Does Your Health Insurance Cover Respiratory Illnesses?

Bhaskar Nerurkar

“According to global health estimates, air pollution now accounts for more than two million deaths annually in India, underscoring the urgent need for both preventive care and financial preparedness.”

 

Air pollution is rapidly increasing across India, with some cities experiencing particularly severe impacts. This growing crisis has become a major public health concern, contributing significantly to serious respiratory problems. Conditions such as asthma, bronchitis, chronic obstructive pulmonary disease (COPD), and lung infections are now more common than ever. Worryingly, these health issues are no longer confined to specific seasons, they have become a persistent threat year-round.

Pollution and Respiratory Health: A Growing Crisis

According to the World Health Organization (WHO) report in 2008, 1.3 million deaths were estimated to be related to ambient air pollution globally. The figure became 3.7 million in 2012, which nearly tripled. Two million deaths were attributable to the effects of household air pollution in 2008. This number also increased as nearly doubled (4.3 million) according to the latest report based on 2012 data by WHO recently. Additionally, according to the State of Global Air 2024, air pollution accounts for more than 2 million deaths a year in India.

Air pollution has impact on most of the organs and systems of human body. It has adverse effects on nervous system, digestive system, and urinary system. India’s air quality index (AQI) frequently crosses hazardous levels, especially in northern cities like Delhi NCR. Prolonged exposure to polluted air can trigger or worsen respiratory conditions, leading to increased hospital visits, long-term medication, and even intensive care in severe cases. With this increase it’s important than ever to know what your health insurance typically covers.

What Health Insurance Covers

Most health insurance policies offer coverage for hospitalisation expenses, helping customers manage the costs of both planned and emergency treatments. Many comprehensive plans now include OPD (Outpatient Department) benefits, covering diagnostic tests such as chest X-rays and CT scans, doctor consultations, follow-ups, annual preventive health check-ups, tele-consultations, and ongoing medication costs. This is especially beneficial for individuals managing chronic respiratory conditions, such as asthma or COPD. Additionally, certain plans cover daycare procedures, such as nebulization therapy, which are essential for managing acute symptoms without the need for overnight hospital stays. By incorporating these features, health insurance enables customers to access quality care and preventive services, thereby significantly reducing their financial stress during long-term treatment.

The insurance market now offers customizable plans, allowing customers to select coverage that precisely meets their specific needs. Features may include enhanced OPD benefits (up to twice the premium value), flexible sum insured options as high as ₹5 Crore, unlimited sum insured reinstatement, and built-in home nursing cover. Good news is that insurers are now developing plans and products which make coverage for chronic conditions like asthma and bronchitis easier, especially in terms of the waiting periods. These options are especially valuable for customers managing chronic respiratory conditions, as they provide comprehensive support and improve overall financial well-being.

One critical aspect to understand is how insurers treat pre-existing respiratory conditions. If you’ve been diagnosed with asthma or COPD before purchasing your policy, these may be classified as pre-existing illnesses. In such cases, a waiting period (typically 2–4 years) may apply before coverage begins. You must disclose these conditions during policy purchase to avoid claim rejection later.

Given the rising incidence of pollution-related illnesses, some insurers now offer tailored health insurance plans that focus on respiratory care. These plans may include a no-waiting-period provision for pollution-induced respiratory conditions, preventive care benefits such as annual lung health check-ups, and wellness programs for managing chronic respiratory diseases.

Pollution is now a persistent challenge and health insurance is more than just a policy, it is a vital investment in your future security and peace of mind. The right health insurance plan not only shields you from unexpected medical expenses but also empowers you to access quality care when you need it most. As you consider your options, ensure that your policy offers comprehensive coverage tailored to your unique health needs. By staying protected, you can face the future with greater confidence and focus on what matters most: your health and well-being.

Author is Head – Health Administration Team, Bajaj General Insurance Limited (formerly known as Bajaj Allianz General Insurance Company Limited)