Cataract is covered after a waiting period, but many plans cap it per eye and limit the lens type. The caps from real wordings, and a checklist before surgery.
Is cataract surgery covered by health insurance?
Yes, in almost every health policy, once the waiting period is over. But many plans cap what they pay per eye, and some only pay for a basic lens. The cap matters because a good lens can cost more than the limit.
The waiting period
Cataract is on the listed-illness waiting list in most wordings, usually 24 months from when you first take the policy. Some plans offer an add-on that shortens it. Surgery during the wait is not covered, unless it follows an accident.
Caps per eye, from real wordings
Plans like Care Supreme state no disease-wise sub-limits, so cataract is paid up to the sum insured there.
The lens type
- Niva Bupa ReAssure 2.0 pays for a mono-focal lens only on covers up to ₹10 lakh.
- Niva Bupa ReAssure 3.0 pays for a mono-focal lens only on its Classic and Select variants.
- Care Freedom excludes multifocal lens implants.
If you want a multifocal or premium lens, expect to pay the difference yourself on these plans.
No overnight stay needed
Cataract surgery is a day-care procedure. Policies pay for it without a 24-hour admission.
Checklist before booking the surgery
- Has the cataract waiting period ended?
- What is the cap per eye, and per year?
- Which lens types are paid?
- Does the hospital estimate fit inside the cap, including the lens?
- Ask for pre-authorisation before the surgery date.
Frequently asked questions
Is cataract surgery covered by health insurance?
Yes, after the waiting period, usually 24 months. Many plans cap the amount per eye and some pay only for a mono-focal lens.
How much does health insurance pay for cataract surgery?
It depends on the plan. Examples: Bajaj Health Guard 20% of the sum insured per eye up to ₹1 lakh; Raheja Health QuBE ₹50,000 per eye; Care Supreme up to the sum insured.
Is a premium or multifocal lens covered?
Not always. Some plans pay only for a mono-focal lens, and some exclude multifocal lenses. You pay the difference.
Do I need to be admitted for 24 hours for cataract?
No. Cataract surgery is a day-care procedure and is paid without a 24-hour stay.