Is Cataract Surgery Covered by Health Insurance?

Have you been experiencing blurry vision lately? If you are over 50 and your vision has gotten cloudy and unclear, cataract could be the reason. Cataracts are an eye condition caused by the formation of a dense and cloudy area in the lens of the eye which affects vision. It is common in elderly people and if left untreated, can lead to partial or complete blindness.

While the disease appears in old age, factors like diabetes, smoking and high exposure to sun may also increase the risk.  Modern lifestyle has seen the prevalence of cataracts even in the age group of 45+ years, though the percentage of such people affected by cataracts is low. The only method of treatment is surgery, which costs Rs 10,000 to 1,00,000 (approximately), depending on the method and the choice of lens. Cataract surgery is one of the most common eye surgeries undertaken in India. Around 74% of adults in India who are more than 60 years old have cataract or have undergone a cataract surgery.

With a health insurance plan, you don’t have to stress about such surgical expenses. Health insurance supports you financially during unexpected medical procedures and treatments. Most comprehensive health insurance plans cover cataract surgeries with some predetermined conditions. These vary between insurers and plan types.

Some points to keep in mind for health insurance covering cataracts:

  • Waiting period: Most health insurance plans with cataract coverage classify it as a specific condition, and the procedure carries a waiting period of 2 years on an average. Therefore, you can file a claim for cataract surgery expenses only if you have completed the waiting period. If you buy a health insurance cover as a young adult, you will be in a better position to comfortably serve the waiting period before getting coverage for cataract surgery.
  • Sub limit for cataract surgery: Cover for cataract treatment may come with a limit on the claim amount, that varies from insurer to insurer and policy purchased. For example, the claim limit could be a percentage of the sum insured amount or a certain specified amount. In this scenario, any additional expenses incurred for the cataract treatment would have to be paid out of pocket. When buying a health policy, it is good to check whether the plan comes with a specific limit or covers the full cost.
  • Conditions: Some plans may state that cataract surgery costs will be covered only once during the policy year. It would be advisable to select a health insurance policy that applies few to no conditions on Cataract surgery.
  • Coverage range: Some health insurance policies covering cataract surgery may do so only for procedures conducted on one eye during the policy year or lifetime.  However, a person having a cataract in one eye is prone to get it in the other eye as well. Therefore, make sure the policy you want to buy covers cataract surgery for both eyes.
  • Coverage limit for one or both eyes: The limits specified in the policy may be for both eyes. It is useful to check beforehand whether the limits, if any, are for each eye or for both eyes.

Health insurance covering cataracts is a ray of hope for people affected by this condition. To not have future difficulties in getting cataract surgery, it is important to select a comprehensive health policy. When choosing health insurance there are many factors to consider, such as which treatments are covered, past and present health conditions and future requirements.

SANA.Insure is a health insurance portal that analyzes your health needs and expectations.  On the basis of your requirements, our Health Insurance Experts offer advice and suggestions for the most suitable health insurance plans.

We invite you to visit for quick, unbiased, and easy access to comparative information on various health policies available in India, tailored to your needs. Additionally, to ensure your existing health insurance plan provides satisfactory coverage for future surgeries and treatments, you can get your policy checked on SANACheck on our website. Simply visit SANACheck to learn more. You can also connect with a Health Insurance Expert at SANA.Insure for any queries you may have on health insurance via WhatsApp (8278271818) or a phone call (1800 202 8118).

Wish you a healthy and happy life!

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