Planning a Cataract Surgery? Here are Some Health Insurance Facts to Know


Medically reviewed by

Bajaj Finserv Health

Aarogya Care

4 min read

Key Takeaways

  • Cataract is a condition that causes clouding in the eye lens
  • Cataract is responsible for 80% of blindness in India
  • The cost of cataract surgery in India is Rs.65,000 on average

Eyes are among the more sensitive parts of the body. Any irritation or infection can affect their function, and your vision, to a great degree. A leading cause of blindness, cataract is one such condition. In India, it is the cause for around 80% of blindness cases. Some studies also suggest that it affects women, in some parts of the world, more than men.  This condition presents with clouding in the eye lens. If left untreated, the vision loss can lead to complete blindness. While the exact cause is still being studied, cataracts can be the result of high blood pressure, smoking, diabetes and other risk factors. It is treatable with laser technology surgery, but this is a costly procedure. Thankfully, with health insurance for cataract surgery, you can get this treatment with ease. This is why it is worth it to invest in comprehensive care health insurance for cataract.

Read on to know more about cataract healthcare plans and what to look for when buying one for you and your family. 

health insurance for cataract

Is the Treatment of a Cataract Covered Under Insurance Policy? 

The treatment of cataracts or the cost of cataract surgery is covered under health insurance plans. However, not all policies cover this cost. Some health insurers may exclude coverage for certain treatments, based on the policy you choose. So, go through the terms and conditions to know exactly which treatments are covered and for how much. Before buying a comprehensive health plan, check the policy document to know if cataract surgery is covered. This initial research is crucial to getting the most out of your policy.

Additional Read: Pre-existing Diseases Health Insurance: 7 Important Things to Know 

Why Do You Need an Insurance Insurance for Cataract? 

According to a population-based study, about 74% of adults in India aged 60 years or older have had cataract surgery or have cataracts. This high prevalence among the population suggests that it is quite common. Having health insurance for cataract surgery helps protect yourself in the event that you do develop this condition.

Further, the treatment for cataract in India ranges between Rs.35,000 and Rs.85,000. This does not account for cataract surgery, which can cost more based on the type of cataract and the surgery. For instance, the no-incisions method or bladeless cataract surgery can cost up to Rs.1.2 lakh for a single eye. Considering the high cost of cataract surgery and other medical expenses, having an insurance policy for cataract is essential. 

cataracts healthcare plans

What Is the Waiting Period for a Cataract Mediclaim Policy? 

Almost all health insurance plans come with a waiting period before you can make any claim. Insurers generally have a waiting period of 2 years for a cataract mediclaim policy. However, the waiting period for each plan and insurer varies depending on their terms and conditions. As cataract surgery is a planned procedure, plan your policy and treatment well. Any claim made prior to the end of the waiting period will not be reimbursed by the insurer. So, find out the waiting period terms of your policy in advance.  

How Much Amount Can You Claim Under Cataract Healthcare Plans? 

The amount you can claim solely depends on the insurer’s discretion. Generally, health insurers set a limit to the amount you can claim for cataract surgery. It can be a fixed amount or a percentage of the total sum assured. For example, a limit of 10% for cataract procedures on a sum insured of Rs.5 lakh would be Rs.50,000. However, some insurers may reimburse you only for the actual cost incurred for the cataract surgery. 

cataracts test

Does Group Health Insurance Policy Cover Cataract Surgery? 

Some group insurance policies like the employers’ group health insurance policy cover health insurance for cataract surgery. However, it depends on the terms of the insurer. The benefit of such group plans is that there might be no waiting period whatsoever. So, read the contract of your employer’s group health policy and claim it cataract surgery if the need arises.

Additional Read: Why is Health Insurance During Pandemic a Safe Solution?

Uncertainties and medical expenses arrive without an invite. Make sure you care for your eyes and overall health by insuring yourself with health insurance. Be sure to opt for comprehensive health insurance for cataract surgery for you and your family to ensure you get complete treatment when you need it. To find affordable health plans with high sum assured, use the Bajaj Finserv Health platform. On it, you can explore several top individual and family floater plans and find one that suits your needs perfectly. 

Published on 20 Jul 2021Last updated on 20 Jun 2022

Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.


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