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Health Insurance For Cataract Surgery

A cataract is the most common eye condition, which is caused by the formation of a dense, cloudy area in the lens of the eye that individuals tend to have as they grow older. Cataract problem occurs usually at the age of 40 and above. In India, a conventional cataract surgery (phacoemulsification) costs Rs 20,000 to Rs. 65,000 for both the eyes, whereas the new bladeless surgery can cost Rs 85,000 to Rs 1.2 lakh. As there is no natural cure for cataracts, we have to undergo a process surgery to get rid of cataracts. If the surgery is not taken on time, the cataract may lead to some serious eye issues, even blindness. 

Cataracts can be caused due to multiple reasons. The most common reason for the cataract problem is the rise and prevalence of diabetes in India. Apart from diabetes, there might be various reasons for this eye problem; some of them are – overproduction of oxidants, smoking, ultraviolet radiation, the long-term use of steroids and other medications, certain diseases, such as diabetes, trauma from past injuries to the eye, radiation therapy, and so on. So, when a person is diagnosed with a cataract in his/her eyes, health insurance is needed to take care of its expenses.

Why Should You Get Health Insurance Covering Cataract Surgery?

Health insurance with the cataract cover is very important to have a cataract is very much common among the people of India, it is almost certain that you need to undergo cataract surgery. To know more about its importance, have a look at the below mentions.

To save you financially – As stated before that cataract surgery can cost you Rs. 25,000 to Rs. 1lakh or above, it may cause a financial burden on your shoulder. But if your health insurance policy covers cataracts, then you do not have to face such a crisis as it will compensate up to a certain limit for the expenses. 

Surgery is mandatory – For cataracts, surgery is the only option that you have to cure the problem. So, sooner or later, you have to undergo this process to restore your vision and to get through the symptoms and repercussions of a cataract.

To avoid partial or complete blindness – With the growing age and eye condition depending on the multiple factors, the cataract problem may get worse if it is left untreated. Even, it can lead to partial or complete blindness of the affected eye if not taken proper measures on time. Henceforth, it is important to take care of your eyes and take every possible measure to restore your vision. For that, a health insurance policy with cataract cover is very important.

To restore vision – With the advancement of medical science in India, cataract surgery is one of the less complex and safe surgeries. It can not only cure your cataract but also can restore your vision fully and thus provides you rejuvenated and cured eyes, which are considered to be the most important parts of our body.

To improve the quality of life – If you have an untreated cataract, it raises the complexities to live with that. If the vision is blurred, it is needless to say how many difficulties you have to face in everyday life. Even, it can make you a burden on someone. So, a health insurance policy with cataract cover is almost an indispensable part of life to get a beautiful, healthy, and independent life.

Popular Health Insurance Plans in India With Cataract Surgery Coverage

In India, keeping in mind the importance of cataract surgery, most health insurance companies have come up with health insurance products that can offer you coverage for cataract surgery. Some of the popular plans and companies are stated in the following table.

Company namePlan name
ICICI LombardiHealth ICICI Lombard Complete Health Insurance
Care Health InsuranceCare Senior
Star Health InsuranceSenior Citizens Red Carpet Health Insurance Policy
Oriental InsuranceHappy Family Floater Policy
SBI General InsuranceArogya Supreme Health Insurance
Bajaj AllianzHealth Care Supreme

Mediclaim Policies For Cataract Surgery

To know more about these plans and their key features in detail, have a look at the following mentions.

1. iHealth ICICI Lombard Complete Health Insurance

This policy secures your finances against sudden medical expenses, including cataract surgery. It is a comprehensive policy for you and your family, designed to cater to most of your common healthcare needs. This policy offers you to enjoy additional sum insured that is the sum insured of your medical insurance policy for the family is increased by 10% for every claim-free year up to a maximum of 50%.

