Smoking and consuming alcohol can have negative effects on one’s health and also while purchasing health insurance. Many individuals acquire health insurance with the expectation of never having to use it, but with the assurance that the policy will be there to assist in case of unforeseen circumstances.
Despite common belief, individuals who smoke and drink alcohol can still qualify for health insurance in India. While some insurers may impose limitations, the majority of companies do provide coverage to such individuals. It is essential to understand that drinking alcohol does not automatically lead to denial of your insurance application.
Insurance advisor Nikhil Jha, in a recent post on X, cautioned policyholders that they should conscious about damaging their organs with excessive smoking and drinking. He noted that most insurance companies have a clause in their policies that excludes self-damage/destruction and smoking and drinking are covered under such clauses.
“If you smoke/drink and any of ur organs are damaged. Health insurers will not give u the claim… There is a clause in every policy that specifically excludes self-damage/destruction, Smoking and drinking are covered under such a clause. If one gets lung cancer due to smoking… If one gets Liver cirrhosis due to drinking. Unlikely that the insurer is going to give you a claim,” he wrote on X.
Giving an example, he noted that Care rejected a claim where they state the Self Damage clause.
“Not only Care, all insurers in the health insurance industry have this clause. Health insurers do not load the premium even if u state u smoke/drink. This is so because health insurers already know that they will never pay a claim that arises out of these two conditions, So please be aware. Smoking and drinking is not only injurious to ur health. Smoking and drinking is also injurious to ur health insurance,” Jha wrote.
Smoking and drinking
Often, insurers decline claims related to smoking or drinking-induced conditions such as liver diseases and lung cancers, deeming them intentional risks. They are concerned about the potential increase in claims if the insured continues to engage in habitual smoking and drinking while already dealing with pre-existing conditions caused by these habits. This practice may be perceived as endorsing the individual’s self-indulgence, which dissuades health insurance companies from approving such applications.
Individuals who engage in heavy smoking or drinking habits may find it difficult to obtain insurance coverage.
According to insurance advisors, the disclosure of these habits can negatively impact coverage for specific health conditions such as liver cirrhosis or heart attacks.
Moreover, policyholders who fail to disclose their smoking or drinking status may face claim denials for unrelated health issues upon further investigation of medical records.
Insurance cover for alcohol drinkers
In India, insurance providers offer medical coverage to individuals who consume alcohol. However, they may require you to undergo a pre-acceptance medical examination to determine your alcohol consumption levels. Additionally, certain alcohol-related diseases may be excluded from coverage or have a waiting period before being covered under your health insurance policy.
In the event of a claim, insurance companies cannot deny your claim solely based on moderate alcohol consumption prior to hospitalization. However, claims for illnesses or injuries resulting from alcohol addiction or heavy drinking will not be covered under your policy. This exclusion is commonly found in health insurance policies.
Regular alcohol consumption directly impacts medical insurance premiums. Heavy drinkers who consume alcohol regularly will face higher health insurance premiums. This is because insurance companies charge a higher premium from heavy drinkers to offset the potential financial burden in the future from excessive drinking.
Regular alcohol consumption, particularly in large quantities, heightens the risk of various diseases such as liver failure, high blood pressure, stroke, liver, breast and oral cancer, pancreatitis, and more.
Additionally, it can contribute to memory loss, mental health issues, and reduced fertility. As alcohol consumption leads to significant health problems, it increases the insurance company’s liability, resulting in higher premiums.
What should a policyholder do?
It’s crucial to be honest about your smoking or drinking habits during the application process. As per IRDAI guidelines, misrepresenting or withholding information about smoking or drinking is a serious issue. Failure to disclose such details is considered fraud and can lead to the policy being void.
One should fully disclose and answer all the health-related information as accurately as possible. If one of you has quit smoking, insurers may classify you as a non-smoker after a significant period (typically 12 months).
However, the classification period may vary from insurer to insurer. Being marked a non-smoker can potentially reduce your future premiums. However, full disclosure of past habits is essential.