Health Insurance Restoration Benefit: Sum Insured Reset 2026

Restoration benefit, also called recharge, automatically refills your health cover once the sum insured is used up in a policy year, so a second hospital bill in the same year can still be paid. It is a product feature that varies by insurer, not a legal right, so read your own policy wording before you rely on it.

Restoration, or recharge, is an add-on inside many health policies. When your sum insured falls or runs out because of claims, the insurer tops it back up, usually once per policy year. It protects you against a second, unrelated illness in the same year. The refill amount and trigger differ by insurer and plan.

There is no single law that forces every insurer to give restoration. It is a product design choice, and the terms vary by insurer. What changed in 2024 is the regulatory backdrop that makes such features clearer and claims faster.

The IRDAI Master Circular on Health Insurance Business, ref IRDAI/HLT/CIR/MISC/77/05/2024, dated 29 May 2024, consolidated policyholder entitlements and repealed 55 earlier circulars. Under this circular the cashless authorisation timelines were tightened: the insurer should decide on a cashless request within 1 hour, and grant final discharge authorisation within 3 hours. The same circular makes the No Claim Bonus a policyholder's choice between a cumulative increase in cover and a premium discount, and confirms that renewing within the grace period preserves accrued credits.

So treat the rule like this: restoration itself is an insurer feature (varies by insurer), while the 29 May 2024 circular is the consumer-protection layer that forces transparent terms and quicker claim decisions around it.

RTI angle. You cannot file an RTI against a private insurer; they are not public authorities. But the four public-sector general insurers - New India Assurance, National Insurance, Oriental Insurance and United India - and the regulator IRDAI are public authorities under the RTI Act 2005. If your claim or restoration is wrongly denied by a public-sector insurer, an RTI can extract the claim file, the internal note, and the rule applied. The Insurance Ombudsman is a separate grievance route for escalation, not an RTI authority.

1. Read your policy schedule and wording. Find the word “restoration” or “recharge” and note its exact trigger.
2. Check whether it restores on partial exhaustion or only after full exhaustion. Commonly plans differ on this point.
3. Confirm whether the refill covers the same illness or only a new, unrelated one. Many plans exclude the same illness.
4. Note the cap. The refill is usually up to the base sum insured, once per year.
5. On a family floater, check who can use the restored amount and after which member's claim it triggers.
6. When you claim, keep all bills and the discharge summary so the insurer can confirm the trigger condition.
7. If restoration is denied, ask for the denial in writing, then escalate.

• Policy schedule and the full policy wording or terms booklet.
• Hospital discharge summary and the final bill.
• Earlier claim settlement letter showing how much sum insured was already used.
• Any written denial of the restoration claim.
• Renewal notice or premium receipt proving the policy was active and renewed within the grace period.

• Assuming restoration is your legal right. It is a product feature that varies by insurer; the IRDAI Master Circular of 29 May 2024 governs disclosure and claim timelines, not the existence of the feature.
• Thinking the refill covers the same illness. Many plans restore only for a new, unrelated illness in the year.
• Believing partial-use plans and full-exhaustion plans work the same way. The trigger differs; read your schedule.
• Letting the policy lapse past the grace period and losing accrued credits the circular says renewal within grace preserves.
• Confusing restoration with the No Claim Bonus. They are different benefits under the same circular.

If a public-sector insurer or IRDAI is involved, RTI is a sharp tool. A sample request to a public-sector insurer's Public Information Officer:

Under the RTI Act 2005, please provide: 1 a certified copy of my claim file for claim number ; 2 the internal note recording why the restoration or recharge benefit was applied or denied; 3 the exact policy clause relied on; 4 the name and designation of the officer who decided the claim.

For IRDAI, you can ask for the rule or circular relied on and any guidance on the disputed point. Draft it with the AI RTI Drafter, and if no reply comes in 30 days, file a first appeal.

No. Restoration is a product feature that varies by insurer, not a benefit every policy must carry. The IRDAI Master Circular dated 29 May 2024 governs disclosure of terms and the speed of claim decisions, but it does not force restoration into every plan. Read your own policy wording to confirm you have it.

It depends on the plan. Many plans restore the sum insured only for a new, unrelated illness in the same policy year, and exclude a fresh claim for the same illness. Some newer plans allow the same illness too. Check the exact clause in your policy schedule before assuming.

Commonly it varies. Some plans restore the cover only after the sum insured is fully exhausted, while others top it up even after partial use. The trigger is written in your policy. This single line decides whether a mid-year second claim is paid, so confirm it.

A family floater shares one sum insured across all members. One person's large claim can drain the whole cover, leaving others exposed for the rest of the year. Restoration refills the cover so a second member's hospital bill in the same year can still be paid.

No. Private insurers are not public authorities, so the RTI Act 2005 does not apply to them. You can file an RTI with a public-sector insurer such as New India Assurance or National Insurance, or with the regulator IRDAI, to get records of how a rule was applied.

The Master Circular dated 29 May 2024 tightened cashless timelines: the insurer should decide a cashless request within 1 hour and give final discharge authorisation within 3 hours. It also made the No Claim Bonus your choice and confirmed that renewing within the grace period preserves your accrued credits.

No. They are separate benefits. The No Claim Bonus rewards claim-free years with extra cover or a discount, your choice under the 29 May 2024 circular. Restoration refills cover after a claim. Using restoration in a year means you did make a claim, which can affect that year's bonus as per your policy.

• IRDAI Master Circular on Health Insurance Business, ref IRDAI/HLT/CIR/MISC/77/05/2024, dated 29 May 2024 - https://irdai.gov.in
• Insurance Regulatory and Development Authority of India - https://irdai.gov.in
• Right to Information Act 2005 - https://rti.gov.in

• Draft your RTI with the AI RTI Drafter
• File a first appeal if your RTI is ignored
• Record a voice RTI with AwaazRTI
• The RTI Playbook