What is Restoration Benefit and How Many Times Can You File a Health Insurance Claim in India?

Restoration benefit advantage is a coverage benefit of health insurance that replaces or restores the covered amount if a prior claim is expended. When the coverage/sum assured limit is ‘exhausted’ or used up within the insurance term, the insured sum can be restored by way of restoration benefit either once a year or in compliance with the limitations stated in the terms of the policy, so that the treatment expenses is covered.

Restoration benefit is allowed on unrelated illnesses; subsequent claim must be for a different injury/illness. Also, it is not available for the first claim (only subsequent claims). You must check for the extent of restoration benefit as it varies for different insurance plans (it can be from 50% to 200% of the base sum insured). If the restoration benefit feature is not used, you cannot carry it forward to the next “policy year”

Some Points to Keep in Mind Relating to Claims

1. You can make several claims within the policy period up to the amount insured. Unlimited amounts of claims can be made during a policy period, as per the extent of coverage specified in the policy terms.
2. Filing of claims would completely depend on the provider of health insurance. Before you can make a claim and even for certain ‘specific illnesses’, there may be a ‘waiting period’. And after this is over, during the insurance term, you will lodge a claim up to the limit of the insured amount
3. It is not possible to simultaneously make a health claim with two insurance providers. You must file a claim with the first insurance provider and you can claim for reimbursement from the other insurance policy if the first policy is not sufficient. Usually, it is done with top-up insurance plans that provide coverage above the deductibles of the prevailing health plan. To prevent claim denial by one of the insurance companies, maintain transparency and share all the important information.
4. You can buy ‘multiple’ health insurance plans for the ‘same person’. This will offer a wide coverage and eligibility for the multiple services offered by each insurance company. It may be helpful, particularly through claims, to have access to 2 or 3 health insurance policies.

Advantages of Restoration Benefits

Here are some of the advantages of restoration.

• Restoration benefit increases the advantages available in health insurance plans. By restoring benefit, you will enjoy additional ‘sum insured’.
• Several health insurance policies have an inbuilt restoration benefit. Hence, you need not pay an extra premium for the coverage to be included. However, in some plans, restoration benefit is an ‘optional add-on’. You need to pay extra to opt for this benefit
• In case of an existing illness or your prone to illnesses/accidents, you must opt for the restoration benefit, as it ensures your coverage/sum insured does not fall short of meeting your claims/medical expenses
• If you have a family floater insurance package, the restore benefit is very useful. In such plans, the restore value guarantees that all the members of the family are adequately covered by the insured sum. If one member uses the amount insured, the restored sum insured will guarantee that the policy covers the medical costs of another family member.

Conclusion

The restoration benefit of the sum insured has become a popular coverage feature of several modern health insurance plans. In the event of multiple claims, it proves helpful when it requires sufficient coverage. Therefore, look for health insurance plans with the 'restoration benefit' feature for maximum coverage.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.