Best Health Insurance for Eye Surgery in India
Eye surgeries can be expensive, but the right health insurance can reduce costs and make treatment more accessible. Whether it is cataracts, refractive errors, or diabetic retinopathy, early intervention is important. In India, cataracts cause 60 to 80% of blindness cases, while refractive errors affect nearly 25 percent of the population. Among diabetics, 35% develop diabetic retinopathy, with 10 to 15 percent reaching vision-threatening stages. Regular check-ups can lower the risk of severe vision loss by 20 percent, but many delay treatment due to high costs.
The eye care market is growing fast, expected to reach 200 million USD by 2026. Surgeries like cataract removal have a success rate of 70 to 80 percent, but without insurance, expenses can be a major hurdle. A good policy can reduce out-of-pocket costs by up to 50 percent, making timely treatment easier. With proper care, over 90 percent of patients report satisfaction, highlighting the importance of coverage.
In this blog, we will explore different health insurance options for eye surgery, helping you find the best fit for your needs.
Top 5 Best Health Insurance For Eye Surgery in India
| Feature | ManipalCigna ProHealth Prime Active Plan | Bajaj Allianz Family Health Care (Silver) policy | ManipalCigna Lifetime Health India Plan | Special Care Gold | New India Assurance Yuva Bharat Health |
|---|---|---|---|---|---|
| Types of eye-related coverage | - Treatment of Cataract (Per Eye) is covered under In-patient Hospitalization with specific sub-limits. - Intra vitreal injections are covered either as inpatient or as part of Day Care Treatment up to 50% of the Sum Insured. |
Covers - Cataracts and Macular Degeneration under the list of specified diseases/procedures with a waiting period. Also cover refractive error greater or equal to 7.5 dioptres. | Covers Surgical removal of a complete eyeball as a result of injury or disease - Cataract surgery. - With an add-on, Vascular disease affecting only the eye or optic nerve or vestibular functions can be covered |
covers treatment of Cataract up to Rs. 40,000/- per each eye | Coverage for Cataract Treatments in plans (Base, Gold, and Platinum). Expenses related to the treatment for correction of eye sight due to refractive error equal or greater then 7.5 dioptres covered. |
| Instant Cover | 30-day waiting period, except for claims arising due to an accident | 30-day waiting period, except for claims arising due to an accident | 30-day waiting period, except for claims arising due to an accident | The sources do not explicitly mention "Instant Cover". | The sources do not explicitly mention instant cover for any specific conditions, including eye-related issues. Waiting periods apply |
| Waiting Period for Eye Surgeries | Treatment for Cataract has a specific waiting period of 24 months of continuous coverage from the date of inception of the first policy | Expenses related to the treatment of Cataracts and Macular Degeneration are excluded until the expiry of 24 months of continuous coverage | Cataract has a waiting period of 24 months. Surgical removal of an eyeball due to internal congenital anomaly may also be subject to waiting periods. | Cataract are covered up to a specified limit per eye per policy year with a waiting period of 24 months | Cataract and age-related eye ailments are subject to a 12-month waiting period3 . Age Related Macular Degeneration (ARMD) has a 24-month waiting period |
| Cashless Facility | 15000+ hospitals | 18400+ hospitals | 15000+ hospitals | 13500+ hospitals | 5500+ hospitals |
| Pre/Post Hospitalization | Pre-hospitalization - 30 days before hospitalization post-hospitalization medical - 60 days post discharge are covered This would apply to covered eye surgeries. |
Pre-Hospitalisation - 30 days immediately before hospitalization are covered Post-Hospitalisation - 60 days immediately after discharge |
Pre-hospitalization - up to 60 days preceding the date of Hospitalization Post-hospitalization - up to 180 days immediately after discharge from the hospital |
Pre-Hospitalization - 30 days prior to hospitalization Post-Hospitalization - 60 days from the date of discharge |
Pre-Hospitalization - 30 days prior to hospitalization Post-Hospitalization - 60 days from the date of discharge |
| "Premium Range (Approx. Annual)" | Starts from 10,727/annum | Starts from 4400/annum | starts from 17,942 | Starts from Rs. 12,272 | Starts from ₹2,400 |
