Cataract Coverage in Star Health Insurance
Cataracts cause vision impairment due to clouding of the lens in the eye. This condition can be treated effectively with cataract surgery, a common procedure. The importance of having health insurance coverage for such procedures grows
as medical costs continue to rise. In this article, we will discuss, Is cataract surgery covered by star health insurance, if yes, what is star health insurance cataract surgery limit, and the essential factors to keep in mind.
Star Health Insurance Cataract Surgery Coverage
Cataract surgery is covered under most of Star health insurance policies. Nevertheless, it is crucial to go through the policy documents and terms and conditions so as to comprehend the scope of coverage provided. These are some of the policies
that provide Star Health Insurance Cataract Surgery Coverage:
Star Medi Classic
Star Medi Classic is a comprehensive health insurance plan offered by Star Health Insurance. This plan provides coverage for various medical expenses, including cataract surgery. The waiting period for cataract is 24 months i.e. the coverage
for cataract will be given after 24 months have passed since the inception of the policy. The star health insurance cataract surgery limit Under Star Medi Classic is as follows:
| Basic Sum Insured (Rs.) |
The limit for Cataract Surgery (Rs.) |
| Up to 2,00,000 |
12,000 per person per policy period |
| 3,00,000 to 5,00,000 |
20,000 per eye per person and not exceeding 30,000 per person per policy period |
| 10,00,000 and 15,00,000 |
30,000 per eye per person and not exceeding 40,000 per person per policy period |
Star Family Health Optima
Star Family Health Optima is a family health insurance plan designed to provide comprehensive coverage for the entire family. This plan also includes coverage for cataract surgery. The waiting period for cataract is 24 months i.e. the coverage
will be given post 24 months have lapsed since the inception of the policy. The coverage limits for cataract surgery under Star Family Health Optima are as follows:
| Sum Insured (Rs.) |
Limit per eye (Rs.) |
Limit per policy period (Rs.) |
| 3,00,000 |
Up to 25,000 |
Up to 35,000 |
| 4,00,000 |
Up to 30,000 |
Up to 45,000 |
| 5,00,000 |
Up to 40,000 |
Up to 60,000 |
| 10,00,000 |
Up to 50,000 |
Up to 75,000 |
| 15,00,000 |
| 20,00,000 |
| 25,00,000 |
Other similar Star plans which include Cataract are :
A uniquely designed insurance policy that covers organ donor expenses up to sum insured, AYUSH treatments, modern treatments, and many more.
Unique Features
- All Daycare procedures
- Automatic Restoration
- Domiciliary hospitalization
Medi Classic Policy (Individual) (Pros)
- Plan Variants Available
- Customizable Plan
- Hospital-Cash Benefit
- 5% Family Discount
- Organ Donor Cover
Medi Classic Policy (Individual) (Cons)
- 10% Co-payment
- Obesity Treatment Unavailable
- Hazardous Activity not covered
- HIV/AIDS not covered
- Cosmetic Surgery unavailable
Medi Classic Policy (Individual) (Other Benefits)
- New Born Baby Cover
- 100% Super Restoration
- Up to 100% No-claim Bonus
- Psychiatric coverage
- Patient Care Cover
Medi Classic Policy (Individual) (Eligibility Criteria)
- Entry Age - 16 Days
- Max Entry Age - 65 Years
- SI - 1.5 L to 25 L
- Waiting Period - 30 Days
The plan is ideal for the families who want to get covered under single sum insured.
Unique Features
- Automatic Restroration of SI
- Instant Recharge UPTO 30% of SI
- New born baby cover from 16th day
Family Health Optima Policy (Pros)
- No Pre-Policy Check-up
- Lifelong Renewability
- High SI available
- COVID-19 cover
- OPD covered
Family Health Optima Policy (Cons)
- PED cover not available
- Obesity Treatment Unavailable
- Hazardous Activities
- HIV/AIDS not covered
- Cosmetic Surgery unavailable
Family Health Optima Policy (Other Benefits)
- Long term discounts
- Premium Payment flexibility
- Health Check-up Cover
- Domiciliary Hospitalization
- Modern Treatment Cover
Family Health Optima Policy (Eligibility Criteria)
- Entry Age - 18 Years
- Max Entry Age - 65 Years
- SI - 1 L to 25 L
- Waiting Period - 30 Days
A new-age plan with loaded benefits covering hospitalization expenses arising due to illness or accident.
