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What is Restoration of Cover in Health Insurance?

Imagine you've used up 1 GB of internet data for the day, but your plan refills with 1 GB of data again tomorrow. Each day, the 1 GB data is restored and it keeps on refiling when you consume it. Amazing, right? 🤩 That’s exactly how the restoration benefit works in health insurance!

Restoration benefits in health insurance are the type of coverage benefit where the insurance company restores the original sum insured after it has been fully exhausted for the treatment of any illnesses. So, even if you consume the entire sum insured, you need not worry, your insurance company can restore the whole amount with restoration, and you can use it in the future.

Continue reading to learn about the restoration of cover, the types, who should opt for it, and the benefits of doing so.

Team Digit

What is Restoration Benefit?
Types of Restoration Benefits
Features of Restoration Benefit
Who Should Opt?
Things to Consider
Does Restoration Increase Premium?
Frequently Asked Questions

What is the Restoration of Cover?

The restoration benefit is an add-on provision in health insurance policies that restores the sum insured amount once the primary sum insured has been used within a policy year. This option could be helpful for policyholders who may need to use their initial covered amount because of recurrent illnesses or hospital stays.

Let’s understand this with an example - Mr. Ravi has a health insurance policy of Rs 4 lakhs with a restoration benefit. He had to undergo heart surgery and the entire sum insured of Rs 4 lakh was exhausted.

A few months later, Mr. Ravi was diagnosed with Cancer, which required surgery costing around Rs 2 lakhs. The insurer will cover the cost of surgery, hospitalization and medical treatment for Mr. Ravi as the original sum insured will be restored to Rs 4 lakhs. This was possible only because Mr. Ravi opted for a Restoration Benefit while purchasing his health insurance policy.

3 Important Things about Restoration Benefit in Health Insurance

How about we tell you that if you lose your ₹100, you'll get it back? Surprising, right?

Well, that's exactly what restoration benefits in health insurance do — they restore your used coverage, fully or partially. But before you dive in, there are 3 crucial things you need to know. Watch the video to uncover these important insights and maximize your coverage!

Types of Restoration Benefits in Health Insurance

There are two types of restoration options available and we suggest you must read the fine print of your health insurance policy before opting for either one of them. It includes partial exhaustion and complete exhaustion in health insurance.

1. Partial Exhaustion

Partial Exhaustion in health insurance refers to the situation where a policyholder (you) uses up only a portion of the total coverage limit during a policy year. Even when you make a claim, there remains some amount for your sum insured in health insurance, which can still be used for future claims.

For example, if you have ₹10 lakh of sum insured and you only claimed ₹3 lakhs, then it will come under partial exhaustion. In this case, the total amount of ₹10 lakh of the sum insured will be restored.

2. Complete Exhaustion

Complete Exhaustion in health insurance occurs when a policyholder utilizes the entire sume insured available under thier health insurance policy in a given policy year. In this, once the total coverage limit is exhausted, no further claims can be made during that policy period and any other medical expenses will be paid by your pocket until restored.

For example, if you have ₹10 lakh of sum insured and you claimed the total amount, then it will come under complete exhaustion. In this case, the total amount of ₹10 lakh of the sum insured will be restored.

Let’s compare both the types of restoration benefits in health insurance:

Factors	Partial Exhaustion	Complete Exhaustion
Activation of Benefit	In this option, the benefit will come into force even with partial exhaustion of the sum insured.	In this option, the benefit will come into play only when the entire sum insured is exhausted.
Example	Mr. Shyaam had an insurance policy of ₹5 Lac with partial restoration benefit. Recently, he met with an accident and utilized ₹4 Lac of his insurance. Now, the insurance company will restore the benefit back to ₹5 Lac because he has opted for a partial restoration benefit to use the sum insured again in case of any other emergency.	Miss Priya has an insurance policy of ₹5 lac with a completed restoration benefit. Recently, she had to undergo a minor surgery for which she utilized the entire ₹5 Lac of the sum insured. In this case, the insurance company will restore the full sum insured of ₹5 Lac because she opted for complete restoration.
Ideal For	People who anticipate fewer claims or have lower health risks.	People with higher health risks or those with a family floater plan.

Features of Restoration Benefits in Health Insurance

To make an informed decision, you must know what is restoration of cover in health insurance policy means and the clauses associated with it. Some of the common features include:

The restored sum insured is not transferred over another policy year. It means that you can claim the restoration benefit only in the particular policy year in which you have claimed it previously.
You can purchase the restoration benefit as an add-on to your health insurance coverage just for a small additional premium.
Restored benefits are only available for future claims; they do not apply to existing or pending claims.
Restoration benefits can be added to your health insurance policy depending on your health requirements, and it is not limited to a higher sum-insured policy.

What are the Benefits of Restoration in Health Insurance?

