Health Insurance for Cataract Surgery
Definition
Cost of cataract surgery
Inclusion/Exclusion
Simran has over 4 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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Anchita has over 6 years of experience in content marketing, insurance, and healthcare sectors. Her motto to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
Updated on Jun 30, 2025 8 min read
Health Insurance for Cataract Surgery
Cataract medical insurance is a part of most health insurance plans that help you cover the treatment required to cure cataracts, and you need to stay prepared for such medical expenses.
Protecting your eyes and maintaining healthy eyesight should be a priority in your life.
As we age, our eyes become prone to many conditions that occur naturally, cataracts are 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.
Is Cataract Surgery Covered In Health Insurance?
Cataracts, the clouding of the eye’s lens, are a common age-related condition that can significantly impact vision. If you’re facing this issue, one of your primary concerns is likely, "Will my health insurance cover cataract surgery?" The good news is, in most cases, the answer is a resounding YES! IRDAI has mandated all the insurers to add cataract surgery in the health insurance plan.
However, there are many things to understand in this instance. This article will cover all the details that are required for you to know about health insurance for cataract surgery.
What is a Cataract?
As I told you before, a cataract is the clouding of a normally clear lens of your eye. Proteins within the lens begin to break down and clump together. This clumping causes the lens to become cloudy or opaque. When the cataract progresses, it blocks and scatters light. It causes blurred or distorted vision to you.
Cataract has three variants:
- Subcapsular cataract
- Nuclear cataract
- Cortical cataract
NOTE- Cataracts can even lead to blindness if not treated in time. Just in case if you feel hazy vision or double vision, consult your doctor immediately.
traordinary Facts
Did you know? As per the WHO, the leading causes of vision impairment and blindness at a global level are refractive errors and cataracts.
- In 2020, among overall (all ages), 43.3 million were blind and 295 million with MSVI (moderate to severe vision impairment), out of which 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataracts.
- As per the data released by the Health Ministry of India, more than 83.4 lakh people underwent cataract surgeries in India during 2022-23.
What is the Cost of Cataract Surgery In India?
In India, cataract is a common impairment in people who are 40 years and above in age. The chances of the disorder increase with the increase in age. For the treatment of cataracts, the average expense may range from Rs.15,000 to Rs.35,000 in India. However, various factors can influence the cost of cataract surgery in India, like the type of surgery, type of lens, and doctor’s charges.
For a clear understanding, we have noted the cost of different types of cataract surgeries in India:
- Phacoemulsification Cataract Surgery - Rs 40,000 for one eye.
- Extra Capsular Cataract Surgery - Rs 40,000 to Rs 60,000 for one eye.
- Bladeless Cataract Surgery - Rs 85,000 to Rs 1,20,000 for one eye.
The costs mentioned above can vary from one city to another and from one hospital to another.
Which Age Group Is More Affected from Cataract Surgery?
Earlier cataracts were common among people above 60 years of age. At present, it is found among people in their 40s. There can be several reasons for the occurrence of cataracts. It can be because of smoking, obesity, diabetes, high blood pressure, excessive alcohol intake, etc. People who have undergone eye surgery or have an eye condition are more vulnerable to this disease. Ageing people are prone to the disorder.
Health Insurance Plans for Cataract Surgery In India
| Cataract Surgery Health Insurance Plans | Mediclaim Limit for Cataract Operation | Entry Age |
| Aditya Birla Activ Health Platinum Plan | Up to ₹40,000 | Adult: 18 years onwards Child: 91 days to 25 years |
| Bajaj Allianz Health Guard Plan | 20% of the SI or up to ₹1 lakh per eye | Adult: 18 to 65 years Child: 91 days to 30 years |
| Care Health Insurance Plan | Up to ₹30,000 per eye or SI limit (depending on the plan variant) | Adult: 18 years onwards Child: 91 days to 24 years |
| Future Generali Health Absolute Plan | 10% of the SI or up to ₹2 lakh per eye | Adult: 18 years onwards Child: 1 day to 25 years |
| HDFC ERGO Optima Restore Plan | Up to the SI limit | Adult: 18 to 65 years Child: 91 days to 25 years |
| ICICI Lombard Health AdvantEdge Plan | Up to the SI limit | Adult: 18 years onwards Child: 91 days to 30 years |
| IFFCO Tokio Family Health Protector Plan | - | Adult: 18 years onwards Child: 91 days to 30 years |
| Magma HDI OneHealth Insurance Plan | Up to ₹1 lakh per eye | Adult: 18 years onwards Child: 91 days to 26 years |
| ManipalCigna SecureHealth Plan | Up to ₹40,000 per eye | Adult: 18 to 65 years Child: 1 day to 17 years |
| Niva Bupa GoActive Plan | Up to the SI limit | Adult: 18 to 65 years Child: 91 days to 21 years |
| Reliance Health Infinity Plan | Up to the SI limit | Adult: 18 to 65 years Child: 91 days to 25 years |
| SBI Arogya Supreme Plan | Up to ₹1 lakh per eye | Adult: 18 to 65 years Child: 91 days to 25 years |
| Star Family Health Optima Insurance Plan | Up to ₹75,000 | Adult: 18 to 65 years Child: 16 days to 25 years |
| Tata AIG Health SuperCharge Plan | Up to ₹1.6 lakh per eye | Adult: 18 to 65 years Child: 16 days to 26 years |
| Zurich Kotak Health Premier Plan | 10% of the SI or up to ₹1 lakh per eye | Adult: 18 to 65 years Child: 91 days to 25 years |
Waiting Period For Cataract Surgery
You need to wait for a certain period before getting coverage for the cataract surgery. Generally, the waiting period in most health insurance companies is 2 years for treatment-related cataracts. But, you should confirm with your health insurance company for detailed information.
