Eye Surgery Insurance Coverage Explained

Losing your vision is scary and can change everything. Thankfully, modern eye surgery can often restore sight and stop further damage in some cases. However, the financial aspect is not always clear. In India, insurance may cover some procedures and exclude others, depending on the condition and the policy. This makes it necessary for you to understand what eye surgery includes, when it is needed, how much it costs and how insurance can help.

What is eye surgery?

Eye surgery for vision involves treating conditions of the eye through surgical procedures that may include lasers, incisions or implants like intraocular lenses. These surgeries are done to correct vision problems, repair damage or prevent further complications.

What conditions are treated with an eye surgery?

Eye operation is used to treat a wide range of conditions that affect vision or eye health. They include:

• Cataracts: Clouding of the eye’s natural lens that causes blurry or dim vision.
• Refractive errors: Issues like nearsightedness, farsightedness, astigmatism and presbyopia.
• Glaucoma: An increase in eye pressure that may harm the optic nerve.
• Retinal detachment: The Retina pulls away from its normal position at the back of the eye.
• Ptosis: Sagging of the upper eyelid that may interfere with vision.
• Eye cancer: Abnormal growths or tumours that may require removal.
• Injuries: Trauma to the eye, such as open globe injuries.
• Corneal diseases: Conditions like keratoconus that may need corneal transplants.

Different types of eye surgeries

Let us now understand what the different types of eye surgery are:

• Vision correction surgery: It includes LASIK, PRK and SMILE. These laser procedures reshape the cornea to correct refractive errors, like myopia, hyperopia and astigmatism.
• Cataract surgery: This involves taking out the eye’s clouded natural lens and implanting a clear artificial intraocular lens in its place.
• Vitrectomy: This procedure involves eliminating a gel-like substance called vitreous from inside the eye. It is usually done in cases of retinal detachment, macular holes or diabetic retinopathy.
• Glaucoma surgery: These are trabeculectomy or tube-shunt procedures. They help lower intraocular pressure to prevent further damage to the optic nerve.
• Strabismus surgery: This surgery treats eye misalignment by repositioning or tightening the eye muscles to improve coordination.
• Corneal transplant (keratoplasty): It replaces damaged or diseased corneal tissue with healthy donor tissue.
• Eyelid surgery (blepharoplasty): This surgery is performed to remove excess skin or correct drooping eyelids.
• Eye removal (enucleation): In rare cases of severe trauma, cancer or infection, the entire eyeball may need to be removed to protect the patient’s health.
• Open globe injury repair: This is an emergency surgery done when the eyeball is ruptured or punctured, often as a result of blunt force or accidental injury.

What is the cost of eye surgery in India?

Here is a general breakdown of the cost of eye surgeries in India:

Why should you buy health insurance for eye surgery and what does it cover

Eye surgeries like cataract removal, glaucoma treatment or retinal procedures can be expensive. Eye surgery insurance coverage helps ease this financial burden by covering hospital stays, the surgery itself, diagnostic tests and follow-up visits. Many insurers also offer cashless treatment at network hospitals, reducing out-of-pocket expenses.

Most health insurance policies cover medically necessary eye surgeries such as cataract removal (with standard intraocular lenses), glaucoma surgeries like trabeculectomy, vitrectomy for retinal issues, corneal transplants and surgeries after eye injuries. Strabismus correction is also typically included.

However, elective or cosmetic procedures like LASIK, PRK, SMILE, eyelid surgeries and premium lenses are usually excluded unless your policy specifically mentions them. LASIK may be covered only in special cases, such as a refractive error above 7.5 dioptres or when glasses or lenses cannot be used due to medical or physical constraints.

How to claim health insurance for eye surgeries?

Here’s how you can claim health insurance for eye surgery:

1. Pre-authorisation: Submit your doctor’s reports and a cost estimate to the insurer in advance for planned procedures like cataract surgery.
2. Choose a network hospital: This allows for cashless treatment, where the insurer deals directly with the hospital through a TPA.
3. Submit documents: Keep the discharge summary, prescription, test reports, itemised bills and your insurance details ready.
4. Reimbursement if not cashless: Send all documents to your insurer within 7–15 days after discharge if you have paid upfront.
5. Check waiting periods: Many policies have a 1–to 2–year wait for surgeries such as cataract or LASIK procedures.
6. If rejected: Ask your doctor for a written explanation and file an appeal with supporting documents.

Conclusion

For many people, eye surgery is often necessary to prevent severe vision loss. The good news is that many procedures are now covered by health insurance in India. Eye surgery cost are also on the rise, so a health insurance plan that includes eye care can offer real financial relief. Just be sure to check what your policy covers.

FAQs

• Does health insurance cover eye surgery for vision correction?

Most insurers don’t cover eye surgery for vision unless it is medically necessary. Elective procedures like LASIK are usually excluded.

• What does health insurance for eye surgery usually include?

Health insurance often covers medically required treatments. However, it may not include cosmetic or elective options.

• Are all different types of eye surgery covered under eye surgery insurance coverage?

No, eye surgery insurance coverage depends on the type. Some plans exclude specific procedures, so it is important to check.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.