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

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Published on June 9, 2021. EST READ TIME: 3 minutes

Eyes are undoubtedly among the special gifts bestowed on all living beings by nature. They not only help you see the world around you, but also are windows to your soul and emotions. And they are super sensitive, so much so that even if a tiny dust particle gets inside, it can cause a lot of irritation. So, it is natural to worry when your eyes get affected by an illness like cataract. And it also makes you ponder on whether you are financially prepared for the associated treatment. Even if you have the best health insurance policy possible, you might be wondering if it covers cataract treatment. So, find out more about this affliction and get to know about your policy coverage in detail.

What is a cataract?

A cataract is a condition that affects the human eye by causing clouding. It can lead to vision impairment as well, if left untreated. Cataracts are of three types, namely cortical, subcapsular, or nuclear. So, immediately consult an eye doctor if your eyesight has been foggy and blurry for some time.

Who is more prone to this disease?

Cataracts are more common in those over the age of 60. However, adults in their 40s might also be at risk due to their lifestyle. Cataracts can happen due to smoking, high blood pressure, diabetes, and other factors. It is more common in those who have undergone eye surgery or have any other eye disease. Aging people are more prone to cataract too.

Does health insurance provide coverage for cataract?

In India, cataract surgery is covered by health insurance. However, not all policies provide this protection. As such, before purchasing health insurance, you should review the policy's provisions. If you have already bought the policy, go through your insurance booklet for better understanding of the coverage. 

Is there a waiting period for cataract?

Any claim concerning cataract is usually admissible after a two-year waiting period. However, this may differ from one insurer to another. This clause exists because cataract surgery is a planned procedure. As such, insurers want to protect themselves against policies purchased only for cataract treatment. The insurer is not obligated for any claim if you get  cataract surgery  before the waiting period expires.

Do health insurance companies have a claim limit for cataract treatment?

Insurers usually put a limitation on the amount for which you can claim for cataract procedures. However, this solely depends on their discretion. The maximum amount payable is a percentage of the sum assured, limited to a specific amount. For example, the claim limit for a cataract is Rs. 30,000 for an insurance amount of Rs. 3 lakhs. However, the calculation can be done on a percentage basis in specific circumstances.

Usually, if you go for the best health insurance policy , there might be no limit on the amount of acceptable claim. The insurer will reimburse the actual cost of the surgery. So, before obtaining a policy, understand the coverage and exclusions.

Is cataract covered under a group policy?

There is a scope to include cataract in a group policy. For example, your employer's group insurance policy may include cataract coverage. However, it solely depends on the insurer that is providing the policy. There may also be no waiting period in such circumstances. 

To conclude

By now, you know that cataract is a common ailment and is more likely to affect elderly people or those with pre-existing conditions. Plus, the surgery can be expensive. Hence, the right health insurance is important for those over 60 or approaching retirement. However, before purchasing the same, compare policies by different insurers. Also check for the waiting period, claim benefits and other things, so that you choose the best health insurance policy .

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