीवन के बीच रोज़ाना संतुलन साधने के बीच हम हमारे स्वास्थ्य की अनदेखी कर रहे थे, पर अचानक अब हम उस पर ध्यान देने लगे हैं. स्वास्थ्य ही संपदा है, यह कहावत आज एक बार फिर चरितार्थ हो रही है. इन सब बातों को ध्यान में रखते हुए, हेल्थ इंश्योरेंस पॉलिसी लेना बहुत महत्वपूर्ण हो गया है. जब आप
हेल्थ इंश्योरेंस पॉलिसी खरीदते समय मन में सबसे पहले यह विचार आता है कि सम इंश्योर्ड खत्म हो जाने पर क्या होगा. लेकिन आधुनिक पॉलिसी कई विशेषताओं से सुसज्जित होती हैं, जिनमें से एक है रेस्टोरेशन लाभ.
How Does Restoration Benefit Work?
Restoration benefit in health insurance replenishes the sum insured once it is exhausted due to medical claims within the policy year. It acts as a financial safety net, ensuring that policyholders remain covered for additional medical expenses. This benefit is triggered automatically when the insured amount is depleted. For example, if a policyholder has a sum insured of ₹5 lakh and incurs a claim of ₹4 lakh, they are left with ₹1 lakh for the remaining policy period. If another significant claim arises, the restoration benefit restores the sum insured to its original amount, offering continued coverage. However, it is essential to note that the restoration typically applies only to unrelated illnesses or accidents in the same year and does not cover claims for the same illness.
हेल्थ इंश्योरेंस में कवर का रीस्टोरेशन क्या है?
रेस्टोरेशन लाभ एक ऐसी सुविधा है जिसके तहत इंश्योरेंस कंपनी आपके इंश्योरेंस कवर का सम अश्योर्ड खत्म होने पर उसकी मूल राशि दोबारा बहाल कर देती है. इस विशेषता के साथ, अगर आप आपके हेल्थ कवर का सम अश्योर्ड खत्म हो जाता है तो भी आपको चिंता करने की ज़रूरत नहीं है. आइए हम रीस्टोरेशन को समझते हैं
हेल्थ इंश्योरेंस में लाभ को उदाहरण के साथ समझते हैं. श्री किशन के पास रेस्टोरेशन लाभ वाला रु. 8 लाख का फैमिली हेल्थ कवर है. उनकी गंभीर हृदय स्थिति के कारण उन्हें एक ऑपरेशन करवाना पड़ा जिसमें उनका पूरा सम अश्योर्ड खत्म हो गया. कुछ महीने बाद, उन्हें स्ट्रोक हो गया जिसके लिए उन्हें दोबारा ऑपरेशन करवाना पड़ा और उसमें रु. 4 लाख खर्च हुए. चूंकि श्री किशन की इंश्योरेंस पॉलिसी में रेस्टोरेशन लाभ है, इसलिए दूसरा उपचार भी उनकी इंश्योरेंस कंपनी ने कवर किया.
हेल्थ इंश्योरेंस प्लान में रेस्टोरेशन लाभ क्यों होना आवश्यक है?
लाइफ स्टाइल से जुड़े रोगों और उपचार की बढ़ती लागतों के साथ, अक्सर ऐसा होता है कि सम अश्योर्ड राशि कुछ वर्षों के बाद अपर्याप्त हो जाती है। ऐसे में, रेस्टोरेशन लाभ के रूप में बैकअप प्लान होना एक सुरक्षा उपाय का काम करता है, जिससे ज़रूरत पड़ने पर अतिरिक्त कवरेज मिलती है. इसलिए, सही निर्णय लें और अपनी हेल्थ इंश्योरेंस पॉलिसी में रेस्टोरेशन लाभ चुनें.
Types of Restoration Benefit
1. Complete Exhaustion Restoration
This type of restoration benefit is activated only when the entire sum insured under the health insurance policy is completely utilized. Once your base coverage is fully exhausted due to medical claims, the insurance company restores the sum insured to its original amount for any future claims within the same policy year.
2. Partial Exhaustion Restoration
Unlike the complete exhaustion restoration, this type activates even if the sum insured is only partially utilized. If you have used a portion of your base coverage but still need additional coverage for ongoing or new medical claims, the unused portion of the sum insured is replenished.
