Is Cataract Surgery Covered under Health Insurance in India?

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Is Cataract Surgery Covered under Health Insurance in India?

Yes, many health insurance policies cover cataract surgery. However, there is a possibility that your policy has sub-limits on the coverage. Read on to know all the possibilities.

  • Oct 28, 2021

Cataract is a common eye disorder that affects both men and women, especially those older than 40 years. In cataract, the vision gets affected due to the occurrence of a cloudy layer over the lens. The condition causes blurry or double vision. Although cataract is not a critical condition, it can cause significant discomfort. If the condition is not treated early, the vision can slowly deteriorate, leading to complete loss of sight.

One of the best treatments for cataracts is to remove the cloudy cover through surgery. Cataract surgery is a minor operation, and generally, it takes about 15-30 days to completely recover post-surgery.

Cataract surgery cost in India

The average cataract surgery cost ranges from Rs. 30, 000 to Rs. 80,000 or more. The cost mainly depends on where you avail of the treatment, the surgeon’s credibility, your location, etc

Is cataract covered under health insurance?

Yes, many health insurance policies cover cataract surgery. However, there is a possibility that your policy has sub-limits on the coverage. For example, the policy may cover only 80% of the surgery cost.

In such a situation, when you file a claim, the insurance company will pay only 80% of the total cost, and you must pay the balance amount from your pocket. Also, there may be limitations on expenses covered. So, make sure that you carefully read the terms and conditions while buying a health insurance policy. If you already have health insurance, check the policy document to know about the inclusions and exclusions.

Is there a waiting period for cataract surgery?

All health insurance policies have a waiting period. If you are not sure what the waiting period is? It is the period during which you cannot claim the policy benefits; you must wait for a specific period before filing a health insurance claim. The waiting period varies for different illnesses, and it usually ranges from 3-60 months.

For cataract surgery, there may be a waiting period, and the waiting duration may vary from insurer to insurer. Generally, the waiting period for cataracts is 12-24 months. Make sure that you check the policy documents to know the exact waiting period.

Is there a maximum limit on the claim amount for cataract surgery?

The claim limit depends on the insurance company providing the coverage. The limitation (if any) will be mentioned in your policy documents. Most insurance companies do not have any limits for cataracts. However, some insurers may set a claim limit.

The insurance companies generally decide the claim limit for cataract treatment based on the sum assured. For example, some health insurance policies may limit the cover up to 10% of the sum assured. So, if you have a health insurance policy for five lakhs, you may get maximum coverage of Rs. 50,000.

Coverage for cataract surgery under group health insurance policy

A group health insurance refers to the policy issued by an employer, and it covers all the employees under a single policy. Generally, such policies have limited coverage and benefits. Also, the coverage terms and limits vary based on the type of policy your employer has purchased.

In most cases, group health insurance covers cataract surgery. However, it is best to check with the employer to know about the coverage, waiting period and coverage limit.

Final Word

Having a health insurance policy covering cataracts can help you cover the treatment cost if you suffer from the condition. So, make sure that you purchase health insurance at a young age to easily surpass the waiting period and get policy benefits immediately when the need arises.

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