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All About Restoration Benefit in Health Insurance

Updated On Feb 16, 2021

Health insurance is a pool of benefits. Those who possess a health insurance know how beneficial it is at the time of a medical emergency. A significant means to avoid financial pressure during a critical time, health insurance offers peace of mind and mental support to a person when they need it the most. All in all, a blessing for the insured, health insurance is a massive support system, which with its string of benefits, saves one from watching their savings go down the drain in one go. Owing to countless health insurance benefits, numberless people have started opting for health insurance so that they can at least be free from financial instability at a time when they cannot afford to shell out from their pocket. 

What is Restoration Benefit?

Restoration benefit is yet another gem, in the vast range of health insurance benefits. It is a benefit where the health insurance company restores the original sum insured, after it gets exhausted, in the policy year, for illness treatment. Commonly purchased with family floater or family health insurance plans, restoration benefit is a prime health insurance feature that covers all the insured members of the family in a health insurance. 

Its Types?

One can make a choice between two types of restoration benefits. The categories of restoration benefit types include: 

  • Partial exhaustion of the Sum Insured - Under this type, the restoration benefit comes into force even when the sum insured is partially exhausted. This restoration benefit type is more beneficial for insured individual.
  • Complete exhaustion of the Sum Insured – Under this type, the restoration benefit comes into force only when the complete sum insured gets exhausted. Learn that most health insurance policies offer this restoration benefit type. 

How Restoration Benefit Helps You?

Restoration Benefit is like a backup that one can make the most of when their sum insured gets exhausted. In other words, when owing the sky-rocketing medical costs the sum insured of an insured gets exhausted in a single hospitalisation, then the support of restoration benefit starts. Needless to say, restoration benefit, when available with a health insurance policy, comes across as a massive savior.

Key Conditions Related to Restoration Benefit Feature?

There are multiple policies that provide the benefit of sum insured restoration. However, not all offer the feature under same conditions. Therefore, it is important to note that the conditions to avail the restoration benefit vary according to the policy. Some of the common conditions for restoration benefit include:

  • Sum insured is reinstated on complete or partial exhaustion of base sum insured. 
  • Restored sum insured cannot be carried forward to the next policy year, in case it is not consumed in the same policy year of restoration.
  • Since maximum health insurance policies provide restoration cover for unrelated medical conditions, the restoration benefit only triggers for an unrelated condition. 
  • A few health insurers do not allow restoration benefit on the first claim. They allow it from the second claim. However, there are also insurers that allow subsequent claims for different family members. Note that there are also insurers that allow restoration benefit in first claim in case of hospitalisation due to accident. 
  • There are certain health insurance plans that provide in-built restoration benefit, while others provide them as add-ons. For add-ons, the insured is required to pay an additional amount, thereby increasing the premium by a small margin. As far as the marginal amount is concerned, it depends on the policy term, plan type, and other add-ons availed with the health insurance plan. 

Who Should Go For Restoration Benefit Add-on?

Those buying a family floater policy to make the most of benefits available in the policy can opt for the add-on of restoration benefit. An ideal choice for a family floater plan, restoration benefit will enhance the worth of your insurance, since the cover 'floats' between various members of the family in family floater plans. Opting for family floater plan and then the restoration add-on will benefit you with the same in a massive way.  

Things to Keep in Mind While Opting Restoration Benefit?

  • First and foremost, conditions related to restoration benefit should be kept in mind while choosing the option. 
  • Keep in mind that the restoration benefit will not only apply to the higher sum insured, but in fact to any given sum insured. 
  • Yet another feature to take note of is that restoration benefits are only for future claims and only one person at a time can avail it. 
  • Last but not the least, while some health insurance policies do not cover same illnesses within the same policy term (but allow the restored sum to be still used by other members with same disease), there are also policies that cover even the same illness during a policy year.

Also Read

Standalone Policy vs Critical Illness Rider - What to Choose?


Needless to say, restoration benefit is a great addition to a policy. 

If willing to learn more about restoration benefit, other health insurance concepts or policies, feel free to give us a call at 18001205698. 

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