Never Run Out Of Sum Insured With This Incredible Feature!

Medical costs are increasing at a rapid rate, and treatments can be very costly, especially in the case of a major illness or surgery. As a result, it is quite possible for you to exhaust your entire health insurance sum insured in one hospitalisation, leaving you without cover for the remaining part of the year. It is like building a sandcastle on a beach. You can spend a lot of time and effort to build it, but the tide can erase it in a matter of minutes if you are not careful.

And, if you have a family floater plan, the situation can get even more complicated. It is a one-size-fits-all type of health insurance plan, where the sum insured is shared among all the family members. If one of the members exhausts the sum insured, the other family members won't have any coverage and will have to bear the entire cost of hospitalisation. How can you get out of this mess? This is where a health insurance plan's restoration benefit steps in to save the day.

Restoration Benefit

Most health insurance policies nowadays have this 'Restoration Benefit'. Also called Restore, Reinstatement, Refill or Reset by different insurance companies, it is a feature that refills or restores your sum insured if it runs out within a policy year up to a set percentage- usually 100%. Some policies have this feature by default, while others have it as an optional benefit. A restoration triggers when you use up your base sum insured and bonus (if any). Restoration only kicks in in some policies when the entire sum insured is exhausted; in others, even partial exhaustion can trigger it.

In most plans, the Restoration benefit kicks in once a year, except some offer unlimited restorations. In either case, your maximum claim can't be more than your base sum insured (plus any bonus, if any). Furthermore, the restored sum insured expires every year, so once it's triggered, the restored sum insured can't be carried over to the next policy year. In some policies, restoration may not apply to the first claim you make in a year - that means you can't use the restored sum insured for your first hospitalisation.

You can, though, under Niva Bupa Aspire and ReAssure 2.0. Introducing - ReAssure Forever Benefit.

Reassure Forever Benefit - A Gateway To Never-Ending Protection

With this benefit, you get an unlimited sum insured. ReAssure "Forever" kicks in when the first claim is paid. If the policy is renewed without a break, it stays for life. It’s like having a never-ending cup of coffee – no matter how much you use, it will always be refilled and ready for you.

This benefit comes with a few conditions -

1. After making your first claim, you'll always have a sum insured equal to your base sum insured available to you, unlimited times in a year.
2. This benefit pays up to your base sum insured for any single claim. This means that after you make your first claim, you will be able to make claims for multiple hospitalisations as many times as you need in a year.
3. It'll trigger either on partial or full exhaustion of the base sum insured.
4. You can use the restored sum insured for all conditions, treatments, and injuries (related and unrelated). This ensures you have coverage for any medical situation without worrying about incurring additional costs.
5. You can make use of this benefit if you submit a claim under one of these categories -

• Expenses for reaching a hospital
• Expenses during hospitalisation
• Expenses before and after hospitalisation
• Home Care / Domiciliary Treatment
• Organ donor expenses

Let’s understand how this benefit works with an example:

Rahul buys Niva Bupa ReAssure 2.0 health insurance policy with the base sum insured of Rs 10 lakhs. He makes multiple hospitalisation claims under his policy.

Let's see how the ReAssure Forever Benefit works under his policy –

1st Policy Year

👉1st Hospitalisation

The claim amount is Rs 7 lakhs. The amount will be paid from his base sum insured, leaving him with a balance of Rs 3 lakhs. Now, the ReAssure Forever benefit will trigger and restore the base sum insured.

👉2nd Hospitalisation

The claim amount is Rs 12 lakhs. It will be paid from his base sum insured (Rs 3 lakhs) and ReAssure Forever benefit (Rs 9 lakhs). The base sum insured will now be 0.

👉3rd Hospitalisation

The claim amount is Rs 11 lakhs. The amount will be paid from the ReAssure Forever benefit (Rs 10 lakhs). The remaining amount of Rs 1 lakh will have to be paid out of his pocket.

2nd Policy Year After Renewal

Rahul’s base sum insured is Rs 10 lakhs, and the ReAssure forever benefit of Rs 10 lakhs has already been triggered.

👉1st Hospitalisation

The claim amount is Rs 15 lakhs. It will be paid from his base sum insured (Rs 10 lakhs) and ReAssure Forever benefit (Rs 5 lakhs). The base sum insured will now be 0.

👉2nd Hospitalisation

The claim amount is Rs 12 lakhs. The amount will be paid from his ReAssure Forever benefit (Rs 10 lakhs). He needs to pay Rs 2 lakhs from his end. His base sum insured is still 0.

👉3rd Hospitalisation

The claim amount is Rs 10 lakhs, which will be paid from his ReAssure Forever benefit (Rs 10 lakhs). Thus, the base sum insured is triggered unlimited times throughout the year.

For every action, there is an equal and opposite reaction. For example, while technology has helped to make many aspects of life more convenient, it has also caused increased cybercrime and privacy concerns. In the same way, these benefits may seem great on the surface, but there are some downfalls to note.

So, Here’s The Catch!

As per IRDAI regulations, an insurer can withdraw a product anytime based on internal policies and approval from internal product committees by simply notifying the regulator (IRDAI). All insurers need to do is show that they're losing money on current terms. This regulation is in place to ensure that insurers can remain profitable and manage their business effectively. By being able to withdraw a product, insurers can reallocate resources to suit their business needs and goals better.

Therefore, it is important to be aware of the potential risks associated with any product or service an insurer provides, as it could be withdrawn at any time. You could then be moved to another product that doesn't have this feature.

What’s MyInsureBuddy Take?

While fancy features and benefits can be removed, one thing stays with you through thick and thin - the sum insured. Having said that, ensure you stake your money on the base sum insured and consider restoration as simply an added benefit.

Ensure you've got the right coverage for your needs - including an adequate sum insured, low/no financial limits on room charges, specific treatments, daycare, organ donation, and modern treatments. It's best to focus on getting the basics right first and consider any other benefits and features as just added perks.

Want to understand these features better? Go for MyInsureBuddy’s Free 1-to-1 Consultation and speak to an experienced advisor today!