What's Restoration of Sum Insured Balance?

Exhausted your sum insured? Worried what would happen if another hospitalisation occurs within the same policy year? Paying the entire hospital bill from your own pocket is definitely not something you would want. 
But is there any other option available? Yes, there is. The yes made you happy, didn’t it?

Today, most health insurance policies offer what is known as a ‘restoration benefit’. Having a restoration benefit can be really advantageous for you. It is a benefit that restores the entire sum insured back to your policy in case you exhaust it for a claim during hospitalisation. It is a kind of a recharge to restore back your original balance. 
When your cover is exhausted, sum insured gets replenished automatically for the next hospitalisation within the same policy year. 

People with family floater plans, in which the sum insured is shared by all family members, there’s a higher probability of sum insured getting exhausted, leaving the other members vulnerable without health insurance cover. Sum insured restoration benefit is of great help not only for family floaters but also for individual health plans. 

Like everything in insurance, this benefit too has its own terms and conditions - it's always strings attached! 

• This benefit is only available for different illnesses and not for same illness or injury
  Restoration benefit is only available for future claims that are not related to any illness, treatment or injury for which a claim has already been paid by your insurer during the same policy year.
  
  
• Restoration not available for the first claim
  This is one of the most important conditions pertaining to this benefit. Your sum insured will not get reinstated in the first claim itself, even though it gets exhausted.
  
  For example - Rishabh who has a health insurance policy of Rs 3 lakhs got admitted and was billed for Rs 4 lakhs. Since it’s the first claim, he will not be able to take the benefit of restoration. The policy will cover only Rs 3 lakhs and he’ll have to pay the difference of Rs 1 lakh out of his pocket only. He will get the sum insured amount restored that can only be utilised for another claim in the same policy year for an illness that is not the same as in the first claim.
  
  
• Sum insured is reinstated on partial or full exhaustion of base sum insured
  Most health policies often provide restoration of sum insured only upon complete exhaustion of sum insured. Some policies however provide the flexibility of restoration even in case of partial exhaustion of base sum insured. You must check this clause very carefully before buying the health policy.
  
  Sum insured gets completely exhausted - Restoration benefit in this case can only be utilised when the entire sum insured amount gets exhausted.
  For example, in the case of Rishabh, with a sum insured of 3 lakhs, if the first claim is of 2.5 lakhs, the policy will still have 50k sum insured which is not used yet. If another event of hospitalisation occurs with an expense of 75k, which is greater than the balance sum insured, restoration will not get triggered as base sum insured wasn’t exhausted in the first claim and policy still had a balance of 50k at the time of second hospitalisation. In such a case, the insured will have to pay the difference of 25k from his pocket only. Restoration can be triggered in case of the next claim, provided it’s in the same year.
  
  Sum insured gets partially exhausted - Restoration benefit with this clause is favourable for the insured. Health plans with this clause will restore the sum insured for the second hospitalisation even if there was partial exhaustion of the base sum insured.
  
  Total claim paid by insurance in case 1 is 3 lakh. Total claim paid however in case 2 is more, i.e., 3.25 lakhs. You must check which type of restoration benefit is being offered in the health policy plan you’re seeking to buy. It is preferable to buy a plan with restoration even with partial exhaustion of sum insured. It comes as a rescue in times of need.
  
  
• Restoration benefit cannot be carried forward
  If your sum insured gets restored in a policy year, it cannot be carried forward to the next policy year if it is not consumed in the same policy year of restoration.

Now that you know all the conditions to keep in mind that come with the restoration benefit, you should definitely look to get it in your policy. It might just save your pocket in the most uncertain of times!