More than 60% of all blindness in India is caused by cataract, or the clouding of the internal eye lenses. The probability of developing a cataract is significantly higher as you age – the prevalence of cataract-related blindness in the seventy-plus age group is estimated to be four times that of other younger age groups. For senior citizens, most of whom have no regular source of income, finding the resources for cataract surgery necessary, is, therefore a challenge. The question therefore arises, is the cost of surgery and treatment covered by health insurance? The answer is a resounding YES! Many general insurance companies, such as National Insurance Company Limited, offer the same.
National Young India Mediclaim Policy and National Mediclaim Plus Policy offered by National Insurance Company Limited, the oldest General Insurance Company in India, also provide cataract surgery coverage.
Cataract Surgery Coverage Under National Health Insurance Schemes
Cataract surgery coverage under National Health Insurance Policies is likely to be subject to fulfillment of the waiting period as specified in the policy document. These policies will likely have a waiting period of two years. If the cataract has been classified as a pre-existing disease condition, the waiting period could increase up to four years. There could also be a cap on the cost of surgery depending on the type of scheme you have opted for and the premium you have paid. The coverage will also depend on the extent of a defect in your eyes. Only when the refractive error of the eye exceeds 7.5 dioptres will you get cataract coverage under National health insurance. Again, if the policy you have purchased mandates a co-payment, you will have to pay some percentage of the total cost from your own pocket. You will need to check your policy document to understand this. Alternatively, check this out by contacting your health insurance company.
Does National Health Insurance Come with a Sub-limit for Cataract Coverage?
Yes, National health insurance comes with a sub-limit for cataract coverage. A sub-limit means the extent to which the coverage you will get for a specified illness or treatment. Here’s how National health insurance applies sub-limits on cataract coverage across policies.
| National Health Insurance Plans | Sum Insured (In INR) | Sub-limit |
| National Young India Mediclaim Policy | 3, 5 and 10 lakh | Up to 10% of the sum insured, up to INR 50,000 per eye per year |
| National Mediclaim Plus Policy | Plan A - 2-10 lakh
| Plan A - Up to 15% of the sum insured or INR 60,000, whichever is less, for each eye Plan B - Up to INR 80,000 for each eye Plan C - INR 1 lakh for each eye |
Understanding Cataract
A cataract is said to occur when the naturally clear lenses in your eyes become cloudy. This makes it difficult to see. It is associated with ageing and usually begins in the forties, when the normal protein in the eye lenses begins breaking down. Though this is easily treatable through a relatively safe and simple procedure, this often goes untreated, even though the procedure does not require hospitalisation. Due to the lack of awareness regarding the simple nature of treatment and the cost factor, the number of blind people in India is over one crore. Most of them could overcome their blindness with a simple cataract operation.
During cataract surgery, the surgeon will replace the cloudy natural lens with an artificial lens. This relatively simple and safe procedure could vastly improve the quality of your life. However, to increase the success of your surgery, you will need to follow some basic precautions for a week or so after the surgery, as advised by your doctor. Usually, such precautions include avoiding strong light, keeping your eye away from heat (yes, no cooking!), no water on the eyes, avoiding any activity that may stress your eye muscles - such as lifting heavy weights or exercising, and no reading.
So, if you are suffering from blurry vision, it is advisable to visit an ophthalmologist and find the reason for this blurriness. If you are diagnosed as having a developing or developed cataract and are advised surgery, you do have the option to have the costs covered under National health insurance plans.
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