Individual Insurance

You can file multiple numbers of claims in a health insurance plan up to the limit of sum insured. The limit of sum insured is pre-specified and insured can get coverage up to that particular amount only. In the policy tenure, the unlimited number of claims can be covered depending upon the scope of coverage and limit of sum insured.

There are chances that your limit of sum insured might get exhausted in the first two or three claims, in such cases, there is a restoration benefit provided by the insurer once in a year. Restoration benefit is also known as refill benefit.

When the limit of sum insured is exhausted, there is an inbuilt feature called restoration benefit which recovers the cost of medical treatments by refilling the basic sum insured amount once in a year or as per the number of times specified in the terms of policy.

Once the limit of sum insured is used up during a year, restoration feature automatically reloads the basic sum insured of your insurance for later use. Restoration benefit provides peace of mind as it doubles the sum insured amount.

Some key things to remember about restoration benefit:

-In case of restoration benefit, the refilled amount of sum insured cannot be used for the treatments which have been claimed earlier.
– Restoration benefit is provided only when your limit of sum insured gets exhausted.
– Restoration benefit is offered once during the policy tenure.

Case Study:

Raman has purchased a health insurance policy. The sum insured of the policy is 3 lakh and it has restoration benefit applicable under the terms of policy. The first claim was made when Raman underwent heart bypass surgery and the medical cost of treatment was around 2.5 lakh which has been recovered from the insurer. Later a claim has been made of Rs. 50,000 occurred due to some medical issue.

The limit of sum insured is exhausted during the second claim which leads to the automatic restoration of basic sum insured. Raman can get the coverage of medical cost up to 3 lakh again during that year by the virtue of restoration benefit.

Later, in the same year, Raman had some health problem due to previous heart surgery. Although the limit of sum insured is 3 lakh still the claim will not be settled. Under the purview of restoration benefit, if the claim has been made earlier due to the same course of treatment, insured will not get coverage for the same treatment again.

Unfortunately, Raman will not get coverage for the treatment again. He has to bear the financial repercussions himself. Hence, It is important to know the terms of policy and features of your health insurance plan.

Always, have an optimum limit of sum insured. Mostly, all private insurers provide restoration benefit still, always check with the insurer about the restoration benefit. Refill benefit doubles the sum insured amount. It is a value-added feature offered by the private insurer.

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Health insurance plan can cover any number of claims, provided that the accumulation of all the claims made cannot be more than the limit of sum insured. The limit of sum insured is the crucial factor in ascertaining whether your claim will be covered or not and up to how much amount your claim can settle.