Major Restriction on Use of Restored Sum Insured under Staff GMC Policy 2026-2027

 📢 NIARAS Kerala – Member Guidance Circular

Subject: Major Restriction on Use of Restored Sum Insured under Staff GMC Policy

Dear Members,

👉 1️⃣ Minimum Sum Insured should be ₹25 Lakhs & above to be eligible for Restoration benefits. Policies with Sum Insured below ₹25 Lakhs will not be eligible for restoration benefits.

👉 2️⃣ Under the Family Floater Staff GMC Policy, the original Sum Insured is available to the insured member and all covered family members for admissible hospitalization expenses during the policy period.

👉 3️⃣ An insured person can avail reimbursement for a particular disease/illness multiple times, provided the claims are within the limits of the available original Sum Insured.

👉 4️⃣ In other words, expenses relating to the same disease are admissible from the original Sum Insured until it is fully exhausted.

👉 5️⃣ Upon full exhaustion of the original Sum Insured, the policy provides for Restoration of Sum Insured, subject to policy terms.

👉 6️⃣ However, a key restriction applies after such restoration:

The restored Sum Insured cannot be utilized by the same insured person for the same disease/illness for which a claim has already been made during the same policy period.

👉 7️⃣ Therefore, the restoration benefit does not operate as a continuation of coverage for:

* the same insured person,

* for the same disease,

* within the same policy year,

after exhaustion of the original Sum Insured.

👉 8️⃣ The restored Sum Insured is permissible only in the following cases:

(a) For other insured family members, or

(b) For the same insured person for a different disease/illness,

strictly in accordance with policy conditions.

👉 9️⃣ In the subsequent renewal policy period, the insured person will again be eligible to claim for the same disease, subject to the terms and conditions then in force.

👉 🔟 Conclusion (for clear understanding):

Same disease → Claim allowed from original Sum Insured (till it is available)

After exhaustion → Restored Sum Insured cannot be used by the same person for the same disease during that policy period

👉 1️⃣1️⃣ In short:

The restored Sum Insured cannot be used by the same insured person to make a second claim for the same illness during the same policy period.

This clarification is issued for proper guidance of members and to avoid any misunderstanding regarding the scope of the restoration benefit.

A NIARAS KERALA VISION