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Find out Everything about the Restore/Refill Benefit in Health Insurance

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Published on February 22, 2022. EST READ TIME: 3 minutes

Let’s say you have bought a comprehensive health insurance plan after doing intensive research. That’s undoubtedly a wise move on your part. You have chosen a certain sum insured knowing that even in the worst cases, it will suffice. But then, after a few years, imagine that you contract a critical ailment. The medical expenses will quickly reach the threshold limit in that scenario. So, what will you do if the sum insured you had selected gets exhausted? You will need to start paying from your own pocket. And that can get scary! But if you opt for the restore benefit as part of your health plan, this hassle can be avoided. Read on to learn more about it.

Restore benefit in health insurance

The term reveals the whole story. Still, for more clarity, the restore benefit helps you to restore your exhausted sum insured and your accumulated NoClaim Bonus. There is no doubt that a health insurance plan helps you get the best treatment available without fretting over medical bills. It gives you peace of mind so that you can solely concentrate on getting better. But financial stress enters the picture the moment your sum insured gets exhausted. You can keep this kind of stress at bay with restore or refill benefit, an additional component to your base plan.

Here’s an example. Say you buy a health insurance plan with a cover of INR 7 lakhs. Then you end up getting diagnosed with an ailment or meet with a fatal accident. The treatment consumes the entire sum insured. But fortunately, not a penny is charged extra. Now suppose, during the same policy period, you get hospitalised again for another reason and incur a medical bill of INR 4 lakhs. Who pays for it this time? You? Well, no, if you have the restore benefit. This benefit will refill your base plan with another INR 7 lakhs, from which you can pay the bill of INR 4 lakhs and easily cover the second hospitalisation’s expenses.

What do you need to know to claim restore benefit?

Now that you have understood how restore benefit works, here are some factors to keep in mind when opting for this benefit.

• Works on a tenure basis:

In the above hypothetical situation, if your question was what happens in the case of a third hospitalisation, the answer would be, you will foot the bill. This is because restoration benefit can be used one time during the policy year. You cannot carry forward the remaining sum to the next year, irrespective of the fact whether you used it or not.

• Not meant for the first claim:

Restoration benefit is meant only for future claims. It comes into play only when the sum insured gets exhausted in the incident of hospitalisation. It can’t be used for the first or even second claim till the sum insured gets exhausted. Therefore, if your cost of treatment for the first ailment was INR 8-9 lakhs, the insurer would cover only up to INR 7 lakhs as the predefined limit.

• Works differently with related and unrelated ailments:

Some policies come with the condition that either your second hospitalisation should be because of different conditions from the first one or there should be a gap of 30-45 days if it’s a relapse case. However, the reason is of little significance if another insured member of your family is hospitalised. But having said that, clarify the terms and conditions with the insurer before buying the add-on feature. In case of family floater plans, the reinstatement of the sum insured will be done on a floater basis for everyone insured under the plan.

• Application limits:

This plan is meant for treatment done in India.

How and when can it be used?

Keeping the above conditions in mind, use the restore feature judiciously. Experts say that its of greater value when taken under a floater plan as two hospitalisations for the same person are less likely compared to two different family members requiring treatment in the same year. Buying this add-on cover will increase your premium though. So, if your sum insured is huge, buying a restore benefit may be counterproductive as the sum insured will never get exhausted. So, take the call on your budget and medical history.

Conclusion

Setting the right sum insured is of paramount importance when purchasing a health insurance plan. This depends on factors like your medical history, whether it’s an individual or family floater, your budget, etc. If you feel the sum insured may not be enough, you can opt for the restore benefit in your policy. In times of medical emergencies, nothing works better than financial security and, of course, peace of mind.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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