Like the rest of the human body, the human eyes also age with time. One may need prescription glasses at the start, but the deterioration of the eyes can advance to cataract. In such a situation, one might need to undergo cataract surgery. If the question ‘is cataract surgery covered by insurance’ has crossed your mind, this article is for you.

The human eye has a natural lens that bends light rays to help us see. Ideally, the lens should be clear. However, ageing can cause the lens to become cloudy, leading to blurry or hazy vision. Other symptoms of cataracts include extra sensitivity to light, night-vision issues, distorted imagery, etc. While ageing is the most common cause, eye injury, diabetes, smoking, extended exposure to the sun, side effects of steroids, etc., can also cause cataracts.

If detected early, cataracts can be treated without surgery. An ophthalmologist may initially recommend contact lenses or prescription glasses. Ophthalmologists might also advise you to reduce your exposure to screens and blue light and wear polarised or anti-glare sunglasses while stepping out during the day.

If the cataract hinders your everyday activities, the doctor might recommend surgery. The ophthalmologist surgically removes the clouded lens and replaces it with an artificial lens (intraocular lens). In such a case, you can use your individual health insurance policy to pay for the cataract surgery costs, provided you follow the conditions laid down by the insurer.

Like all medical conditions, the cataract treatment costs in India can vary across locations and types of procedures. For example, a phacoemulsification cataract surgery costs less than laser-assisted cataract surgery. If you decide to encash your health insurance plan to pay for the cataract operation costs, you should ascertain your coverage by checking these two critical factors.

1. Claim Limit
   

   Check how much money can you claim for cataract surgery. Insurers typically cap the claim limit for outpatient procedures like cataracts. Assume your policy states that you can claim up to 15% of the sum insured subject to a maximum of Rs 25,000 per eye, including any post-surgery costs. Thus, if your sum insured is Rs 2 Lakh, 15% of it would be Rs 30,000. However, the insurance company will only reimburse Rs 25,000 for cataract surgery per eye.

2. Waiting Period
   

   You can encash your individual health insurance policy for cataract surgery costs after riding out the waiting period of 12-24 months. You may file a claim only after the waiting period ends. If you undergo surgery during the waiting period, the insurer is not liable to pay the claim amount.

Your health insurance policy covers you against a wide range of medical conditions and illnesses. Whether you require emergency surgery or need to seek treatment for a developing medical condition, you can encash your policy. But before you buy a policy, you must ascertain whether cataract surgery is covered by insurance. You can speak to your insurance provider to know more about the same.