Is Cataract Surgery Covered by Medical Insurance?

Health Blog
29 Jan 2025
1615 Viewed

Contents

What Is a Cataract?
Health Insurance Plans and Cataract Coverage*
Why is it essential to get operated on for cataracts?
Cataract Surgery Cost in India
Benefits of Buying Health Insurance for Cataract Surgery
Inclusions and Exclusions of Health Insurance for Cataract Surgery
Key Considerations for Cataract Coverage*
Buying Health Insurance9. Choosing the Right Policy10. Conclusion

Eyes are not just windows to the soul; they are our primary means of experiencing the world around us. Thus, maintaining eye health becomes crucial. Over the years, several ailments can hamper our eye health. Hence, not only should we be taking the best care of our eyes throughout our life, but we should also focus on being prepared for unavoidable eye issues that may require treatments. One should be especially wary when it comes to conditions like cataracts since they can significantly impair vision. With the cost of medical treatments, including eye surgeries, on the rise, understanding how cataracts are covered under health insurance plans is essential for financial planning and peace of mind.

What Is a Cataract?

A cataract is a common eye condition characterised by the clouding of the eye's natural lens, leading to a decrease in vision. It is a condition that predominantly affects the elderly but can occur at any age due to various factors, including lifestyle choices and diabetes. Cataract surgery is a standard and successful procedure to restore vision, where the clouded lens is replaced with an artificial one.

Health Insurance Plans and Cataract Coverage*

In India, health insurance plans have evolved to cover a range of treatments, including cataract surgery. However, coverage can vary significantly between policies. It's essential to carefully review the terms of your policy or consult a health insurance calculator for an estimate of coverage amounts and limitations.

Why is it essential to get operated on for cataracts?

Cataract surgery is recommended as it helps in the following ways:

Restores clear vision: With cataract surgery, any blurriness in your vision can be restored to normal. With the advancement in medical science, the treatment takes not more than an hour, and thus, no admission to a hospital is required. The treatment is classified as a day-care procedure.
Avoids complete loss of vision: A cataract surgery helps to prevent the loss of your eyesight, thereby avoiding a complete or even partial loss of vision.
Enhances the quality of life: Since vision is one of the critical sensory cues, treating a cataract helps to restore the quality of life.

These are some of the different points to know about health insurance coverage for cataract surgery. Plans such as individual/family health insurance, senior citizen policy as well as the Arogya Sanjeevani policy cover cataract surgery. Make sure to select a plan that provides comprehensive coverage with an adequate sum insured for optimal financial security.

Cataract Surgery Cost in India

The cost of cataract surgery in India typically ranges from ?50,000 to ?1,20,000, depending on several factors such as the type of surgery, your age, the city of residence, and the hospital you choose. Below is a detailed breakdown of the costs for different types of cataract surgeries in India:

1. Phacoemulsification Cataract Surgery

Cost: Approximately ?40,000 per eye.
A widely preferred technique due to its precision and minimal invasiveness.

2. Extra Capsular Cataract Surgery (ECCE)

Cost: Ranges between ?40,000 and ?60,000 per eye.
A traditional method, often recommended for advanced cataracts.

3. Bladeless Cataract Surgery

Cost: Around ?85,000 to ?1,20,000 per eye.
A premium option that uses laser technology, eliminating the need for incisions and offering greater accuracy.

The overall cost may vary based on additional factors like lens type, surgeon’s expertise, and post-operative care. Also Read: All You Need to Know About Dark Circles Under Eyes

Benefits of Buying Health Insurance for Cataract Surgery

Cost Coverage: Reduces out-of-pocket expenses for surgeries costing ?50,000–?1,20,000 per eye.
Advanced Treatments: Covers modern procedures like bladeless cataract surgery.
Cashless Facility: Offers cashless treatment at network hospitals.
Pre- and Post-Operative Care: Includes expenses for tests, consultations, and follow-ups.
Tax Savings: Get tax benefits under Section 80D.
Inflation Protection: Shields against rising healthcare costs.

Health insurance ensures financial security and access to quality care for cataract treatment.

