Alarming Spike: Heart-Related Insurance Claims Double In 5 Years, Average Claim Size Triples

In the past five years, heart-related insurance claims have doubled, while the average claim size has surged by three times, according to data from Policybazaar. As hospitalisation costs continue to skyrocket, the financial strain on patients and families is becoming more severe, highlighting the urgent need for robust health insurance coverage and preventative care measures.

1. Increasing share of heart-related insurance claims

This consistent growth in both the share of heart-related treatments and claim size highlights the escalating burden of heart diseases on both individuals and the healthcare system, with more patients needing insurance support for expensive treatments.

2. The rising cost of heart-related treatments 

The highest claim size recorded last year for heart-related treatment was around ₹50 lakhs, reflecting the substantial financial burden that advanced treatments like heart transplants can place on individuals.

Recently insurance company ACKO’s data also revealed that the largest claim related to heart disease – specifically for a cardiac procedure – filed in the past year exceeded ₹1.1 crore.

3. Age demographics of heart-related claimants

The Policybazaar data reveals significant shifts in the age demographics of individuals making heart-related insurance claims:

-Below 40: Approximately 15-20% of heart-related claims are now being made by younger individuals. The sharp rise in claims from those under 40 years old is largely due to lifestyle-related health problems, such as increased stress, poor diet, and lack of physical activity. In 2020, younger claimants accounted for 10-12% of total heart-related claims, but by 2022-23, this figure had risen to around 15-18%.

-Age 40-60: This age group remains the most affected, with 50-60% of heart-related insurance claims. Sedentary lifestyles, unhealthy diets, and high stress levels are key contributors to heart diseases in this demographic.

-Above 60: The share of claims from individuals above 60 stands at 30-35% of total heart-related claims. While this percentage is the second-highest, because of disease management programs by insurers and advanced preventive care, this number is slowly declining.

4. The gender split in heart-related claims

• Men: Approximately 60-70% of heart-related claims are filed by men. They tend to have better insurance penetration, which means they are more likely to file claims for such conditions.
• Women: Only 30-40% of heart-related claims come from women. Despite an increasing awareness of women’s risk of cardiovascular disease, their insurance penetration remains lower than men’s.

5. Regional variation in heart-related claims

-North India leads with 20-25% of heart-related insurance claims, driven by high pollution, and lifestyle-related health issues in major cities like Delhi.

-East India has the lowest share (10-12%), likely due to lower insurance penetration, though heart disease rates remain significant in urban areas like Kolkata.