Heart insurance claims double in 5 years; treatment costs surge 53%: Report

The cost of coronary artery bypass grafting (CABG) has risen from Rs 2.1 to Rs 4.2 lakh in 2018-2019 to Rs 3 to Rs 6 lakh in 2023-2024

Heart-related insurance claims in India have doubled over the past five years, according to a report by Policy Bazaar. The report also notes that the size of these claims has surged, now three times higher than in previous years, as more individuals seek financial assistance for expensive treatments. Moreover, the cost of treatment has increased by 47% to 53%.

"With heart-related insurance claims accounting for nearly 20% of total claims in 2023-24, heart disease is becoming an increasing health and financial burden. This is particularly true for those under 40, where stress and lifestyle choices contribute to skyrocketing medical expenses for heart treatments," said Siddharth Singhal, Head of Health Insurance at Policybazaar.

What does the data reveal?

The statistics indicate a substantial rise in both the share of heart-related claims and their respective sizes. In the financial year 2023-2024, heart-related claims constituted 18-20% of total health insurance claims, up from 9-12% in 2019-2020. The average claim size has also escalated, growing from Rs 4-5 lakh in 2019-2020 to Rs 12-15 lakh in 2023-2024.

Treatment costs rise

The rising costs of heart-related treatments add to the financial strain. Here’s a look at some key treatments and their costs over the past five years:

Coronary artery bypass grafting (CABG): Cost has increased from Rs 2.1 - 4.2 lakh in 2018-2019 to Rs 3 - 6 lakh in 2023-2024.

Heart valve replacement: Prices have surged from Rs 2.8 - 4.9 lakh to Rs 4.3 - 7.5 lakh.

Pacemaker implantation: The cost rose from Rs 4.9 - 7 lakh to Rs 7.2 - 10.3 lakh.

Heart transplant: Expenses have jumped from Rs 21 - 35 lakh to Rs 31 - 52 lakh.

The highest recorded claim for heart treatment last year reached around Rs 50 lakh.

Who is affected? Age demographics in focus

Shifts in age demographics show that heart-related claims are increasingly made by younger individuals.

Below 40: This group now accounts for 15-20% of heart-related claims. The rise is attributed to lifestyle-related issues, such as stress, poor diet, and lack of exercise. In 2020, younger claimants made up only 10-12% of total claims, a figure that increased to 15-18% by 2022-23.

Age 40-60: This demographic remains the most impacted, responsible for 50-60% of claims. Key factors include sedentary lifestyles and unhealthy eating habits.

Above 60: Individuals over 60 years old represent 30-35% of heart-related claims. However, thanks to disease management programs and improved preventive care, this number is gradually declining.

Gender dynamics

Gender also plays a role in heart-related claims:

Men: About 60-70% of claims are submitted by men, who generally have better insurance penetration. This means they are more likely to claim for heart conditions, according to the report.

Women: Only 30-40% of claims come from women. Despite increasing awareness of cardiovascular risks among women, their lower insurance penetration remains a concern.

Regional differences

North India (Delhi, Punjab, Haryana): This region accounts for 20-25% of heart-related claims, largely due to high pollution levels and lifestyle-related health issues prevalent in major cities.

West India (Maharashtra, Gujarat): Contributes 15-18% of claims.

South India (Tamil Nadu, Karnataka): Accounts for 15-20%.

East India (West Bengal): Has the lowest share at 10-12%, likely due to lower insurance penetration, despite significant heart disease rates in urban centres like Kolkata.  

Health insurance plans
 

"Many health policies today cover advanced treatments such as bypass surgeries and valve replacements. Coupling these plans with critical illness riders enhances your financial safety net," said Singhal.

"Insurers are also offering wellness benefits and preventive care features that help identify and mitigate health risks early, providing a holistic approach to maintaining health," he added.

Take a look at some health insurance plans for a 30-year-old male living in Delhi:

CARE HEALTH (Plan: CARE FREEDOM)

Premium: Rs 9,668

Cover amount: Rs 5 lakh

Features:

Restoration of cover

Annual health check-up

Pre and post-hospitalisation coverage

NIVA BUPA (Plan: REASSURE)

Premium: Rs 13,749

Cover amount: Rs 5 lakh

Features:

Unlimited claims in a year up to the sum insured

No room rent limit

Unlimited restoration of cover

STAR HEALTH (Plan: STAR COMPREHENSIVE)

Premium: Rs 9,053

Cover amount: Rs 5 lakh

Features:

Rs 2.5 lakh no-claim bonus

Restoration of cover once a year

Pre and post-hospitalisation coverage

ADITYA BIRLA (Plan: ACTIVE ONE)

Premium: Rs 12,185

Cover amount: Rs 7 lakh

Features:

No room rent limit

Rs 7 lakh renewal bonus (optional)

Unlimited restoration of cover