Unique Features
- Premium Payment Flexibility
- Wellness Program
- Short Waiting Period
Assure Insurance Policy (Pros)
- Second Medical Opinion
- Health Check-up Covered
- 100% Cumulative Bonus
- Compassionate Travel
- AYUSH Treatment
Assure Insurance Policy (Cons)
- 10% Co-pay applicable
- Deductibles
- HIV/AIDS not covered
- Cosmetic Surgery unavailable
- Injuries due to breach of law
Assure Insurance Policy (Other Benefits)
- In Utero Fetal Surgery
- Pain Management
- Rehabilitation Cover
- Organ Donor Cover
- Modern Treatment Cover
Assure Insurance Policy (Eligibility Criteria)
- Entry Age - 18 Years
- Max Entry Age - 75 Years
- SI - 5 L - 2 Cr
- Waiting Period - 30 Days
This policy is designed to provide complete protection against all health care eventualities to you and your family.
Unique Features
- Avail free health check-ups
- Hospital Cash Benefit
- 100% Automatic Restoration
Star Comprehensive Plan (Pros)
- 99.6% CSR
- Up to 1 Cr SI
- Maternity Cover
- New Born Baby Cover
- Road and Air Ambulance
Star Comprehensive Plan (Cons)
- No Global Coverage
- No IVF Treatment
- No compassionate Travel
- HIV/AIDS not covered
Star Comprehensive Plan (Other Benefits)
- Individual and family floater
- Mid-term inclusion available
- Accidental Death
- Permanent Total Disablement
- Star Wellness Program
Star Comprehensive Plan (Eligibility Criteria)
- Entry Age - 3 Months
- Max Entry Age - 65 Years
- SI - 5 L to 1 Cr
- Waiting Period - 30 Days
Factors to Consider While Choosing Star Health Plans
Considering certain factors that may affect the coverage is essential even with Star Health Insurance for eye surgery coverage. These factors consist of the following:
- Cataract surgery and other specific treatments are subject to a waiting period in many health insurance policies. A few months to a few years is the time frame for the waiting period, depending on the policy. Before making a claim for
cataract surgery, being aware of this waiting period is crucial. Certain plans of Star have a waiting period of 3 years such as Star Comprehensive Health policy but it can be brought down to two by paying a slightly higher premium.
- Cataract surgery coverage limits may differ for the various policies provided by Star Health Insurance. Certain policies might pay for the complete expense of the procedure, whereas others could include sub-limits or require co-payment.
Carefully reviewing the policy documents and understanding the coverage details is vital in order to avoid any unexpected surprises when making a claim.
- A network of hospitals and healthcare providers have tie-ups with Star Health Insurance. When looking for cataract surgery, it is recommended to select a hospital
within the network to access cashless services. Nonetheless, in case you go with a non-network hospital, it may require you to make an upfront payment and later submit a claim for reimbursement with your insurance provider.
- Obtaining pre-authorization from Star Health Insurance is necessary before undergoing cataract surgery. The submission of relevant medical documents is necessary for this process and should include the doctor's recommendation for surgery.
Not obtaining pre-authorization could lead to coverage denial or reimbursement challenges.
- Carefully reviewing the policy documents is crucial in order to understand any exclusions or limitations related to cataract surgery. Coverage may require meeting specific conditions or requirements for some policies. For instance, if
the vision is significantly affected or if certain age criteria are met, the policy might only cover cataract surgery.
What is The Process To Claim Coverage
These general steps will help you claim coverage for cataract surgery under Star Health Insurance:
- As soon as possible, let Star Health Insurance know about the scheduled cataract surgery. To get this done, one can contact their helpline or the customer service team.
- To obtain pre-authorization from Star Health Insurance, submit the necessary documents, including the doctor's recommendation and any other required medical reports.
- You can choose from the Network Hospitals (if applicable). Inform the hospital about your Star Health Insurance coverage if you plan to undergo surgery at a network hospital to avail of cashless services. The hospital will partner with
the insurance company to organise direct settlement of the medical bills.
- Should you decide on a non-network hospital, paying for the surgery upfront is necessary. Subsequently, you can file a claim for reimbursement with Star Health Insurance. Make sure to retain all the required bills, receipts, and medical
records for the process of reimbursement.
- Observe the claim process detailed by Star Health Insurance. The specified time frame requires submitting the reimbursement form and all required documents.
Closing
Cataract surgery is covered by the plans of Star Health Insurance, such as Star Medi Classic, Star Family Health Optima and more. The coverage limits per eye and per policy period change according to the sum insured, with higher sums insured
giving higher coverage limits. Considering factors like the waiting period, coverage limits, and network hospital options is important when choosing a plan. Availing of coverage requires obtaining pre-authorization and following the necessary
claim procedures, which are crucial. Understanding the policy details and procedures allows individuals to ensure financial protection and access to quality healthcare for cataract surgery with Star Health Insurance.
