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Is Cataract Surgery Covered by Insurance?

Yes, cataract surgery is covered by medical insurance in India. Insurance makes it easier for patients to cover the overall expense of cataract surgery. However, the terms and conditions around the coverage and the amount you can claim may vary for each patient.

Yes, cataract surgery is covered by medical insurance in India. Insurance makes it easier for patients to cover the overall expense of cataract ... Read More

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Cataract Surgery Treatment Insurance Claim
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No-Cost EMI

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1-day Hospitalization

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USFDA-Approved Procedure

USFDA-Approved Procedure

Cataract Treatment with Insurance at Pristyn Care

Hospitalization Expenses
Get a wide range of expenses associated with surgery covered seamlessly, including room rent, medical procedures, diagnostic tests, surgeon’s fees, nursing fees, ICU costs, OR charges, etc.
Pre & Post Hospitalization
Comprehensive coverage as specified by your insurance, including preparation and recovery for 30/60 days before and after hospitalization. Additional support through free follow-ups beyond the policy.
Cashless Payment
Eliminate the need to carry cash and make the payment process swift and easy. Pay and track the hospital transactions with added security.

Is Cataract Surgery Covered by Medical Insurance?

A cataract is a very serious condition that progresses slowly but can significantly impair vision. It affects the quality of life of the patient. And if left untreated for a long time, it can lead to blindness. Thus, the treatment is medically necessary.

As there is no natural cure for cataracts, surgery is the only option. The surgery can successfully restore vision. Thus, to ensure that the patient doesn’t lose vision, insurance companies offer ample coverage for cataract surgery in the base policy.

Typically, the cataract surgery cost with insurance in India ranges from Rs. 25,000 to Rs. 1,40,000 approximately. The actual cost may vary for each patient depending on factors like doctor’s fees, diagnostic tests, hospitalization fees, cataract lenses, post-surgery care, etc. If a patient has health insurance, they can get maximum coverage for the procedure and optimal care at their choice of hospital.

• Disease name

Cataract

• Surgery name

Phacoemulsification

• Duration

4 weeks

• Treated by

Ophthalmologist

Cataract Surgery Surgery Cost Calculator
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Types of Cataract Surgery Covered by Insurance & Their Cost
All types of surgery, including phacoemulsification, MICS, and FLACS, are covered by health insurance. Though the cost of each technique is different, the insurance plan will cover the cost of treatment entirely or partially. For instance, phacoemulsification cataract surgery costs around Rs. 25,000 to Rs. 40,000 per eye, extracapsular cataract surgery costs around Rs. 40,000 to Rs. 60,000 per eye, and bladeless cataract surgery costs around Rs. 85,000 to Rs. 1,40,000. *Note- Bladeless procedures involve MICS (micro-incision cataract surgery) and FLACS (Femtosecond laser-assisted cataract surgery).
1 Intimation
Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval
2 Approval/Rejection
Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval
3 Hospitalisation
Hospitalisation can be done on the basis of pre-auth approvalHospitalisation can be done on the basis of pre-auth approval
4 Claim Settlement
At the time of discharge, we settle the claim directly with hospitalAt the time of discharge, we settle the claim directly with hospital
1 Hospitalization At Non Network Hospital
You need to pay the bills initially and preserve the original invoices
2 Register A Claim
Post hospital discharge send us all your invoices and treatment documents
3 Verification
We verify your claim related invoices and treatment documents
4 Claim Settlement
We send the approved claim amount to your bank account
Top Specialists for Cataract Surgery
  • online dot green
    Dr. Prerana Tripathi (JTV8yKdDuO)

    Dr. Prerana Tripathi

    MBBS, DO, DNB - Ophthalmology
    15 Yrs.Exp.

    4.6/5

    15 + Years

    location icon Pristyn Care Clinic, Indiranagar, Bangalore
    Call Us
    8527-488-190
  • online dot green
    Dr. Tushara Aluri (GKxcGEGDHn)

    Dr. Tushara Aluri

    MBBS, DO-Ophthalmology
    22 Yrs.Exp.