Benefits of Buying a Health Insurance for Cataract Surgery
Buying health insurance that covers cataract surgery offers several important benefits, particularly in a country like India where healthcare costs can be a significant burden. Here’s a breakdown of the key advantages:
Financial Protection:
Reduced Out-of-pocket Expenses:
Cataract surgery, especially with advanced lens options, can be expensive. Health insurance helps to cover a substantial portion of these costs, lessening the financial strain.Coverage of Associated Costs:
Beyond the surgery itself, insurance can cover pre-operative tests, post-operative care, and medications, further reducing your expenses.Protection Against Rising Healthcare Costs:
Healthcare costs tend to increase over time. Having insurance provides a buffer against these rising expenses.
Access to Quality Care:
Choice of Hospitals:
Many health insurance plans have a network of hospitals, giving you the flexibility to choose a reputable facility for your surgery.Coverage for Advanced Procedures:
Some policies may cover advanced cataract surgery techniques, such as laser-assisted surgery, and premium intraocular lenses (IOLs).Cashless Treatment:
Many insurers offer cashless treatment at network hospitals, simplifying the payment process and reducing your immediate financial burden.
Additional Benefits:
Peace of Mind:
Knowing that you have financial protection for a common age-related condition like cataracts can provide significant peace of mind.Tax Benefits:
In India, you are eligible for tax deductions on health insurance premiums under Section 80D of the Income Tax Act.
Important Considerations:
Waiting Periods:
Most health insurance policies have a waiting period for cataract surgery. It’s essential to understand these terms before purchasing a policy.Coverage Limits:
Insurance policies may have limits on the amount they will cover for cataract surgery. Carefully review the policy details to understand these limitations.Policy Exclusions:
Make sure to fully understand what the policy excludes. Pre-existing conditions and certain types of lenses may not be covered.
By carefully evaluating your health insurance options, you can ensure that you have adequate coverage for cataract surgery and protect your financial well-being.
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 cataract health insurance, whereas a 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 a percentage basis. For example, 10% of the sum insured up to INR 25000 (Maximum).
What are the Inclusion of Health Insurance for Cataract Surgery?
- In-patient expenses
- Daycare procedures
- Pre-hospitalisation
- Post-hospitalisation
- AYUSH coverage
- Tele-consultation
What are the Exclusions of Health Insurance for Cataract Surgery?
- Routine examination
- OPD expenses
- Non-allopathic treatment
- Unproven treatment
- Dietary supplements
- Substances for health
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 they should be preserved 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 cataract symptoms.
If you have any questions related to health insurance for cataracts, ask experts at PolicyX.com. Our only motto? No Spam, No Gimmicks, Only Expert Insurance Advice.
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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& 039;s case and medical history, however not all plans cover laser cataract treatment. Read the policy wordings carefully before making any decision.
6. Is cataract surgery covered by medical insurance in India?
Yes, most health insurance plans in India cover cataract surgery.
7. How much can I claim for cataract surgery?
Claim limits vary by policy. Check your policy documents for specific details.
8. What is the waiting period for cataract surgery in Care Health Insurance?
The waiting period varies, typically around 2 years. You need to confirm with Care Health Insurance.
9. Is cataract surgery covered by ICICI Lombard health insurance?
Yes, ICICI Lombard health insurance does cover cataract surgery, review the policy for details.
10. Is cataract surgery covered by Bajaj Allianz health insurance?
Yes, Bajaj Allianz health insurance does cover cataract surgery, review the policy for details.
11. How do you get covered for cataract surgery?
Purchase a comprehensive health insurance plan that includes cataract surgery coverage. Ensure you understand the waiting period and coverage limits.
12. Are advanced IOLs covered by my insurance?
This varies greatly by policy. Many basic policies cover mono-focal lenses, while more expensive multi-focal or toric lenses may not be covered, or only partially covered.
13. What documents are required to claim for cataract surgery?
Typically, you’ll need the doctor’s prescription, hospital bills, discharge summary, and policy documents. Contact your insurer for a complete list.
14. If my cataract is caused by a pre-existing condition like diabetes, will it be covered?
Yes, in the case of pre-existing conditions, the waiting period may vary.
15. What is the limit for cataract surgery in the Care health insurance?
Care Health Insurance coverage for cataract surgery varies by plan, typically ranging from ₹20,000 to ₹30,000 per eye or a percentage of the sum insured, but specific limits and IOL coverage depend on your policy; therefore, reviewing your policy documents or contacting Care Health Insurance directly is essential for accurate details.
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Written By: Simran Saxena
Simran has over 4 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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