Summary of this article
Delhi saw 68,411 acute respiratory illness cases in 2024 amid rising pollution
Comprehensive health insurance covers pollution-triggered respiratory and cardiac issues
OPD and critical illness riders offer added protection during high AQI periods
Review exclusions, waiting periods, and add-ons for full seasonal health coverage
Individuals need to consider comprehensive health insurance to protect themselves from pollution-related illnesses. With Diwali around, it is common for people to face pollution-related or smog-related problems, which can lead to major health issues.
The numbers are scary. The data from six central hospitals reported that in 2024 alone, around 68,411 cases of acute respiratory illness were reported in Delhi.
Standard Health Insurance Policies Cover Pollution-Related Respiratory and Cardiac Conditions
A comprehensive health insurance policy covers a wide range of medical emergencies, including respiratory and cardiac conditions caused by pollution. “Apart from this, for minor problems arising solely due to this pollution condition at a specific time of the year, an OPD rider could be a good option. It covers outpatient expenses, including medicines, consultations, and diagnoses. It secures you from common minor pollution-triggered ailments,” says Bhaskar Nerurkar, head- health administration team, Bajaj General Insurance.
A standard health insurance policy covers pre- and post-hospitalisation expenses, which include most diseases, excluding pre-existing conditions, and any diseases specified as excluded. Treatment of respiratory or cardiac complications caused or increased by high air pollution is typically included in a standard health insurance policy.
A policy may not list air pollution as the cause, but usually covers the diseases that pollution can trigger. Hospitalisation, diagnostic tests, and critical care are included in the policy.
“However, pre-existing conditions and waiting periods must be carefully reviewed. The key is to choose plans that have broader inclusions and minimal exclusions related to lifestyle or environmental factors,” says Narendra Bharindwal, president, Insurance Brokers Association of India (IBAI).
OPD And Critical Illness Cover Recommended
Along with this, outpatient department (OPD) coverage and critical illness cover can be bought as extended support or coverage for complete financial protection. Apart from a comprehensive health insurance policy, having an out-patient department cover helps in expenses that do not require hospitalization.
It offers services like doctor consultations, diagnostic tests, and medicines. This is an important add-on during high air quality index (AQI) periods, as it may be the time when people visit doctors for more common issues, such as coughs, throat infections, and eye irritation.
“For more serious conditions, a critical illness rider is a worthwhile option. It provides a lump-sum payment in the event of a life-threatening disease. It includes severe conditions like terminal lung failure, certain cancers, and heart attacks, which can be triggered or worsened by long-term exposure to air pollution,” says Nerukar.
One can also look for wellness benefits, as they are also important for active health management during periods of poor air quality. One should look for a policy that offers a free annual medical check-up. This way, one could keep up with their changing health condition. “A policy that also includes teleconsultations provides ease of access to a doctor remotely and immediately for quick advice on minor illnesses or a second opinion and consultations,” says Nerukar.
“Those with pre-existing respiratory conditions can include add-ons like Day 1 coverage for pre-existing diseases (PEDs) that can further provide additional protection during this high–risk Diwali and winter season,” says Siddharth Singhal, business head - health insurance, Policybazaar.com.
