Mediclaim for Cataract
Surgery
  • Why Cataract Surgery Coverage Important?
  • Waiting Period For Cataract Surgery
  • Claim Limit & Procedure
Cataract Surgery Covered In Health Insurance
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Is Cataract Surgery Covered In Health Insurance?

Protecting your eyes and maintaining healthy eyesight should be a priority in your life. As we age, our eyes get prone to many conditions that occur naturally, cataract is one of them. A cataract is a common eye condition faced in old age but, can also be triggered by injuries to the eyes. If left untreated or unattended it might lead to partial or complete blindness. Cataract mediclaim is a part of most health insurance plans that help you cover the treatment required to cure cataracts and is very important for you to stay prepared for such medical expenses.

What Is Cataract?

A cataract is a disorder concerning human eyes. In cataracts, clouding occurs on the natural eye lens. It can lead to impaired vision or loss of vision. It has three variants:

  • Subcapsular Cataract
  • Nuclear cataract
  • Cortical cataract

Cataracts can even lead to blindness if not treated in time. In case of hazy vision or any doubt, the doctor should be consulted at the earliest to control the disorder at the initial stage.

Which Age Group Is More Affected?

Earlier cataract was common among people above 60 years of age. At present, it is found among people in the 40s. There can be several reasons for the occurrence of cataracts. It might be because of smoking, obesity, diabetes, high blood pressure, excessive alcohol intake, etc. People who have undergone eye surgery or having an eye condition are more vulnerable to this disease. Aging people are prone to the disorder.

Is There Health Insurance For Cataract Surgery?

Yes, there is provision for the inclusion of cataract treatment in the health insurance policy. There might be a possibility, that few of the health insurance policy does not include cataract treatment. So, it must be checked properly in the policy details at the time of purchasing the policy. In case you already with hold a health insurance policy then you can check in the policy documents and the inclusions of the policy.

Health Insurance Companies

Waiting Period For Cataract Surgery

The insured needs to serve the waiting period to utilize cataract treatment coverage. Generally, the waiting period in most of the health insurance companies is for 2 years for treatment-related cataracts. But, it should be confirmed with the concerned insurance company if they provide the facility.

What Would Be The Claim Limit?

The claim limit is completely in the hands of the insurance companies providing a cataract health insurance facility. All that is to be done is to check the inclusions and exclusions of the policy properly.

Few insurers might have set claim limits under the cataract health insurance whereas few companies might not have set any such claim limit. The claim limit for cataract treatment is finalized by the health insurance company based on the sum insured and in some cases, it can also be on the percentage basis. For example, 10% of the sum insured up to INR 25000(Maximum).

Which Plans Comes With Cataract Health Insurance Cover?

Here is the name of a few of the health insurance companies and their plans which provide cataract health insurance coverage. One thing common in all of the plans mentioned below is that they all have a waiting period of 2 years. The other details have been mentioned below:

A comprehensive health insurance policy that covers you and your family with SI of up to 50 lakhs. Provides additional benefits as well.

Unique Features

  • Available in 4 different variants
  • 100% Automatic Restoration of SI
  • Riders for enhanced coverage

Get medical coverage for pre-existing diseases like BP, diabetes without any waiting period by bearing a co-pay of 20-30%.

Unique Benefits

  • No pre-policy checkup needed
  • Dialysis cover available
  • Annual Health Checkup

Care Freedom (Pros)

  • Cashless Healthcare
  • No pre-policy check-ups
  • SI Recharge
  • Lifelong Renewability
  • 15-day free-look period

Care Freedom (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Freedom (Other Benefits)

  • 2 Plan variants
  • Consumable Allowance
  • Annual Health Check-up
  • Long Term Discounts
  • Dialysis Cover

Care Freedom (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - Lifelong
  • SI - 3 to 10 L
  • Waiting Period - 30 Days

The plan is specially designed for those individuals who are willing to secure their old-age medical needs after their retirement.

Unique Features

  • Guaranteed Lifelong renewals
  • No Pre-acceptance Medical test
  • Availability of Instalment Facility

Senior Citizens Red Carpet Policy (Pros)

  • Individual & family floater plan
  • Flexible SI
  • Road Ambulance Cover
  • ICU cover
  • Health Check-up cover

Senior Citizens Red Carpet Policy (Cons)

  • Obesity Treatment Unavailable
  • Hazardous Activity not covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable
  • Congenital Disease Cover

Senior Citizens Red Carpet Policy (Other Benefits)

  • Flexible-Premium Payment
  • Cataract Treatment available
  • Modern treatment cover
  • No pre-policy checkup
  • OP Consultation

Senior Citizens Red Carpet Policy (Eligibility Criteria)

  • Entry Age - 60 Years
  • Max Entry Age - 75 Years
  • SI - 1 L to 25 L
  • Waiting Period - 30 Days

Covers all types of cancer at all stages with lifelong renewability option. If diagnosed with IV stage cancer or relapse, this plan pays 100% of SI as a lump sum.

