Is Cataract Surgery Covered Under Health Insurance?
Certain lifestyle disorders, such as diabetes and hypertension, can cause various other health disorders. Cataracts is one such common disorder in India, which ultimately leads to blindness if left untreated. Hence, to avoid such risks, having a health insurance plan that covers cataract surgery is crucial for safeguarding your vision.
Our eyes are the main organs through which we perceive the outside world, and it is very important to take care of them in all circumstances.
In this article, you will gain a basic understanding of the types of cataract surgeries that are offered in India, the duration of the waiting time before receiving coverage, and the advantages of getting coverage for cataract surgery under your health insurance plan.
What is a Cataract?
A cataract is a disorder of the eyes in which the natural lens of the eye becomes clouded, reducing vision. It can happen at any age due to several causes, such as lifestyle decisions, smoking, diabetes, etc. As you grow older, the risk of having a cataract increases. If left untreated for a longer time, it could lead to permanent vision loss. cataract surgery is a common and effective method of restoring vision which involves replacing the clouded lens with an artificial one.
What is Cataract Surgery?
The National Institutes of Health's 2017 evaluation of research indicates that Surgery is the only option for treating a cataract. Hence, cataract surgery is performed to remove the cataracts and replace them with an artificial lens. The surgery is performed by an ophthalmologist (eye doctor) and it is only recommended to individuals whose contact lenses or glasses cannot are no longer working for their eye problem.
Types of Cataract Surgeries in India
Over the past 20 years, there has been a complete transformation in the technology utilized in cataract surgery. The following are the six primary types of cataract surgery, having a unique process of replacing the lenses.
Is Cataract Surgery Covered Under Health Insurance?
Many of you dealing with eye issues might have wondered, "Is cataract surgery covered by health insurance?" The good news is, YES!!! However, not all insurers offer coverage for cataract surgery, so it’s essential to review the policy's inclusions before making a purchase. Also, be aware of any sub-limits in your insurance plan. These limits could restrict the amount of coverage you receive for your cataract surgery.
For example, Mrs. Meghna, aged 38, previously purchased a plan that provided cataract surgery coverage under her insurance. Recently, she started experiencing problems with her vision, and after consulting with a Doctor, she was suggested to undergo Cataract surgery. After checking her insurance, she found that it has a copayment, where the insurance provider will only cover 80% of the cost of the surgery, and the remaining 20% will be paid by her.
Therefore, it is essential that you thoroughly read and review the terms and conditions of your plan before purchasing.
Why should you get a Health Insurance covering Cataract Surgery?
The average cost of cataract surgery for one eye in India ranges between ₹18,000 to ₹1,20,000, depending on several factors.(1)
There is no natural cure for cataract. A 2017 review of studies published by the National Institutes of Health confirmed the only available treatment for cataracts remains surgery. (2)
The average age of people who experience cataracts in Western Countries is above 60, but in India, it is increasingly observed around the mid-40s. (3)
What is the Waiting Period for Cataract Surgery in Your Health Insurance?
The waiting period for cataract surgery often varies for 1-2 years, depending on your insurance company.
But what does the waiting period mean?
Waiting period, as the name suggests, is a time period during which you cannot claim any benefits from cataract surgery that is covered by your insurance. Basically, it is the duration you need to wait to use benefits from your health insurance policy.
What’s Great about Health Insurance Covering Cataracts?
Simple online processes - From the process of buying a health insurance policy to making claims is paperless, easy, quick and hassle-free! No hard copies, even for claims!
No Age-based or Zone-Based Co-payment - Many health insurance come with no age-based or zone-based copayment. This means, during health insurance claims, you need not pay anything from your pocket.
No Room Rent Restriction - Everyone has a different preference for opting a room. That’s why insurers provide no room rent restrictions. Choose any hospital room you prefer.
SI Wallet Benefit - If you exhaust your Sum Insured during the policy period, insurers will refill it for you.
Get treated at any hospital - Choose from 8800+ of network hospitals in India for a cashless treatment or opt for a reimbursement.
Wellness Benefits - Get exclusive wellness benefits in collaboration with top-rated health and wellness partners.
Key Benefits of Health Insurance by Digit
*Available only on Worldwide Treatment Plan.
What is Cataract Surgery Cost in India?
There are different types of cataract surgery and each surgery varies in cost. The cost of surgery differs from one person to another depending on what your doctor has recommended, the city you live in, the hospital you pick, the type of cataract, medication and your age.
