Asthma And Health Insurance: What Patients Should Know Before Choosing A Policy

For people living with asthma, treatment is rarely a one-time affair. Whether it is daily inhalers, routine or occasional doctor visits, managing flare-ups during seasonal changes, etc., care for this condition is continuous. This is one of the reasons why having a health insurance plan that supports this long-term condition matters, though many may not realise how nuanced the coverage can be.

One of the most misunderstood points regarding asthma is whether it’s covered by most standard health insurance plans. There is a key detail that makes all the difference here, was the condition diagnosed before you bought the policy or after.

“If someone already has asthma when applying for a policy, insurers generally treat it as a pre-existing condition,” explains Siddharth Singhal, Head of Health Insurance at Policybazaar, an online insurance marketplace. And when a condition is tagged ‘pre-existing’, most policies will not cover related expenses immediately. There’s usually a waiting period, commonly two to three years before asthma-related costs like hospitalisation or specific treatments are reimbursed.

On the other hand, if asthma is diagnosed after the policy starts, it will typically be covered without delay. This means that it is important for policy buyers to declare any known history at the time of buying the policy.

Even if asthma was diagnosed in childhood and has not flared up in years, it still counts as pre-existing in the eyes of insurers.

Are OPD consultations, hospitalisations and long-term medications typically covered in standard health insurance policies?

Then there’s the question of what kind of care is actually covered. Asthma is a condition that doesn’t usually land people in hospitals but does rack up smaller, ongoing costs. Routine consultations, diagnostic tests, prescription refills, all of these are central to asthma care, but rarely covered by default.

Many standard plans do not automatically cover these routine needs. Consultations at clinics, daily medications, and periodic tests fall under OPD (Outpatient Department) care, and unless you’ve taken an OPD add-on or chosen a plan that includes it, those costs are typically borne out-of-pocket.

Hospitalisation, however, is a different story. If an asthma attack leads to hospital admission, say, for oxygen support or emergency treatment, it is generally covered, provided the waiting period is over. “Hospitalisations are included under most policies once the waiting period for pre-existing diseases has passed,” Singhal confirms.

What other options do you have?

For those looking for better support, there are options. Some newer health plans come with modular features that allow buyers to customise their cover. You can add riders that reduce or waive the waiting period for pre-existing diseases or include OPD benefits for consultations and prescriptions.

“We’re seeing pre-existing disease reduction riders gaining ground,” Singhal says. “Some even eliminate the waiting period entirely.”

However, these products are still new and not as widely understood by policyholders or available as they could be. The market has the tools; the awareness just hasn’t caught up yet.

So, what should asthma patients actually look for when looking for a health insurance policy?

For starters, clarity on the waiting period. Look carefully at the fine print around exclusions. Before purchasing the plan, you should confirm how long it is (waiting period) and whether it can be reduced or waived with an add-on.

Also, if you are someone who manages asthma with regular doctor visits and medication, and not hospital stays, look into OPD coverage or chronic care management add-ons. You can also look for plans that offer routine health check-ups and discounts on medicine for chronic patients.

Another, and most important, thing to remember is the ‘full and clear disclosure’ of PEDs on your end. Skipping details about your asthma history might seem okay if the condition is not serious. However, it can backfire later in your claim.

In all, while asthma is covered by most insurers, the when, what, and how much varies quite a bit. Understanding these aspects upfront can help patients avoid unwelcome surprises—and choose a plan that actually works for their needs, both day-to-day and in emergencies.