Key Highlights of Policy:

  • Under this policy, cataract cover is available whereas the sub-limit of Rs. 20,000/- is applicable per eye per Policy year for Plans with a Sum Insured up to 5 Lakhs. Sub limit of Rs. 1,00,000 per eye per Policy year will be applicable for cataract treatment for plans with a Sum Insured above Rs. 5Lakhs.
  • Domestic road emergency cover for the transportation of the patient to a hospital is available with this policy along with the AYUSH treatment cover.
  • Medical expenses for day care procedures in case of In-patient hospitalization for a continuous period of fewer than 24 hours are covered by this policy.
  • It has come up with a long list of add-on covers to enhance the benefits and the facilities of the policy. Those additional covers are – Hospital Daily Cash, Convalescence Benefit, Critical Illness, and Donor Expenses.

Eligibility Criteria:

ParametersDescription
Minimum entry age

Adults – 18 years, Dependent children – 91 days

Pre-hospitalization coverUp to 30 days
Post-hospitalization coverUp to 60 days
Income tax benefitAvailable, under Section 80D
Grace period30 days
Free look period15 days
Sum insuredRs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, Rs. 5 lakhs, Rs. 7 lakhs, Rs. 10 lakhs, Rs. 15 lakhs, Rs. 20 lakhs, Rs. 30 lakhs, and Rs. 50 lakhs.

2. Care Senior Plan

You can age gracefully with this Care Senior plan offered by Care Health Insurance without worrying much as this is a comprehensive health insurance plan that includes your cataract surgery expenses too. With this policy, both the individual and the family floater variants are available and for availing of the policy, you do not even go through pre-policy medical check-ups.

Key Highlights of Plan:

  • Under this policy, the cover for the expenses for the treatment of cataracts is available, whereas the sub-limit is up to Rs. 20,000 per eye for the sum insured Rs. 3 lakhs and for the sum insured of Rs. 5 lakhs, Rs. 7 lakhs, and Rs. 10 lakhs, the sub-limit is 30,000.
  • Pre and post-hospitalization expenses are covered up to a certain day limit and also day care cover, emergency ambulance cover, organ donor cover, and domiciliary hospitalization covers are available.
  • Under this plan, the second option facility is available and you can also opt for an alternative treatment that is subject to a certain limit.
  • To cater to your specific needs, this plan has come up with some add-on covers to enhance the benefits of your policy according to convenience and they are – Covid Care, Reduction in PED Wait Period, No Claim Bonus Super, OPD Care, Care Shiel, and Co-payment Waiver.

Eligibility Criteria:

ParametersDescriptions
Entry age

Minimum – 61 years, Maximum – Lifelong

Grace period30 days
Waiting period

In general – 30 days

For named alignments – 2 years, For pre-existing diseases – 4 years

Tenure options1, 2, 3 years
RenewalLifelong renewability
Co-payment20% per claim, when the age of the insured member is 61 years or above.
Sum insuredRs. 3 lakhs, Rs. 5 lakhs, Rs. 7 lakhs, and Rs. 10 lakhs.

3. Senior Citizens Red Carpet Health Insurance Policy

This plan is specially designed for senior citizens so that they can live the golden days of their life with full protection, safety, and without any anxiety. This plan accepts pre-existing diseases and to avail of this policy, you do not have to take any pre-policy medical check-up. One unique feature of this plan is guaranteed constant premium with a lifetime renewal facility.

Key highlights of the policy:

  • Treatment of Cataracts and diseases of the anterior and posterior chamber of the eye is covered under this policy. Cataract limits are revised and made super customer-friendly.
  • Cost of Health Check-up for every claim free year up to the limits specified and expenses of All day-care procedures are covered.
  • This plan promises to protect the insured person from in-patient hospitalization expenses for a minimum of 24 hrs. These expenses include room rent, nursing and boarding charges, Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs up to the limits specified.
  • Expenses on Medical Consultations as an Out-Patient in a Network Hospital are also covered up to a certain limit as specified in the policy wordings.

