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Is Cataract Surgery Covered In Health Insurance?

By Vikas Chandra Das
21 July 2022, 11:46 AM
is cataract surgery covered in health insurance

Your eyes are one of the most important organs of your body. Without proper eyesight, it becomes very difficult to function and remain independent. This is why eye health is so important. 

However, at times, certain conditions go beyond our control and the symptoms begin to strike. Such a condition is a cataract. Cataract affects the eyes and causes blurred vision, and if left untreated, can also lead to partial or complete blindness. 

This is why you need to seek treatment if even the smaller of the cataract symptoms show up. 

Having a health insurance plan to pay for a particular surgery makes it a lot easier to manage the condition. But does health insurance cover cataract surgeries?  The good news is that it does!

What is a Cataract and Why is it Dangerous?

A cataract happens when a layer of tissues form around the lens of the eye. This leads to blurry vision. If not treated, the tissues keep piling on and this worsens the vision till the person becomes completely blind. 

Thankfully, cataract surgeries can be carried out to remove the layers of tissues and restore the vision of the patient. These surgeries, though complicated, are done very commonly and with great success by the eye specialists across India. 

The types of cataract that can impair vision are:

Nuclear Cataract

Subcapsular Cataract

Cortical Cataract

Who is Most Likely to Get Cataract? 

A cataract is normally an age-related illness. This is why people in their 60s or 70s are affected more by it. However, lifestyle disorders such as obesity, excessive exposure to screens, etc also lead to a lot of the younger people in their 40s and 50s also getting cataract. Then, people who have in the past had some form of eye surgery are also more likely to get a cataract. 

How does Health Insurance Help in Carrying Out the Cataract Surgery? 

As stated above, cataract affects a wide range of people. This is why you need a good health insurance plan that can offer coverage against cataract and all its symptoms. You can easily afford the treatment that includes diagnosis, medication and surgery if you have a health insurance plan. Many health insurance plans offer cataract as a day-care procedure under the comprehensive family floater health insurance policies or individual health insurance policies. Get a good health insurance plan from a good insurance provider and stay comfortably covered.

Things to Know About Cataract Cover in Indemnity Health Insurance

Waiting Period:

There is usually a waiting period of 2 years(from the purchase date) in order to raise a claim for cataract treatment. So, for the first 2 years from policy inception, any claim raised for cataract treatment will not be honoured.

Claim Limit:

Some insurers have a limit for cataract treatment. For example, a health plan may have a limit of 20% of the total sum insured up to a maximum of INR 1,00,000 for each eye. So, it is vital to check for any such sub-limits in a health plan.

Age:

Cataract treatment is usually done for people more than 60 years of age, i.e. senior citizens. However, it would be payable even if the person is less than 60 years of age.

Group Insurance:

Cataract treatment is also covered by most group insurance plans, but up to the specified limit. However, all plans do not cover cataract surgery. It varies from plan to plan.

List of health insurance plans that cover cataract

Here is a List of Some Health Insurance Plans that Cover Cataract

Plan NameCataract CoverOther Benefits related to cataract treatment
ICICI Lombard Complete Health Insurance PlanA comprehensive health insurance policy that has a cataract cover of up to INR 20,000 for each eyeCataract surgeries and OPD expenses are covered from a certain variant. There is a waiting period of 2 years
Oriental Insurance Happy Family Floater PlanComprehensive health insurance policyA cataract is covered after 2 years from policy inception
Bajaj Allianz Health Guard Gold PlanComprehensive health insurance plan with 20% sub-limit of the total sum insured upto a maximum of INR 1,00,000 for each eyeCataract surgeries and OPD expenses are covered
Care Freedom Health Insurance PlanComprehensive health insurance plan up to INR 20,000 for each eye for a  coverage of INR 3 lakhs plan. Whereas it is up to INR 30,000 for each eye for a coverage of INR 5, 7 and 10 lakhs planA cataract surgery is covered after 2 years from policy inception

These are some of the options you have if you are looking for a good health insurance cover for cataract surgeries. It is advisable for you to compare health insurance plans and then find your ideal policy.

The final word

Read the policy terms and conditions carefully to ensure cataract surgeries are indeed covered. Some insurers may list cataract as an exclusion or may have a waiting period of more than 2 years. So you should be doubly sure before you buy a policy. Also, consider getting plans that have shorter waiting periods because you never know when a health insurance claim will be required. Compare health plans and find the best cover for cataract treatment and stay covered.

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