Page 49 - The Insurance Times November 2024

FEATURE

Do smoking and drinking impact

your health insurance?

F ifty- Six- Year- Old Ravi Sinha (name change) was Explains Dr Suranjit Chatterjee, senior consultant of internal
medicine at Indraprastha Apollo Hospital, New Delhi, "For
taken aback when his insurance provider denied
coverage for complications related to his liver
instance, a person is admitted to the hospital for dengue. If
cirrhosis, despite his long history of paying premiums
smoking or drinking habit while vetting their claims, it may
and disclosing his drinking habits. He found himself paying out- the insurance company realises that they did not disclose their
of- pocket for his treatment, unaware that any condition refuse to process it altogether. This can happen even though
directly related to his drinking would disqualify him from dengue is in no way related to smoking or drinking habits."
benefits. "Yet I had paid premiums for over five years," he says.
What are Grey Areas?
Insurers often reject claims linked to conditions arising
While most insurance providers say that smokers and
from smoking or drinking - like liver diseases and lung
drinkers are covered, in reality they might find it extremely
cancers - viewing them as deliberate risks. They fear there
difficult to get coverage. "While insurance premiums go up
would be too many claims if the patient continues to
for term plans - insurance plans that provide benefits to the
smoke and drink frequently while dealing with habit- related
nominee if the policy- holder dies - most companies do not
pre- existing ailments. This would then seem like under-
have a separate pricing for health coverage. If a person
writing a patient's self- indulgence. This is what
smokes more than six cigarettes a day or drinks more than
dissuades health insurance companies from accepting such
50 ml alcohol every day, they will not be able to get an
proposals.
insurance policy," says insurance advisor Aditya Shah.
"People with conditions such as liver cirrhosis are denied Most companies do not check for smoking or drinking status
insurance coverage because it is mostly the result of alcohol prior to selling a policy but a user must declare it or risk
abuse. Many patients worry about their insurance money denial of coverage. "The condition of the lungs or liver can
and request us not to mention drinking as the cause of liver very easily be detected on liver function tests, X- rays and
damage. I then tell them to change their doctor. Many scans that are routinely done when a person is admitted to
patients do that, trying to get their costs reimbursed," says hospitals. If the company finds evidence of smoking or
Dr SK Sarin, vice- chancellor of the Institute of Liver and drinking in these tests, they are likely to refuse coverage,"
Biliary Sciences (ILBS). adds Shah. Even for those who make proper declarations,
the insurer can refuse coverage for certain conditions.
If you are a heavy smoker or drinker, you are likely to be
denied insurance coverage altogether. The disclosure may However, this doesn't mean that smokers and drinkers
work against you for certain diseases such as liver cirrhosis cannot get any coverage at all. "This is where the role of
or heart attacks, say insurance advisors. For those who get the treating doctor comes in. Coverage will be refused if
the policy without declaring their smoking or drinking status, they say that a certain condition is caused specifically due
their claims for unrelated diseases could be denied on to smoking or drinking. All companies have a standard
investigation of medical reports. exclusion for self- harm in their policy wording. While this

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