    4.6/5

    22 + Years

    location icon Hyderabad
    Call Us
    8527-488-190
  • online dot green
    Dr. Deependra Vikram Singh (3DyND2oYFW)

    Dr. Deependra Vikram Sin...

    MBBS, MD-Ophthlamology
    15 Yrs.Exp.

    4.6/5

    15 + Years

    location icon Delhi
    Call Us
    8527-488-190
  • List of Top Health Insurance Providers for Cataract Surgery

    Here, we are listing some of the popular health insurance providers in India. You can take a look at them and choose the best plan yourself.

    • Aditya Birla Health Insurance
    • Future Generali Health Insurance

    Many other reliable insurance providers offer various health insurance plans according to the patient’s needs. Choose the plan most suitable for you.

    Are you going through any of these symptoms?

    All Major Insurance Accepted

    Difference Between Health Insurance and Mediclaim

    Many people feel confused about health insurance and mediclaim policies, thinking they are the same. However, there is a key difference between these two types of medical coverage.

    Mediclaim is a policy that offers specified financial protection for medical emergencies. An individual can only cover the treatment expenses if he/she is hospitalized. Unlike this, health insurance is a policy that offers comprehensive coverage for medical and surgical treatments, regardless of hospitalization. Health insurance allows an individual to cover expenses, such as annual health checkups, daycare surgery, OPD expenses, alternative treatments, post-surgery consultations, etc.

    Furthermore, there is a limit on the hospitalization cover, stating that the expenses should not exclude Rs. 5,00,000. In contrast to mediclaim, a health insurance policy provides flexibility and the cover limit is calculated on the basis of age, city, number of members in a single plan, etc. Overall, health insurance policies are more beneficial for people compared to mediclaim policies.

    Pristyn Care’s Free Post-Operative Care

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    Frequently Asked Questions about Cataract Surgery Insurance Cover

    Does health insurance provide coverage for pre and post-surgery expenses?

    Most health insurance policies don’t cover the expenses incurred before or after undergoing cataract surgery. It means that if the patient has had diagnostic tests before or after the surgery, he/she will have to bear the expenses on his/her own. Other expenses, such as prescription eyeglasses, eye drops, medications, etc., also won’t be covered by health insurance or mediclaim.

    Why is the cost of the premium intraocular lens not covered by health insurance?

    Health insurance policies only provide coverage for treatments and visual aids that are considered a medical necessity. As premium intraocular lenses are a personal choice to improve vision, their cost is not covered by insurance or mediclaim. It means if the patient chooses a multifocal or toric lens, the insurance company will not pay for them.

    Is cataract surgery performed on both eyes at the same time?

    No, generally, cataract surgery is performed on one eye at a time. This is to ensure that the patient can perform basic activities. If both eyes are treated at the same time, the patient’s vision will be compromised for a few days which can make his/her regular life difficult.

    Can I claim insurance for cataract surgery twice?

    Yes, for example - Bajaj allianz cataract limit, as cataract surgery is performed only on one eye at a time, the patient has to file the claim request again when the second eye is being treated. The claim request and approval process remains the same.

    Which documents are required to get approval for the claim request?

    The following documents should be submitted with the claim request to get authorization from the insurance providers- The patient’s health card issued at the time of inception of the Policy (if available) supported with KYC document The policy number Name of the policyholder Name and address of Insured Person in respect of whom the request is being made Nature of the Illness/Injury and the treatment/Surgery required Name and address of the attending Medical Practitioner Hospital where treatment/surgery is proposed to be taken Date of admission First and any subsequent consultation paper/Medical Record since the beginning of diagnosis of that treatment/Surgery Admission note Treating Medical Practitioner certificate for Illness / Insured Event history with the justification of Hospitalization The insurance provider will validate the documents as soon as possible and approve the claim request after verification.

    Expenses Covered by Medical Insurance

    Here is a breakdown of the expenses that are usually covered by health insurance-

    • Hospitalization expense which includes admission fees, bed charges, room rent, medical consumables, ICU charges, OT charges, nursing fee, etc.
    • Pre and post-surgery hospitalization expenses, such as pre-surgery consultation and follow-ups.
    • Ambulance cost is also covered in the policy, usually up to Rs. 2,000.
    • Cost of medicines given to the patient during the stay.
    • Surgeon’s fees, anesthetist’s fees, and anesthesia costs.
    • Cost of standard intraocular lens, i.e., monofocal lens.
    • Second opinion from another doctor.