| "Claim Settlement % (Overall)" | 90% | 93% | 90% | 94.44% | 90% |
| Unique Benefits | • Wellness Program: For individuals with Diabetes, the program includes an Ophthalmologist Consultation as part of the medical tests. • Discount from Network Providers: You can avail discounts on Diagnostics and Pharmacy offered by network providers. |
• In house claim settlement • Life time renewal • Free look period • Preventive Health Check Up at the end of every continuous 3 policy years (reimbursement up to 1% of sum insured, max ₹2000) • Hospital Cash Benefit of ₹300 per day (max 30 days) • Cumulative bonus of 10% of base sum insured per claim-free year (max 50%)17 |
Items that are to be subsumed into procedure charges - Eye Pad - Eye Shield - Eye Kit - Eye Drape |
• This policy is specifically tailored for individuals with disabilities and those who are HIV/AIDS positive • There is no pre-policy medical check-up irrespective of age • A lumpsum coverage for HIV/AIDS is available if the CD4 count goes below 150 • AYUSH Treatment is covered up to 100% of the SI • Coverage for Modern treatment is included up to 50% of the SI • Instalment facility for premium payment is available (Half-Yearly with 2% loading, Quarterly with 3% loading) |
- Auto TOP-UP under the Gold Plan. - Health Check-up is available for a block of every 2 claim-free years. - Cumulative Bonus is a renewal benefit. - Up to 10% for healthy lifestyle parameters (BMI, blood sugar, blood pressure). |
| Sum Insured (in ₹) | 3 Lacs, 5 Lacs, 7.5 Lacs, 10 Lacs, 12.5 Lacs, 15 Lacs | INR 50,000 to INR 10 Lakhs | 50 Lacs / 75 Lacs / 100 Lacs / 150 Lacs / 200 Lacs / 300 Lacs | The SI options are Rs. 4,00,000/- and Rs. 5,00,000/- | ₹5 Lakh, ₹10 Lakh, ₹15 Lakh, ₹25 Lakh, and ₹50 Lakh. |
| Entry Age | Minimum: 91 days for children, 18 years for adults Maximum: 17 years for children, 70 years for adults |
• Self, Spouse & Parent: 18 years to 65 years • Children: 3 months to 25 years |
The minimum entry age - 91 days for children and 18 years for adults. No limit for maximum entry age. Children up to 23 years can be covered under a floater, and beyond 23 years under an individual policy. |
For Adults: Minimum - 18 years & Maximum - Up to 65 years For Dependent Children: Newborn to 17 years |
18 to 45 Years for Adults and Children: 91 Days to 25 Years |
| "Policy Type (Individual / Family Floater)" | Individual basis or Multi Individual. | Annual floater policy | The policy can be issued on an individual or a family floater basis | Individual | individual coverage is available |
| Policy Tenure | 1, 2, or 3 continuous years | Annual, renewable for lifetime | 1/2/3 years | The Policy Term is 1 Year. | 1, 2, or 3 years |
| Refill / Restoration Benefit | If the Sum Insured (including cumulative bonus) is insufficient due to claims, the plan offers a 100% Restoration of the Sum Insured for any number of times in a policy year for future claims of unrelated illness/condition | The sources do not mention any refill or restoration benefit. | Yes, the policy offers a Restoration of Sum Insured benefit. | The sources do not mention any refill or restoration benefit. | The sources do not mention any refill or restoration benefit. |
| No Claim Bonus | 10% Cumulative Bonus of the Base SI is added for each claim-free policy year upon renewal, up to a maximum of 100% of the SI If a claim is made, the accumulated bonus is reduced by 10%. |
Cumulative bonus is provided, increasing the Limit of Indemnity by 10% of base SI per annum for each claim-free renewal, up to a maximum of 50% of the first policy's SI . If a claim is made, the increased limit is reduced by 10% | NA | The sources do not mention any No Claim Bonus. | Cumulative Bonus is mentioned as a renewal benefit |
*Please read the disclaimer at the end of this page before purchasing any of these policies.
Our Top 3 Picks for Eye Surgery Health Insurance
Finding a good health insurance plan for eye surgeries can save you from unexpected medical bills. Here are three plans that provide excellent financial support for eye-related medical needs.
ManipalCigna ProHealth Prime Active Plan
This plan is one of the most comprehensive options available, covering both hospitalisation and outpatient treatments for eye-related medical issues. It includes everything from cataract removal to advanced retinal surgeries, making it a great choice if you want complete coverage for eye care.
Why It Stands Out
Covers major eye surgeries such as cataract removal, laser treatments, and retinal procedures.
