Insurance Plans March 4, 2020

Digit Maxima Restore Super Plan

One of the critical insurance needs in our daily life is Health Insurance without which we can’t think of getting a financial shield in case of any untoward incident. With more increased awareness now, every individual has a minimum of one health insurance plan for himself or his family, with several features and benefits, which are specifically designed to meet the financial requirement. An example can be taken for HDFC Ergo Health Optima Restore plan which has the benefit of restoration.

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What is Digit Maxima Restore Super Plan?

One of the benefits which all of seeing in most of the health insurance plans is the Digit Maxima Restore Super or the Restoration Benefit. With the mounting cost of medical expenses and with complexities of diseases, it is likely that you may finish your existing sum assured in one single hospitalization, here the benefit of restoration comes of great use. It permits an insured person to restore the whole sum assured in the same policy year when it is exhausted fully or partially because of claims made. Maximum health plans in today’s time offer ‘restoration benefit’ which can be considered as a strong back up to boost your exhausted sum assured. After the sum insured gets exhausted, the same will be refilled automatically and will be available for the next hospitalization within any policy year.

How Digit Maxima Restore Super Plan or the Restoration work?

Usually, health plans come as individual policies or as a family floater which covers the specified family members under one single umbrella and the sum insured is shared by all. There might be a high possibility that the complete sum assured may get exhausted because of a severe disease or injury of any family, whereas the other members remain uncovered. In this condition, when the sum assured is exhausted, restoration benefit demonstrates to be of great use both for family floater plans as well as for individual health insurance policies.

Let us take an example. You have bought a health policy with a sum assured of INR 4 Lakhs. Now, one of the family members gets identified with a severe illness and had to be hospitalized with expenses that occurred to the tune of INR 3.5 Lakhs. If he or she is again hospitalized, say after 4 months, and this time medical expenses are INR 3 Lakhs, you will get the cover of INR 50,000 and the residual amount of INR 2.5 Lakhs will have to be paid out from your purse. And, if you have a plan which has the restoration benefit, the plan will pay the whole expenses of INR 3 Lakh and you need not pay this time.

For maximum insurers, the benefit of restoration is made available for unconnected claims only. However, Apollo Munich or HDFC Ergo Optima Restore plan that offers restoration on all diseases but not for the same claim.

Terms and Conditions for Sum Insured Restoration

You must understand the terms and conditions of availing the benefit of Refurbishment or Reinstatement before you decide to buy a plan as knowing these you will be able to understand and then decide as per your need. Below are the main key conditions that will apply to this benefit:

  1. Restoration benefit is obtainable for different diseases only and not for similar diseases or injuries: You need to check if the plan covers illnesses for which the plan has already been utilized earlier. In layman’s language, for some plans, if you have utilized the sum assured for a definite disease like severe gastritis, you will not be able to use the refilled sum assured for the same issue once more within the same term of the policy. The reinstated sum assured can still be utilized by other family members and for the same illness. On the other hand, some plans provide coverage even for the same disease as the plan will provide restoration of sum assured for the treatment of a similar illness during any given policy year.
  2. Restoration is not offered during the first claim: This is a very important condition related to the restoration benefit which is this benefit is never offered during the first claim of a policy year. There are very limited plans that offer this benefit for the first claim, however the same is only for cases of hospitalization due to an accident.
  3. Reinstation of Sum Assured on Whole or Part exhaustion of basic Sum Assured: Many health plans offer the benefit of restoration or reinstatement mainly on the full exhaustion of the sum assured. However, some plans provide the ease to use the rebuilding of sum assured even if the basic sum assured has been partly utilized so you must check this condition before buying the health plan. Here is an example for you to see the difference between the above condition. Under restoration
    SituationsRestoration under Complete Use of Sum Assured (INR)Restoration under Part Use of Sum Assured (INR)
    Sum Assured 4 lakhs4 lakhs
    Claim Number 13.5 lakhs3.5 lakhs
    Remaining Sum Assured50,00050,000
    Claim Number 270,00070,000
    Restoration BenefitNoYes – 4 lakhs
    Claim Number 2 Paid 50,00070,000
    Total Claims made in a year420000420000
    Total claims paid with a health plan in a policy year4 lakhs4,70,000
  4. Restoration benefit cannot be extended to the next policy year: The restoration sum will not be allowed to be carried forward to the next policy year. Hence, do check on this point too.

Conclusion

With the restoration benefit or Digit Maxima Restore Super, you can get real advantage of the increased sum assured, keeping in the mind inflation rate and the rising cost of medical expenses. However, do not forget to analyze the terms and conditions as mentioned to get the best of the restoration benefit.

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