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Is Cataract Surgery Covered Under A Health Insurance Policy
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Is Cataract Surgery Covered Under A Health Insurance Policy?

Eyes are the most delicate and imperative organs of your body as they help you to explore the world and its beauties. You need to take proper care of your eyes as any mishap may snatch your vision completely. Cataract is the most buzzing world in the field of healthcare industry. Cataract is the most common eye problem that hits more than 74% of the adult population. Cataracts imply the clouding of vision that may cause loss of vision if it remains untreated.



So, like any other health surgery, is cataract surgery covered by insurance? Read on to get an answer to this and many more concerns regarding cataract surgery insurance coverage in India.

Is Cataract Surgery covered by Insurance?

These days, cataract surgery is covered by insurance policies. Many health insurance plans are offering cataract surgery insurance coverage in India. Earlier, people who were above 60 years were more susceptible to having cataracts.  But now, younger people (around 40 years) are also affected by cataracts. The prime reasons behind cataracts are smoking, obesity, diabetes, or substance abuse, etc. People who have eye problems or have undergone eye surgeries are more vulnerable to cataracts. So it is advisable to consult with your doctor if you are suffering from hazy vision.

What is a Cataract?

A cataract is an eye disorder that may lead to impaired or loss of vision. There are three types of cataracts.

  • Subcapsular Cataract
  • Nuclear Cataract
  • Cortical Cataract

Is Cataract Surgery covered by Insurance

Though many insurance policies offer cataract surgery insurance, some don’t include cataract treatment under their plans. So, before purchasing a policy, check is cataract surgery covered by the medical insurance plan that you wish to purchase or not. Check all the inclusions of the policy at the time of purchasing.

Also Read: List of Vitamin A for Eyesight and Eye Health

The Waiting Period and Coverage Amount for Cataract Surgery

Most insurance policies these days offer coverage for cataract surgeries. But before making any commitment, check your policy details. The waiting period for cataract surgery is 2 years, and the claim limit depends on your insurer regarding how much they will offer for the surgery and its facilities. The average cost of cataract surgery without insurance is Rs. 15,000 to Rs. 35,000. The insurance providers usually offer this amount to their policyholders so that they can meet up their treatment costs.

Now, you have an idea regarding how much is cataract surgery without insurance. You must purchase a health insurance policy that offers coverage for all healthcare expenses including hospitalization, surgery, and post-surgery expenditures. In most health insurance plans, the entire cost for cataract treatment can’t be dissipated. Apart from this, specific sub-limits are enforced to the policy plan. You can even buy a health insurance policy online. Always compare various available policies in the market and find out the most suitable policy as per your requirements.

Things to Consider while purchasing Health Insurance Plans for Cataract

Nowadays, many health insurers are embracing their customers with health insurance policies that offer coverage for cataract treatments. In this fast-paced life, many people in their 40s or 50s are suffering from cataracts. Health insurance companies are well aware of this fact. Thus, they are offering cataract surgery insurance once the policyholder qualifies certain terms and conditions.

Health Insurance Plans

Mentioned below are certain points you need to consider while choosing a health insurance policy for cataracts.

1. Waiting period

Most health insurance companies are providing disease-specific waiting periods for various healthcare conditions. The insurers usually offer cataract coverage after a waiting period of 2 years. The prime purpose of the waiting period is to discourage policyholders from taking the benefits of insurance just for cataract surgery. If you purchase a health insurance policy at a young age, you will not be eligible for coverage for cataract surgery.

2. Sub-limit

For cataract treatments, you may not get the entire treatment amount from your policyholder. Most insurers set specific sub-limits for cataract treatments. You need to pay an additional amount from your pocket. But some insurance policies don’t come with any specific sub-limit for this treatment. We already gave you an idea regarding how much is cataract surgery without insurance. So, you should prudently choose your health insurance coverage if cataract treatment is your prime requirement.

3. The Extent of Coverage

Cataract is not contagious, thus it doesn’t spread from one eye to another. But if you have a cataract in one eye, your chance of getting a cataract in another eye also increases. So, always check the sub-limit for your cataract treatment for each eye. Don’t forget to check other provisions while treating cataracts for both eyes.

Cataract Coverage in Group Insurance Plans

If you are under the coverage of employer group insurance plans, then there will be no waiting period for any pre-existing conditions. You can go for cataract treatments immediately without any waiting period. For a group insurance policy, there is no sub-limit in the case of cataract treatment. Ask your policy provider whether cataract surgery is covered by insurance cover given to the group or not. You can ask your service provider regarding the same or go through the policy documents carefully.

Health Insurance Plans that offer Cataract Coverage:

  • Bajaj Allianz Health Insurance (10% of the sum insured or Rs. 35000)
  • ICICI Lombard (up to Rs. 20,000 per eye)
  • Star Health Insurance (the maximum limit for the cataract coverage is Rs. 25000)
  • SBI General Health Insurance (the maximum limit for the cataract coverage is Rs. 25000)
  • Oriental Insurance (there are no sub-limits related to cataract treatment)


The Bottom Line

Eyes are priceless parts of the body and any kind of eye problem should be addressed properly. Cataract insurance policies bring a smile to policyholders who are suffering from this condition. Surgeries are the only treatment plans that help you to deal with cataracts. Due to health insurance policies, you can opt for cataract surgeries without any hassle.

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