Replenishing Your Medical Insurance with Restoration Benefit

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The above plans and premiums are for AED 1,000,000 Sum insured for 1 Adult of 30 Years for Dubai city.

In an ideal scenario, your health insurance plan would cover all your healthcare expenses. However, a hundred per cent coverage is hindered by many limits and sub-limits that health insurance plans come with. Once you have exhausted the assured sum of your health insurance plan, it ceases to cover any additional medical expenses that occur within the same tenure, even if they are technically covered under the plan. The bright solution to this predicament is the restoration benefit in health insurance plans. Designed to ensure that your health insurance coverage covers you beyond the initially offered sum assured, restoration benefit in health insurance offers the ultimate solution to most problems related to limits and sub-limits of health insurance plans. 

What is Restoration Benefit in Health Insurance?

Restoration benefit or restore benefit is an added coverage for a health insurance plan that helps in restoring the assured sum of your plan to its maximum limit as soon as you exhaust it during your tenure. You may also find it being referred to as a refill benefit. All different kinds of health insurance plans can be combined with the restoration benefit, be it an individual health insurance plan or a family floater policy. Restoration covers are incredibly helpful when you are susceptible to falling ill frequently due to health complications or old age. 

How Does It Work?

Precisely, the restoration benefit in health insurance refills your assured sum limit to its original, complete amount after you use it completely or partially in a health insurance claim. For example, Miss A had to be hospitalised to get treated for asthma, which is covered by her health insurance plan. After the treatment, post-hospitalisation services and rehabilitation, the assured sum of her insurance plan was completely exhausted. Soon after she was discharged, she came down with a horrible case of non-alcoholic jaundice during the same tenure of her health insurance plan. She had already exhausted the assured sum offered by her health insurance plan when she made the first claim. But since she also has the restoration cover, the health insurance plan will be restored to its original form with the complete assured sum available to be used again for the second claim for treatment of jaundice.  

Types of Restoration Benefits in Health Insurance

Restoration benefit in health insurance covers can be divided into two basic types:

  • Partial Sum Exhaustion: As the term suggests, this type of restoration benefit in health insurance will come into effect even if you have exhausted only a part of your assured sum in one claim. The process remains the same though. Let’s say the assured sum of your health insurance plan is AED 500,000. The first claim you made only went up to AED 300,000. When you apply for the second claim in the same tenure, your assured sum will be reset to AED 500,000. 

  • Complete Sum Exhaustion: This type of restoration benefit in health insurance only comes in effect if you exhaust the assured sum of your health insurance plan completely in the first claim. The benefit will not be utilised here if only a part of the assured sum is used in the first claim. 

Standard Rules for Restoration Benefit in Health Insurance

  • Tenure Based Application: Restoration benefits in health insurance work on a tenure-based format. The restoration benefit you buy in tenure can only be utilised once in the same tenure. It expires when you renew your plan and hence cannot be carried forward. In other words, the restoration benefit you buy in tenure 1 can only be used for the second claim you make in tenure 1. It cannot be applied to any further claim made in the same tenure or the upcoming tenure. 

  • Works as Per Ailment Concerned: Restoration benefit in health insurance and its utilisation can differ as per the ailment. If the second claim in the same tenure is for the same illness as the first, the restoration benefit kicks in after a waiting period. The waiting period is counted after your discharge. For example, Miss A got treated for asthma and made the first claim of the tenure. If she wants to make a second claim for asthma treatment, her restoration benefit in health insurance will only kick in if the claim is made after the waiting period. This period differs for each provider and can range between 30-60 days. 

  • Family Floater Plans Are Different: If you have taken restoration benefit with a family health insurance plan, it will work in a slightly different way. Let’s understand with an example. Your spouse and children were involved in an accident and got injured. The assured sum of your family health insurance plan is AED 500,000. Since the claim will be made for all three of them, the restoration benefit in health insurance would increase the assured sum to AED 500,000 each for all three members. Another way to use the restoration benefit in a family health insurance plan is when two members submit different claims on different timelines. For example, members A and B need to make two separate claims. If member A makes the first claim, the restoration benefit in health insurance will immediately restore the assured sum after claim settlement for member B to use.  

  • Geographical Application: Most insurance providers offer restoration claims within the geographical bounds of the UAE only, the home country. Your international claims cannot be covered by restoration benefits in your health insurance plan. Still, check with your provider to get better clarity on this particular condition. 

Should You Buy Restoration Benefit in Health Insurance?

Whether you should buy the restoration benefit or not should depend on your claim requirements. Senior citizen health insurance plans and family health insurance plans are the ideal types of health insurance plans to be paired with restoration benefits. Since multiple people are insured in a family health insurance plan, the restoration benefit can ensure that everyone gets to use the insurance cover for their treatment, even if it gets exhausted once. In the case of senior citizens, the chances of receiving more than one expensive healthcare service are higher. The restoration benefit in health insurance here can ensure quality healthcare for the second time without the backlash of financial burden. 

Can You Get It as a Basic Benefit?

While this is extremely rare, some health insurance plans in Dubai may provide restoration benefits as a basic benefit in their most exclusive plans. Needless to say, these plans will be some of the most expensive health insurance plans in the country. Apart from that, you can get the restoration benefit as a basic add-on with your health insurance plan. An additional premium will be charged, but the benefit will be highly cost-effective when bought and used smartly. And yes, only buy restoration cover when you need it since you will be paying for it on top of your basic health insurance plan in Dubai. 

In a Nutshell

As it’s evident, the restoration benefit in health insurance plans is rather impressive and useful for those in need of such a service. It works wonders for family floater plans and provides substantial help to individuals and senior citizen health insurance policyholders. But just like any other health insurance benefit, do not forget to compare before you make your purchase. Weigh your options and see what fits your needs the best. Buy from authentic and safe platforms like Policybazaar UAE. 

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