Severe air pollution in Delhi at this time of the year has become an annual affair. While governments have failed to effectively curb the root causes behind deteriorating air quality in the National Capital Region, the gloomy atmosphere is leading to a rise in the number of patients with breathing issues.
Several reports in the last few days have quoted doctors claiming a spike in the count of patients complaining of breathlessness and other respiratory problems. Hospitalization or frequent visits to hospitals due to pollution-related ailments can lead to a substantial financial burden for patients and their families. Such a burden can be reduced with the help of health insurance.
In an email interaction with FE Money, Indraneel Chatterjee, Co-founder of RenewBuy, an online insurance platform, explains the most important points policy buyers affected by air pollution, or those living in cities like Delhi, should know.
Are air pollution-related ailments covered by health insurance?
Yes, air pollution-related ailments are covered by health insurance. Most health insurance plans are all-inclusive and the usual airborne ailments like bronchitis, pneumonia, asthma, and COPD that require hospitalization are covered under most health insurance policies (under Terms & Conditions). Any kind of pre-existing medical conditions should be disclosed for seamless settlement of claims.
Also Read: Delhi air quality slips back into ‘severe’ category, AQI at 421
How can health insurance help in pollution-related ailments?
Hospitals in Delhi are witnessing rise in patients with respiratory conditions, asthma or COPD (Chronic Obstructive Pulmonary Disease), cardiovascular diseases, some requiring ICU admissions too.
Though normal airborne ailments like bronchitis, pneumonia, asthma, and COPD that require hospitalization are covered under a health insurance policy; in many cases, patients do not require hospitalization. They might need regular OPD consultations, medications and diagnostic tests, during this time. Thus, a health insurance policy with good OPD cover/ tele-consultation cover plans can help consumers sail through.
In severe cases, a consumer and his/family might require immediate hospitalization or even ICU support; in such cases, a family health insurance with ICU expenses cover and cashless claim is highly recommended.
Most cases of pollution related ailments are of low severity; the management of these diseases mostly happens at the OPD level, which is usually not covered in standard health insurance policies. Many insurers have recently introduced, low-cost/customized health insurance policies, which provide coverage for diagnostic tests and OPD / teleconsultations, which can legitimately help people for pollution-related ailments.
Can someone facing breathing problems due to severe air pollution in Delhi claim reimbursement from health insurance in case of hospitalization?
As mentioned above, most of the standard health insurance policies provide coverage for hospitalization, related to pollution related illnesses. In case a policyholder’s health insurance policy does not provide enough coverage for treatment/ hospitalization; he or she can opt for specialized coverage for specific pollution-related diseases, such as lung diseases or skin conditions. These add-ons ensure that policyholders have comprehensive protection against pollution-related health risks; and there are many insurance companies today, which offer such specialized policies.
How much claim would be admissible if someone is hospitalized due to pollution-related ailments?
The admissible claims do not depend on hospitalization due to pollution-related illness. Claim settlements depend on the coverage limits/ room rent capping a policyholder is opting for, based on the type of health insurance policy and the premiums paid by the policyholder.
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Do health policy wordings acknowledge pollution-related ailments for claim processing?
Many health insurance policies acknowledge pollution-related ailments, such as bronchitis, pneumonia, asthma, and COPD (to name a few), for claim processing. However, it is highly recommended that the policyholder reads the terms and conditions carefully before buying any policy. In many policies there are hidden clauses, which consumers get to know only during the claim settlement process and many-a-times, end up paying the treatment cost from their own pocket.
It is important that consumers look for optimum health cover, which includes common diseases and critical illnesses. It is always suggested that they take the route of digitally enabled insurance advisors, so that they can get proper guidance on health insurance policies as per their individual/ family needs and requirements.
What are the possible reasons an insurance company might deny a claim to someone hospitalized due to breathing issues caused by pollution?
Insurance companies might deny a claim due to reasons such as insufficient medical documentation, undisclosed pre-existing conditions, or policy exclusions. However, if a disclosed pre-existing condition worsens due to pollution, it is generally expected to be covered.