Should you purchase a Health Insurance Plan with restore benefit?

In our busy lives, we often get so held up with our responsibilities such as career, family and more, that we forget to take care of our health. When we are young, we do not take our health seriously and tend to indulge in wrong lifestyle habits, like eating fast food, drinking alcohol, etc. It is only in the longer run that we understand the importance of good health.

Having a health insurance plan is just as important as following a healthy lifestyle. You cannot plan and get sick, but if you have a health insurance plan by your side, you can plan your medical treatment well in advance.

Buying a comprehensive health plan is very important, but often during a medical crisis most of us realize that our health insurance coverage is not enough. And this is when the ‘Restore Benefit’ of a health plan kicks in. Health insurance providers keep coming up with new and better plans and benefits for customers, and almost all comprehensive medical plans now come with a built-in sum insured restoration or refill benefit.

You must be aware that every health insurance policy whether an individual plan or a family floater plan has a fixed sum assured that the insured can avail during the policy term. But what if the insured falls ill and exhausts the entire sum assured in one claim, before the policy term ends? Obviously, the insurer won’t pay for further claims during the policy term as the sum assured is already exhausted.

If you have a health insurance plan with Restore Benefit, the sum assured will be re-credited and you can use it again. Thus, the insured continues to get the financial support for medical treatment even if he has exhausted the sum assured. The Restore Benefit feature can prove to be value for money when buying a health plan.

Restore Benefit is an add-on option that can be purchased with certain health insurance plans. For instance, if you have purchased a family floater plan and exhausted the entire sum assured in the beginning of the policy, you will have to pay for all the medical expenses during that year from your own pocket, if in case a family member falls ill. This is where the ‘restore’ feature is really useful. You need to pay extra premium to opt for the ‘restore’ option, and the insurer will reinstate the entire amount on exhaustion of the sum assured.

Let us consider an example to understand Restore Benefit in a health insurance plan in a better way: –

Ramesh has purchased a health insurance plan with a sum insured of Rs 10 lakhs. He gets diagnosed with liver disease and spends the entire sum assured of Rs 10 lakhs on treatment within the first 6 months. If he gets diagnosed with another covered ailment in the same policy term, the insurer will restore the sum assured of Rs 10 lakhs and pay up for the claim. Therefore, Ramesh will receive an additional Rs 10 lakhs during the same policy year.

Therefore, customers can receive up to double cover by paying half the amount, if they opt for this add-on benefit. But there are a few things that you need to consider before you purchase this add-on benefit, to ensure that you can extract maximum benefit out of it.

Health insurance providers offer two types of restoration options to customers –

• Complete exhaustion –
  This benefit is usually offered as a part of most health insurance policies. This benefit will be applicable only when the entire sum assured along with the bonus is exhausted.
• Partial exhaustion –
  This benefit will be applicable even if there is a partial exhaustion of the sum assured.

The Restore Benefit is only applicable under the following conditions –

• Restore Benefit will be offered only for different illnesses and not for the same illness or injury.
• Restoration Benefit is not available for the first claim during a policy term.
• Restoration Benefit cannot be carried forward to the next policy year if it is not consumed in the same policy year.

• HDFC ERGO- Health Suraksha Plan – With Regain Benefit (add-on cover), you can reinstate 100% sum insured when the provided ‘no claim bonus’ has been completely exhausted in that year.
• Reliance General Insurance – Health Gain Insurance - When the entire sum insured and cumulative bonus (if any) is exhausted, and there is requirement for further hospitalization, your sum insured will be recharged at no extra cost.
• Religare Care Freedom – Sum insured is restored if the claim amount gets exhausted, at no extra cost.
• Apollo Munich – Optima Restore Individual – Automatic reinstatement of the basic sum insured once in a policy year, if the basic sum insured and multiplier benefit has been exhausted during the policy term.
• IFFCO Tokio Individual Health Protector Policy – An add-on cover with the policy, reinstatement of sum assured will be done after charging an appropriate premium.

Restore Benefit, quite clearly, is an ideal add-on to a health insurance plan. While you can choose a higher sum assured to get more coverage, it will come at the cost of paying a higher premium. In comparison, Restore Benefit helps you keep the premium well within your budget while you avail additional cover. When you purchase a health insurance plan with Restore Benefit, it is very important to read the fine print before signing on the policy document, to understand the benefits in a better.