Is Cataract Surgery Covered by Health Insurance?
Yes, health insurance plans cover the costs of cataract treatment, subject to the policy terms and conditions. Under our family health insurance plans, the coverage for cataract includes:
- Surgeon’s fees
- Operation theatre charges
- Day-care hospital expenses
- Pre-hospitalisation tests
- Post-hospitalisation follow-up
Optional Benefits You Can Consider
When purchasing health insurance for cataract surgery, you may consider the following optional benefits available with Care Health Insurance plans:
- Unlimited Care: This add-on allows a single, large claim during the policy's lifetime to be paid, regardless of the coverage amount.
- OPD Care: Physical consultations with general physicians and specialist doctors.
- Grace Period Coverage: Policy coverage is extended to include the grace period during the policy term.
- Claim Shield Plus: Coverage for non-payable items under Annexure-I.
These benefits enhance overall protection beyond basic hospitalisation coverage.
>> Read more: Why You Can’t Afford to Skip Cataract Surgery Health Insurance
What is Covered and Not Covered under Health Insurance for Cataract Surgery?
Before purchasing health insurance for cataract surgery, it is important to review the coverage and the standard exclusions applicable under the policy:
- In-patient Hospitalisation: Hospital expenses such as room rent, ICU charges, doctor’s fees, and other medical costs during hospitalisation.
- Pre-hospitalisation Expenses: Consultations, diagnostic tests, and medicines incurred within 60 days prior to hospitalisation.
- Post-hospitalisation Expenses: Follow-up consultations, medicines, and diagnostic tests for up to 90 days after discharge.
- Modern Treatments: Specialised procedures, including robotic surgeries, and other advanced treatments as per policy terms.
- Domiciliary Hospitalisation: Covers medical treatment taken at home when the patient cannot be moved to a hospital.
- AYUSH Treatments: Ayurveda, Naturopathy, Unani, Siddha, and Homoeopathy, in accordance with policy terms.
- Waiting Period: Cataract treatment during the initial waiting period specified in the policy.
- Sub-limits: Expenses exceeding the specified sub-limit per eye as mentioned in the policy schedule.
- Premium Lenses: Cost of premium or specialised intraocular lenses beyond the base policy coverage.
- Elective Procedures: Non-medically necessary treatments or elective procedures are not covered.
- Non-Network Limitations: Treatment undertaken at non-network hospitals (specifically for cashless claims, unless filed for reimbursement).
- Non-Disclosure: Any pre-existing cataract condition not declared at the time of policy purchase.
Note: Policy exclusions may vary depending on the insurer and plan selected. Always review the policy wording carefully.
Looking for Cataract Surgery? Read How Much Does It Cost in India
Why You Need Cataract Surgery Medical Insurance
Having the right health insurance for cataract surgery ensures financial protection and access to quality treatment without delay. Without cataract surgery medical insurance, expenses may include:
- Diagnostic tests (eye scans, vision tests)
- Surgery charges
- Lens implantation cost
- Follow-up consultations
Things to Check Before Buying Cataract Surgery Health Insurance
Buying early ensures coverage before diagnosis, as new policies may not provide immediate benefits for pre-existing conditions. Before choosing a policy, review:
- Waiting period for cataract disease
- Sub-limit per eye
- Co-payment (especially for senior citizens)
- Network hospitals in your city
- Coverage for advanced lenses
Documents Required to Purchase Health Insurance for Cataract Surgery
Submission requirements may vary based on age, sum insured, and underwriting guidelines. Below is the standard list of documents required to purchase a health insurance policy covering cataract surgery:
- Identity Proof: Aadhaar Card, Passport, Voter ID, PAN Card
- Address Proof: Utility bills, Passport, Aadhaar Card
- Medical History Documents: Past medical records, especially related to cataract disease or other eye conditions (if applicable)
- Recent Medical Reports: As requested by the insurer during underwriting
How to File a Claim for Cataract Surgery
If your family member gets hospitalised due to a cataract, there are two types of claims you can make:
| Basis |
Cashless Claim |
Reimbursement Claim |
| When to Use |
When treatment is taken at a network hospital |
When treatment is taken at a non-network hospital |
| Step 1 |
Choose a network hospital |
Pay hospital bills upfront |
| Step 2 |
Inform the insurer before admission |
Collect all original documents |
| Step 3 |
Get approval from the insurer |
Submit the claim form and documents to the insurer |
| Step 4 |
Insurer settles eligible bills directly with the hospital |
Get reimbursed as per policy terms |
Choosing Care Health Insurance for Cataract Surgery
Selecting the right health insurance plan ensures financial protection for cataract surgery and other medical emergencies. Care Health Insurance offers:
- Wide network of cashless hospitals across India
- Coverage for day-care procedures, like cataract surgery
- Flexible sum insured options
- Easy digital policy purchase and renewal
- Dedicated claim support assistance
- Plans tailored for individuals, families, and senior citizens
Disclaimer: Plan features, benefits, coverage, and underwriting of claims are subject to policy terms and conditions. Please refer to the brochure, sales prospectus, and policy documents carefully.