Is cataract surgery covered by health insurance

Cataract surgery insurance coverage in India provides financial protection against medical expenses during or after the surgery. Read on to know more.
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Is cataract surgery covered by health insurance
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3 min
20-July-2023

Cataract surgery is a common surgical procedure in India. The surgery involves the replacement of the lens of the eye, which becomes cloudy due to a cataract, with an artificial lens. The procedure is quick, generally takes less than 30 minutes, and is largely painless.

However, cataract surgery can be an expensive procedure, and the cost may be prohibitive for many individuals. In this article, we will explore cataract surgery insurance coverage in India, which provides financial protection to patients in the event of unexpected medical expenses.

Importance of cataract surgery insurance coverage

Cataract surgery insurance coverage is important because not everyone may be able to afford the cost of the surgery, especially those who require bilateral surgeries or who have comorbidities. Insurance coverage helps to cover the cost of not only the surgical procedure, but also assists in recovery and associated pre-and post-operative charges such as medication, consultation fees, investigation, and follow-up visits to the surgeon. Essentially, subscribing to an insurance plan for cataract surgery can eliminate the financial burden, eliminate stress and anxiety and improve the patient’s overall quality of care.

Types of insurance coverage for cataract surgery

Some types of insurance policies that cover cataract surgery include:

● Health insurance policy:

Most health insurance policies cover cataract surgery, except plans that exclude it specifically. Health Insurance policies usually cover the charges incurred during cataract surgery, prescription cost, and post-surgery treatment up to the policy limits.

● Group insurance policy:

This type of policy covers employees of a company or an institution. The scheme coverage will depend on the terms and conditions agreed between the insurance provider and the group policyholder.

● Senior citizen policy:

A senior citizen policy is customarily for citizens above the age of 60 years who face the risk of medical ailments. This policy features higher coverage limits for cataract surgery due to the increased medical risk for senior citizens.

Why is cataract surgery required?

Cataract surgery is a common procedure performed to remove a clouded lens from the eye and replace it with an artificial one. The surgery is usually performed on individuals with age-related cataracts, although it may also be recommended for individuals with other types of cataract. Here are some reasons why cataract surgery may be required:

  • Vision impairment: Cataract can cause vision impairment, including blurred or hazy vision, photophobia, and difficulty seeing at night.
  • Inability to perform daily tasks: Cataract can interfere with daily tasks such as driving, reading, or cooking, making cataract surgery necessary to restore independence.
  • Risk of falls: Cataract can increase the risk of falls, particularly in older adults, making surgery necessary to reduce the risk of injury.
  • Other eye conditions: Cataract can worsen other eye conditions, such as macular degeneration, making surgery necessary to maintain overall eye health.

Factors to consider when choosing an insurance plan for cataract surgery

When choosing an insurance plan for cataract surgery, there are several factors to consider. Some of which include:

● Coverage and benefits:

Review your policy to determine the extent of cataract surgical coverage, the types of lenses included, pre-and post-operative care coverage, and other relevant benefits. It is essential to compare policies to ensure that your policy covers all the costs associated with cataract surgery.

● Policy premium:

Ensure that the policy's premium is affordable. It should fit within your budget and provide coverage.

● Hospital network:

Check for the list of hospitals and healthcare providers associated with your insurance company for eye care facilities in India.

● Sum assured:

Check the maximum coverage offered by the policy is suitable for your requirement.

Coverage for cataract care in India can be pivotal in getting the right care for a medical procedure that can restore one's vision and improve the quality of life. It is imperative to research and compare various policies, and understand their features, terms, and conditions before subscribing to one. Insurance coverage eliminates the burden of medical bills and ensures continued treatment and support throughout the recovery phase.

Therefore, it is essential to choose and employ a reliable platform that provides comprehensive insurance coverage suited to your requirement, which ensures a truly stress-free surgical procedure.

Note: While we do not offer an insurance policy specifically for cataract surgery, we offer other insurance policies on our Bajaj Finance Insurance Mall. Click here to know more.

Also, check:

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Frequently asked questions

Is coverage for cataract surgery insurance necessary in India?

Coverage for cataract surgery insurance is important in India, but not mandatory. The cost of this surgery can be high, especially for someone with comorbidities or requiring bilateral surgery. Insurance coverage, in such instances, can help in reducing the financial burden and ensure that patients receive the best treatment for their condition.

Can individuals purchase standalone insurance for cataract surgery in India?

Yes, insurance providers generally offer standalone insurance policies that cover cataract surgery and other eye procedures. However, it may be more financially beneficial to opt for health insurance that covers cataract surgery, equipped with other pre-existing or additional benefits as per the insurance policy.

Will insurance cover the cost of premium lenses during cataract surgery?

Yes, some insurance policies may cover the cost of premium lenses during cataract surgery. However, not all policies cover the cost of premium lenses, so it is essential to read the policy document carefully.

What is the waiting period for claiming insurance for cataract surgery in India?

In most health insurance policies, the waiting period for cataract surgery ranges from 1 to 2 years. It is important to check the specifics of your policy before making any claims.

Which age group is prone to cataract?

Cataracts are more commonly seen in older adults, particularly those over the age of 60 years. However, cataracts can also develop in younger individuals due to other factors such as genetics, trauma to the eye, or certain medical conditions.

Do I have to separately get an add-on cover for cataract surgery?

The requirement for an add-on cover for cataract surgery depends on the health insurance policy. Some insurance policies may cover cataract surgery as a part of the base plan, while others may require an add-on cover. It is important to check with your insurance provider to understand what is covered under your policy and whether an add-on is required for cataract surgery. Additionally, insurance providers may have certain limitations and exclusions for coverage of cataract surgery, such as a limit on the number of surgeries covered or the type of surgery covered.

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