Restoration Benefit coverage is a unique feature of the insurance plan that offers policyholders a safety net beyond standard coverage. Let's discuss the main benefits of Restoration and see how it can help individuals like you.

1. Continuous Coverage

The restoration benefit guarantees that even if your initial sum insured is used, you will still receive health care for the rest of the policy year. This is especially helpful if you have an unanticipated medical emergency or serious illness that increases the chances of long hospital stays.

2. Financial Security

Unexpected medical expenses could be more than the sum insured. The restoration benefit gives policyholders, aka you, an extra degree of financial stability to pay for unanticipated medical costs without worrying about using up all of your coverage.

3. Flexibility

The restoration benefit makes health insurance policies more flexible. It enables you to handle unforeseen medical crises without worrying about running out of coverage. This flexibility is extremely helpful in a family floater plan that covers several members needing medical attention.

4. Affordable

Insurance companies hope to give you a cost-effective alternative by providing restoration benefits. When necessary, you can rely on the restoration benefit to refill your coverage rather than buying a bigger sum insured policy.

Who Should Opt for a Restoration Benefit?

While the restoration add-on might not be suitable for everyone, it makes sense for some people in some groups. If any of the following categories apply to you, you must consider having a plan that has restoration benefits:

People who have previously suffered from several diseases.
Require regular medical care & treatment.
Need extra financial security in health insurance policy.
Want to avoid the hassle of buying a new insurance.

Furthermore, we advise you to buy this add-on benefit while purchasing a family floater policy to enjoy maximum benefits of your policy. This benefit will suit your Family Floater plan as it adds tangible value.

For those less aware, the cover 'floats' between family members in family floater plans. In such policies, the restoration benefit feature comes in handy.

For instance, you have a floater plan with a Sum Insured of Rs. 4 lakhs, and your spouse falls ill, consuming the entire coverage. Unfortunately, if another family member gets hospitalized later in the same policy year, this feature would help you in this situation by restoring your Sum Insured.

Pros of Buying a Health Insurance Plan with Restoration Benefit

In recent years, insurance companies have included new features to improve the reach and usefulness of health insurance plans. Restored benefits are one such feature that is becoming increasingly popular. Some pros of getting restoration of coverage in health insurance include:

1. Increased Protection without Adding Higher Premiums

Most health policies require you to pay for further medical costs after the policy's maximum benefit has been used up. However, a policy with restoration benefits provides continuous protection at an affordable premium.

2. Financial Security Against Multiple Health Issues

Health problems can surprise you at times. In these circumstances, restoration benefits offer financial safety. These benefits guarantee that you have the required coverage for a variety of medical problems.

3. Flexibility in Coverage

Restoration benefits provide flexibility in how coverage is used. Depending on the type of restoration benefit (fixed or partial), you may have all or a portion of the whole sum insured to use again upon exhaustion.

4. Avoiding Coverage Gaps

Traditional health insurance policies may include coverage gaps, particularly for people with chronic problems. Restoration benefits serve as a guard that prevents coverage gaps by providing the sum covered and guaranteeing ongoing protection for the policy year.

5. Cost-Effective Option for Higher Sum Insured

Restoration benefits offer a more affordable option than choosing a larger sum insured because you need to pay a higher premium for a higher sum insured.

Things to Consider When Opting for Health Insurance with Restoration Benefits

When choosing health insurance with a restoration benefit, you're not just investing in your health but in peace of mind. But before you make a decision, it's important to consider a few factors that can help you make an informed choice of having restoration benefits in your policy.

Restoration benefit will trigger for an unrelated medical condition.
It is an Add-on benefit which you can buy with your insurance policy.
It can be taken while buying a policy with nominal extra cost.
Restoration will happen on exhaustion of complete sum insured or partial sum insured.
Restored sum insured is not liable to be carried forward to the next policy year.
Restoration benefit will not apply in the first claim.
It can be applied to any given sum insured and is not restricted to the higher sum insured.
Restore benefit reinstates the total sum insured once you exhaust it in a single claim within the policy term.
Restore Benefits are only for future claims.

Does Restoration Benefit Increase the Health Insurance Premium?

Yes, the restoration benefit increases the premium amount, but only up to a minimal extent. This is an extra cost that an insured person bears for the additional cover.

One of the thumb rules for determining the premium of an insurance policy is that the more features a policy has, the higher its premium. The same happens when you add the restoration benefit feature to your policy.

For instance, a Rs 4 lakh insurance plan would cost a 34-year-old a little more than Rs 5,000 annually, while a plan with restoration benefits would cost more than Rs 6,000.

What are Recharge Benefits in Health Insurance?

Recharge benefit is a feature that restores your sum insured within the policy year so that you don’t run out of coverage. So, if you first get hospitalized and use up most of your sum insured, you get a recharge for extra protection due to some other health issue in the same year.

