Insurance claims for seasonal illnesses rise 150% in past 3 years

Health insurance claims for seasonal illnesses have risen by about 150% over the last three years, according to a report put out by the online insurance platform Policybazaar.

The report pointed out that cost of treatments for dengue and malaria can go up to Rs 1.5 lakh, while for gastroenteritis it can soar to Rs 1.8 lakh. In peak seasons, claims for these ailments account for 35-40% of the total health insurance claims.

About 50-60% of the claims for these afflictions are for prescriptions covering medications such as antivirals and antibiotics. Outpatient Department (OPD) visits account for 30-40% of claims, including consultations with general physicians and specialists. Hospitalisations for severe cases comprise 15-20% of claims.

"With seasonal illnesses contributing nearly 40% of total health claims during peak season, their impact on medical expenses is far from insignificant,” says Siddharth Singhal, Head, Health Insurance, Policybazaar.

Amongst the top five seasonal illnesses, water-borne gastroenteritis (or stomach flu) constitutes 18% of total seasonal illness claims. Its treatment costs range between Rs 50,000 and Rs 1.8 lakh.

Treatment costs for mosquito-borne dengue and malaria, which bring in 15% of the claims, typically range between Rs 50,000 and Rs 1.5 lakh. Claims for these illnesses surge during the monsoon (July and August).

Bronchitis, which contributes 12% of claims, can cost between Rs 40,000 and Rs 1.2 lakh. For influenza (commonly known as the flu) which accounts for 20% claims, this ranges from Rs 25,000 to Rs 1 lakh. For these illnesses, claims peak during winter (November to February).

For allergies (including seasonal allergies) at 10% of claims, costs range from Rs 30,000 to Rs 90,000. Claims peak during the spring and monsoon seasons, varying by region.

“This highlights the increasing financial burden that even these once-considered minor illnesses can impose, particularly on young families," Singhal said.

Seasonal illnesses show higher incidence in the metropolitan cities. Mumbai records the highest number of claims at 20%, followed by Delhi at 18%, Bangalore at 15%, Chennai at 12%, and Hyderabad at 10%.

Senior citizens (over 60 years) account for the highest percentage of seasonal illnesses claims at about 25-30%, followed by age groups under 18 years and between 45-60 years making up 20-25% each, then young adults (18-30 years) presenting 15-20%, and adults aged 30-45 years logging 10-15%.