Quick Answer
Yes, cataract surgery is covered by health insurance in India. It is a day care procedure so no overnight stay is required. Basic monofocal lens is fully covered. Premium lenses (multifocal, toric) are typically not covered. Waiting periods of 1 to 2 years are common.
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Cataract surgery in India costs Rs 15,000 to Rs 80,000 per eye depending on lens type and hospital. Insurance covers the basic procedure but lens selection determines out-of-pocket cost.
Is Cataract Surgery Covered by Health Insurance in India?
Yes. Cataract surgery is explicitly covered as a day care procedure (no overnight stay needed) by all major health insurance policies in India. This is one of the most commonly claimed procedures in Indian health insurance.
Waiting Period for Cataract Surgery Insurance
Cataract is listed as a specific disease with a defined waiting period in most policies. Typical waiting periods: Star Health — 1 year. HDFC Ergo — 1 year. Care Health — 1 year. Bajaj Allianz — 2 years. ICICI Lombard — 2 years. New India Assurance — 1 year. Note: The waiting period clock starts from the date the policy was first purchased, not the renewal date.
What Is Covered Under Cataract Surgery Insurance?
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Phacoemulsification procedure. Monofocal standard lens (IOL): Fully covered. OT charges, anaesthesia (topical), consumables. Day care facility charges. Pre-hospitalisation: eye drops, investigations. Post-hospitalisation: eye drops, follow-up visits.
What Is NOT Covered?
Multifocal (trifocal) lenses: Most policies do not cover premium lenses. You pay the lens upgrade cost out of pocket. Toric lenses for astigmatism: Similarly not covered by most policies. LASIK, SMILE, or refractive lens exchange for spectacle freedom: Not covered. Sunglasses or spectacles after surgery: Not covered.
Monofocal vs Multifocal Lens — Insurance Perspective
Insurance covers the cost of a standard monofocal lens which corrects distance vision. If you choose a multifocal lens (Rs 25,000 to Rs 50,000 extra per eye) for spectacle freedom, you pay the difference. MySurgery ophthalmology team helps patients understand the lens upgrade cost vs spectacle freedom benefit before making the decision.
Day Care Benefit — No Admission Needed
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Cataract surgery takes 15 to 20 minutes and most patients go home within 2 to 3 hours. You do not need to be admitted overnight. Ensure your policy has a day care procedures list that includes cataract surgery — virtually all modern policies do.
Sub-Limit on Cataract Surgery
Some older policies have a cataract sub-limit of Rs 25,000 to Rs 40,000 per eye per year. Check your policy for sub-limits. Newer comprehensive policies typically have no cataract-specific sub-limit.
How to Claim Cashless Insurance for Cataract Surgery
Inform your insurer 2 to 3 days before the procedure. Submit the ophthalmologist's prescription recommending surgery, and the hospital estimate. Pre-auth for day care cataract is typically approved within 2 to 4 hours. MySurgery manages this for you at no charge.
Call MySurgery at 8588967050 for a free insurance check and cataract surgery appointment at a partner eye centre near you.
Dr. Kavita Rao
Ophthalmologist, MS Ophthalmology, 14 years experience
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