Apollo Munich-Health Insurance has created quite flurry in the market, with its name of ‘Optima Restore’. This variant is also creating bit confusion in among the people.  Automatic Restore benefit is different from other standard health insurance plans due to its unique and super benefit but one big drawback faced.
automatic

Restore Benefit:

Under restore the company will automatically re-instate the sum insured once in a year, in case the sum insured and any no claim bonus accumulated is exhausted during the policy year. Restore Sum Insured can be used for only future claims made by the Insured Person and not against any claim for an illness/disease (including its complications) for which a claim has been made in the current policy year. If the recharge sum insured is not utilized in a policy year, it shall not be carried forward to any subsequent policy year.

Let’s consider following cases with a family floater restore policy of Rs 5 lakh sum assured which get more clarity on this benefit.

Suppose, I get an illness ‘A’, cost is Rs. 3 lakh, get claim. Now, I get an illness ‘B’ and cost is Rs.4 lakh. Then, I get Rs.2 lakh only from company and rest Rs.2 lakh from my pocket. No restore, as I had not exhausted my Rs. 5 lakh after illness ‘A’.

In another instance, suppose, I get an illness ‘A’, Cost is 3 lakh, get claim. Now, other family member gets an illness A/B and cost is Rs 4 lakh. Then, I get Rs 2 lakh only  from the company and rest Rs 2 lakh from my pocket. No restore, as I had not again exhausted my Rs 5.00 lakh after illness ‘A’.

Thus, the restore option will trigger for the subsequent claim, only after the entire sum assured is exhausted completely and restore only once in a year. 

Multiplier Benefit:

In all other standard health insurance policies, the insurance companies  give No claim bonus (NCB) increasing by 10% on the Sum assured in every claim free year. In case of Restore benefit policy, the insurance company gives you NCB increasing by 50% on the sum assured in every claim free year. But, if a claim is made after the bonus has applied then in the following policy year the multiplier bonus is decreased by 50% of basic SA.

Premium of Restore:

The premiums in Restore are slightly higher compared to standard variant of its Easy Health Plan. Premium in Optima Restore is higher by 30% in comparison to Easy Health Standard Policy

Conclusion

Since, the product has a restoration benefit and a 50% No claim cumulative bonus, it seems to be good product and having unique features.  But, it is available only on any new illness or any illness to some other member in the policy and the restore would be useable only when the existing sum insured including the bonus is completely exhausted. Instead, one should go for a higher sum assured in Standard Policy so that it will keep you covered adequately in the future too.

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Suresh Kumar Narula

SEBI Investment Advisor, Founder & Principal Financial Planner at Prudent Financial Planners
Suresh K Narula is founder and Principal Financial Planner at Prudent Financial Planners. He has earned the professional CERITIFIED FINANCIAL PLANNER and got registered with SEBI as Investment Advisor. He writes on personal and financial planning articles and got published in Dainik Bhaskar, Business Bhaskar and The Financial Planner's Guild, India. He is also a member of Financial Planner's Guild India ( An association of practicing SEBI registered Investment advisers) to create awareness about Financial Planning in general public, promote professional excellence and ensure high quality practice standards. Suresh received his an M.com from Himachal Pardesh University and an MFC from Punjab University, Chandigarh. He can be reached at info@prudentfp.in
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