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All about Cataract Treatment Coverage in Your Health Insurance

Team AckoJan 17, 2024

Eyes enable you to see the world. They are often appreciated with adjectives such as beautiful, soulful, intense, etc. People get uneasy even if a tiny dust particle enters the eye. Thus, one can only imagine the discomfort associated with eye-related diseases.

One of the prominent issues associated with human eyes is cataracts. And like in the case of other major diseases, people look towards medical insurance plans to safeguard their finances with respect to cataract surgery.

Read ahead to know more about cataract treatment coverage in medical insurance plans.




What is a cataract?

Cataract is a disease associated with the human eye. It causes clouding in the eye leading to impaired vision. There are three types of cataracts; subcapsular, nuclear, and cortical. If not treated promptly it can also lead to blindness. If you feel your vision has been hazy and blurred for a long time, it is suggested to visit an eye doctor at the earliest.

Whom does it affect?

People above 60 years of age are vulnerable to cataract. In some cases, cataract has also affected people in their 40’s; this can be associated with lifestyle changes. Smoking, diabetes, etc. can also actuate cataracts.

Does medical insurance in India cover cataract?

Medical insurance in India does cover cataract surgery. However, not all policies offer such a cover. Thus, you must have a look at the policy’s inclusions before purchasing. In case you have already purchased the policy and want to check if it covers a cataract surgery, you can go through your policy document for a detailed understanding of the coverage.

Is there a waiting period?

Yes, there is a waiting period associated with a cataract cover. Generally, such a waiting period is for two years. This means you will have to wait for a period of two years (from the policy purchase date) to undergo cataract surgery and raise a claim for it. If you go for a cataract surgery before the expiry date of the waiting period, the insurance company is not liable to honor your claim request.

Is there a claim limit?

Some insurers might have a limit some might not. It solely depends upon the insurer’s discretion. However, whether there are limits or not shall be communicated upfront. Thus, one must be diligent and read through the policy’s inclusions and exclusions before purchasing the plan.

Some insurers might have claim limits based on the sum insured. For example, for a sum insured of Rs. 4 lakhs, the claim limit for cataract shall be Rs. 30000. In some cases, it can be on a percentage basis as well. For example, 10% of sum insured up to Rs. 25000 (maximum).

Is cataract covered in a group plan?

There is scope for covering cataract in a group plan. For example, the group insurance policy offered by your employed might offer cataract coverage. However, again, it depends upon the insurer offering the plan. In some cases, there might be no waiting period as well.

Health insurance policy online:

Thanks to digitization. You can purchase a health insurance policy online. Unlike the previous era, you do not have to rely on an agent for buying a health insurance policy. You can simply go online, compare policies and select the one that meets your requirements based on the coverage and the premium. One must also consider the insurer’s credibility and service quotient while purchasing the policy. If it is a new company, you can go through their website to understand their service proposition in detail. Policies of new companies have exciting features at a low price.

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Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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