Restore Sum Insured in Health Insurance: Types & Benefits

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In current times, health insurance has become an important aspect of an individual's financial plan. It helps consumers deal with any unexpected medical issue without stressing about the financial load. Despite owning a health insurance policy, consumers may still face the difficulty of emptying their insured amount owing to unforeseen medical costs. This is when the restorative benefit in health insurance comes into play.

In this article, we will clarify the terms and policies about recharge and restoration benefits in health insurance.

What is The Restoration of Coverage in Health Insurance?

The policyholder files a claim to pay the expense of hospitalisation or other covered events under the policy. These coverages are claimable till you have an adequate sum covered. Unless you have particular benefits, you are usually not allowed to make a claim after you have exhausted all of your insurance coverage. This is where the restore or recharge features come into play.

The restoration benefit allows you to file a claim after you have exhausted the sum covered, as it "restores" it. This means that once the entire amount has been used, the insured sum can be restored. You can therefore file a claim to cover medical costs in the future.

What are the Different Types of Restoration Benefits?

Once you have decided to use the restoration benefit, you may choose from the following options based on your needs or preferences.

Partial Exhaustion

With this option, the restoration bonus applies even if the sum covered is only partially exhausted. When it comes to being more advantageous, you should choose this form of repair benefit.

For example, if you have a sum covered and make a claim of Rs 4 lakh, the remaining amount is Rs 1 lakh. Nonetheless, the restoration benefit would apply, and the money insured would be returned to Rs 5 lakh, which may be used for future claims.

Complete Exhaustion

When the entire amount insured is depleted, this form of restoration benefit kicks in. The majority of health insurance policies provide a restoration benefit in the event that the insured sum is completely exhausted.

For example, a claim of Rs. 4 lakh is filed against a health plan with an amount covered of Rs.5 lakh. Following claim settlement, you would have a residual sum insured of Rs 1 lakh. The restoration benefit will not apply if a second claim is submitted within the same insurance year. Only after the remaining sum insured is spent will the restoration benefit become effective and your sum insured fully restored.

What Advantages Does Sum Insured Restoration Offer?

If you are looking to acquire medical insurance, a policy with restoration benefits can be beneficial in a variety of ways. The following are some of the advantages of acquiring a health insurance policy with restoration benefits:

Multiple Claims

Restoration benefits allow you to file multiple claims during the policy year. Its benefits are particularly obvious to policyholders who have a variety of conditions or require frequent doctor appointments.

More Financial Protection

After primary coverage is exhausted, the supplementary sum insured offers a financial cushion to meet unforeseen medical expenses during the insurance year.

Cost-effective

Health insurance plans that provide restoration benefits may cost a little bit more than those that don't. In the long run, nevertheless, they might save money because they offer more financial security without necessitating the acquisition of an additional plan.

Gives Peace of mind

You may feel more at ease knowing that you have health insurance coverage that offers restoration benefits. You may be sure that you will have more financial stability and be able to pay for any unforeseen medical costs.

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What are the Features of Health Insurance's Restoration Benefits?

To make an informed decision, you must comprehend what health insurance policy restoration of coverage includes. Among the most common benefits of restoration are:

It is vital to note that the reinstated sum insured is not ported over to the subsequent policy year. Only the remaining policy term is covered by it.
Restored benefits are only available for future claims; they do not apply to existing or pending claims, it should be noted.
Policies having a higher sum insured are not the only ones that offer the restoration benefit. It can be bought in addition to any specified sum covered depending on your needs.
For a small additional fee, you can purchase the restoration benefit as an add-on to your insurance coverage.

For whom is The Restoration Benefit Best Suited?

Choosing to accept the restoration benefit is not required. But this benefit works best for a specific group of people with specific kinds of health insurance policies. The following individuals will find value in the restoration benefit.

Policyholders with family health insurance should consider using the restoration benefit because the total covered will be divided by numerous family members.
In order to lower their out-of-pocket costs, policyholders with low sums insured may choose to use this benefit as a fullback in the event of total exhaustion. This benefit can save your bacon in an emergency, especially with the current pandemic and spike in medical expenses.
If you fall into one of the categories, such as having a history of many illnesses, requiring regular medical attention, needing additional financial protection in your health insurance policy, wanting flexibility in making claims, or wanting to avoid the inconvenience of acquiring another policy.

