Does Cataract Surgery Covered Under Health Insurance Policy


4 min read

Is Cataract Surgery Covered Under Health Insurance Policy? 

Can you get compensation for cataract surgery under your health insurance plan? Is cataract surgery covered by medical insurance? If you want to know more about it, read on.

Many people, especially the elderly suffer from the condition of cataract in their eyes, which require immediate attention and surgery. Now the general perception is that health insurances do not offer coverage against cataract. So, a common query Is cataract surgery covered by insurance is observed? The fact is most health insurance providers allow protection against cataract surgery, with exceptions of some.

So, there are some health plans that do not cover you against cataract, while there are others under which you can avail such coverage. Thus, the insurance policy seeker must check the policy and its coverage well to know if it allows protection against cataract.  This can be checked by reading the policy documents carefully and checking the various inclusions available under the policy.

Cost of Cataract Surgery in India?

Now, considering the rising inflation in the cost of healthcare facilities in the country, the cataract surgery cost in India has also gone high. Since cataract is a common problem among elderly and people above the age of 40 are prone to this medical condition, so they want cataract to be included under their health policy. Further, the chances of Cataract rises as we age, so it becomes difficult for the elderly to spend a sum of over 35,000 to 85,000  rupees for the treatment of cataract and cataract surgeries in India during their old age.

Cataract can be removed by various kinds of surgeries and most widespread among them is the Phacoemulsification Cataract Surgery. However, depending on the condition of your eyes and the recommendation of your doctor, you can choose the best surgery suiting your needs. Various factors, such as age, your location, the hospital where you are going to undergo the treatment etc. decide the kind of surgery that you must choose. Further, even in India, the surgery cost might vary depending on the city where you are living in.

Below are some of the popular cataract surgeries that takes place in India:

  • Phacoemulsification Cataract Surgery: The cost of getting this surgery done in India is around 40,000 rupees for one eye that is damaged.
  • Extra capsular Cataract Surgery: The cost of this surgery will range from Rs 40,000 to Rs 60,000 for the eye affected.
  • Bladeless Cataract Surgery : As compared to others, this is a costly surgery that can cost over 85,000 to 120,000 rupees. But the costs might vary depending on the city and the hospital that you choose to get the surgery done.

Also Know : Is LASIK Eye Surgery Covered under Health Insurance Policy?

Why Need Cataract Surgery?

Cataract Surgeries are required to treat cataract in your eyes. Surgery is regarded as the best way to treat the condition of cataract. With Cataract surgery the patient gets clear vision back without any consequences.

Here are the important facts due to which cataract surgery is needed:

  • Return your vision : With Cataract surgery, you can get back your vision successfully and restore complete safety to your eyes without side effects. Further, the surgery is a simple procedure that can be done within half an hour’s time. You may not get hospitalized and can get back to work after resting for a couple of days.
  • Save you from blindness (partial or complete) : Cataract is a condition that can get worse if not treated well. Further, it might lead to part or full blindness if not treated properly. Thus, if the doctor suggests, it is better to get cataract surgery done to cure the condition completely.
  • Improves your vision and living : By curing your eyes with cataract surgery, you can improve your vision and allow yourself a quality life where you do not have to depend on others.

Cataract Surgery Waiting Period 

Yes, like in the case of other diseases, the waiting period before you could file a claim for cataract surgery has to be served by the policyholder. In most cases, this waiting period is 2 years in case of health insurance companies. However, it might differ depending on the insurer that you get the policy from.

Claim Limit for Cataract Surgery

The claim limit of insurance for cataract surgery under a health insurance policy is normally decided by the Health Insurance providers. It is easy to know the limit by checking the policy inclusions and exclusions so that you know how much compensation can be availed by you under your policy. In most cases, the sum insured becomes the deciding factor that decides the claim limit. So, it can be 10% of SI or up-to 25,000 rupees.

Can you get covered for Cataract Surgery under Group Health Plan?

Yes, in many cases cataract surgery insurance is available under group health plans. This again depends on employer to employer. Further, the  waiting period and other things can also be clarified by means of the policy document. So, you need to read the policy document properly before buying the policy.

To Conclude

Now you know that cataract surgery is covered by insurance. So, get the details of the coverage from your insurer and protect your eyes against cataract. By buying a family floater plan with cataract coverage, you can provide protection to your aged parents and siblings as well. So, learn more about the cataract clause in your policy document and procure your health plan after considering it well.

May 06, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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