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. 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.
Is Cataract Covered Under Health Insurance
The answer to your query, “Is cataract covered under health insurance?” is generally yes! But before you fix a date to undergo surgery, it’s essential to be aware of any sub-limits that may exist in your policy. These limits may cap the amount of coverage you receive, leaving you to foot the bill for the remaining balance.
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.
Types of Cataract Surgeries in India
There are different ways to treat cataracts in India. Thus, it is essential to discuss with your insurance provider — does health insurance cover 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 IOLs through a corneal incision.
- 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.
- 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.
FLACS, or Femtosecond Laser-assisted Cataract Surgery, is the most advanced method. The laser breaks the lens, performs anterior capsulotomy, and places the IOL.
Waiting Period in Cataract Surgery
- Every medical insurance policy comes with a waiting period during 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.
Why should you get Health Insurance covering Cataract Surgery?
- The surgery cost is determined by several factors such as the location, type of lens implanted, and surgical procedure involved.
- Generally, the price ranges from Rs 10,000 to Rs 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 Rs 60,000 for one eye.
- To save money on medical expenses, especially for ageing parents, purchasing a health insurance plan with affordable premium costs 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.