    Insurance policies are offered to people so that they can get optimal care without worrying about expenses. However, there are some exclusions in the insurance plans which people are usually not aware of.

    Expenses Not Covered by Medical Insurance

    Please keep in mind that the following expenses or mediclaim limit for cataract operation are not covered by health insurance under any circumstance-

    You’ll have to bear the cost of these on your own.

    Standard Clause of Medical Insurance for Cataract Surgery

    There are several clauses mentioned in insurance policies that can limit the amount of sum insured that can be claimed for cataract surgery or even exclude them from getting any coverage.

    Waiting Period 

    Most health insurance policies come with a waiting period of 2 years for cataract surgery coverage. This means that the patient has to wait for at least 2 years before he/she can file a claim. This clause is added to the policy to ensure that the policyholders don’t purchase the policy only to cover the expense of the cataract operation.

    In corporate insurance policies, there may not be a waiting period clause in the insurance policy. To clearly understand the terms and conditions, it will be best to talk to the healthcare providers.

    Claim Limit 

    Insurance providers also put a cataract surgery insurance claim limit on the amount of the policyholders for cataract surgery. Any additional expense that is incurred during or after the treatment over the specific sub-limit must be borne by the patient.

    The good thing is that the limit on claim amount is usually not the same across policies. So, while purchasing a health insurance policy, make sure that you go through the terms and conditions carefully and ensure that you can avail the full sum insured amount for most surgical treatments, including cataract surgery.

    Cataract Surgery Insurance Claim Process

    Thanks to modern technologies, cataract surgery is performed on a daycare basis. Thus, insurance policies cover the treatment under daycare procedures. This means that the patient doesn’t need to be hospitalized for 24 hours to get a claim.

    The insurance companies offer two options to make a claim for cataract surgery- cashless and reimbursement and the process for each are slightly different.

    Cashless Claim 

    To get a cashless claim from the insurance company, you are obliged to choose a network hospital to undergo cataract surgery.

    Step 1- Inform the insurance provider at least 3 days before the procedure and fill out the cashless form. The hospital’s TPA team will coordinate with the insurance company to get the claim beforehand.

    Step 2- The insurance company will send you an email or message or both to confirm that your claim request is approved.

    If your claim amount is lesser than requested, you can always submit a second claim request to ask for more coverage for the procedure.

    Reimbursement Claim 

    Step 1- Choose a hospital and schedule your surgery. Let the insurance company know that you’ll be undergoing surgery. You can also choose to inform the insurance provider within 2 days of admission.

    Note- It will be best to inform the company earlier to avoid issues with the paperwork and claim process.

    Step 2- Get the reimbursement form online or from your insurance agent. Fill the form and submit all paperwork, including discharge summary, pre and post-surgery evaluations, and other bills.

    Step 3- As soon as the documents are submitted, the insurance company will validate them and reimburse the total amount of surgery at the earliest.

    You will also get notified if your claim is denied. It should also be noted that there is a specified duration within which a patient can get a reimbursement claim. Typically, this duration is 30 days after surgery. This period may vary depending on the insurance plan.

    Contact Pristyn Care to Undergo Cataract Surgery With/Without Insurance

    If you have been diagnosed with cataracts and need to undergo surgery, you can always contact Pristyn Care. We offer best-in-class services for cataract patients. We also provide assistance to the patients to get the maximum amount of claim against the treatment.

    As more than 80% of Indians don’t have an insurance policy, they can’t avail the benefits of health coverage. Thus, Pristyn Care provides affordable medical care along with services that reduce the expense of treatment at the patient’s end. The services include-

    • Free initial consultations
    • Free transport service on the day of surgery
    • Multiple follow-up consultations without additional fees
    • Flexible payment options, including cash, credit cards, and health insurance
    • No-Cost EMI service to divide the treatment cost in easy installments

    You can give us a call to learn more about our services.

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