Restoration Advantage in Health Insurance

• It is 2025, and in this new decade, the world is in the midst of navigating a pandemic situation. Health, which previously took a backseat in our daily hustle to balance work and personal lives, has suddenly become a focal point. The saying, health is wealth, has reaffirmed its significance once again. Considering all these factors, obtaining a health insurance policy is of the utmost importance.

• When purchasing a health insurance policy, the first concern that arises is what if it gets depleted. However, contemporary policies come with an array of features, one of which is the restoration benefit.

How Does Restoration Benefit Work?

The restoration of the sum insured in health insurance is triggered only after the sum insured is entirely or partially consumed, depending on the type of benefit selected. Here’s how it operates:

1. Full Restoration

• The sum insured is replenished to its initial value once it is completely consumed. For example, if your INR 10,00,000 policy is entirely utilized, Bajaj Allianz General Insurance Company will restore INR 10,00,000 for future claims.

2. Partial Restoration

• The policy reinstates a portion of the utilized sum insured even if only a fraction of it has been used, guaranteeing continuous coverage for future claims. This restoration benefit in health insurance is particularly advantageous for families with a floater plan, where multiple members can take advantage of the restored coverage.

What is the Restoration of Cover in Health Insurance?

• The restoration benefit is a provision where the insurance company re-establishes the sum assured of your insurance cover to its original amount once it is fully consumed. With this feature, you need not be concerned even if you inadvertently deplete the sum assured of your health cover. Let us illustrate the restoration benefit in health insurance with an example.

• Mr. Kishan possesses a family health cover of ₹8 lakhs with the restoration benefit. Due to his serious heart condition, he had to undergo surgery, which led to the complete exhaustion of this sum assured. In the following months, he experienced a stroke and required another operation, which cost ₹4 lakhs. Since the restoration benefit is included in Mr. Kishan’s insurance policy, the second treatment is also covered by his insurance company.

Why is it crucial to have a restoration benefit in health insurance plans?

• With the rise of lifestyle diseases and escalating treatment costs, it is common for the sum assured to appear inadequate after a few years. At this juncture, having a backup plan in the form of a restoration benefit will serve as a protective measure, offering additional coverage if necessary. Therefore, make the right decision and include a recovery benefit in your health insurance policy.

Types of Restoration Benefit

1. Complete exhaustion

• This applies when the entire sum insured is fully utilized. For instance, a policyholder with an INR 10,00,000 sum insured will have it restored only after the entire amount is consumed.

2. Partial exhaustion
   The policy triggers the restoration benefit when a part of the sum insured is utilized, without necessitating the complete depletion of the coverage. This guarantees ongoing protection for future claims. For example, if INR 6,00,000 out of an INR 10,00,000 policy is utilized, Bajaj Allianz General Insurance Company reinstates a portion of the used amount, like INR 4,00,000, providing continued coverage.
   Both options come with their benefits, and the selection of the appropriate type relies on personal medical needs and financial planning.

Features of Restoration Benefits in Health Insurance

• The restoration benefit in health insurance is a significant add-on that increases the usefulness of your policy, ensuring monetary protection during unforeseen medical emergencies. Below are the essential features that render this benefit essential:

1. Applicable for Future Claims

• The restoration benefit is only relevant for new claims that arise after the original sum insured has been fully utilized. It cannot be used retroactively for ongoing treatments or claims. This guarantees that policyholders have extra financial support for future medical costs within the same policy year.

2. One-Time Activation Per Policy Year

• Bajaj Allianz General Insurance Company permits the sum insured to be restored only one time in a policy year. This restriction ensures fair utilization of the feature, providing a safety net for emergencies without significantly raising policy costs.

3. No Carry Forward to the Next Year

• The restored sum insured is solely valid for the current policy year and cannot be transferred to the following year. This ensures that the benefit fulfills its intended role of addressing immediate, unexpected medical expenses rather than creating a surplus for upcoming years.

Benefits of Buying a Health Insurance Plan with Restoration Benefits

• The restoration benefit in health insurance is a robust add-on that presents numerous advantages to policyholders, boosting their financial security during medical emergencies. Here’s a detailed examination of the primary benefits:

1. Increased Coverage

• One of the primary advantages of the restoration feature is the capability to reinstate the sum insured once it is used up. This guarantees ongoing financial protection for various hospitalizations within the same policy year, proving particularly beneficial in cases of serious illnesses or repeated treatments.

2. Cost-Effective Solution

• While acquiring a new health insurance policy for extra coverage can be costly, choosing a restoration benefit is a cost-effective option. For a minimal additional premium, policyholders can receive enhanced financial protection without needing a second policy.

3. Peace of Mind During Emergencies

• The restoration benefit alleviates the anxiety of exhausting the sum insured, providing reassurance that further coverage is available for unforeseen events. This peace of mind can be invaluable, particularly during extended or unexpected medical treatments.

4. Multiple Claims in a Policy Year

• This benefit is perfect for individuals or families with recurring medical needs. For family floater plans, where multiple members share the sum insured, the restoration feature guarantees sufficient coverage is available for everyone, even after significant claims. Such advantages make this add-on feature a wise choice for greater financial security.