For example, the cost of robotic cataract surgery in India will differ from that of laser cataract surgery.
On average, considering all the factors, the cost of robotic surgery ranges between ₹15,000 to ₹2,00,000. (4) Below mentioned is the approximate cost for all the types of cataract surgeries in India.
Disclaimer: The above-mentioned cost is the average cost of different types of cataract surgery. The cost can vary depending on your age, city, hospital, type of lens and medications.
Things to Remember Before Getting Health Insurance that Covers Cataract Surgery
Before purchasing any Health insurance plan, make sure that it covers the Cataract surgery cost. However, even if the insurer is providing you with Cataract coverage, you must remember a few important things that include:
- Waiting Period: You cannot claim for cataract coverage when you are under your waiting period. Therefore, it is your responsibility to ensure that the medical insurance coverage you choose does not need an extended waiting period.
- Limits: Most insurers limit the amount a patient with cataracts can claim. You must pay any expenses incurred above this limit separately. However, the maximum amount of a claim may vary among insurers. Therefore, choose a plan with no limits if you want your health insurance to cover the whole cost of cataract treatment.
- Features: Not every policy provide coverage for every facet of the cataract procedure. Therefore, be sure the insurance you select offers you the most coverage and has all the features you want.
Why is Cataract Surgery Important?
- There is no natural cure for cataracts apart from surgery - Unfortunately, as confirmed by the National Institute of Health, there is currently no natural cure for cataracts apart from surgery. Hence, to improve your vision and get through the symptoms and repercussions of cataracts, you will need to get a cataract surgery done.
- Untreated cataract can lead to partial or complete blindness - Depending on one’s age and eye condition, symptoms can get worse with time and without getting it treated (through surgery of course), it can lead to partial or complete blindness of the affected eye. Hence, it is important to opt for cataract surgery if you or your parent have a cataract in one or both eyes to avoid worse repercussions.
- Successful cataract surgery restores vision - Cataract surgery is considered one of the safest surgeries due to the involvement of advanced medical equipment. And, the good news is that you barely need to be admitted to a hospital as the surgeries require a few hours (recovery is quick too!) as compared to other surgeries. The surgery helps you to restore vision without any side effects!
- Improves the quality of life - You know what they say, eyes are the windows to the soul and the window to the world! They might be just tiny pupils but we’re dependent on them in more ways than we can imagine. Hence, getting a cataract surgery improves not only one’s vision quality but also, overall quality of life.
FAQs about Health Insurance Covering Cataract Surgery
Which age group is prone to cataracts?
The senior age group is mostly affected and prone to cataracts, but recent data suggests that people above the mid-40s have started experiencing cataracts due to their lifestyle.
Do all medical health insurance cover cataract surgery?
No, this would depend on different health insurer’s terms and conditions. Always better to check your policy document or ask your insurer to see if it is covered or not. 😊 At Digit, it is covered under Daycare Procedures.
Is there a waiting period for cataract surgeries?
Yes, there is a minimum waiting period of 2 years for cataract surgery at Digit since it comes under specific illnesses.
If I have diabetes, does this mean I will get cataracts too?
No, just because you are diabetic doesn’t mean you will get cataracts. However, it’s said that people who are diabetic (especially high levels) are more prone to getting secondary cataracts too.
Do I have to separately get an add-on cover for cataract surgery?
This would again depend on your health insurer. However, at Digit – cataract surgeries are covered under Daycare Procedures which are included as a default in all our health insurance options.
Does everyone with cataracts need surgery?
This primarily depends on your symptoms and current vision quality. For most people with cataract, it is recommended to get a surgery since it is safe and successfully restores quality of vision. However, the surgery can be delayed basis how affected your eyes are currently. All said and done, your eye specialist will be best suited to give you the right recommendation post an eye checkup and examination.
Is there a Maximum limit on the Claim Amount for Cataract Surgery?
Yes, some insurance providers have a cap on the amount you can claim for cataract surgery, whereas in some insurance policies, you can claim the total sum insured. For example, if the cataract claim limit is ₹30,000 for an amount insured of Rs. 4 lakhs, you can only use ₹30,000 for your cataract surgery.
So, it is important to carefully review the policy’s coverage and exclusions before purchasing the plan.
Is coverage for cataract surgery insurance necessary in India?
Yes. Considering the high cost of medical treatment and the growing number of people with cataracts in India, you need to have cataract surgery coverage.