Imagine you have 1 GB of data for the day but have exhausted it before the day ends. What will you do? You will top-up with an extra 1 GB of data for the day, allowing you to keep using the internet. Recharge benefits work similarly in a health insurance policy.

Difference Between Restoration and Recharge Benefits in Health Insurance

Both types of coverage give extra protection, but they are quite different from one another. Here is the difference between Restoration Benefits and Recharge Benefits in Health insurance:

Factors	Restoration Benefits	Recharge Benefits
Meaning	The restoration benefit is an add-on that restores your full coverage multiple times in a policy year after it has been used up.	A recharge benefit is an add-on that restores the full coverage only once in a policy year after it has been used up.
Types	Partial Restoration and Complete Restoration	No types
Example	Mr. Mehta has ₹5 lakh of sum insured with restoration benefit. He used ₹4 lakh in May for surgery. He had an accident that required ₹4.5 lakh again. In restoration benefit, the company will restore the full ₹5 lakh amount. This amount is restored every time Mr. Mehta uses the sum insured in a policy year. Now, if he is again required to claim the money, he can.	Mr. Sharma also has ₹5 lakh of sum insured with recharge benefit. He used ₹4 lakh for surgery and later required another surgery for a different illness. With the recharge benefit, the company will restore the full ₹5 lakh amount. However, this amount is only recharged once per policy year. He cannot claim more money in such a case.
Type of Coverage	Partial or complete sum insured can be restored	The total sum insured is recharged
Frequency for Claims	Multiple times a year	Once a year
Medical Condition	Different medical illnesses are covered, but some insurers provide coverage for the same illness as well	Only different illnesses or accidents are covered

Don’t wait for the next time life throws unexpected medical bills on your way! With the restoration of cover in health insurance, you can eliminate the concerns of not using up your entire sum insured amount in the fear of exhausting it.

Stay covered! Stay cool!

FAQs about Restoration Benefit in Health Insurance

All

Is Restore benefit applicable to the same illness?

Few companies offer to restore benefit for the same illness with a gap of 30 to 45 days with an extra price.

Otherwise, the industry practice is - restoration benefit in health insurance can only be availed if there is hospitalization for unrelated diseases. For instance, you had to hospitalized for a fracture and claimed your health insurance. Unfortunately, in the coming months, you get affected by swine flu. Your restore benefit will be activated for your health insurance claim as the hospitalization done are not for the same illness.

Can you avail restoration benefit in health insurance in the same claim?

Restore Benefits are mostly for future claims. So, it cannot be availed on the same claim. For instance, if you a health insurance policy of 5 Lakhs, but your hospitalization expenses come to 8 Lakhs, the extra 3 lakhs you will have to pay from your pocket. But if you need to be hospitalized again in the coming days, then your Sum Insured will be restored to 5 lakhs again, although you had already used up the entire limit in the last claim. However, there are some health plans where if the claim exceeds the Sum Insured that will trigger the restore benefit automatically.

Do you need to exhaust the entire sum insured in one claim to avail restore benefit?

For most health insurers, the total sum insured is restored only if the entire sum insured is exhausted under a single claim. However, some health insurers offer a restore benefit as soon as hospitalization is required. Some plans can also be restored unlimited times in the policy year. So, it is always advisable to check with your health insurer before opting for this benefit.

What happens in case of an accident with a family floater policy?

In case of accidents, some health plans ensure that the insured members have an unlimited coverage. Say someone has a family floater policy with a limit of 5 lakhs as Sum Insured. Unfortunately, in an accident, 3 members of the family get injured. The Restore benefit will kick in here, where each of the injured family members covered under the policy will get 5 Lakhs as the Sum Insured, so effectively the Sum Insured will get raised to 15 lakhs from 5 lakhs.

Can 2 members of the family suffering with the same disease claim for restore benefit?

Restoration benefit can be claimed for only future claims, so only one person can avail it at a time. The trigger point for disease must be at different time intervals. However, in some special cases, restoration will work for different people in the family floater plan. For example, due to an accident, if multiple members are injured and hospitalized, claims for different members can be triggered for the restore benefit.

Are there any hidden terms & conditions attached to the restoration benefit?

There are no hidden terms and conditions in restoration benefits, but you must check and read the policy wordings thoroughly to avoid miscommunication. Before purchasing any health insurance policy, you must check the number of times you can opt for a restoration claim, if the claim can be made for the same or different diseases, the restoration will happen after full exhaustion or partial exhaustion, the gap between the first claim and second claim after restoration, etc.

What is the advantage of having a restoration benefit in health insurance?

There are several advantages of having restoration benefits in health insurance, such as:

It provides continuous coverage throughout the year.
It increases the protection against illnesses without buying multiple policies.
Provides financial security against unexpected medical bills.
It is a cost-effective option for getting a higher sum insured.

