What is Restore Benefit in Health Insurance?

Definition of Restore Benefit

Restore benefit can be defined as the benefit under which the Sum Insured for the health insurance policy gets restored or reinstated after a claim. In simple words, even if Sum Insured under the health insurance policy gets exhausted in a claim, the insured need not worry about costs for next hospitalization as the sum insured would again get reinstated. It is one of the most powerful benefits in a health insurance policy, but different policies have different terms and conditions regarding how the benefit will be triggered and how it can be utilized.

How does Restore benefit work?

Let’s understand how Restore benefit works in a health insurance policy. For this example, we will consider a policy which offers unlimited restore benefit and does not have other conditions like same disease limit, or same member limit.

Mr. A has a health insurance policy with 10 Lac Sum Insured. The members covered in the policy are Mr. A, Ms. B and Mr. C. For the claims in the year, the health insurance will cover as per the below table.

Claim No.	Claim For	Claim Amount	Available Limit		Claim Paid
			Sum Insured	Restore Benefit
1	Mr. A	6 Lac	10 Lac	0	6 Lac
2	Ms. B	8 Lac	4 Lac	10 Lac	8 Lac
3	Mr. A	12 Lac	0	10 Lac	10 Lac

From the above example it is clear that despite having health insurance cover of 10 Lac, the health insurance company has paid out 24 Lac as health insurance cover in a year. This is the reason restore benefit is such a powerful benefit in a health insurance policy.

Types of Restore benefit in health insurance

Different health policies have different terms and conditions attached with the Restore Benefit and how it can be utilized. While Restore benefit is the universal name, some of the companies have offered the same benefit with slightly different terms and conditions under different name. For example, Niva Bupa has named the benefit as ReAssure and offered an enhanced version of the Restore benefit. The usual limits applied by health insurance companies regarding Restore benefit are:

1. Count of Restores: Health insurance policy with restore benefit might limit the number of times the sum insured will restore; it can range from 1 to unlimited times.
2. Limit on disease: The health insurance policy might have a clause in restore benefit stating that in case of hospitalization due to same disease in one policy year the restore benefit would not be applicable.
3. Limit on members: The health insurance policy would have restore benefit, but not for the same member.

Important points to remember regarding the Restore Benefit

1. The Restore benefit does not exceed the Sum Insured of the health insurance policy for a single claim. This would be applicable for the basic Restore Benefit, and some health insurance policies might offer a little extra benefit, but Restore Benefit is not a substitute for high sum insured.
2. Always check the policy terms and conditions to understand how the Restore benefit would work