Unlimited Refill Benefit: How to Not Run Out Of Sum Insured

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Jun 27, 2023
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Ms Patel has a health insurance plan with a sum insured of INR 5 lakh with an unlimited sum insured refill add-on. At the start of the year, she had to undergo surgery following an accident that cost her INR 2.5 lakh. With her health insurance, she was able to cover her operation costs without spending her savings. In the same year, Ms Patel had to undergo a heart surgery the cost of which was INR 3 lakh. Like before, her health insurance policy covered all her medical costs, thanks to the unlimited refill benefit. You can find information on the unlimited refill benefit in health insurance below.

What is unlimited refill benefit?

The unlimited refill benefit is an add-on cover that you can purchase along with your base health insurance plan. With this add-on, the insurance provider replenishes the sum insured benefit when it gets exhausted. Additionally, there is no limit on the number of times the sum insured can be restored in a policy year.

When Ms Patel had her first operation, she used up INR 2.5 lakh from her sum insured. Her first claim triggered the unlimited refill benefit wherein her insurance provider restored her sum insured to the original sum insured limit. This allowed her to undergo another surgery in the same policy year without breaking her bank.

Types of unlimited refill benefits

The unlimited refill benefit can be classified into the following:

  • Refill benefit for partial exhaustion

  • With this type, the insurer restores the basic sum insured upon using a portion of the sum insured. For instance, if Ms Patel files a claim of INR 75,000 for accidental injuries from her sum insured of INR 5 lakh, the insurance provider restores the sum insured to INR 5 lakh after her first claim.

  • Refill benefit for complete exhaustion

  • In this case, the insurance provider refills the sum insured amount only when 100% of the sum insured is consumed. For instance, if Ms Patel exhausts her INR 5 lakh sum insured to pay for an expensive treatment, her entire sum insured is replenished to INR 5 lakh.

Unlimited refill benefit and family floater plans

In a family floater health insurance plan, all family members insured under the plan share a single sum insured limit. When one member uses up a portion of the sum insured, the insured members can only access the balance sum insured.

Let’s say Ms Patel purchases a family floater plan of INR 10 lakh to cover her spouse and two children. Her spouse files a claim worth INR 4 lakh for a knee surgery. In this case, the family can only get cover for subsequent medical expenses up to INR 6 lakh. Ms Patel must finance the expenses exceeding INR 6 lakh from her own pocket.

In case of family floater plan, it would be prudent to opt for an unlimited refill benefit. With this cover, when one member uses the sum insured, the other members can still use the original sum insured. This way, Ms Patel can ensure that her family members are appropriately covered and prepared to face any medical emergency.

Factors to consider

When it comes to the unlimited refill benefit in health insurance, you should keep the following factors in mind:

  • You need to use it in the same policy year

  • If you do not use the unlimited refill benefit in the existing policy year, you cannot carry forward it to the next year. The unlimited refill benefit triggers when a claim is filed. Hence, if Ms Patel does not file a claim during her ongoing policy period, she cannot use the unlimited refill benefit in the following policy period.

  • You need to renew it with your policy

  • The unlimited refill benefit is an additional cover you can purchase with your base plan. To ensure you are covered by this benefit always, you need to renew it along with your policy. Also, if you’re not already covered by the unlimited refill benefit, you can purchase it at the time of policy renewal.

  • It does not cover any one illness

  • In health insurance, ‘any one illness’ refers to a continuous period of illness. It includes relapse within 45 days from the last consultation’s date with the healthcare facility where you received the treatment. The unlimited refill benefit does not apply to such conditions.

  • It will be applicable to certain specific base covers

  • The unlimited refill benefit shall be applicable to certain types of claims. This can differ from insurer to insurer. Therefore, Ms Patel must read the policy wordings thoroughly to understand the inclusions and exclusions.

Related vs unrelated medical conditions

In most cases, the unlimited restoration in health insurance is triggered for unrelated illnesses. Unrelated illness means that the illness for which the claim is filed should be different from the one at the time of the first claim. For instance, if Ms Patel uses the sum insured to cover a bypass surgery, the insurer will refill the sum insured if the next claim is filed for a condition other than a bypass surgery in the same policy year. In case of related illness, Ms Patel can avail of the unlimited refill benefit even if she files a claim for the same surgery again.

Get unlimited refill benefit for both, related and unrelated illnesses with SBI General Insurance’s Health Edge policy.

Ensure maximum coverage at all times with SBI General Insurance’s Health Edge plan

Health Edge Insurance is a completely digital health insurance offering from SBI General Insurance. It comes with 9 basic indemnity plans. These include in-patient hospitalisation, pre and post-hospitalisation, day care treatments, advanced treatments, bariatric surgery, alternative treatments, etc. You can choose from our 18 optional covers to customise your plan as you desire. By opting for the unlimited refill rider, your base sum insured is restored to 100% limitlessly upon claiming medical expenses. This benefit is triggered when you file the first claim. Your sum insured will be restored for all the following claims. What’s more, the benefit covers both, related and unrelated illnesses.

Download the SBI General Insurance mobile app and find nearby network hospitals instantly.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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The Inclusions

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The insurance provider is not obligated to cover the expenses associated with the following under your AYUSH treatment insurance.

