What is Restoration Benefit in Health Insurance and its types


29 Oct 2021

Restoration benefits in your health insurance policy with Kotak Health Insurance. Learn how to ensure coverage is available even after a claim exhausts the limit.

The rise in COVID-19 cases in India has put a strain on the healthcare facilities and has increased the cost of treatment, which resulted in the growing awareness and demand for health insurance plans.

Along with a rise in demand for comprehensive health insurance policies - individual and family floater health plans, there has also been an increasing interest in the various features and add-on benefits that improve the insurance policy coverage. Features such as high sum insured, restoration benefits, critical illness cover, etc., have become quite popular.

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 ofRs.5 lakhs along with restoration benefit. He was hospitalized for heart treatment and the entire sum insured ofRs.5 lakh got exhausted.

A few months later, Mr. Joshi is diagnosed with chronic kidney disease which required surgery costing aroundRs.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 ofRs.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 ofRs.5 lakhs and you make the 1st claim ofRs.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 ofRs.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.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.