The Capital city has been battling air pollution for a long time now, with even the Supreme Court weighing in on the remedial measures taken by the government. But, there seems to be little respite. Complaints of breathlessness, severe wheezing, lung infection and chest congestion are on the rise. Sonia Suri (53), a resident of Mayur Vihar in New Delhi, vividly remembers the day she had to be hospitalized. In 2018, she suffered an unusually long bout of uncontrollable coughing. She consulted a pulmonologist who used a spirometer to monitor her breathing. The spirometer is a medical device that measures how much air one can breathe in and out. “I was not able to breathe. My nails were turning blue. The doctor admitted me to the ICU (intensive care unit) right then and put me on treatment for lung infection. I could have died, he told us later,” says Suri, who now wears a N-95 mask all the time. An N95 respirator is a personal protective equipment (PPE) device designed to filter out at least 95% of airborne particles, including small particles and large droplets.
Suri, who resided near the infamous Gazipur landfill in Mayur Vihar, was asked by her doctor to shift residence to another place. “The doctor suggested that I relocate. I did that but it wasn’t of much help either because entire Delhi is polluted. Every year when the air quality turns worse from October onwards, I get sick and am put on steroids,” she says. Steroids are medications to treat a variety of inflammatory conditions, such as asthma.
Suri is not off the mark when she says that entire Delhi is polluted. The Capital is indeed one of the most polluted city with the worst air quality index (AQI) levels. Data from Central Pollution Control Board (compiled by Respirer Living Sciences, a climate-tech start-up) shows Delhi’s average AQI level in terms of PM2.5 hit 252.7, as on November 15. It was 106.2 in October. A level below 50 is considered safe. It was less than 50 only for Bengaluru, Chennai and Hyderabad among 11 major cities (see graphic). Bhopal, Chandigarh and Pune were among the cities where pollution levels were high. A Reuters report on 13 November said two Indian cities, Mumbai and Kolkata, joined New Delhi among the world’s top 10 most polluted cities the day after Diwali. PM is short for particulate matter, tiny particles that hang in the air and can cause breathing troubles when inhaled.
The worsening air quality has implications— dire consequences for people facing respiratory issues, say experts. Not only do they have to bear medical expenses but also make drastic changes in the way they live, work or stay. “Just as water purifiers have become a norm in houses, air purifiers too are becoming quite common,” says Ronak Sutaria, founder & CEO, Respirer Living Sciences.
Air purifiers, though, are just a minor expense in the battle against pollution. There are significant costs involved in respiratory disease management. But, is it covered under insurance? And, how does one get protection against it—medically and financially ? Read on.
Breathing bad
Pune-based Ravindra Jakareddy (52) suffers from allergic bronchopulmonary aspergillosis, caused by allergies to dust and smog. He has to take steroids every day. “When the season changes or when I travel to cities where AQI levels are higher, the situation aggravates and it results in an asthma attack. I take additional steroids then,” he says. Moreover, the condition affects his eardrums leading to partial deafness. “Allergies develop due to dust particles and causes blockage in the ear. I have to visit an ENT (ear, nose, and throat) specialist every other month to get my eardrums cleaned,” he says.
Jakareddy spends around ₹4,000-6,000 every month on medicines and an additional ₹4,000 when he visits the ENT doctor.
Suri of Mayur Vihar spends more—about ₹10,000 each month between October and March. “My medicines cost me ₹5,000 every month and I have to shell out an additional ₹2,500 each time I visit a doctor, which could be once or twice monthly. I also have to spend about ₹30,000 per year on X-Rays, CT scans and other medical tests ,” says Suri.
According to Sutaria, on an average, a patient may have to spend about ₹10,000-12,000 each month, excluding the one-time cost of nebulisers and air-purifiers. “You need more than one nebulizer if other family members also suffer from respiratory issues. Also, buying one air-purifier does not help. You need it for each of the bedrooms. Besides, one has to replace air-purifier filters once or twice in a year,” he says.
Gurgaon-based Pranav Mehta (33), for example, keeps his air-purifier switched on the whole day. He bought a big air-purifier for ₹18,000 and spends about ₹4,000 each year to replace the filters. “Power bills keep shooting up,” he says.y
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Insurance protection
Typically, health insurance policies get activated when a policyholder is hospitalized for 24 hours or more. Initial doctor consultations, medicines or pulmonary tests are part of out-patient department (OPD) expenses. These are not covered in basic insurance policies. Some insurance companies have started offering an in-built or add-on OPD cover, but the coverage is not exhaustive. It is usually a small percentage of the sum-insured and could just be a couple of thousand rupees for the entire year.
Kalpesh Chavan, senior vice president & product head, Alliance Insurance Brokers, says it is better to opt for a high-sum insured policy so that the OPD component is bigger. “Alternatively, there are wellness companies offering specific OPD expenses coverage that can go up to lakhs of rupees,” he says. Even Healthcare, Practo and Alive Healthcare are a few companies offering this option.
To be sure, if you get hospitalized due to any lung-related disease, your existing health insurance policy will cover it. There are no specific exclusions for chronic obstructive pulmonary disease, or COPD—a group of diseases that cause airflow blockage and breathing-related problems. “COPD treatment can cost anywhere between ₹2 lakh and ₹2.5 lakh. A customer diagnosed with lung cancer, however, may have to spend at least ₹10lakh. As much as 75-80% hospitalization for respiratory disorders is due to COPD,” says Chavan.
As for buying a fresh policy, while there is no region-specific underwriting, but those already suffering from asthma or bronchitis may have to pay an extra premium. “An existing insurance policy covers all this. But if you were to need a fresh policy, you may have to serve a waiting period for your existing respiratory disorders,” says Amit Chhabra, chief business officer, PolicyBazaar.com.
He says people should buy a comprehensive health insurance policy with an adequate sum insured that also has some OPD benefits.
Chronic respiratory disorders can lead to lung cancer or pulmonary hypertension. “It is advisable that people already suffering from respiratory issues take a critical illness cover over and above the base cover,” suggests Chavan.
What lies ahead
Consider relocating to a place where AQI levels are in the safe zone, say health experts. Tracking long-term AQI trends in buildings will become an integral part of home search, says Sutaria.
Jakareddy, for instance, has plans to move to a place with better air quality after retirement. Mehta is unwilling to relocate but he plans his vacations in such a way that he stays out of Delhi-NCR during the peak-pollution period.
Avoiding outdoor activities is important, even for those who don’t suffer breathing issues, when air pollution levels are high. Wearing N-95 mask when outdoors becomes mandatory.
Separately, the government needs to play an active part in implementing effective solutions. “Some policy level changes are needed to regulate industrial pollution and construction work. People living close to a construction site need more protection,” says Sutaria.