Unlimited Restoration in Health Insurance — What it really means.
This is the 3rd article on health insurance. I hope you have already read the earlier articles, if not take a look at them now.
https://viswaram.com/why-health-insurance-should-be-a-mandatory-product-in-india-e60fbf9556d4https://viswaram.com/why-health-insurance-should-be-a-mandatory-product-in-india-e60fbf9556d4
Today we are going to discuss an important feature called Unlimited Restoration. You might already be familiar with Sum Insured from our earlier articles, it is the maximum amount the health insurance company can reimburse for your hospitalization expenses.
For example, if you had taken the 10 Lakhs policy, the insurer will settle a maximum claim of 10 lakhs in a single bill. There are 2 possibilities here.
case 1: If your hospital bill is less than 10 lakhs i.e. 5 lakhs, then the insurer will settle the amount amounting to 5 lakhs only.
case 2: If your hospital bill is greater than 10 lakhs i.e. 12 lakhs, then the insurer will pay you only 10 lakhs, and the rest 2 lakhs has to be borne from your pocket.
It is always advised to opt for the highest sum insured if you can afford it. Opting for a 20 lakhs sum insured from 10 lakhs will only cost you 16% higher premiums, read more.
What if you have already used up your health insurance SI and you had another hospitalization event? This is where Unlimited Restoration comes to the rescue.
The new generation health insurance providers will auto top up your sum insured even if you have exhausted it. That means, even if you have used up your 10 lakhs balance, you could claim hospitalization benefits again during the same year.
We will illustrate it with some examples, assuming your SI = 10 lakhs.
case 1: Your first hospitalization bill is 10 lakhs, the insurance provider will settle the entire 10 lakhs claim for you.
case 2: You have another hospitalization bill of 5 lakhs, then the insurance provider will restore your sum insured and you could claim this bill amount.
case 3: You have a 3rd hospitalization event and the bill amount is 4 lakhs, this will also be claim settled as you have an adequate balance from the topped-up amount.
Wow, that is amazing — isn’t it? When I learned about this feature, it really gave me goosebumps. Earlier health insurers did not have such an offer, now all the new-generation insurers are providing this benefit. But before buying the policy, you need to talk through their agent and ensure this package is available and activated.
Few insurers have tweaked this scheme to their benefits. Let me illustrate it for you. Let us assume the SI = 10 lakhs here also.
Case 1: Your hospital bill is 7 lakhs and the insurer settles the entire 7 lakhs bill.
Case 2: Your next hospital bill is 6 lakhs, but the insurer will only settle 3 lakhs out of it as they mandate the SI of 10 lakhs to be totally exhausted for the unlimited restoration to come into effect.
This could pose a serious challenge and might not work in your favor. When I compared the plans available, I found out that Manipal Cigna had the best solution for this problem. They will restore your sum insured even if there is a partial balance.
Example: If your first hospital bill is 5 lakhs, they will restore the SI to 10 lakhs immediately. This means that the total balance is 5+10 = 15 lakhs as of now. If your next hospital bill is 15 lakhs then you can confirm that it would be claim settled for sure.
Most of the time, the insurer and agents may not reveal the exact terms and conditions during policy login, so it is your responsibility to agree and pay the premiums after finding out the required details.