While selecting health insurance, you want the best medical facilities and care for several serious illnesses. Protecting your family from unplanned hospitalisations would also be beneficial if you had strong health insurance coverage. You are allowed to file more than one claim as long as the total amount insured stays within the policy's upper limit. The policyholder is only eligible for coverage up to the predetermined coverage limit. Any number of claims that fall under the scope of coverage during the duration of the policy will be reimbursed.
The Insurance Regulatory and Development Authority of India (IRDAI) states that the insured can submit a claim under one or more plans, even in the case of a single hospitalisation. However, the actual cost won't be covered more than once. The terms and circumstances of each policy will govern the settlement. Both these scenarios have different ramifications for reimbursement claims and cashless transactions. Additionally, you should be aware that no single plan or combination of plans will allow you to claim more than the sum assured. However, there are instances where the costs of the treatment outweigh the amount guaranteed. The additional health insurance can be used to cover the remaining costs. The maximum number of health insurance plans a person may purchase is unlimited. However, to avoid misunderstanding during claim settlement, experts advise adhering to a maximum of two approaches with an acceptable sum insured (one basic insurance and a top-up over and above what your employer gives).
Sounds Confusing? Let us Explain it to You Step-by-Step
Let's say you have purchased a family floater health insurance policy, and a member of your family urgently needs hospitalisation for a life-threatening ailment. Hospitalisation, nowadays, we all know, is not easy on our pockets. It can drain one out of their lifetime of savings. So if the charges skyrocket and you file a health insurance claim, you can get by. But what if you exhaust the sum insured in your first claim itself? That's where the restoration benefit or a refill of the sum insured comes into play. The insurance provider offers it once a year. The insurer recovers the cost of medical treatments by replenishing the basic coverage amount when the original sum insured is used up throughout the policy period. It either occurs once a year or within the parameters indicated in the policy text. The goal is to make sure the insured can live comfortably and get paid for their medical care.
In your case, say your policy has a sum insured value amount of INR 3 lakh with restoration benefit, and you already filed a claim worth INR 2 lakh a few years ago for some other treatment. Now for the current hospitalisation, if the charges go beyond INR 2 lakh and you file a claim for the same which easily surpasses your sum insured amount, you can avail of claim benefit up to INR 3 lakh under restoration benefit.
God forbid the health insurance claim won't be settled if hospitalisation occurs again in the same year for the same illness, even though the policy value is INR 3 lakh. The restoration benefit is deemed invalid to the same course of treatment. As a result, your health insurance claim process will not be initiated for the same medical treatment, and the expenses will have to be borne from your kitty.
However, if another member of the family gets hospitalised in the same year for a different reason, in that case, the restoration benefit can come to the rescue. Hence, it is necessary to know your policy inside out.
The Different Restoration Benefits
There are two different restoration alternatives available, and before selecting either one, we advise you to review the terms of your health insurance policy carefully:
Total Depletion of the Amount Insured
In this case, the benefit won't kick in until the total amount insured has been used up.
Partial Depletion of the Amount Insured
In this case, the benefit will take effect even if the sum insured is only partially used up.
Does Restoration Benefit Result in a Higher Insurance Cost?
Economic benefits result from the restoration process. But remember that the policy's premium is directly proportional to the number of features selected. This benefit exceeds the cost of the premium. Most health insurance plans will have restoration benefits under the base coverage, so it does not result in an additional premium. However, if restoration comes as a rider, you will need to pay an additional premium.
Read more- Are You Aware of Health Insurance Restoration Benefits
Here's a Checklist on Restoration Benefit
- Restoration will happen on exhaustion of complete sum insured or partial sum insured.
- The insured cannot be restored to the following policy year.
- The restoration benefit won't be available for the initial claim.
- It can be used for any amount of insurance, not just the higher sum covered.
- Restore benefits are only available for future claims.
- The insurer reinstates the total sum covered if you use them in a single claim during the policy period.
Conclusion
While purchasing health insurance in India, you should select a suitable coverage amount and confirm the maximum restoration benefit. If you want to submit multiple claims during a policy year, you must consider that. Most private health insurance providers in India offer restoration benefits, but you should still double-check with yours. Your sum insured amount doubles with the refill benefit, which aids in covering all your medical costs.
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