Reinstatement of Health Insurance Policy

When or if you make a claim under your cashless Mediclaim policy, then there is a slight chance that the amount that was insured will be completely exhausted. There remains a risk in such a situation, as you will be without any further coverage at that moment until the cashless Mediclaim period expires. In such a case, there is a method to be followed for the reinstatement of the basic sum previously insured.

The sum insured of your health policy will be restored to its original amount after an appropriate premium has been charged for the same. This process will ensure that the full amount of the basic sum that was insured is available to you for the remainder of the period that is due to the policy: -

• Basic Sum Insured can be reinstated only to the level of the amount that has been claimed and paid for it.

• The reinstatement of policy premium which is paid will also be deducted from the amount.

• Upon reinstatement, the policy will hold true for a period of time, which generally extends from the first date of hospitalization when the claim was made to the last expiry date.

• The reinstated amount cannot be used for paying for the expenses incurred while treating the particular diseases, illnesses or injury which was the reason for the hospitalization of the person, which again led to reinstatement. On the other hand, it can be used to make payments for the expenses that are incurred while treating an illness that is similar to any other disease except those which are excluded. These are valid for as long as the illness is not caused by the relapse of the disease within 45 days of initial hospitalization for which the person had made the original claim.

• The reinstated basic sum will be used to pay for any and all claims which come during the initial hospitalization period. This means that if they sustain any other injury or illness other than the reason for their hospitalization, the basic sum can be used to pay for it.

• The premium which has to be paid for the reinstatement of the cashless Mediclaim will be recovered. This recovery is from the claim amount of settlement, and the basic sum insured shall be reinstated within the time that the insured person suffers hospitalization.

• Mediclaim policies having a basic sum insured of Rs. 3 Lacs or above will only be able to avail this option.

• The premium calculation for the health insurance policy has to be done using a pro-rata basis of the proportion of annual premium and the sum percentage claimed of the basic sum insured.

• Once the Cashless Mediclaim has been reinstated, the sum that was insured cannot be used to claim expenses for the following chronic ailments, where the initial claim under the same policy has been filed.

After reinstatement, the basic sum insured cannot be claimed for expenses incurred due to Domiciliary Hospitalization of Unani, Ayurvedic, Sidha or Homeopathic treatments.