Is Cataract Surgery Covered Under Medical Insurance?

Cataract surgery is a medical procedure to remove the eye's lens when it becomes cloudy. Several medical insurance plans cover cataract surgery, but only after a waiting period of up to 2 years. However, there is a possibility that your health insurance policy may apply certain sub-limits on the coverage.

For instance, your policy may provide coverage for only a percentage of the total surgery cost. If the insurer pays only 80% of the surgery cost, the remaining amount will be paid by the policyholder.

In addition, sometimes there may be some restrictions or limitations on the expenses covered. Therefore, it is recommended to carefully go through policy terms and conditions to better understand its inclusions, exclusions, waiting periods, sub-limits, etc., before buying a policy to avoid unpleasant surprises later. In situations, if you have already purchased a policy and are unsure if it covers cataract surgery, you can check the policy document or directly ask the insurer for a detailed understanding of the coverage.

Keep reading to know more about cataract treatment coverage in medical insurance plans.

Is there any Waiting Period for Cataract Surgery?

Mostly all health insurance policies have a waiting period linked to a cataract cover. Usually, the waiting period ranges from 1 to 2 years, which means you cannot claim policy benefits for cataract surgery during this period and must wait until the waiting period is completed after purchasing the policy.

Once the waiting period is over, you can undergo cataract surgery and raise a claim for it. However, if you undergo cataract surgery before serving the waiting period, the insurance company will not approve your claim.

Under most health insurance plans, the coverage for cataract surgery may include:

• Surgeon’s fees


• Operation theatre charges


• Day-care hospital expenses


• Pre-hospitalisation tests


• Post-hospitalisation follow-up

Key Considerations

Before undergoing cataract surgery, it is important to check several key aspects of your health insurance policy. Confirm with your provider if your health insurance covers daycare procedures. Daycare treatments are the procedures that provide coverage for treatments that do not require hospitalisation. Cataract surgery is usually completed within a few hours due to advanced technology and equipment. Also check if there are any sub-limits on room rent, surgeon’s fees, or lens costs, as these can impact your out-of-pocket expenses.

Besides that, confirm whether the treatment is available under a cashless claim at network hospitals or requires reimbursement.