If you get diagnosed with a cataract, and your ophthalmologist advises surgery, you may be curious about the question, “Is cataract surgery covered by medical insurance”. Well, the good news is that your health insurance can indeed cover cataract surgery, but there are essentially a few things you need to be aware of before scheduling your procedure. For example, your policy may only cover 80% of the surgery cost, leaving you responsible for the other 20%. Also, your policy may not cover additional expenses related to the surgery. So, it’s crucial to thoroughly read your plan’s terms and conditions before signing up for it or scheduling your surgery.
Let’s explore the types of cataract surgeries available in India, the waiting period associated with coverage, and the benefits of purchasing a health insurance plan that covers such procedures.
How Much Does Cataract Surgery Cost in India?
There are different ways to treat cataracts in India. Thus, it is essential to discuss with your insurance provider — does health insurance covers cataract surgery — for any particular surgical procedure of your choice.
- The commonest type of cataract surgery is Phacoemulsification, which takes less than 30 minutes. Ophthalmologists make a small incision and use an ultrasonic probe to break the eye’s lens into fragments. The lens gets replaced with an intraocular lens or IOL through a corneal incision. This can cost anywhere between INR 22,000 to INR 60,000 or more.
- Ophthalmologists advise ECCE or Extracapsular Cataract Extraction for complex cataracts. It requires larger incisions to remove the cataract in one piece, and a patient requires sutures to seal the wound. The cost for ECCE ranges from INR 32,000 to INR 40,000.
- Intracapsular Cataract Surgery needs more extensive incisions, where your eye surgeon removes the lens and surrounding capsule and implants an IOL in front of the iris. This surgery costs between INR 32,000 to INR 39,000.
- FLACS, or Femtosecond Laser-assisted Cataract Surgery, is the most advanced method. The laser breaks the lens, performs anterior capsulotomy, and places the IOL. This surgery costs between INR 50,000 to INR 1,60,000.
What's the Waiting Period for Cataract Surgeries?
- Every medical insurance policy comes with a waiting periodduring which you are ineligible to receive the benefits of the cataract surgery covered by health insurance. You must essentially hold off on making any claims during this time.
- Policies that provide coverage for cataract surgeries, in particular, may have their unique waiting period that varies depending on the insurance provider. Usually, the waiting period for cataract surgeries falls between twelve to twenty-four months.
It is vital that you check your policy documentation with great care to avoid any ambiguity or confusion regarding the waiting period. Therefore, it is imperative that you familiarise yourself with the complexities of your policy and make a note of the waiting period associated with any condition you intend to seek treatment for.
Is Cataract Surgery Covered by Medical Insurance?
Yes, cataract surgery is covered by most comprehensive health insurance policies, but the extent of coverage is limited by certain factors. Here is a list of exclusions and inclusions:
Inclusions
- Surgical costs, such as fees for the surgeon and operating room charges.
- Hospitalisation charges, including room rent and nurse fees during the treatment.
- Pre and post-surgery care expenses, like charges for diagnostic tests, medical bills, and follow-up consultation
- Intraocular lens or basic IOL costs.
Exclusions
- Cosmetic upgrades, such as the use of premium lenses.
- Some policies have a cap amount, the cost beyond which is not covered during reimbursement.
- Treatment in non-network hospitals may not be covered.
Claim Process
Cashless Treatment: If you are admitted to a network hospital, the insurance provider will make a cashless payment directly to the hospital.
Reimbursement: In the case of a non-network hospital, you can submit bills later for reimbursement from your insurance provider.
Benefits of Health Insurance Covering Cataract Surgery
The benefits of a health insurance policy include financial support during and after the procedure, access to quality healthcare, and comprehensive coverage for the whole family.
The cost of cataract surgery is determined by several factors, such as the location of the hospital, the type of lens implanted, and the surgical procedure. Generally, the price ranges from INR 10,000 to INR 1,00,000, but if you undergo surgery at a leading hospital in a metro city or if your ophthalmologist suggests advanced procedures, the cost can go up to INR 60,000 for one eye. To save money on medical expenses, especially for ageing parents, purchasing a health insurance plan with an affordable premium is a good option. These plans can cover the costs of daycare treatments and post-surgery expenses, subject to the policy’s terms and conditions.
Some health insurance companies also offer plans with cataract coverage, which can help individuals save a significant amount of money. Researching and choosing a reputed health insurance company for the best coverage options is advisable.
Conclusion
Cataract surgery can restore vision and have a positive impact on the quality of life of an individual. While the process and costs may seem complex, having comprehensive health insurance provides you with the mental and financial security to undergo the surgery. Always read the policy documents carefully and consult the insurance provider before proceeding. With the right insurance plan, you can easily take a step closer to a better vision!
Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.