Health claims up 30% in 3 years; heart diseases drive 30% of term claims

Younger adults (18-35 years) contribute the most to health insurance claims, according to a report by Policybazaar

Health insurance claims in India have grown by 30% over three years, driven by rising costs, seasonal illnesses, and chronic conditions such as diabetes and cancer. Heart disease accounts for 25–30% of term insurance claims, according to a report by Policybazaar.

 

These trends from the insurance industry in India reflect increasing medical costs and a greater reliance on insurance to manage healthcare expenses.  

 

Health insurance

 

“The rising cost of healthcare is putting a strain on people’s pockets. For many families, a single hospitalisation can result in substantial financial strain, depleting years of savings or forcing them to take loans. This is particularly evident in urban areas like Delhi and Maharashtra, where higher costs of advanced medical facilities have led to average claims exceeding Rs 1 lakh,” said Siddharth Singhal, Head of Health Insurance, Policybazaar.

 

 

Seasonal and chronic conditions dominate health insurance claims. Seasonal diseases, such as fever and viral infections, surge during monsoon and winter months. Chronic conditions like heart disease, diabetes, and cancer show a troubling rise across all age groups.

 

Payouts increasing every year  

 

The average claim payout has steadily grown:  

FY23: Rs 62,014  

FY24: Rs 70,152  

FY25: Rs 81,025  

 

Maharashtra and Delhi lead in claims  

 

Policybazaar's data shows Maharashtra accounts for 14.5% of total claims, with an average payout of Rs 86,402. Delhi contributes to 10.2% of claims but has a higher average payout of Rs 100,600. Haryana and Tamil Nadu follow, with payouts averaging Rs 97,573 and Rs 113,074 respectively.

 

More young adults claiming insurance  

 

Younger adults (18–35 years) contribute the most to health insurance claims, with a 38.2% share. This is followed by:

 

36–45 years: 29.5%

46–60 years: 25.3%

61–75 years: 6.4%

75+ years: 0.5%

 

The high share of claims by younger adults is linked to seasonal illnesses and early-onset chronic conditions like diabetes.

 

"This trend shows how even the seemingly healthy population is not immune to rising healthcare expenses,” said Singhal.  

 

Meanwhile, men make 86% of claims, pointing at higher health insurance penetration among males.  

 

Rising frequency of claims  

 

Claims frequency has also increased:  

FY23: 4.9%  

FY24: 5.26%  

FY25: 6.39%  

 

Motor insurance claims surge during monsoons  

 

Motor insurance claims saw a 40% increase during the monsoon season in regions prone to heavy rains. Accidents, thefts, and damage caused by natural events such as flooding remain the leading reasons for claims.  

 

Claims based on car type  

 

SUVs have the highest claim payouts, ranging from Rs 30,000 to Rs 35,000, due to higher repair costs. Hatchbacks, despite lower claim payouts of Rs 20,000 to Rs 25,000, account for 54% of claims due to their higher market share.  

 

Add-ons gaining traction  

 

Insurers report a rising preference for motor insurance add-ons like zero depreciation and engine protectors, even for cars up to 10 years old. “Customers are increasingly seeking comprehensive coverage to safeguard against unforeseen expenses,” an industry representative said.  

 

Regional variations in motor claims  

 

Delhi NCR and Maharashtra report a high volume of accidental claims, while Tamil Nadu, Karnataka, and Andhra Pradesh see higher claims due to cyclones and monsoon-related damage.  

 

Term insurance claims dominated by heart diseases

 

Heart disease accounts for 25–30% of term insurance claims, while natural deaths make up 30–35%. Accident-related claims stand at 15–20%. Covid-19-related claims are still being reported, showing the lingering effects of the pandemic on life insurance trends.  

 

Male policyholders dominate term insurance claims  

 

The majority of term insurance claims—90%—are made by male policyholders. This is attributed to higher mortality rates among men and greater penetration of term insurance policies among male policyholders.  

 

Urban areas see more claims  

 

Regions with higher urban populations, including Maharashtra, Uttar Pradesh, Delhi, Karnataka, and Gujarat, report the most term insurance claims. Higher awareness of life insurance products and access to financial services are driving these numbers.  

 

Riders gaining popularity  

 

Around 35–40% of policyholders are now opting for riders like critical illness and accidental death benefits. According to Policybazaar, these add-ons are becoming popular among those seeking enhanced protection for unforeseen events.