Pollution-linked health insurance claims surge 4.3x in three years; working professionals account for 59%

Pollution-linked health insurance claims have surged 4.3 times over the past three years, with cardiovascular and respiratory ailments accounting for the bulk of hospitalisation claims, according to data from Policybazaar.

The data shows that pollution-associated claims rose 67% in FY24, followed by 70% growth in FY25 and another 53% increase in FY26. The total claim payout increased 4.5 times between FY23 and FY26, reflecting both rising claim volumes and higher treatment costs.

The average claim amount also rose 9% in FY24 and has remained above FY23 levels, with the average pollution-linked health insurance claim amount reaching ₹62,662.

Cardiovascular, respiratory illnesses drive 78% of claims

The impact of pollution extends beyond conventional respiratory ailments, the data suggests. Cardiovascular conditions account for 43.5% of all pollution-associated claims, followed by other respiratory infections at 35%.

Pneumonia contributes another 11.2% of claims, while bronchitis accounts for 6%.

Together, cardiovascular and respiratory conditions account for nearly 78% of pollution-linked health insurance claims, highlighting the wider health burden associated with deteriorating air quality.

Working professionals, senior citizens account for 90% of claims

Working professionals aged between 31 and 55 account for the largest share of pollution-associated claims at 59%, followed by senior citizens aged above 55 years at 31%.

Young adults in the 21–30 age group contribute 6.7% of claims, while children below 20 account for 3.7%.

The data points to a significant health and financial burden among economically active individuals as well as older populations, who are more vulnerable to pollution-related health complications.

Smaller cities account for 55% of claims

While Delhi tops the list of cities reporting the highest number of pollution-associated health insurance claims, Pune, Bengaluru, Mumbai and Hyderabad follow.

The trend, however, is no longer confined to major metros. Tier-2 and Tier-3 cities account for 27% each of total claims, taking the combined share of smaller cities to 55%.

Cities such as Ernakulam and Faridabad also feature among the top 10, underlining the widening geographical spread of pollution-related health concerns.

Winter accounts for 56% of annual claims

Pollution-associated health claims show a strong seasonal pattern, with the October–March period accounting for nearly 56% of annual claims in FY26. The spike coincides with the winter months, when air quality deteriorates sharply across several parts of the country, potentially aggravating respiratory and cardiovascular conditions.

The data also points to increasing awareness about financial protection against healthcare costs. Nearly 48% of consumers in highly polluted cities are opting for higher sum insured under their health insurance policies.

“India’s rising pollution levels are increasingly reflected in its healthcare burden. Our health insurance data shows that pollution-associated claims have surged 4.3 times. The impact extends beyond respiratory illnesses, with cardiovascular conditions accounting for 43.5% of claims and respiratory infections contributing 35%,” said Rohan Goel, Business Head, Health Insurance at Policybazaar.

“Working professionals aged 31–55 account for nearly 59% of claims, while senior citizens contribute another 31%. The trend is also spreading beyond metros, with Tier-2 and Tier-3 cities together accounting for 55% of claims,” he added.

Goel said the trends highlight the growing importance of preventive healthcare, timely medical attention and adequate health insurance coverage to manage unexpected medical expenses.