Is Cataract Surgery Covered by Health Insurance?

Posted on: Sep 1, 2023 | 3 mins | Written by: HDFC ERGO Team

Is Cataract Surgery Covered by Health Insurance?

A cataract is a condition that occurs when the natural lens of your eye becomes cloudy and causes blurry vision. The risk of developing a cataract increases with age; the condition is common among people over 40 years old. Other factors that can lead to this eye condition are diabetes, UV rays, trauma, family history of cataracts, and eye conditions such as myopia.

Considering that cataract is an important vision correction procedure, the commonly asked question is, ‘Is cataract surgery covered by medical insurance?’ The answer is yes, as most insurance companies in India cover cataract surgeries of policyholders. However, there can be a pre-determined sub-limit or cap on the maximum amount the insurance company will pay for your cataract surgery. Therefore, before going for the surgery, it is important that you check the terms and conditions of your medical insurance policy to know the sub-limits and other conditions to avoid any confusion later.

Who Should Buy Cataract Surgery Insurance?

Individuals aged over 50 and senior citizens have an increased risk of developing cataracts. Also, those who are diabetic, have hypertension, suffer from vitamin deficiency, have a family history of cataracts, suffered an eye injury/surgery, have been diagnosed with eye inflammation, indulge in excessive smoking and/or drinking, take corticosteroid medications for a prolonged period, have too much exposure to UV rays or ionising radiation (such as cancer radiation therapy or X-ray), or have other health issues, have a higher chance of developing cataracts.

If you fall in any of these brackets, you must consider investing in cataract surgery insurance. Check whether your healthcare plan covers daycare treatments and post-surgery expenditures.

What is the Cataract Surgery Cost in India?

The cost of cataract surgery in India can range from INR 50,000 to INR 1,20,000¹. The cost usually depends on various factors, such as hospital admission charges, pre- and post- operative charges, doctor's fees, cost of the lens, medication costs, etc.

Intracapsular Cataract Extraction Surgery

This surgical procedure removes the clouded lens as well as the thin capsule surrounding it. After removing the lens, an artificial intraocular lens (IOL) is implanted in its place to restore vision.

Since intracapsular cataract extraction, or ICCE, requires more extensive incisions in the cornea of the eye, the procedure is more invasive when compared to ECCE and carries a greater risk.

What is the Waiting Period for Cataract Surgery?

The waiting period for cataract surgery usually varies from insurer to insurer. In most cases, the waiting period ranges from 12 to 24 months. However, make sure you check the terms and conditions of your health insurance policy to avoid confusion at the time of surgery.

Insurance companies do not entertain claims when the policy is in the waiting period. In case you opt for surgery within the waiting period, you will have to pay the bills from your pocket.

Who Should Buy Health Insurance for Cataract Surgery?

If you fall under one of the following categories, you need to buy insurance coverage for cataract surgery:

• Are 50 years or older, as the risk of age-related cataracts increases

• Have chronic conditions such as diabetes or hypertension

• Have a family history of cataracts or other eye disorders

• Have been diagnosed with nutritional or vitamin deficiencies

• Smoke or consume alcohol regularly, which can affect eye health

• Have existing eye-related issues, including past surgeries, injuries, or long-term inflammation

• Are frequently exposed to harmful UV rays or medical radiation, such as X-rays or radiation therapy

• Have been on long-term corticosteroid medication, which may increase the likelihood of developing cataracts

Benefits of Buying Health Insurance for Cataract Surgery

When you buy health insurance to cover your cataract surgery costs, these are the likely benefits you can enjoy:

• Financial Protection Against Surgery Costs

With healthcare costs rising every year, a suitable health insurance plan protects you from the high expenses of cataract surgery. Instead of paying a large sum from your savings, you can rely on your policy to cover most of the treatment costs.

• Cashless Treatment at Network Hospitals

If you choose a network hospital for your cataract surgery, you can avail of cashless treatment. This allows your insurer to settle the eligible medical bills directly with the hospital, so you can focus on your recovery without worrying about payments.

• Coverage for Related Medical Expenses

Your health insurance does more than just cover the surgery. It also helps pay for related expenses such as hospitalisation, doctor consultations, diagnostic tests, prescribed medicines, and follow-up care, depending on the terms and conditions. This reduces your overall financial burden.

• Tax Benefits

When you pay premiums for your health insurance policy, you can claim tax deductions under Section 80D of the Income Tax Act, 1961. This means you protect your health while also saving on taxes.

Inclusions of Health Insurance for Cataract Surgery

Usually, the following are included in most insurance cover cataract surgery plans:

• Hospitalisation costs, including pre- and post-hospitalisation expenses as defined in the policy.

• Daycare treatment, as cataract surgery usually does not require a 24-hour hospital stay.

• AYUSH treatments, if the policy allows and the treatment is taken at approved centres.

• Doctor consultations and follow-ups, when covered under post-hospitalisation benefits or explicitly mentioned.

Exclusions of Health Insurance for Cataract Surgery

Health insurance plans that cover cataract surgery usually do not include:

• Routine eye check-ups or vision tests

• Outpatient (OPD) expenses, unless specifically covered by an add-on

• Experimental or unproven treatments

• Dietary supplements or vitamins, unless prescribed as part of hospitalisation

Remember, coverage varies by insurer, so it is important to check your policy document for specific inclusions and exclusions.

Conclusion

Health insurance can ease the financial burden of cataract surgery, but it’s important to remember that coverage comes with certain conditions. If you’re over 50 or have underlying health concerns, opting for this cover can be a smart and timely decision. Take the time to read your policy carefully, especially the waiting period for cataract procedures. Knowing when you’re eligible to file a claim helps you avoid surprises later and ensures your policy supports you when you need it most.

FAQs

1. Is cataract surgery safe? Will my vision be restored?

Yes, cataract surgery is considered safe for restoring vision and preventing partial or total blindness. A cataract is a medical condition in which the natural lens of your eye becomes cloudy, causing blurry vision. Cataract surgery is a corrective surgery in which the natural lens is removed and replaced with an artificial lens. Yes, your vision will be restored.

2. Will health insurance cover cataract surgery?

Yes. Most health insurance companies in India cover cataract surgery, though there may be a cap on the maximum amount the insurer will pay you. So, you must check the terms and conditions of the policy before opting for the surgery.

3. How much does cataract surgery cost in India?

In India, the cost of cataract surgery can range from INR 50,000 to INR 1,20,000¹. The price depends on many factors, such as the type of lens, hospital, doctor’s fees, cost of medication, etc.

4. Is there a waiting period to cover cataract surgery?

Yes, most health insurance plans cover cataract surgery after a waiting period of 1-2 years, which can vary from insurer to insurer.

5. Why do you need health insurance for cataract surgery?

The cost of cataract surgery in India is quite high. Considering the high cost coupled with medical inflation, it is wise to stay financially prepared.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

Planning for a Cataract Surgery? Here are some health insurance facts to know

Everything you need to know about cataract surgery

What is OPD Cover in Health Insurance?

Common Inclusions of Health Insurance

Is Robotic Surgery Covered Under Health Insurance?