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

17 Apr, 2022 | by Balu Ramachandran

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?
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?
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?

Health Insurance

1 Answer

Post

17 Apr, 2022

Rohit Dhingra

4.5

MBA | 5 years experience

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

6 Comments

18 Apr, 2022

Balu Ramachandran

Dear Rohit Dhingra,

Thanks for answering my queries. If you don't mind, I have a couple of questions more.

ICICI Lombard's Super Topup Offers 50 lakhs where as HDFC Ergo's Super Topup offers only upto 20 lakhs, without significant difference in premium. Going through the policy wordings, I was unable to find any significant differences in their offerings. Does ICICI Lombard's Super Topup has any disadvantages compared to HDFC Ergo's like more sub-limits or something?
I was planning to purchase a base policy of 10 lakhs, since most policy with 5 lakhs SI have room rent limit (please correct me if I'm wrong). In addition I am planning to purchase a Super Topup with 10 lakhs deductible. But ICICI Lombard's Super Topup offers only a maximum of 5 lakhs deductible. Is that a positive or negative, clubbing a Super Topup having 5 lakh deductible with my 10 lakh base policy?

18 Apr, 2022

Rohit Dhingra

4.5

MBA | 5 years experience

Hi,

To your further query below is what you should know

1) I will not be able to answer if any plan is advantageous to you unless I get to know more details about you. The two plans have some differences like ICICI Health Booster has a Co-payment of 20% after the age if 60 yrs if the policy holder has purchased the policy over the age of 45 yrs. In HDFC My Medisure Supertop there is a compulsory 10% co-payment after the age of 80 yrs. In ICICI Health Booster there is a defined list of 150 day care procedures in HDFC Ergo Medisure Super Top up there is no such list hence it will cover all day care procedures. Domicillary Expenses is not covered under HDFC Medisure Super Topup while it is covered under ICICI Health Booster. HDFC Medesure Super Top-up does not reset/restore/recharge benefit, this is available with t&c in ICICI Heath Booster. Bonus incase of no claim is available in ICICI while it is not available in HDFC Ergo My Medisure Super Top-up. Pre & Post Hospitalisation is for 60 & 90 days incase of ICICI Health Booster while it is 30 & 60 days in case of My Medisure Super Top up.

2) There are plans available that either don't have cap on room rent. Plans state room rent limit as 1% of SI or upto Single Pvt Ac room (most economical) or upto Single Pvt Ac Room or Any Type of Room - as a policy holder one should know what room types are available. Taking a larger base cover is always better on most occasions it will be utililised. It will not make much difference if you have a 5 Lac deductible while you base policy is 10 Lacs.

Please note:- Buy base + super top up from same insurer. The super top up should not be the deciding factor for your base policy.

Hope your query is answered now. You may schedule a call for any further queries.

Regards

Rohit Dhingra

Reply |

18 Apr, 2022

Balu Ramachandran

Thank you! Much appreciated!

19 Apr, 2022

Balu Ramachandran

Dear Rohit Dhingra,

Sorry for the trouble, but I have one more question. Can I buy multiple Super Topup policies to increase coverage? Say I have a base plan of 10 lakhs and a Super Topup of 20 lakhs with 10 lakhs deductible. So my total coverage is 30 lakhs. Now is it possible to buy another Super Topup from the same company with 20 lakhs sum assured (with 10 lakhs deductible) and will it take my total coverage to 50 lakhs?

19 Apr, 2022

Rohit Dhingra

4.5

MBA | 5 years experience

Hi,

No one stops you from buying multiple super-top up policies.It however might be a headache to manage all the policies. Hence keep it simple buy a larger base cover.

By any chance have you seen the movie Sholay and remember the bike in the song Yeh Dosti... the bike had a side car. In 70's-80's families use to add a side car to their to their bike or a scooter as cars were unaffordable. It use to work well for the family back then low cost option. A super top-up is like that side car....now you wish to have two side cars one on each side... surely you can have. But think of parking space, manuverbility, is that amount of cover required by you etc.

I hope you have got my point.

For any further query you may schedule a free call. Since you are still under evaluation stage. one-one conversation are help bring better clarity.

Regards

Rohit Dhingra

Reply |

19 Apr, 2022

Balu Ramachandran

Yes I do have watched Sholay and remember the scene very well. The analogy was great. However to make things clearer, I think its better to schedule a call. Thanks once again for your time and response.

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