It is believed that eyes are the doorway to our soul. They betray our emotions and speak volumes about our feelings. We treasure our eyes and protect them against any harm. But with age and changing lifestyle, many people develop certain eye conditions – whether it is a minor case of myopia or a major yet common case of cataract. In fact, many would be surprised to know that a majority of the elderly population suffers from the ailment in either one or both eyes.
Given the fact that a cataract surgery may turn out to be a costly affair, it is best to know if your health covers for the expenses or not.
Cataract is usually age-specific and affects people in the age of 60 years and above. Although modern lifestyle has seen the prevalence of cataract even in the age group of 45+ years, the percentage of people in that age affected by cataract is low. Cataract is characterized with a clouding of lens in the eye that impairs vision. While the disease appears in the old age, factors like diabetes, smoking, excess exposure to sun, etc. may trigger it. The only method of treatment is surgery, which costs depending on the method and the choice of lens. The usual average cost ranges somewhere from Rs. 15, 000 to Rs. 30,000, and can go up to as much as Rs. 60,000 for advanced procedures. Is the cost included in your health insurance plan or will you have to foot the bills?
Several health insurance plans cover the cost of a cataract surgery, but certain clauses pertaining to the coverage must be remembered:
Waiting Period –
Health insurance providers usually have a 2 year waiting period after which any claim relating to cataract will be honored. This clause exists as cataract is a planned surgery and insurers want to protect themselves against policies taken for the sole purpose of undertaking the surgery and making a claim. So, if you are planning undergo a cataract treatment, you will have to wait out the specified waiting period before your policy becomes available to pay the claim for the surgery.
Limit on Claim Payable –
Insurers often limit the amount of claim payable for cataract surgeries. The maximum amount payable is usually depicted as a percentage of the Sum Assured, and is subject to an absolute amount. However, there are certain policies that do not have any limit on the amount of admissible claim and pay the actual expenses incurred on a cataract surgery.
The list below states some of the popular plans and the corresponding terms and conditions relating to the coverage of cataract:
|Plan||Waiting Period Applicable for Cataract||Admissible Amount of Claim|
|Bajaj Allianz Health Guard Individual Plans||2 years||Lower of 10% of the chosen Sum Assured or Rs. 35,000|
|Religare Care||2 years||No limit on the amount of claim for cataract|
|Religare Care Freedom||2 years||For Rs. 3 lakhs sum assured Rs. 20,000 per eye For Rs. 5 lakhs sum assured Rs. 30,000 per eye|
|New India Mediclaim 2012 Plan||2 years||20% of the Sum Assured up to a maximum of Rs. 24,000 per eye|
|Apollo Munich's Optima Restore||2 years||No limit on any cataract claim |
|United India Gold Plan||2 years||Lower of 25% of the Sum Assured or the actual expenses|
|Star Family Health Optima||2 years||Up to Rs. 2 lakhs - Rs. 12,000 Rs. 2-5 lakhs - 20,000 per hospitalisation & Rs. 30,000 for entire policy period Above Rs. 5 lakhs- Rs. 30,000 per hospitalisation & Rs. 40,000 for the entire policy period |
All of the above plans have the same waiting period. For you to choose the right policy, always consider the limit of admissible claim Going for a cataract surgery in a metropolitan city in a decent hospital will cost you somewhere in the range of Rs. 25,000 and above. If you opt for an advanced procedure, or a superior quality lens, the expenses only increase.
Wisely choose a plan which has the highest allowable limit or has no limit at all. This will enable you to get the best available treatment for your eyes, for they deserve nothing less.