Eligibility Criteria:

ParametersDescriptions
Entry age

Minimum – 60 years

Maximum – 75 years

Policy term1, 2, and 3 years
Policy type

Individual sum insured basis

Family floater sum insured basis

Sum insuredRs. 1 lakh to Rs. 25 lakhs
Premium installmentsQuarterly, half-yearly, Annually, Biennial (Once in 2 years), and Triennial (Once in 3 years.
Co-paymentThis policy is subject to a co-payment of 30% for all claims.
Coverage for modern treatmentAvailable

4. Happy Family Floater Policy

This policy offers you protection against multiple diseases and ailments including cataracts. As this has come up with three variants, the policy-seekers can choose as per their convenience to suit their purposes. All the variants are full of benefits and facilities.

Key highlights of the policy:

  • Under this policy, for cataract treatment, the waiting period is 2 years. The vascular disease affecting only the eye or optic nerve or vestibular functions is also covered by the policy.
  • Medical second opinion benefit and telemedicine expenses cover are available under this policy.
  • This plan has offered a unique feature and that is the Life Hardship Survival Benefit under all the variants of the plan.
  • Maternity expenses cover and the new born baby cover is provided.

Eligibility Criteria:

ParametersDescriptions
Entry age

Adults

Minimum – 18 years, Maximum – 65 years. Can be extended up to 70 years.

Dependent children:

Minimum – 91 days, Maximum – 25 years

Plan variantsSilver. Gold and Diamond
Policy term1 year
Sum insuredRs. 1 lakh to Rs. 20 lakhs (depends on the chosen variant)
Waiting period90 days, 1 year, 2 years, and 4 years (depends on the alignment)

5. Arogya Supreme Health Insurance

This is a comprehensive health policy offered by SBI General Insurance that has come up with 20 basic covers and 8 optional covers to cater to your needs. This plan is inclusive of the cover for the cataract surgery. Under this plan, a wide range of sum insured options is available.

Key highlights of the policy:

  • Exclusive covers like domestic air ambulance cover, compassionate benefit, recovery benefit, and e-opinion cover are available under this policy.
  • NCB protector optional cover is available with this policy to protect cumulative bonus and enhanced cumulative bonus.
  • This policy has also come up with multiple discounts such as family discounts, loyalty discounts, and term policy discounts.
  • Domestic emergency assistant services including road ambulance and air ambulance cover are available for the transportation of the patient to the hospital.

Eligibility Criteria:

ParametersDescriptions
Minimum Entry AgeAdult – 18 years, Dependent children – 91 days
Maximum age at entryAdult – 65 years, Dependent children – 25 years
Policy duration1, 2, and 3 years
Preventive health check-ups coverAvailable

6. Bajaj Alianz Health Care Supreme

It is a comprehensive plan with a wide range of benefits that ensures a cover for maximum expenses related to Illness and Accidents. It is an ideal plan if you want to have a health insurance plan with cataract cover as apart from the cataract cover, it has come up with a sack full of benefits.

Key highlights of the plan:

  • For cataract treatment, the waiting period for this policy is 1 year.
  • To avail of this policy, no pre-policy medical tests are required up to 45 years, subject to no adverse health condition. But, for certain ailments like diabetes, hypertension, obesity, etc. it is mandatory to undergo a pre-policy medical check-up.
  • Hospitalization expenses, including pre and post-hospitalization expenses, are covered under this policy.
  • Sum Insured Reinstatement Benefit, Recovery benefit, and AYUSH treatment expenses are also covered by this policy.

Eligibility Criteria:

ParametersDescriptions
Minimum entry ageAdults – 18 years, Dependent children – 3months
Maximum entry ageAdults – Lifetime and 65 years, Dependent children – 25 years
RenewalAdults – Lifetime, Dependent children – Up to 35 years
Policy typeIndividual and family floater
Grace period30 days

Waiting Period For Cataract Surgery

Most of the health insurance plans with cataract coverage come with a waiting period of 2 years, which indicates that the policyholders will have to wait for 2 years after the date of policy purchase to avail of the cataract coverage. Insurers include this clause in the policy terms to make sure that policyholders shouldn’t take a health insurance plan only to meet the expenses of their cataract operation.