Can individuals purchase standalone insurance for cataract surgery in India?
Yes, you can purchase standalone insurance for cataract surgery and other eye problems. However, it is recommended that you purchase health insurance that provides coverage for cataracts along with other benefits.
Will insurance cover the cost of premium lenses during cataract surgery?
Yes, some insurance providers cover the cost of premium lenses during cataract surgery. However, not all insurance providers cover the cost of premium lenses. Before purchasing any insurance policy, you must thoroughly check and read the documents.
Who can get Cataract Surgery?
People with vision loss that makes it difficult for them to do daily tasks like driving, reading, or watching TV are usually advised to get cataract surgery. When suggesting cataract surgery, the doctor may also consider other factors, such as age, genetics, high UV exposure, and certain medications.
Is there a waiting period for cataract surgery under most health insurance plans?
Yes, almost all insurance providers have a waiting period for cataract surgery. Most have a waiting period of 1 to 2 years, after which you can claim the amount for your surgery. At Digit, the waiting period is two years, which comes under specific illness coverage.
Does every health insurance policy cover cataract surgery?
No, not every policy covers cataract surgery. However, Digit provides coverage for cataract surgery in its health insurance under daycare procedures. If you have a policy other than Digit, please ensure that it includes the cost of cataract surgery.
Does my health insurance cover the cost of pre-operative consultations for cataracts?
No, not all health insurance covers the cost of pre-operative consultations for cataracts. But Digit provides you coverage for the cost of your pre-operative consultation with the doctor, depending on the number of days you opt for or mention in your policy.
Does my health insurance (Digit) cover the cost of intraocular lenses (IOLs)?
Yes, Digit covers the cost of intraocular lenses (IOLs) only if they are Monofocal. However, Digit does not cover multifocal IOLs.
Are there additional out-of-pocket costs associated with cataract surgery (e.g., medications)?
Yes, there are some chances that you will have to pay additional out-of-pocket costs associated with cataract surgery. This is because some insurance providers have sub-limits on the total amount you can claim for the cataract surgery. Always check and read the documents to ensure that you are not encountering any additional out-of-pocket costs for cataract surgery.
What should I consider when choosing a health insurance plan for cataract surgery?
There are several factors you may consider before choosing a health insurance plan for cataract surgery. These factors include:
- Coverage Benefits
- Policy Premium
- Hospital Network
- Total Sum Insured
Should I consider getting a separate vision insurance plan to cover cataract surgery?
You can get a separate vision insurance plan to cover cataract surgery, but buying health insurance is more advantageous as it comes with additional benefits and coverage that could also cover your overall health.
Are there any risks associated with cataract surgery?
Yes, some people are unfortunately more prone to cataracts than others. Some of the risk factors include:
- Increasing age
- Heavy alcohol intake
- Regular smoking
- Obesity
- High blood pressure
- Previous eye injuries
- Family history of cataracts
- High sun exposure
- Diabetes
- Exposure to radiation from X-rays and cancer treatments
Is there any alternative to cataract surgery, and why is health insurance important in this context?
No, so far, there is no alternative to cataract surgery. Hence, health insurance is essential to cover the expenses incurred due to cataracts so that you don't have to pay any costs yourself.
Does health insurance provide coverage for pre and post-surgery expenses?
No, not all health insurance provides coverage for pre- and post-surgery expenses. However, Digit has something more for you. 🙂 At Digit, we cover your pre and post-surgery expenses depending on the policy you have, which includes costs involved in diagnosis, tests, doctor’s consultation, and recovery.
Is cataract surgery performed on both eyes at the same time?
No, cataract surgery cannot be performed on both eyes simultaneously. Doctors suggest keeping a week to one-month gap between the surgeries for both eyes. This is done to ensure that your first eye is healed completely and your vision is stabilized before having another surgery.
Which documents are required to get approval for the claim request for cataract surgery?
The document requirement depends on the type of claim you are requesting from your company.
- For Cashless Claim: You are just required to fill out the form given by TPA at the hospital and don't need to submit any document.
- For Reimbursement: In this, you need to submit your health invoices, medical bills, doctor’s prescriptions and other relevant receipts.
Is There Any Way to Prevent Cataracts?
Yes, cataracts can be prevented primarily by maintaining your eye health and overall well-being as well.
Some of the ways to prevent cataracts include wearing sunglasses in the sun, having a regular eye checkup, eating healthy food, avoiding smoking, maintaining a healthy weight, etc.