Delhiites may pay more health insurance premiums as pollution stings

New Delhi: Indian insurers are considering making New Delhi residents pay 10 per cent to 15 per cent more for new health policies after an extraordinary spike in claims related to air pollution in 2024 in India's capital, according to nine executives aware of the matter.

The plan, now in discussion amongst insurers and which would need approval from the insurance regulator, follows record-breaking air pollution in New Delhi last year. If approved, it would be the first time air pollution was used as a direct factor in figuring health insurance premiums in India and could be used to justify price hikes in other cities as well.

Toxic air led to more Delhi residents seeking treatment for asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular conditions in 2024, higher than in any prior year, five of the executives said.

All the executives spoke on condition of anonymity as they are not authorized to speak with media.

"We have to start thinking about pollution as a separate factor in the pricing in the sense that can we then start executing a particular charge for the areas which are impacted by it," said Amitabh Jain, the operating chief of Star Health, India's No.1 standalone health insurer.

In 2024, the number of patients with respiratory ailments who needed to be hospitalized rose to 17 per cent-18 per cent in the second half of the year versus 5 per cent - 6 per cent in the first half, Jain said.

Also, respiratory claims rose 8.3 per cent from fiscal year 2023 to fiscal year 2025 in the state of Delhi, which recorded the highest rise in healthcare costs in India during that period, according to a joint report from Boston Consulting Group and Indian healthcare administrator Medi Assist.

Star Health and ICICI Lombard said pollution could soon become a direct factor in determining health insurance premiums if poor air quality persists. Bajaj Allianz General Insurance said the industry could also add new clauses specifically addressing pollution-related health concerns.

The Insurance Regulatory and Development Authority of India (IRDAI) and prominent Indian insurers including Aditya Birla Health Insurance, Tata AIG, New India Assurance and Go Digit did not respond to requests seeking comment.

For 2023/24, Indian insurers collected Rs 10,75,26,60,00,000 crore ($12.4 billion) in health insurance premiums, an increase of about 20 per cent over the previous year, according to the latest IRDAI annual report.

Not just Delhi

New Delhi chokes on smog every winter due to a blend of vehicle emissions, construction dust and smoke from illegal farm fires. In November, Delhi overtook Pakistan's Lahore as the world's most polluted city in Swiss group IQAir's live rankings, with Mumbai and Kolkata also making it to the list of top 10 cities with the most toxic air.

On November 18, India's pollution control authority said the national capital territory's 24-hour air quality index (AQI) score touched a season-high of 491 on a scale of 500. Anything over 400 is "severe", affecting healthy people as well as "seriously impacting" those with existing health issues.

In India, insurers can vary health insurance premiums by city based on factors ranging from hospitalisation costs to demographics.

Getting the regulatory nod to include air pollution as a factor would depend on insurers submitting proof to back the assertion that toxic air is leading to an increase in claims.

"The frequency and severity of hospitalization purely due to the toxicity in the air needs to be isolated," PwC India Financial Services Advisory Leader Joydeep Roy said.

"That involves commissioning longer-term studies."

It is not known how long it would take to conduct such studies or to get the needed approvals from IRDAI.

Senior citizens, children, outdoor professionals and those with preexisting respiratory conditions would likely pay the highest premiums. The plan, if approved, would likely make health insurance unaffordable for many who need it most.

New Delhi's per capita income was Rs 4,62,304.32 ($5,331) in 2024 according to the Delhi Statistical Handbook, and under current guidelines health insurance with a coverage limit of Rs 8,67,175 ($10,000) for a family in the city would cost between Rs 8,667.90 ($100) to Rs 34,671.60 ($400) per year.

"In India, owning health insurance cover is a luxury," said Delhi resident and COPD patient Aniket Tiwari, 28, who decided against getting coverage in 2024 because it was too pricey.