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How Restoration Benefit works?

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02 Jun, 2021 by  Rishabh Agarwal

If I have A health Insurance with base plan of 5 lakh and medical bill incurred is 8 lakh how restoration benefit will work and is there A need for a topup. In another scenario, again person gets medical bill of 4 lakh in same year for same disease, so how the things will play out

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1 Answer

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02 Jun, 2021
Sandesh Shetty

The concept of Restoration benefits differ across the insurance companies and can be briefly explained below.


1) Restoration of Sum Insured will trigger upon complete or partial exhaustion of Sum Insured + Cumulative Bonus, if any.

1).a) This benefit can be availed for illness/disease for which claim was already made.

1).b) This benefit can be availed only for illness/disease unrelated to illness/disease for which claim was already made.


2) Restoration of Sum Insured will trigger upon complete exhaustion of Sum Insured + Cumulative Bonus, if any.

  2).a) This benefit can be availed for illness/disease for which claim was already made.

2).b) This benefit can be availed only for illness/disease unrelated to illness/disease for which claim was already made.


  • Scenario : S.I is Rs.5,00,000/-, Cancer Surgery claim Rs.4,00,000/- of Mr.A


1) Balance Sum Insured will be 1 lakh + 5 lakh = 6 Lakh

2) Balance Sum Insured will be 1 lakh and restore S.I will trigger only after 1 lakh is exhausted


1 & 2) a) Can claim for cancer surgery next time by any insured including Mr. A under the restored S.I

1 & 2) b) Can't claim for cancer surgery by Mr. A under restored S.I but can claim for any other illnesses. However other

insured can claim for cancer & other ailment provided illness/disease unrelated to illness/disease for which claim

was already made by them.


Policy condition must be read before availing benefit under restoration benefit since certain expense are not covered for instance

Star health comprehensive policy states restore benefit is not available for expense incurred under OPD treatment, Delivery & New born baby cover, Organ donor expenses, Health checkup expense, Bariatric Surgery, AYUSH treatment, Accidental death & PTD & Modern treatment.









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