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The following are the advantages of opting for a medical insurance policy with AYUSH cover:

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Leprosy is one of the most ancient diseases. It is also called Hansen’s Disease, after the Norwegian physician Gerhard Henrik Armauer Hansen who discovered the bacteria that causes leprosy. In 2020, the World Health Organization noted 127558 new leprosy cases globally. As leprosy is a bacterial disease, it is known to affect the skin and lead to the appearance of external lesions and sores. Leprosy also affects the nerves and muscles. If left untreated, this disease can disfigure the patient.

Let’s take a closer look at what causes leprosy, examine the symptoms, and explore treatment options.

Causes of leprosy

Leprosy is caused by the Mycobacterium Leprae Bacterium. As a disease, leprosy is not highly contagious. It only spreads through close contact with a patient who already has the condition. Studies show that Mycobacterium leprae bacteria can spread through sneeze or cough droplets from an infected patient to others.

There is a lot of stigma around leprosy. Patients are often shunned from society and forced to live in isolation. It is, therefore, important to note that leprosy does not spread if you sit next to an infected person in public transport or shake hands with them once. To actually spread the disease, there has to be close and repeated contact with a patient. Once a patient has begun treatment, they can no longer pass on the infection to others.

Expectant mothers cannot transmit leprosy to an unborn child.

Types of leprosy

Leprosy is broadly classified into two main types. These are lepromatous and tuberculoid. Tuberculoid is a milder form of the disease and relatively less contagious. Lepromatous is very contagious and affects the kidneys apart from causing major disfigurement and hair loss.

There is also a third type of leprosy which is called borderline. Borderline is a type in which the patient exhibits symptoms of both the lepromatous and tuberculoid forms.

Symptoms of leprosy

Several years may pass before a patient exhibits noticeable signs of leprosy. In fact, some studies indicate that symptoms may even appear anywhere between 5 and 20 years after the initial infection.

Symptoms to note include light-coloured skin lesions, muscle weakness, lumps on the skin, dry skin, and a loss of sensation in the limbs.

Leprosy can also lead to nerve damage, blindness, kidney failure, hair loss, and loss of use of hands and feet. There is a common misconception that leprosy causes fingers to fall off. This is untrue. What really happens is that the bacterial infection leads to a loss of sensation in the affected areas. This loss of sensation means that burns, cuts, and other wounds go unnoticed until they eventually lead to infection that causes permanent damage.

Diagnosis and treatment of leprosy

If a skin sore is suspected to be a sign of a leprosy infection, the patient will be advised to undergo a biopsy. In a skin biopsy, a small sample of the affected area will be taken and sent for testing. The patient may also be advised to undergo a skin smear test or a lepromin test.

The diagnostic tests aim to identify the type of bacteria and type of leprosy. Upon proper identification of the type of leprosy, the course of treatment can be decided.

The good news is that leprosy can be cured. Treatment for leprosy involves multi-drug therapy which has been developed by the World Health Organization.

Patients need to take prescribed medication for an extended period of time that can range anywhere from a few months to a year. The medication is usually a combination of antibiotics for the bacteria and steroids for inflammation. Certain medicines used to treat leprosy might not be suitable for pregnant women as they may cause birth defects. If an expectant mother is undergoing treatment, her doctor may avoid prescribing certain medicines.

Living with leprosy

Patients living with leprosy are often isolated and excluded. This happens due to a lack of awareness among the masses on the exact nature of the disease. Once a patient has begun their course of multi-drug therapy, they can live normally with their family without worry of infecting them. They can attend office, shop for their necessities, and follow their normal routine. Proper education and awareness among the masses will help reduce the social ostracization faced by people living with leprosy.

Health insurance and leprosy

These days, medical procedures can run into lakhs of rupees. And it is not wise to deplete one’s savings in paying for medical costs. A health insurance plan is the only way to afford the rising cost of healthcare. Health insurance covers hospitalisation expenses as well as charges incurred pre- and post-hospitalisation within limits specified by the insurer. It is much easier to pay a premium each year than pay an actual hospital bill each time you fall ill.

Does health insurance cover leprosy?

Insurers in the country are known to include coverage for leprosy under a critical illness cover. A critical illness cover is a rider that you can add to your health insurance plan for an extra premium. Most riders are affordably priced and so it does seem advisable to add as much coverage as you can to your base health insurance plan. This way, you can enjoy peace of mind with the knowledge that you are covered. Do bear in mind that health insurance policy inclusions can vary between insurance providers. You must read the fine print and ask your insurer what extent of coverage is offered before you buy insurance.

SBI General offers a range of medical insurance plans that are designed to offer holistic coverage when you fall ill. These plans include coverage for hospitalisation expenses (room rent, nursing costs, etc.), doctor’s fees, charges for anaesthesia and oxygen, procedural costs, and ambulance charges. Patients can also make a claim for day care procedures. SBI General offers its policyholders access to over 6000 cashless hospitals in India for cashless treatment. There is also a benefit of a free health check-up once in every four claim-free years.

Apply for health insurance today with SBI General to enjoy true peace of mind.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.