इसे भी पढ़ें:
हृदय रोगियों के लिए हेल्थ इंश्योरेंस के बारे में सब कुछ
Benefits of Buying a Health Insurance Plan with Restoration Benefits
1. Enhanced Coverage
Restoration benefits replenish your sum insured during the policy year after it has been exhausted, ensuring you have coverage for additional medical expenses.
2. Financial Security During Multiple Claims
These benefits are particularly helpful if you or your family members face multiple illnesses or accidents in the same year, reducing out-of-pocket expenses.
3. Ideal for Family Floater Plans
In family floater policies, restoration benefits provide peace of mind by covering multiple family members, even if one member exhausts the entire sum insured.
4. Applicable for Unrelated Ailments
Restoration benefits are often available for unrelated ailments or accidents, ensuring comprehensive support for diverse health issues.
5. Unlimited Restoration Options
Some plans offer unlimited restoration, enabling multiple replenishments within the same policy year, offering extensive financial protection.
6. Cost-Effective Solution
Buying a plan with restoration benefits can reduce the need for a higher sum insured, as the replenishment feature provides extended coverage at a relatively lower premium.
7. Support During Critical Illnesses
These benefits are particularly advantageous when dealing with costly treatments or prolonged hospitalizations, ensuring continuous financial support. A health insurance plan with restoration benefits ensures you and your loved ones are protected against unexpected medical expenses, offering flexibility and security.
इसे भी पढ़ें:
ओपीडी कवर वाले हेल्थ इंश्योरेंस के लाभ
Features of Restoration Benefits in Health Insurance
- Replenishment of Sum Insured: Restoration benefits allow the sum insured to be replenished after it has been completely utilized during the policy year, providing additional financial coverage.
- Applicable for Unrelated Claims: Most policies offer restoration benefits for unrelated illnesses or accidents, ensuring coverage for new medical events during the same year.
- Single-Use or Multiple-Use Options: Depending on the policy, restoration benefits may be used once or multiple times within the same policy year, offering flexibility in coverage.
- Family Floater Advantage: In family floater plans, restoration benefits apply to any insured family member, ensuring protection for the entire family even if one member exhausts the sum insured.
- No Carry-Forward: Restoration benefits are valid only for the ongoing policy year and do not carry forward to the next policy period, encouraging policyholders to utilize them within the tenure.
- Cost-Effective Feature: Restoration benefits eliminate the need to opt for a very high sum insured, as the replenishment provides extended coverage at a nominal additional cost.
- Not Applicable for the Same Illness: Typically, restoration benefits are not applicable for claims related to the same illness or hospitalization, ensuring they are used only for distinct medical events.
Who should opt for a Restoration Benefit?
हमारी यह सलाह है कि हर उस व्यक्ति को यह अतिरिक्त सुविधा खरीदनी चाहिए जो इसकी कीमत वहन कर सकता हो. एक के बाद एक कई बार हॉस्पिटलाइज़ेशन की ज़रूरत पड़ना दुर्लभ होता है, पर दुर्लभ तो मेडिकल एमरजेंसी भी होती हैं. लेकिन अगर सभी के लिए नहीं, तो कम से कम
फैमिली हेल्थ इंश्योरेंस प्लान्स 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
- Eligibility Criteria: Understand the conditions under which restoration benefits are applicable, such as whether they cover all illnesses or are limited to unrelated claims.
- 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.
- 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.
- 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.
- 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.
- Nature of Claims: Determine if the restoration benefit applies only to inpatient treatments or if it includes day-care procedures and other medical expenses.
- 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.
- 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.
इसे भी पढ़ें:
हेल्थ इंश्योरेंस पॉलिसी पोर्ट करने के लाभ
अक्सर पूछे जाने वाले प्रश्न
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.
*मानक नियम व शर्तें लागू
बीमा आग्रह की विषयवस्तु है. लाभों, शामिल न की गई चीज़ों, सीमाओं, नियम और शर्तों के बारे में अधिक जानकारी के लिए, कृपया इंश्योरेंस खरीदने से पहले सेल्स ब्रोशर/पॉलिसी डॉक्यूमेंट को ध्यान से पढ़ें.
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