Is there an additional cost for the restoration benefit?

Yes, an additional premium cost is included in your health insurance policy for getting restoration benefits. For example, if Mr. Sumit is 34 years old and has a Rs 10 lakh insurance plan, it costs him more than Rs 8000 yearly. However, if he has an insurance plan that includes restoration benefits, it can cost him more than 9000 yearly.

Is there any waiting period for the restoration benefit?

Yes, insurance companies generally require a waiting period of 30 days before you can claim a restoration benefit. This waiting period starts from your first claim to the second claim after the restoration benefit and differs from one insurance company to another. Always read the documents for the waiting period before including a restoration benefit feature in your policy.

Is restoration benefit applicable to the same illness?

No, not all insurance policies include a restoration benefit for the same illness. However, this can be changed by mutual decision of the policyholder (you) and policy provider (your insurance company).

Can you avail of restoration benefits in the same claim?

No, you cannot avail the restoration benefit in the same claim. Restoration benefit is only provided for future claims in a policy year for the same or different illness. Once you completely use the sum insured in a policy year, you can claim the restoration benefit in the future for the same year.

Are restoration benefits available in all health insurance policies?

No, restoration benefits are not applicable to all the policies. It is included in some health insurance policies, while in others you need to ask your policy provider to add it as an add-on along with other benefits.

Is there a limit on how many times I can avail the restoration benefit?

You can use the restoration benefit unlimited times in a policy year, but there are some factors you need to check, which include the waiting period in your policy between your first claim and your second claim through restoration, the disease for which you are claiming (some policies don’t allow for similar illness claim) and the amount you can claim (certain policies limit the amount of restoration).

Does the restoration benefit reset every year with the policy renewal?

Yes, the restoration benefit resets every year with the policy renewal. This means that every year when you exhaust your sum insured and use the restoration benefit as well, the benefit will again be available in the next policy year.

What happens if I switch health insurance plans during the policy year and the new plan doesn't offer restoration benefits?

Switching health insurance plans during the policy year can be a little bit tricky, especially if your new plan doesn’t offer restoration benefits. In such a case, you will lose this benefit. You won't be able to utilize it until you switch back to a plan that offers a restoration benefit or you can ask your insurance provider to include the restoration benefit as an add-on during the open enrollment period.

Is there a difference between restoration benefit and recharge benefit?

Yes, although both restoration and recharge benefits do the same work, they are quite different. A restoration benefit is a type of add-on that restores the total amount of the sum insured multiple times in a year. In contrast, a recharge benefit is a type of add-on that restores the full amount of the sum insured only once a year.

How can I check if my existing health insurance plan offers restoration benefits?

To know if your existing health insurance plan offers restoration benefits, you can read the policy details or connect with your insurance provider for all the details.

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What is Restoration of Cover in Health Insurance?

Table of Contents

What is the Restoration of Cover?

3 Important Things about Restoration Benefit in Health Insurance

Types of Restoration Benefits in Health Insurance

1. Partial Exhaustion

2. Complete Exhaustion

Features of Restoration Benefits in Health Insurance

What are the Benefits of Restoration in Health Insurance?

1. Continuous Coverage

2. Financial Security

3. Flexibility

4. Affordable

Who Should Opt for a Restoration Benefit?

Pros of Buying a Health Insurance Plan with Restoration Benefit

1. Increased Protection without Adding Higher Premiums

2. Financial Security Against Multiple Health Issues

3. Flexibility in Coverage

4. Avoiding Coverage Gaps

5. Cost-Effective Option for Higher Sum Insured

Things to Consider When Opting for Health Insurance with Restoration Benefits

Does Restoration Benefit Increase the Health Insurance Premium?

What are Recharge Benefits in Health Insurance?

Difference Between Restoration and Recharge Benefits in Health Insurance

FAQs about Restoration Benefit in Health Insurance

Is Restore benefit applicable to the same illness?

Can you avail restoration benefit in health insurance in the same claim?

Do you need to exhaust the entire sum insured in one claim to avail restore benefit?

What happens in case of an accident with a family floater policy?

Can 2 members of the family suffering with the same disease claim for restore benefit?

Are there any hidden terms & conditions attached to the restoration benefit?

What is the advantage of having a restoration benefit in health insurance?

Is there an additional cost for the restoration benefit?

Is there any waiting period for the restoration benefit?

Is restoration benefit applicable to the same illness?

Can you avail of restoration benefits in the same claim?

Are restoration benefits available in all health insurance policies?

Is there a limit on how many times I can avail the restoration benefit?

Does the restoration benefit reset every year with the policy renewal?

What happens if I switch health insurance plans during the policy year and the new plan doesn't offer restoration benefits?

Is there a difference between restoration benefit and recharge benefit?

How can I check if my existing health insurance plan offers restoration benefits?

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