Updated on - 14 May 2026
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 insurance can indeed cover cataract surgery, but there are essentially a few things you need to be aware of before scheduling your procedure. 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.
This blog explores the types of cataract surgeries available in India, the waiting period associated with coverage, and the benefits of purchasing a policy that covers such procedures.
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 consultations
- 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.
This is an indicative list. Please read the policy wordings for the complete list of inclusions/exclusions.
What Are the Benefits of Health Insurance Covering Cataract Surgery?
The benefits of a mediclaim policy include financial support during and after the procedure, access to quality healthcare, and comprehensive coverage for the whole family.
Generally, the price ranges from INR 15,000 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 medical 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 insurance companies also offer plans with cataract coverage, which can help individuals save a significant amount of money. Researching and choosing a reputable insurance provider for the best coverage options is advisable.
How Much Does Cataract Surgery Cost in India?
There are different ways to treat cataracts in India. The cost of cataract surgery is determined by several factors, such as the hospital location, the type of lens implanted, and the surgical procedure. Thus, it is essential to ask 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 is replaced with an intraocular lens (IOL) through a corneal incision. This can cost anywhere between INR 19,000 and INR 32,000.
- 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 12,000 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 and INR 1,60,000.
What's the Waiting Period for Cataract Surgeries?
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 own waiting period that varies by insurance provider. Though most have a waiting period of 1 to 2 years.
It is vital that you review your policy documentation carefully 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 note the waiting period for any condition you intend to seek treatment for.
What Is the Claim Process for Cataract Surgery under Medical Insurance?
Nowadays, you can easily file a claim for medical procedures such as cataract surgery. The claim process is straightforward for both:
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, along with related medical records, later for reimbursement from your insurance provider.
Factors That May Affect Your Health Insurance Claim For Cataract Surgery
Several factors may influence whether your claim for cataract surgery is approved and how much is reimbursed. For example, high-end lenses or advanced procedures are not usually fully covered, unless stated otherwise in the policy wording. Others may include:
- Many policies impose a specific waiting period (often 1–2 years) before cataract-related claims are allowed.
- Regardless of the total sum insured, several plans limit reimbursements for cataract surgery.
- The approval of a claim depends on correct diagnosis, the surgeon's recommendation, and full documentation.
- Policies may have set caps or require that you contribute a portion of the cost.
Conclusion
Cataract surgery can restore vision and positively impact an individual's quality of life. While the process and costs may seem complex, having comprehensive health insurance plans 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.
FAQs
1. Can I claim cataract surgery if the diagnosis was before buying the policy?
Cataract is considered a pre-existing ailment if it was discovered prior to purchasing the policy. Coverage is generally only permitted when the insurer's designated waiting period has passed.
2. Is cataract surgery covered under senior citizen health insurance?
Yes, most of these plans cover cataract surgery.
3. Do I need to follow any specific process to get cashless treatment for cataract surgery?
You usually need to select a network hospital, get prior authorisation from the insurance company, and provide the necessary medical records ahead of time in order to receive cashless treatment. If this procedure is not followed, cashless approval may be replaced with reimbursement.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the topic featured in the article. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure/policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.