Is Cataract Surgery Covered by Medical Insurance?

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

Is Cataract Surgery Covered by Medical 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 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 (for one eye) in India can range from INR 15,000 to INR 1 lakh. 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.

Conclusion

Cataract surgery is a medical necessity that helps restore vision and prevents partial or complete blindness. Since cataracts are common and the surgery can be on the expensive side, it is important that you opt for medical insurance or critical illness insurance and take a healthcare plan covering the cost of cataract surgeries. With a handy cataract surgery insurance, you can opt for the best treatment at a reputed hospital without spending a huge amount of money from your pocket.

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 when 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 all 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 Rs 15,000 to Rs 1 lakh for one eye. 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.

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