Summary of this article
Monsoon season sees up to 150 per cent rise in health insurance claims.
Vector, waterborne, and respiratory diseases drive hospitalisation spikes.
OPD, diagnostics, and consumables often excluded from basic policies.
Higher sum insured, OPD cover, and restoration benefits safeguard finances.
According to recent data by Policybazaar, claims for monsoon-related illnesses have gone up by 150 per cent in the last three years or so. These conditions often require multiple days of hospitalisation, intensive diagnostics, and in some cases, intensive care unit (ICU) care.
From Fever To Fractures. How The Monsoon Strains Your Health Cover
Hospitalisation claims generally go up during the monsoon season for reasons specific to various states or directions: vector-borne diseases (dengue, malaria, chikungunya), waterborne diseases (typhoid, cholera, hepatitis, accident and emergency, acute gastroenteritis), and respiratory infections (influenza, respiratory syncytial virus, pneumonia).
The extended season for dampness also becomes a favorable period for fungal skin infections and aggravation of asthma. With the weather turning messier, accident claims also tend to surge, as waterlogged roads, potholes, poor visibility, and slippery surfaces, a perfect recipe for an increase in vehicular accidents, falls, and fractures. In the flood-prone areas, electrocution is counted, and so are the injuries sustained during rescue operations and clean-up efforts.
“One day in a private hospital can cost you anything between Rs 25,000 - Rs 1 lakh. We’ve seen that Mumbai, Bangalore, and Delhi form the majority of the claims filed during this season,” says Siddharth Singhal, head, health insurance, Policybazaar.
Often, this can make things worse. “Seasonal spikes raise claim payouts and claim ratios, thereby straining insurer and third-party administrator (TPA) resources. This leads to settlement delays during peak weeks. Alternate occurrences of monsoon-related losses affect underwriting, consequently tightening coverage terms or tweaking premiums, especially for high-risk zones,” says Narendra Bharindwal, president, Insurance Brokers Association of India (IBAI).
How To Stay Protected
Yet, most health policies aren’t built to handle this reality. While hospitalisation is covered, expenses like outpatient department (OPD) visits, diagnostics, day-care procedures, and consumables (like gloves, syringes, Personal Protective Equipment (PPE) kits) are either excluded or capped with sub-limits. That’s where the real financial hit lands.
In many households, the same Rs 3 lakh to Rs 5 lakh floater is expected to cover multiple members across multiple health events. But seasonal illnesses don’t wait, and rarely come alone. “With repeat hospitalisations, rising treatment costs, and short gaps between illnesses, a higher sum insured (Rs 10 lakh to Rs 5 lakh or more) is no longer just a safeguard — it’s a necessity,” says Rajagopal Rudraraju, senior executive vice president & national head, consumer claims, TATA AIG General Insurance.
A well-prepared health cover for the monsoon months should go beyond basic hospitalisation. Look for short-term hospitalisation benefits that include both 24-hour admissions and day-care procedures, along with vector-borne disease protection for ailments like dengue, malaria, chikungunya, and typhoid. “Opting for OPD and diagnostic coverage helps take care of fever panels, physician consultations, and repeat tests, while consumables inclusion ensures that hidden costs such as gloves, masks, or syringes don’t quietly drain your wallet,” says Rudraraju.
Finally, a higher sum insured with restoration benefits can prove invaluable, allowing multiple hospitalisations within the same policy year without running out of cover.
