Pollution-linked health claims rise over 4 times in 3 years: Insurer data | Personal Finance

Air pollution is increasing health care costs for Indian households, with associated health insurance claims increasing more than four times in three years, according to data from Policybazaar. The average claim amount has reached Rs 62,662, while the total claim payout has increased 4.5 times between FY23 and FY26.

 

The data highlights how air quality is affecting respiratory and cardiovascular health, increasing the potential financial burden on households. Working professionals aged 31-55 account for the largest share of such claims, suggesting that the health impact is not limited to children and senior citizens.

Heart and respiratory conditions drive most claims

Cardiovascular conditions account for 43.5 per cent of pollution-associated health insurance claims, making them the largest category. Other respiratory infections contribute 35 per cent, followed by pneumonia at 11.2 per cent and bronchitis at 6 per cent.

  

Together, cardiovascular and respiratory conditions account for nearly 78 per cent of the claims.

 

Working professionals account for 59 per cent of claims

 

People aged 31-55 account for 59 per cent of pollution-associated health insurance claims, according to Policybazaar. Senior citizens aged 55 and above contribute another 31 per cent.

 

The remaining claims come from young adults aged 21-30, at 6.7 per cent, and children below 20, at 3.7 per cent.

 

The figures suggest that “economically active” individuals are also facing a considerable health burden, according to Policybazaar. For working households, this can mean medical expenses alongside potential income disruption due to illness.

Claims increase more than fourfold in three years

The growth in pollution-associated claims has remained high over the past three financial years.

 

FY24: Claims increased 67 per cent.

 

FY25: Claims rose 70 per cent.

 

FY26: Claims increased another 53 per cent.

 

The average claim amount increased 9 per cent in FY24 and has remained above FY23 levels. The combined effect of rising claim volumes and higher average claim costs pushed the total payout to 4.5 times its FY23 level by FY26.

 

Smaller cities account for 55 per cent of claims

New Delhi leads the city-wise list of pollution-associated health insurance claims, followed by Pune, Bengaluru, Mumbai and Hyderabad.

 

However, the trend is no longer restricted to metropolitan cities. Tier-II and Tier-III cities account for 27 per cent each, together contributing 55 per cent of claims. Ernakulam and Faridabad also feature among the top 10 cities.

 

This suggests that pollution-related healthcare costs are becoming a concern across a wider geographical area, Policybazaar said.

 

Winter accounts for more than half of annual claims

The October-March period accounts for 56 per cent of annual pollution-associated health insurance claims. In FY26, nearly 56 per cent of claims were recorded during these six months, coinciding with the period when several parts of India experienced deteriorating air quality.

 

The seasonal concentration of claims highlights the importance of being financially prepared for periods when pollution levels worsen.

 

Are people opting for higher health insurance cover?

Policybazaar’s data shows that 48 per cent of consumers in highly polluted cities opt for higher health insurance coverage. This indicates growing awareness of the need for adequate financial protection against medical expenses.

 

However, buying a larger policy alone may not be sufficient. Policyholders should examine room-rent limits, disease-specific restrictions, waiting periods, co-payment clauses and exclusions before choosing a policy.

 

Rohan Goel, business head, health insurance at Policybazaar, said pollution-associated claims had increased 4.3 times, with cardiovascular conditions accounting for 43.5 per cent of claims.

 

For households, the rising numbers underline the importance of preventive health care, timely medical attention and adequate health insurance coverage. A policy should be assessed on the protection it actually provides during hospitalisation, rather than just its sum insured.