Hyderabad: Comprehensive health insurance has become more of a necessity than a choice these days. This policy will protect you from wiping out your savings due to illness. Of late, medical policies are designed to suit the changing medical needs. During these times, getting to know more about restoration is key. If you were admitted to the hospital for illness and also claimed the policy amount for the same. It would become difficult if you have to go to the hospital again without insurance coverage. Forcing you to spend money from your pocket. To avoid such situations, it is better to refill the policy once you are out of the hospital. This is called restoration or refill benefit. Despite exhausting the insured limit, the policy will return to its normal status. That is the big advantage of this facility.
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For instance, Kumar has an insurance policy for Rs 5 lakhs and gets admitted to a hospital after three months due to some illness. He has utilised the complete insured amount of Rs 5 lakhs. Then he has to wait for another nine months to renew the policy. In between, if he has to be admitted to the hospital for another illness and has to shell out Rs 2 lakhs, then he has no other choice than to pay from his pocket. However, if Kumar had restored or refilled his policy after his first hospitalisation, the money of Rs 5 lakhs would have come to his account as soon as he returned home. Ensuring no issues, if he had to go to the hospital once again. But the number of times a restoration facility is available depends on the insurance company and the kind of policy chosen. Hence, the policyholder has to keep this in mind before availing of a policy. Restoration is possible only after exhausting the insured limit. For example, a policyholder takes a policy for Rs 5 lakhs and spends only Rs 4 lakhs out of it on hospitalisation, while the remaining Rs 1 lakh can facilitate restoration, depending on the insurer and policy terms. The restoration benefit is limited to that policy, and cannot be carried forward to next year.
For the same ailment...
One important thing to note about restoration policies where value is reimbursed. Suppose a policyholder is hospitalised with a heart ailment and utilised the Rs 5 lakh sum assured for bill payment. Later, the policy was restored to the same value. Now, if the policyholder gets hospitalised again with the same ailment, the policy may not cover the cost of treatment. If you go to the hospital with the same illness, you will get only compensation. Now, some policies offer restoration benefits for a single disease as well. It is better to choose such policies. This will be clearly stated in policy terms.
Another important provision needs to be observed. Let's say the bill works out to be Rs 6 lakhs after being admitted to the hospital. Whereas, the policy value is only Rs 5 lakhs. Even in such cases, there is a possibility of restoration. Nonetheless, the policyholder has to pay Rs 5 lakh, along with Rs 1 lakh, to clear the bill. Thereafter, the whole amount will be restored.
Apart from individual policyholders, people who have availed family floater policy (for all family members) can also avail of restoration benefits. Especially, when the family floater policy is taken, the restoration benefit draws high priority. For instance, if one member of a family is hospitalised and exhausts the entire sum assured, the rest of the family members will remain uncovered. In such cases, the restoration benefit comes in handy to provide additional security to the family. Also, don't forget to check out the insurance policy from time to time, says Bhaskar Nerukar, Head, Health Administration Team, Bajaj Allianz General Insurance.