Cashless treatment at over 7600 hospitals, including many that specialise in eye care.
Outpatient benefits cover diagnostic tests, doctor consultations, and follow-up visits. This ensures you don’t have to pay out of pocket for pre- and post-surgical care.
Annual free eye check-ups help detect problems early, making it easier to manage vision-related issues before they become severe.
Short waiting period for pre-existing eye conditions such as glaucoma and diabetic retinopathy. The plan only requires a 90-day waiting period for these conditions, which is shorter than many other policies.
Potential Limitations
The premium is higher compared to basic health insurance plans, mainly because it provides extensive coverage for outpatient and hospitalisation expenses.
Cosmetic eye procedures like LASIK are not covered unless they are considered medically necessary due to an accident or disease.
A mandatory 10% co-payment applies, meaning you’ll have to pay a small portion of the bill.
There is a specific waiting period of 24 months for the treatment of Cataract.
Bajaj Allianz Family Health Care (Silver) Policy
This plan is ideal for families, particularly those with elderly members who may require frequent medical care. It provides affordable coverage for common eye surgeries and also covers a wide range of daycare procedures.
Why It Stands Out
Affordable coverage for eye surgeries like cataract removal, retinal procedures, and glaucoma treatment.
Covers over 130 daycare procedures, including minimally invasive eye surgeries that do not require long hospital stays.
Cashless hospitalisation is available across India, allowing you to get treatment without worrying about upfront payments.
Short waiting period for cataract surgery—the procedure is covered after just one year which is good for the price it comes at.
Pre- and post-hospitalisation coverage pays for medical expenses up to 30 days before and 60 days after surgery. This includes doctor consultations, medicines, and follow-up treatments.
Potential Limitations
High co-payment for pre-existing eye conditions-if you have an existing condition like glaucoma, you may have to pay up to 50% of the treatment cost out of pocket.
Limited flexibility for add-ons-while this plan covers essential eye treatments, there aren’t many options to customise benefits specifically for eye care.
Elective procedures like LASIK are not covered unless required due to an injury or medical condition.
Expenses related to the treatment of Cataracts and Macular Degeneration are excluded until the expiry of a 24-month waiting period.
New India Assurance Yuva Bharat Health Plan
Designed for younger individuals and families, this plan offers strong coverage for basic medical needs, including cataract surgeries and other necessary eye treatments. It is a budget-friendly option that ensures financial support for unexpected surgical expenses.
Why It Stands Out
Covers cataract surgery as part of the standard benefits, making it a good option for those concerned about age-related vision issues.
Cashless hospitalisation services allow you to get treated at a wide network of hospitals without worrying about upfront costs.
Regular health check-ups include vision tests, helping in the early detection of eye diseases that may require surgery.
Family floater option makes it possible to cover multiple family members under a single policy, which is helpful if more than one person in the household requires eye care.
Different plan options (Base, Gold, and Platinum) allow you to choose a level of coverage that fits your medical needs and budget. The Gold and Platinum plans provide higher coverage for advanced treatments.
Potential Limitations
Age Restrictions Apply-this plan is primarily designed for younger individuals, so older applicants may have fewer options or need to pay higher premiums.
Basic Coverage in the Lower Plans-The base plan provides limited benefits, so if you need extensive coverage for eye treatments, you may have to opt for the Gold or Platinum plan.
Elective Surgeries like LASIK are Not Covered unless they are required due to an injury or severe medical condition.
The cashless facility network is smaller (5500+ hospitals) compared to the other two plans.
What is Eye Surgery?
Eye surgery, also known as ophthalmologic surgery, is a medical procedure used to treat different eye conditions. It can be as simple as correcting vision or as complex as repairing serious issues like glaucoma, cataracts, or a detached retina. Some treatments involve minor procedures, while others require detailed surgical work to protect or restore eyesight.
Treatment depends on what the problem is. In some cases, wearing glasses or contact lenses is enough to improve vision. When a condition is more serious, surgery might be needed to fix the issue and prevent further damage. Whether it is a routine procedure or a critical operation, the goal is always to help you see better and keep your eyes healthy.
Why You Need Eye Health Insurance
Taking care of your eyes is just as important as looking after the rest of your health. Eye treatments can be expensive, and vision problems are becoming more common. Having insurance for eye care can help you manage costs and get the right treatment when needed.
