Restore option is in a health insurance


Can you please tell me what a restore option is in a health insurance plan?



In some Health Insurance policies, the sum insured is reinstated if the insured exhausts the coverage amount in a year. For instance, the restoration benefit can also be used in cases where an insured has to bear expenses for any medical condition which is different from the condition for which a claim was made. For example, let’s say an individual has procured a health policy that has a sum assured of Rs. 20 lakhs. He gets diagnosed with a heart ailment and spends the entire Rs. 20 lakhs on that ailment within the first 6 months. In case he gets diagnosed with a kidney issue after around 2 months, the company that has provided the insurance policy will restore the entire Rs. 20 lakhs. Therefore, the individual will receive an additional Rs. 20 lakhs during the policy year.

Therefore, customers will receive a cover of Rs. 40 lakhs by paying half the amount, if they procure this benefit.

There are two types of restoration options available and customers must read the fine print of their Health Insurance policy before opting for either one. These options are –

Complete exhaustion of the insured sum - This type of benefit is offered as part of most Health Insurance policies. This benefit will come into play only when the entire insured sum along with the bonus is exhausted. In the example mentioned above, if the first claim was Rs. 10 lakhs and there is still a certain sum available, this benefit will not get triggered for the subsequent claim.

Partial exhaustion of the insured sum - This benefit is more advantageous to customers and will come into force even with a partial exhaustion of the insured sum.

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BB Expert