Health Insurance for Smokers in India

Can Smokers Get a Health Insurance Plan in India?

Yes. Although IRDAI has not explicitly said anything in relation to health insurance for smokers in India, it released a Master Circular on 29th May, 2024, which allows everyone in India to apply for health insurance regardless of their risk factor. Therefore, smokers have as much right to apply for health insurance as non-smokers do.

That being said, although the application process for health insurance for smokers may be as seamless as for non-smokers, the scenario of claims is not so rosy. In this article, we’ll discuss how health insurance for smokers in India works, how smoking affects premiums, and the practices regarding disclosure of smoking status.

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How does smoking affect health insurance premiums?

Surprisingly, smoking by itself doesn’t generally increase health insurance premiums in India. At least, in our experience, we have not seen them increase solely due to the applicant’s smoking habits. Unlike term life insurance, where smokers pay approximately 50-100% more, health insurance pricing is not directly linked to smoking. Instead, insurers assess your current health condition. So:

• If you smoke but have no related illnesses, your premium remains more or less the same as a non-smoker’s.
• If smoking has led to a pre-existing disease (PED), like Asthma, COPD, or heart issues, your premium will increase because of the PED, not the smoking habit.

Importance of Disclosing Your Smoking Status

When applying for a health insurance policy, it is critical to provide full disclosure of your smoking habits, whether past or present. Even though smoking itself may not increase your premium, failing to declare it can have serious consequences.

Here’s why:

• Claims can be denied for non-disclosure
  If you develop a smoking-related illness, such as lung cancer, and the insurer finds that you didn’t declare your smoking history, your claim can be rejected. An even worse consequence could be the cancellation of the policy entirely, rendering all the premiums paid in the past useless. This is because insurers consider it a case of wilful misrepresentation or non-disclosure.
• Past smoking matters too
  Many people assume, “I quit 5 years ago, so I don’t need to mention it.” That’s incorrect. Insurers require details of past smoking habits as well, even if you’ve stopped. Omitting this can lead to disputes during claims.

Ditto’s Advice: Even if there is no explicit question regarding present or past smoking habits in the health insurance proposal form, you may find sections such as “Any Other Details” or “Voluntary Disclosures”. Be careful that you divulge details of your smoking habits in those sections. Here’s a snapshot of what the proposal form questions pertaining to smoking and other lifestyle habits may look like:

• It affects claim processing time
  While most genuine claims are eventually settled, non-disclosure can lead to delays. There have been real-life cases where claims linked to substance habits (like alcohol) were initially denied and only cleared after months of escalation.
• Exclusions for substance abuse
  "Treatment for alcoholism, drug, or substance abuse, or any addictive condition and consequences thereof. Code- Excl12." You will find this clause commonly mentioned in all policy wordings in the exclusions section. If it is proven beyond the shadow of a doubt that your ailment is a direct consequence of smoking, insurers are highly likely to reject the claim, even after honest disclosure. What’s more, they may even take your disclosure of your smoking habit in the proposal form and link that history to the development of the disease, and use that information to deny your claim.

Bottom line: Always be transparent about your smoking history in the proposal form. Non-disclosure may save you a small amount of paperwork today, but it could cost you your entire claim tomorrow.

Is it essential for smokers to get health insurance?

Yes. It is of paramount importance that you get health insurance regardless of your smoking status. Not only does smoking directly cause a plethora of diseases, but it also exacerbates other health conditions like hypertension, respiratory diseases, etc.

Moreover, accidents and diseases unrelated to smoking or substance abuse are always covered under health insurance. Therefore, smoker or non-smoker, health insurance cannot and should not be ignored. 

How does smoking affect health insurance claim settlement?

Smoking doesn’t automatically mean your claim will be denied. The outcome largely depends on whether you disclosed your habit and whether the illness can be proven to be directly caused by smoking.

If you disclosed your smoking habit upfront:

Your claim is more likely to be approved, even for smoking-related illnesses like lung cancer. Insurers cannot reject a claim just because you smoke, as long as you were transparent in your proposal form. For a denial, they must present strong medical evidence that the condition falls under the “substance abuse” exclusion.

If you did not disclose smoking habits:

This is where things get risky. Non-disclosure is treated as misrepresentation of material facts, which gives insurers the right to deny your claim and even cancel your policy. In practice, this is one of the most common reasons smoking-related claims get rejected.

If the illness is directly linked to smoking:

Policies sometimes carry exclusions for diseases caused by substance abuse. While smoking isn’t always grouped under “addiction,” if doctors conclude beyond doubt that smoking directly caused the illness, insurers may use this to dispute or delay the claim. Even with disclosure, expect extra scrutiny and potential delays, though outright rejection is uncommon unless policy wording is very specific.

Pro Tip: Never hide your smoking history. Full transparency may not guarantee instant claim approval, but non-disclosure almost always guarantees denial. Disclosing your habit doesn’t make your claim bulletproof, but hiding it makes it nearly impossible to win.

Now that you know why transparency matters, let’s look at some of the best health insurance plans for smokers, based on claim settlement record, benefits, and overall reliability:

Conclusion

Health insurance doesn’t punish you for being a smoker, but it does reward honesty. Smoking may not increase your premium, but it can put your claim at risk if you fail to disclose the habit. Think of disclosure as your safety net: it won’t stop storms, but it will keep you from drowning.

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