1
Eye Treatments Can Be Costly
Eye surgeries and treatments are not cheap. Depending on the procedure and hospital, costs can range from ₹20,000 to ₹2,00,000. If you ever need surgery for cataracts, LASIK, or other eye conditions, paying for it out of pocket can be a huge financial burden. Insurance helps cover these costs, so you do not have to worry about unexpected expenses.
2
More People Are Facing Eye Problems
Conditions like cataracts, glaucoma, and diabetic retinopathy are becoming more common. Many of these issues develop slowly and may not show symptoms at first. Regular eye check-ups are important, and having insurance makes it easier to afford tests and treatments before problems get worse.
3
Covers Both Planned and Emergency Expenses
Eye problems do not always come with a warning. A sudden infection, injury, or worsening vision might require immediate treatment. Insurance helps reduce out-of-pocket costs, so you do not have to delay care due to financial concerns. It also covers planned procedures, making it easier to budget for eye health in the long run.
4
Covers Daycare Procedures
Many eye surgeries do not require an overnight hospital stay. Procedures like cataract removal or LASIK are completed within a few hours, and patients can go home the same day. Eye health insurance covers these daycare treatments, ensuring you receive proper medical attention without the added expense of hospital admission charges.
Eye Surgeries That Health Insurance Covers
Here is a breakdown of the surgeries that are usually covered in a health insurance:
Cataract Surgery
LASIK Surgery
Glaucoma Surgery
Retinal Surgery
Corneal Transplant
Squint Correction Surgery
Treatment for Eye Injuries
What’s Covered and What’s Not in Eye Health Insurance
When choosing an eye health insurance plan, it’s important to know what expenses your policy will take care of and what you might have to pay out of pocket. Let’s break it down.
Most health insurance plans provide coverage for medical expenses related to eye treatments and surgeries. Here’s what you can typically expect:
While insurance helps cover many eye-related medical costs, some treatments and procedures are usually not included. Here are some common exclusions:
Who Should Consider Eye Health Insurance?
Eye health insurance is not just for those with existing vision problems. It can be helpful for many people, especially if there is a higher risk of eye-related issues. If you fall into any of these groups, having coverage can save you from expensive treatments and help you maintain good vision in the long run.
What to Look for in Health Insurance for Eye Treatment
Choosing health insurance for eye treatment requires careful thought. Not all policies cover the same treatments, and you do not want to be stuck with unexpected expenses later. Here are some important factors to keep in mind before making a decision:
Coverage for Specific Eye Surgeries
Not every health insurance plan covers all types of eye surgeries. Some policies include common procedures like cataract surgery, while others may cover more advanced treatments such as LASIK for medical reasons or retinal surgeries. Always check if the policy covers the specific treatments you might need.
Waiting Period
Most insurance plans do not offer immediate coverage for eye-related treatments. There is usually a waiting period, which can range from a few months to a couple of years. If you need treatment soon, choosing a plan with a shorter waiting period can save you from paying out of pocket.
Network Hospitals
Getting treatment at a network hospital means you can use the cashless claim facility instead of paying upfront and waiting for reimbursement. Before selecting a policy, check the list of hospitals included. If your preferred eye hospital or specialist is not on the list, you might have to cover the costs yourself.
Sub-limits and Co-payments
Some policies do not cover the full cost of eye treatments. They might have sub-limits, which means only a certain amount is covered for specific procedures. Others may have a co-payment clause, where you need to pay a percentage of the treatment cost from your pocket. Read the terms carefully so there are no surprises when you file a claim.
Daycare Procedure Coverage
Many eye treatments, including cataract surgery and LASIK, are done as daycare procedures, meaning you do not need to stay overnight in the hospital. Some insurance plans cover these procedures fully, while others may not. If you are considering surgery that does not require hospitalisation, make sure your policy includes daycare coverage.
Premium and Affordability
A policy with the best coverage is only useful if it fits your budget. Compare different plans and see what they offer for the premium charged. A lower premium might mean fewer benefits, while a higher premium could provide more comprehensive coverage. Finding the right balance between cost and coverage is important.
Additional Benefits and Riders
Some insurers offer extra benefits that can be useful for long-term eye care. These may include:
OPD coverage for routine eye check-ups.
Reimbursement for spectacles or contact lenses, reducing your out-of-pocket expenses.
Eye injury coverage under accidental health insurance, providing financial protection in case of an unexpected injury.
Disclaimer