Inclusions and Exclusions of Health Insurance for Cataract Surgery

Health insurance policies that cover cataract surgery typically include several key benefits to ensure comprehensive coverage for treatment. However, it's essential to understand both the inclusions and exclusions to avoid any surprises during a claim process. Here's a breakdown of what is typically included and excluded in health insurance for cataract surgery:

Inclusions	Exclusions
Cost of Cataract Surgery: Coverage for the cost of cataract surgery, as per the policy terms.	Exceeding Coverage Limits: Any surgery costs that exceed the specified coverage amount in the policy.
Pre-Hospitalization Expenses: Costs for diagnostic tests, consultations, and other necessary treatments before the surgery.	Pre-Existing Cataracts: If the cataract condition is pre-existing, it may not be covered unless specifically included.
Post-Hospitalization Expenses: Coverage for follow-up treatments, medications, and other post-surgery expenses.	Surgery During Waiting Period: Treatments that fall within the waiting period of the policy may not be covered.
Cashless Treatment: Access to cashless treatment at network hospitals, simplifying the payment process.	Non-Network Hospitals: Treatments at non-network hospitals may not be covered, depending on the insurer.
Advanced Procedures: Coverage for modern procedures like bladeless cataract surgery, if included in the policy.	Cosmetic or Experimental Surgeries: Any cosmetic or experimental cataract surgeries are generally not covered.
Hospital Room Rent: Coverage for hospital room rent, subject to policy limits and terms.	Excessive Room Rent: If the room rent exceeds the policy's coverage limit, the excess cost may not be covered.
Daycare Treatment: Coverage for surgeries that are completed on the same day, without the need for overnight hospitalization.	Non-Disclosure: Failure to disclose medical history at the time of policy purchase can lead to claim denial.

Key Considerations for Cataract Coverage*

Waiting Period

Most health insurance policies impose a waiting period for cataract surgery, typically around 24 months from the policy start date. It's crucial to be aware of these terms to avoid unexpected out-of-pocket expenses.

Claim Limits

Insurance companies often cap the amount that can be claimed for cataract surgery. This cap could be a specific sum, or a percentage of the sum insured. Knowing these limits can help you plan any additional financial arrangements that may be needed.

Inclusions and Exclusions

Not all policies offer cataract coverage. Some might include it as part of a comprehensive plan, while others might require an additional premium or offer it under a more premium policy tier. When buying a new health policy, it is ideal to go through the inclusions and exclusions. Moreover, if your existing policy does not cover such conditions, you may want to look into buying add-ons.

Group Plans

Employer-provided or group health insurance plans often include cataract surgery coverage. These plans might offer more favourable terms, such as no waiting period, making them a valuable option for employees.

Buying Health Insurance

A health insurance calculator is an invaluable tool for estimating your potential costs and coverage for cataract surgery. By inputting your policy details, you can get a clearer picture of what your insurance plan will cover and what you might need to pay out of pocket, allowing for more informed financial planning. general insurance companies in India offer a variety of health insurance products that cater to the needs of diverse populations, including those requiring coverage for cataract surgery. These companies are regulated by the Insurance Regulatory and Development Authority of India (IRDAI), ensuring that the policies offered meet certain standards and protections for policyholders.# To maintain uninterrupted coverage for cataract surgery and other medical needs, it is vital to Renew Health insurance policies on time. Lapses in policy can result in losing accrued benefits, such as the waiting period for pre-existing conditions or specific surgeries like cataracts. Regular renewal ensures continuous coverage and peace of mind in case of medical emergencies.

Choosing the Right Policy

When selecting a health insurance policy with cataract coverage, consider the following:

Coverage Limit: Ensure the policy covers a significant portion of the surgery costs, considering the limits for cataract treatment.
Premium vs. Benefits: Balance the cost of the premium against the benefits provided. A lower premium might mean less coverage or longer waiting periods.
Insurer’s Reputation: Choose a policy from an insurer with a good reputation for customer service and claim settlement.
Online Policies: The digital age allows for the easy comparison and purchase of health insurance online.

Also Read - Everything About Health Insurance for People with Heart Diseases

Conclusion

Cataract surgery is a necessary medical procedure for many, and the costs associated with it can be significant. Health insurance provides a safety net that can help cover these expenses, but understanding the specifics of your coverage is key. By carefully selecting a policy that includes cataract surgery, considering the waiting periods, and ensuring you understand the limits and conditions of your coverage, you can protect yourself against unforeseen medical expenses. Regularly reviewing and renewing your Health insurance policy ensures that you remain covered and can access the medical care you need without financial strain. The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional. *Standard T&C Apply #Visit the official website of IRDAI for further details. Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.