However, if you buy a health insurance policy with cataract coverage at a young age, you can claim the cataract coverage in the later stages of your life whenever required. But, to be sure about the waiting period for cataract coverage, make sure that you go through thoroughly the policy wordings and terms and conditions of the insurer and talk to the insurance provider about the waiting period clause for the cataract surgery to avoid future complexities.

How To Avail Health Insurance For Cataracts?

Many health insurance providers in India offer health insurance products that cover the cataract treatment expense. These plans can be bought offline and online, as well, depending on the availability of the insurer. Both buying procedures are explained below.

Online Process:

The plans that are available online, to buy those products easily you need to follow the steps below.

  • Go to the official website of the insurer of the product that you have chosen.
  • Select the desired health insurance policy with cataract cover.
  • Put the necessary credentials and details such as personal details, policy related details, add-on cover if any, and so on.
  • Pay the amount displayed before you.
  • On successful payment, you will be notified about the same through your registered mobile number or/and email ID. 

Offline Process:

For buying the policies offline, you can opt for any of the following processes.

  • Go to the nearest branch of the insurer and their experts will be there to guide you through the buying process smoothly.
  • You can also contact the customer service of the insurance company and their executives are helpful enough to assist you through the entire purchasing procedure.
  • You can write to the company via email or can call them or even, you cab=n also contact the insurer availing of their message or WhatsApp service, if available to purchase the policy.
  • Apart from these, you can also contact one of the registered and licensed agents of the company. They are knowledgeable and experienced enough to help you through the procedure.

Frequently Asked Questions

No, it totally depends on the insurance company that you have chosen, the plan you have selected, and the terms and conditions of the policy. It is always advisable, to check thoroughly the policy wordings before buying one.

The insurance companies decide the claim limit for cataract surgery depending on multiple factors. However, some insurance providers may not have such a claim limit. For better understanding, do check the policy wordings and contact the insurance provider.

The probable risk factors associated with cataracts are as follows:

  • increasing age
  • heavy alcohol intake
  • regular smoking
  • obesity
  • high blood pressure
  • previous eye injuries
  • family history of cataracts
  • too much sun exposure
  • diabetes
  • exposure to radiation from X-rays and cancer treatments.

Under this policy, the available value added services are as follows:

  • Free health check-up coupon to Insured for every Policy Year, subject to
  • a maximum of 2 coupons per year for floater policies.
  • Online Chat with Medical Practitioners
  • Specialist e-Consultation with One Follow-up session
  • Diet & Nutrition e-consultation.

Under this plan, you can avail of a tax exemption benefit on the premium paid by you to the plan, which is subject to a maximum limit of Rs. 75,000 under section 80D of IT act 1961.

Though there is no pre-acceptance medical screening, if the following medical records of the person proposed for insurance are submitted, a discount of 10% is allowed.

  • Stress Thallium Report
  • BP Report
  • Sugar (blood & urine) (Fasting / Postprandial)
  • Blood urea & creatinine

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres are not covered by the policy.

No, the expenses of obesity and weight control treatments are not covered under the Arogya Supreme Health Insurance policy.

No, the Health Care Supreme plan does not offer coverage for laser treatment for correction of eyesight.

Yes, if your existing health insurance plan does not cover the expenses of cataract surgery, you need to buy an additional cover for the same, if it is available with the insurer.

Apparently, there is no way to prevent cataracts. But you can minimize the probability or can delay the problem if you take the following preventive measures.

  • As the UVB rays are harmful to the skin, the same is for the eyes as well. Try to wear specific sunglasses to protect your ever from UVB rays.
  • Regular eye check-up is very important, especially if you face eye issues or are above the age of 40 or 50.
  • Smoking is injurious in multiple ways. Even it put a direct effect on your eyes. So, maintaining a healthy lifestyle and eating healthy food such as fruits, green vegetables, antioxidants is very necessary.
  •  If you are an obese person, try to check your weight quickly as it can advance your cataract problem. Same for diabetic patients as it is very much harmful not only for the body but also for your eyes.

No, just because you are diabetic that does not mean that you have a cataract. But, it is said and medically proved that people who have severe diabetes for a longer period of time, are more prone to have cataract problems.

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