What is Restoration Benefit in Health Insurance and its types

The awareness about the importance of health insurance can is increasing rapidly in India, especially since the pandemic of COVID-19 people have come to know the significance of having a health insurance policy with restoration benefit in their life.

What is Restoration benefit in Health Insurance?

The restoration benefit is a coverage benefit wherein the health insurance provider restores or refills the sum insured after the original coverage is insufficient or exhausted for future claims, within a calendar year due to the treatment expenses.

This benefit helps pay for the expenses even if you exhaust your original coverage. So, even if you consume the entire sum insured, there is no need to worry, as your insurance company will restore additional sum insured equivalent to the base sum insured and you can use it in the future.

For example; Mr. Joshi has a health insurance policy of Rs 5 lakhs along with restoration benefit. He was hospitalised for heart treatment and the entire sum insured of Rs 5 lakh got exhausted.

A few months later, Mr. Joshi is diagnosed with chronic kidney disease which required surgery costing around Rs 3 lakhs. The Insurer will cover the cost of surgery, hospitalization and medical treatment of Mr. Joshi as it has restored the original sum insured of Rs 5 lakhs. This was only possible Mr. Joshi opted for Restoration Benefit while purchasing his health insurance policy and Restoration benefit got triggered as the claim was for unrelated medical condition.

It is a very common feature that is widely available with many health insurances plans in India. It is also called the recharge benefit or sum insured restoration.

What are the Types of Restoration Benefits Available?

Following are the two types of Restoration Benefits:

1. Partial Exhaustion of Sum Insured:

In this type of restoration benefit, the sum is restored or reinstated even if it is only partially exhausted by the policyholder. For example- if you have a sum insured of Rs. 5 lakhs and you make the 1st claim of Rs. 4 lakhs, then your insurer will restore the same amount, as there has been partial exhaustion of the sum insured. The restore benefit would apply and the sum insured would be restored to 5 lakh which will be available for any future claim.

2. Complete Exhaustion of Sum Insured

Complete exhaustion is the type of restoration benefit where the insurer reinstates the coverage amount only after the entire sum insured is exhausted after the first claim. For example- If your health insurance policy offers coverage of Rs. 10 lakhs, then the insurance provider will only restore the full amount of the sum insured after the entire original sum insured is exhausted after the first claim.

A restoration benefit is one of the many add-on covers you can purchase to extend the already bought comprehensive health insurance policy. At a nominal cost, you can get the benefits of extra protection and full sum insured restoration benefits.

Kotak General Insurance offers a diverse range of health insurance services and products to help you secure your future from any uncertain medical emergency.

Disclaimer: The content provided is for education and informational purpose only, none of the information contained in our blog amounts to any form of opinion or advice. Please go through policy related documents carefully or consult an expert before making any insurance-related decisions.