Cataracts are one of the leading causes of vision impairment, particularly among older adults. While cataract surgery is a common and effective treatment, the associated costs can be significant. This is where health insurance plays a crucial role. Many health insurance policies in India now offer coverage for cataract surgery, helping policyholders manage medical expenses without financial strain.
This article delves into the details of cataract surgery health insurance, including important considerations, inclusions and exclusions of the coverage and benefits.
Is Cataract Surgery Covered Under Health Insurance?
Most health insurance schemes in India cover cataract surgery costs but include a limit for claims and a waiting period. In India, cataract surgery costs range from Rs. 50,000 to Rs. 1,20,000, depending on the patient’s age, the type of surgery, and the chosen hospital.
In specifications, phacoemulsification cataract surgery costs Rs. 40,000 per eye, and extra-capsular cataract surgery costs up to Rs. 60,000 per eye. Bladeless cataract surgery costs approximately Rs. 85,000 to Rs. 1,20,000 per eye, along with hospital charges, surgeon fees and medication, which are costly enough to operate. So everyone should have cataract surgery health insurance, especially needed for individuals with critical illnesses:
- Family history of cataracts or vision loss
- Diabetes
- Extreme exposure to ionising radiation, such as X-rays and cancer radiation therapy
- Hypertension
- Vitamin deficiency
- Excessive drinking and smoking
- Eye inflammation, Injury and surgery
- Prolonged use of corticosteroid medicines
What are the Coverage Benefits of Having Health Insurance for Cataract Surgery?
The coverage benefits of medical insurance for cataract surgery are the following:
1. Financial Security
Cataract health insurance coverage ensures financial security by paying medical bills for routine and unexpected medical care, check-ups and treatments. This insurance plan reduces the financial burden and safeguards the policyholder from the high medical costs of high-quality treatment for critical care illnesses and advanced surgeries.
2. Hassle-Free Medical Care
Health insurance coverage can reduce out-of-pocket expenses for performing surgery on each eye. Cataract surgery health insurance covers the expenses of surgery costs, doctor fees, room charges and future health check-ups. So, policyholders and their family members can focus on treatment rather than finance.
3. Day Care Facility
Cataract surgery health insurance authorises access to a large network of hospitals, specialist surgeons, and clinics without worrying about expenses. Moreover, cataract surgery can be completed on the day of patient admission, and patients are not required to stay overnight in the hospital. As a day-care treatment, cataract surgery comes under a cashless treatment facility based on the insurance policy.
4. Better Customer Service
Health insurance companies are currently offering in-house claim settlements with just a formal request from the policyholder for more promising customer service. Moreover, policyholders can get cashless claims settlement within 2 hours without involving a third-party administrator. This health insurance facilitates the fastest claim settlement under reimbursement within 7 days of application.
5. Advance Diagnosis Facility
This health insurance policy covers advanced treatment procedures, such as bladeless or laser cataract surgery, including treatments listed under IRDAI guidelines. Eye surgery due to underlying conditions of diabetes and kidney failure, including stem cell therapy for tissue repair as an advanced diagnosis, is covered under a health insurance plan.
6. Pre- and Post-Surgery Care Expense
Cataract surgery health insurance provides clinical expenses incurred before hospitalisation, including ambulance charges, doctor consultation fees, and diagnostic tests. Policyholders can access post-surgery care expenses up to 10% of insurance coverage for medications, follow-up treatments, and tests for monitoring surgical progress.
What are Considerable Factors for Purchasing Cataract Surgery Insurance?
Individuals above 45 should purchase plans, such as health insurance for senior citizens to cut down on the excessive costs of eye surgery. Before buying any health insurance policy, consider the following:
- Coverage Limits per Policy Period
A cataract surgery insurance policy typically covers OT charges, surgery costs, the surgeon’s fee, the nurse’s fee, and operating room charges. The policy includes ambulance charges and post-hospitalisation care.
- Coverage Facilities per Eye
Coverage of cataract surgery costs per eye, along with pre-hospitalisation activities. It includes costs of diagnostic examinations, such as retinal examination, visual acuity test etc., specialist consultation, and medications.
- Network Hospital Option
The policy includes an extensive network of hospitals and diagnostic centres to benefit from cashless treatment. Kindly check the list of networking hospitals and clinics under the insurer to get better quality medical care.
- Sum Insured
Ensure that the insured amount is sufficient to cover all your medical expenses related to cataract diagnosis, treatment per eye, and post-surgery care.
- Premiums and Payment Flexibility
Review the premium amount; it varies depending on the insurance policy category and sum insured. Most insurance policies deliver flexibility in premium payments, such as half-yearly, quarterly or annual payments.
- Waiting Period for the Pre-existing Diseases
Most health insurance schemes maintain a pre-existing disease waiting period, which can be 1 or 2 years from the policy start month or date.
Individuals must review the conditions and terms of the cataract surgery health insurance policy to avoid unexpected out-of-pocket expenses.
How to Purchase Cataract Surgery Health Insurance?
The online process of purchasing cataract surgery health insurance depends on some basic steps, including:
- Step 1: Visit the official website of any health insurance company of your choice
- Step 2: Click the “Buy Now” option shown in the top right corner
- Step 3: Provide the required details, your name, date of birth, email address, and address PIN code
- Step 4: Select your considerable insurance amount and term period
- Step 5: Verify the provided details with the documentation of the required details
- Step 6: Select the calculative premium amount and click on “Buy Now” to complete the insurance purchasing process and make payment
Conclusion
Cataract surgery health insurance policy covers the cost of the surgical process per eye, hospitalisation costs, and pre-and post-surgery expenses. Before buying a health insurance policy, everyone should consider coverage limits per policy period, network hospital options, waiting period and insurer credibility.