Does The Coverage Premium Go Up With Restoration Benefit?

Since restoration benefits are usually provided as an add-on, any additional coverage outside the parameters of the base plan will result in a partially higher premium. It's crucial to consider the add-on long-term benefits instead of just the higher cost, though.

Think about the following case: a policyholder who is 30 years old and free of any ailments selects a regular plan, which has a cost of approximately Rs 5,000. The additional charge, should he want to include the restoration add-on, would come to approximately Rs 1,000-1,500.

When setting the premium for the restoration benefit add-on, insurers take into account many aspects like the policy type, age, medical history, and sum insured.

What Are The Things You Should Consider When Choosing a Health Insurance Restoration Benefit?

Here are some considerations to make if you're thinking about choosing restoration benefits under your health insurance policy:

Exclusions

Certain conditions, such as pre-existing medical conditions or particular therapies, may apply to restoration benefits. To comprehend the exclusions, thoroughly read the policy materials.

Waiting time

You might only be eligible for restoration benefits after purchasing the policy, if there is a waiting time. Before choosing this rider, be sure to check the waiting period.

No Carry Forward

Under health insurance, restoration benefits are not carried over to the following policy year. It is only valid for use during the same policy year.

Claim Process

Make sure the restoration benefit claim process is simple to understand and hassle-free. Verify if the ordinary claim procedure and the restoration benefit claim procedure are the same.

Permissible Restorations

Find out how frequently you can make use of the restoration benefit throughout a policy year. Most insurance only pays out the full amount insured once a year.

What are the Benefits of Getting a Health Insurance Plan from ACKO?

The decision to choose an ACKO health insurance plan may have several advantages. Here are some of the following to look up to:

Although other insurance companies may cover up to 85% of the whole cost of care, ACKO guarantees to pay the full amount of an approved claim.
You may choose between a large sum insured and cost-effective add-on coverage for severe diseases and ambulance rides with the ACKO Platinum Super Top-up health insurance plan.
We have partnerships with over 14,300 network hospitals in India, enabling you to submit claims cashlessly.
If you buy a health insurance plan from ACKO, there won't be a set copay or a limit on hospital room rent.
In addition, under ACKO Platinum Health Plans, the insurance plans provide coverage for pre-existing conditions in addition to many other disorders.

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The Bottom Line

There are several advantages to owning health insurance coverage with the restoration benefit. Be sure to evaluate several health insurance policies before settling on a specific one. When selecting whether to use the restoration benefit, do consider your financial situation and medical background.

Frequently Asked Questions

If you want some more details on how to restore the sum insured in a health insurance policy, check the commonly asked questions and answers we have given below.

How does the benefit of restoration work?

The restoration benefit "restores" the insured amount, so you can file a claim even after you've used it all. That is to say, once you have used up the entire amount, you may be able to restore the amount insured. As a result, you may file a claim to pay for future medical costs.

Can the same hospital stay be covered by the restore benefit?

Plans for individual and family health insurance are available with this feature. Often referred to as the refill benefit, it can be added to your current policy as an additional layer of protection and is useful should you require hospitalisation twice in a single policy year.

In a year, how many times can we file a claim for health insurance?

During the policy period, you may file multiple claims; however, the maximum amount you can claim is the sum assured. The insurer will not pay out any further claims from the policyholder after the sum assured limit has been reached.

Does the recharge benefit make sense for health insurance?

Indeed, the recharge benefit comes in handy when you need more for your next claim and the base sum insured drops.

Are the benefits of recharge and restore the same for health insurance?

In terms of health insurance, recharge and restore benefits are comparable ideas, but they offer distinct advantages. When the insured amount is depleted, you can request a recharge; if it is diminished as a result of a claim, you can have it restored.

Disclaimer: The plans, services, features, processes, and other details mentioned on this page are subject to availability and changes. Please check the applicable policy wordings before making any insurance-related decisions. Feel free to reach out to us at [email protected] for any queries.