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Should Insurance Cover Genetic Obesity Treatments?

The World Health Organisation’s 2022 reports reveal that one in eight people in the world is living with obesity. The number has doubled since 1990. Though obesity is mainly considered a lifestyle condition, studies show that 40% to 70% of obese cases are attributed to genetics. Some mutations like LEPR, MC4R and POMC genes are directly linked to the severe onset of obesity and related complications. Take the case of young girl Asha, aged 23, who has just started her career. She struggles to reduce her weight despite a strict diet and exercise plans. After countless efforts, she had to seek medical advice to combat health issues resulting from her obesity. This is when the genetic tests revealed that inherited MC4R mutations were the culprit that was affecting her metabolism. The surgery and the treatment plan suggested to her would cost around INR 6,00,000. Her insurance company refrain from giving an approval, labelling this treatment/surgery as medically not necessary or cosmetic in nature. Hence, the diagnosis has come with both relief and worry for Asha. This story highlights the growing debate on –Should there be health insurance coverage for genetic obesity treatments?

Health

Should Insurance Cover “Preventive” Cosmetic Surgeries?

On a rainy Sunday morning, Meera, a 30-year-old IT professional in Bengaluru, is contemplating a hard decision of whether to get a mastectomy done or not. She has a history of breast cancer in the family. Considering the heredity, the doctor has advised her to undergo a mastectomy for reconstruction as a preventive surgical procedure. However, her health insurance company has not given her approval to claim, labelling the procedure as ‘cosmetic surgery’. Stories like this highlight the health insurance dilemma around preventive cosmetic surgeries. Let us explore what preventive cosmetic surgeries are, why there is a growing demand and the insurance industry’s stance on covering these procedures.

Health

How Urban vs. Rural Healthcare Gaps Reflect in Premiums

India’s 65% of the population lives in rural areas. But 75% of the healthcare infrastructure is concentrated in the main cities and urban areas, making access difficult for the majority of the population in rural areas. This disparity in healthcare affects every aspect, from doctor availability to insurance penetration. Let’s take two different scenarios to understand the impact of healthcare disparity in rural and urban India. 40-year-old Ashok in a remote village in Uttar Pradesh had to travel 40 km on a borrowed bike to get his ailing father admitted for treatment at a district hospital nearest to his village. When he arrived after a long two-hour travel, the district hospital was short of equipment and specialist doctors. Two main things to notice here are – delayed treatment, lack of quality and too much out-of-pocket expenses. Now, let us imagine a contrast scenario of a family in Mumbai that has quick access to a hospital, doctors and multispeciality hospitals all at a distance of a few kilometres. These differences make a huge impact on the health insurance premiums. Let’s explore how this healthcare gap shapes health insurance risk assessment and impacts the insurance premium.

Health

How Air Quality Index May Decide City-Wise Premiums

According to a recent survey, insurance companies in India are considering increasing health insurance premiums by 10% to 15% in New Delhi, due to the spike in air pollution in the city. This is not just the case with New Delhi, but AQI is set to become a vital factor in deciding city-wise premiums. Considering AQI as a factor in deciding health insurance premiums is no longer an alien concept. Take the example of Rashmika Srivastava, a 26-year-old content writer from New Delhi, who recently purchased health insurance. When she shared the news with her twin sister, who lives in Jaipur, she was surprised to discover the differences in premiums for the same policy, that too from the same insurer. Why this difference? The AQI levels in New Delhi are significantly higher than those in Jaipur. This might be the new reality in the health insurance realm. Let’s break down the role of AQI in city-wise health insurance premiums in detail.

Health

How AI Chatbots Are Speeding Up Health Claim Processing?

Artificial intelligence is reshaping every industry and sector, including insurance. With the rise of InsureTech companies, AI adoption is in every process is helping the insurance companies to improve customer experience through various tools. AI chatbots are one of those popular tools that have transformed the insurance sector by accelerating efficiency and speed. Take the case of Raj, a 35-year-old IT professional working in Hyderabad. He faced a medical emergency when his father had to undergo immediate surgery. His insurer’s AI-powered chatbot reduced his worry of tedious paperwork instantly by allowing him to upload the documents for approval via chatbot. His claim was approved and processed instantly, and the bills got settled in real-time.

Health

Seasonal Outbreak Insurance – Is It the Next Big Thing?

On a busy July morning in Mumbai, Smita had to take a day off to rush her son to the hospital for a persistent fever. The hospital’s paediatric waiting room was overflowing with anxious families. Everyone, from kids to adults, faces this health scare specifically during June to September every year, with vector-borne illnesses like chikungunya, dengue, and water-borne illnesses increasing. This seasonal outbreak has a huge impact on both health and finances. Last year’s Policybazaar study reveals that one-third of health insurance claims (33% to 40%) in metro cities like Mumbai come from seasonal outbreaks of illnesses like malaria, dengue, and gastroenteritis, with treatment costs ranging from INR 50,000 to INR 1,50,000. Vector-borne illnesses are surging year on year during the rainy season. In 2025, India reported over 13,052 dengue cases and 19 deaths by the end of July. South states like Kerala and Tamil Nadu have recorded the highest number of cases. With healthcare costs rising, health insurance claim payouts are also projected to rise by 30% growing from INR 62,014 in FY 23 to INR 81,025 by FY 25. This is why seasonal outbreak insurance is gaining traction over the years.

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Jio Insurance Broking Limited
IRDAI License No: 347,
Direct Broker (Life & General),
Valid upto: 11/03/2028
(Renewable)

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