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Questions regarding "Restore" option and "Deductible" in Health Insurance

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17 Apr, 2022 by  Balu Ramachandran
  1. Why are insurance companies offering Reset/Restore/Refill option? Won’t it prevent customers from purchasing a plan with higher coverage? Eg: Let’s say HDFC Ergo offers 100% restore option for a 5 lakh plan. So the customer is effectively getting a 10 lakh coverage. Why should a customer take a 10 lakh coverage when a 5 lakh plan offers 100% restore? What’s the catch here?
  2. If a base plan has 5 lakh coverage with 50,000 deductible, and I get a bill of 550,000, will the insurance company pay 500,000 or 450,000?
  3. Similarly if I have base plan with coverage 5 lakhs, and a super Topup with coverage 20 lakhs and with 5 lakhs deductible, will my total coverage be 20 lakhs or 25 lakhs?
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Health Insurance

1 Answer

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17 Apr, 2022
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Hi,


Here is answer to your questions


1) Restore was

introduced over a decade by Apollo Munich it's Health Insurance Plan over a decade ago. The objective was to give risk cover to other members incase the sum insured is consumed by a single person incase of a family floater. Back then the feature was not valid for same person same illness. Almost all insurers had the feature with a seprate name & condition under which it will be available. The current restore in Optima Restore & Optima Secure from HDFC Ergo is valid for same person and same illness as well however the condition states

a) will not be available in very first claim of the year b) a single claim amount will never exceed base sum insured.


2) Since the deductible is 50K fo insurer will pay 5 Lacs for a claim of 5.5 lacs.


3) Your cover will be 25Lacs.


I hope I hve been able to clarify your doubts. Feel free to connect over a call incase you have further queries.


Have a great day.


Regards

Rohit Dhingra

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18 Apr, 2022
Balu Ramachandran
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18 Apr, 2022
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18 Apr, 2022
Balu Ramachandran
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19 Apr, 2022
Balu Ramachandran
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19 Apr, 2022
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19 Apr, 2022
Balu Ramachandran
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