Unique Features

  • Coverage for modern treatments
  • Second opinions available
  • Coverage for follow-up care

HDFC iCan Cancer (Pros)

  • Ambulance Cover
  • Follow up care post treatment
  • Conventional Treatments
  • Hormonal Treatment
  • Stem Cell Transplantation

HDFC iCan Cancer (Cons)

  • No Non Allopathic treatments
  • No Prosthetic Devices
  • No Overseas Treatments
  • Pre-existing condition for Cancer

HDFC iCan Cancer (Other Benefits)

  • Sum Insured Enhancement
  • CritiCare Benefit
  • Family Care Benefit
  • Lifetime Renewal
  • MyCare Benefit

HDFC iCan Cancer (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 5 L to 50 L
  • Waiting Period - 120 Days

A comprehensive policy that is designed to secure the healthcare needs of a family. The plan comes in 4 variants and the SI goes up to 50 lacs.

Unique Features

  • Covers SAARC countries
  • Midterm inclusion allowed
  • Assisted Reproduction Treatment

Happy Family Floater Policy (Pros)

  • New Born Baby Cover
  • Maternity Expenses Cover
  • Modern Treatments
  • Plastic Surgery Due To Injury
  • Family Floater Benefits

Happy Family Floater Policy (Cons)

  • No Gender Treatments
  • No Global Coverage
  • No Alcoholism Cover
  • No War Injury Cover
  • No Obesity/Weight Cover

Happy Family Floater Policy (Other Benefits)

  • Zone Wise Rates
  • Non-TPA Discount 5.5%
  • 10% Discount on Online Renewal
  • Waiver of Proportionate deduction
  • Dental Treatment Covered

Happy Family Floater Policy (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 1 L to 50 L
  • Waiting Period - 30 Days

A plan with 3 variants offering up to 1 Cr SI. It covers expenses incurred during hospitalization resulting from serious illness or accident.

Unique Features

  • Avail Discounts
  • Maternity cover available
  • Organ Donor expenses covered

Bajaj Allianz Health Guard (Pros)

  • Convalescence benefit
  • Super Cumulative bonus
  • Daily cash benefit
  • New Born Baby Cover
  • Pre & post hospitalization

Bajaj Allianz Health Guard (Cons)

  • No Global Coverage
  • No Dental Treatment
  • No Parkinson's Cover
  • HIV/AIDS not covered
  • No Obesity/Weight Cover

Bajaj Allianz Health Guard (Other Benefits)

  • Health prime rider
  • Non-medical expense rider
  • Wellness benefits
  • Bariatric surgery cover
  • SI reinstatement benefit

Bajaj Allianz Health Guard (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 1.5 L to 1 Cr
  • Waiting Period - 30 Days
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What Is The Cataract Surgery Cost In India?

In India cataract is common impairedness in the people who are 40 years and above in age. The chances of the disorder increase with the increase in age. In the treatment of cataracts, the average expense may range from Rs.15,000 to Rs.35000 in India.

Insurance companies have several procedures and plans for cataract health insurance. All that is required to be done is research and buy a best health insurance Plan covering cataracts.

Is Cataract Covered Under Group Health Plan?

There might be a probability that the group health insurance provided by the employer includes insurance for cataracts. But, it always depends on the insurance company providing group health insurance. There might not be a waiting period in this case.

Conclusion

Eyes are the most precious part of the human body and it should be procured in any of the challenging conditions. Health insurance for cataracts is a ray of hope for the sufferers. Surgery is the only way out for cataracts and the fund can easily be sponsored by the health insurance companies. So, take the initiative at the earliest if you are having the cataract symptoms.

Mediclaim for Cataract Surgery: FAQs

1. Which age group is the most prone to get cataract disease?

Most likely, senior citizens have to undergo cataract surgery as it is a problem that emerges in old age.

2. Are all health insurance plans covering cataract surgery/treatment?

No, kindly read the coverage terms and conditions of the health insurance plan before purchasing. Most health insurance plans have sub-limits provided for cataract treatment.

3. Is there a waiting period applicable for cataract surgeries?

Yes, most health insurance plans have a waiting period of 24/48 months before one can avail of cataract treatment.

4. Do I have to get separate coverage to avail of cataract treatment?

Most health insurance plans offer cataract treatment included in the health plan but this depends on the health insurer and your requirements.

5. Which is better laser or regular cataract surgery?

It depends entirely on every individual's case and medical history, however not all plans cover laser cataract treatment. Read the policy wordings carefully before making any decision.

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Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.