Does National Health Insurance Cover Cataract Surgery?

Cataract is an extremely common disease in India. As per a survey by WHO and the National Programme for Control of Blindness, about 3.8 million people suffer from cataract blindness. The only solution to a cataract is an expensive surgery. If you have health insurance by National Insurance Company, read on to know if the cost of cataract surgery will be covered by the insurance company.

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    What is Cataract Surgery?

    Cataract surgery is the surgery performed to treat cataracts. Also known as lens removal surgery, it involves the removal of the natural lens from the eye and replacing it with an artificial lens to restore the vision. This surgery is absolutely safe and is one of the most effective surgeries performed today.

    For the unversed, cataract refers to the clouding of the eye lens that obstructs vision and can lead to blindness. This eye disease develops with age and therefore, is common among senior citizens.

    Cataract surgery procedures have evolved over time. In modern cataract procedures, the cloudy eyes lens is broken down into small pieces using a high-frequency ultrasound device, which is then removed from the eye using suction. Referred to as phacoemulsification, this procedure makes smaller incisions, reduces complications and promotes faster healing.

    More recently, laser cataract surgery has been introduced in India that uses multiple femtosecond lasers.

    Cost of Cataract Surgery

    Generally, the cost of a cataract surgery ranges between Rs 50,000 to Rs 1.2 lakh. However, the surgery cost may depend on a variety of factors, including the type of the surgery and the city where the surgery will take place.

    For instance, laser cataract surgery costs more than traditional cataract surgery. Similarly, the cost of a cataract surgery performed in Mumbai will be more than the one conducted in Raipur. This is because metropolitan cities are more expensive than smaller cities.

    That’s not all, you may incur medical expenses on diagnostic tests before undergoing the surgery. You will also be required to go for follow-up consultations with your doctor after the surgery. These expenses will add to your overall cost of cataract surgery. This brings us to the question of whether cataract surgery is covered under health insurance plans offered by the National Insurance Company. Let’s find out.

    Is Cataract Surgery Covered by National Health Insurance?

    Yes. National health insurance plans like the National MediclaimPlus policy and the National Parivar Mediclaim policy provide coverage for cataract surgery. As cataract surgery does not require hospitalization of 24 hours, it is covered by the National Insurance Company as a day care procedure. A National Health Insurance policy covers the cost of cataract surgery, operation theatre fees, doctor’s fees, cost of surgical appliances, etc. It also covers pre-hospitalization and post-hospitalization expenses arising out of the surgery.

    Coverage Limit for Cataract Surgery Under National Health Insurance

    The coverage limit for cataract surgery may vary from one National Health Insurance plan to another. For example, the National Parivar Medicalim policy covers the cost of cataract surgery up to 10% of the sum insured or Rs 50,000 per eye (whichever is lower). On the other hand, the National MediclaimPlus policy offers coverage of up to 15% of the sum insured or Rs 60,000 per eye (whichever is lower) in Plan A and up to Rs 80,000 and Rs 1 lakh per eye under Plan B and Plan C respectively.

    Therefore, you must check your National health insurance policy documents carefully to know the coverage limit for cataract surgery.

    Waiting Period to Cover Cataract Surgery Under National Health Insurance

    National Insurance Company does not provide coverage for cataract surgery from the first day. You need to spend a waiting period before you are eligible for a claim for cataract surgery under your policy.
    Most National health insurance plans cover cataract surgery after a waiting period of 2 years. This means that you raise a claim for this surgery with your insurance company after two consecutive policy renewals.
    However, if you have been diagnosed with a cataract before purchasing your National health insurance policy, then pre-existing waiting period will apply. This is because the insurance company will consider cataract surgery as a pre-existing disease in this case.
    National health insurance plans usually cover pre-existing diseases after a waiting period of 3 or 4 years. You can go through your policy documents to know the exact waiting period for pre-existing diseases.

    Activities to Avoid After a Cataract Surgery

    You must avoid the following activities in the first week after cataract surgery:

    • Splashing water directly in your eye
    • Any strenuous activity like exercising
    • Exposure to dust and contaminants that could cause infection
    • Bending or similar activities that may stress your eyes
    • Lifting heavy weights of more than 10 kg
    • Swimming or using hot tubs

    In a Nutshell

    Getting a cataract surgery done is not going to burn your savings if you have a National health insurance policy. Make sure to check the coverage limit and the applicable waiting periods under your policy before you raise a claim. Also, take the above-mentioned precautions to ensure proper recovery after the surgery.

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