Is Cataract Surgery Covered in Health Insurance? | RenewBuy

Is Cataract Surgery Covered in Health Insurance?

A cataract is a common eye condition caused due to a dense formation around the eye's lens. This formation that looks like a cloud slowly becomes opaque and results in blurred vision. When left untreated, the condition can also cause partial or total loss of sight.

The average age of an Indian contracting cataract is 50 years, which is much lower than in many other countries. Pinpointing the sole cause of cataracts has not been possible, though increasing age and diabetes are its leading causes. A modern lifestyle that includes smoking, steroids, radiation therapy, and traumatic eye surgeries can also lead to a cataract.

If you have a history of cataracts in your family or have seen people with cataracts around you, the fear of this disease may hover over you too. And one of the first thoughts you have while planning to buy health insurance may be, "Is Cataract Surgery Covered In Health Insurance?" You are not alone.

Cataract Surgery and Health Insurance:

Apart from surgery, a cataract does not have a natural cure. Average conventional cataract operation may cost Rs. 40,000 for an eye. But if you opt for a bladeless/ laser eye surgery, you may have to shed anything between Rs. 80,000 to Rs. 1.5 lakhs. Laser eye surgery cost is high; it is, therefore, only natural that you would be concerned if your health insurance plan would cover this treatment.

Answer is "Yes", Cataract Surgery is covered in Health Insurance.

Several health insurance plans may cover the medical expenses of cataract surgery, but it comes with its own set of terms and conditions.

Points to keep in mind while opting for a health plan for possible cataract surgery:

  1. Waiting Period: Most health insurance plans have a 24 month or more waiting period for cataract eye surgery. Therefore, the plan would cover the medical expenses of cataract surgery only when it is performed after 24 months of continuance coverage from the date of initial policy purchase.
  2. Cap on Claim: For example, you have a health plan with the sum insured of Rs. 5 lakhs. And in your plan, cataract eye surgery is covered till up to 10% of the sum is insured. So, the expenses are only up to Rs. 50,000 would be covered. There are also specific plans that do not put any cap on expenses and pay for the actual cost of the treatment, as covered by the sum insured.
  3. Co-Payment: There is a clause of co-payment in some health insurance plans when certain surgeries such as cataract surgery are performed. This means that in the total expenses of the treatment, a certain percentage of 20% to 30% is paid by the policyholder. For example, if you have to copy 25% of the expenses, and if the cost of your cataract surgery were Rs. 1 lakh, you would have to pay Rs. 25,000 from your pocket. The insurance company would pay the remaining Rs. 75,000.

Importance of Coverage of Cataract Surgery :

  • No Natural Cure: As discussed, there isn't any natural cure for cataracts so far. Thus, if diagnosed, surgery would be the only way to improve your vision.
  • The severity of the Disease: With growing age, untreated cataracts would get worse. It can also lead to complete or partial blindness. It, therefore, becomes imperative that you invest in a comprehensive health insurance plan that covers cataract eye surgery.
  • A Safe Surgical Process: Fortunately, cataract surgery is a safe surgery. The procedure takes a few hours only, and so does the recovery. Most patients do not suffer any side effects. This means that even if you are diagnosed, there are much brighter chances of your vision getting better.
  • Restoration of Vision: Needless to say, after the cataract eye surgery, your vision quality can get so much better. We are so dependent on our eyes that an improved vision can be life-altering. The surgery would not just improve your vision but also your overall quality of life.

Claiming for Cataract Surgery under Your Health Insurance Plan:

Mainly, cataract surgery does not require more than 24 hours of hospitalization, and thus it is covered as a day-care treatment. Claiming cataract surgery is quite like making any other health insurance claim. There are some standard procedures which all health insurance companies generally follow.

Cataract surgery would be a planned surgery, and therefore when your doctor prescribes you or a family member the surgery, you must inform the insurance company soon. Keep in mind that your claim must be registered with the company 3 to 4 days before the surgery.

There are two ways in which a claim may be settled:

  1. Cashless Claim: In case you go to a network hospital for your treatment, you would be able to avail of the cashless facility wherein you need to submit your Pre-authorization form along with your company-issued Health Card. You would have to pay your share of co-payment at the time of discharge, if any, or for uncovered expenses.
  2. Reimbursement Claim: In case you did not seek treatment in a network hospital, you can still request reimbursement. Inform the company about the surgery 3 to 4 days in advance. Post the surgery, and you need to make the payment yourself. Later you can claim by submitting the Claim Form, treatment-related papers, along with your KYC and bank account details. Once all paperwork is verified, your expenses would be reimbursed.

Conclusion:

Eyes are one of God's greatest gifts. And thus, your ability to see is probably as important as your health. However, it is also a fact that your eyes are constantly changing. It is often seen that people who have a problem in their eyes take a long time to realize that they have a problem. And because vision changes may come gradually, worsening vision is not easily detected. If you face any issues with one or both of your eyes, you must consult an ophthalmologist today.

Note: Refer to your policy document and see if the expenses can be covered.


FAQs:

 

1) Who is more susceptible to the problem of cataracts? 

Mostly, it is the senior citizens, that is, people over the age of 60 years, who are more vulnerable to this disease. However, these days people in their 40's are also being diagnosed with cataracts.

2) How can I opt for eye insurance?

Eyes insurance, also called vision insurance, is still a new concept in India and is not available as a standalone health insurance policy. However, you can opt for a plan that covers cataract eye surgery.

3) What is the waiting period for undergoing a cataract operation?

In most health insurance policies, after the waiting period of 24 months, cataract surgery is covered.

4) What should I get my cataract surgery at a network hospital?

These hospitals collaborate with the insurance company, so the company or its TPA clears the bills. It makes the claim process easier and quicker.

5) What is the meaning of "Cap on Claim"?

A surgical procedure is covered in a health insurance plan, and it generally comes with an upper limit. This means that only a specific percentage of the sum insured may be spent on the treatment.

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