Is cataract surgery covered by insurance?
Yes. Cataract surgery is a standard day-care procedure covered by nearly all individual, family-floater and employer group policies, usually after the initial waiting period (commonly 1–2 years for cataract in individual policies; often none in group policies).
The cataract sub-limit
Many policies cap what they pay for cataract per eye, for example ₹25,000, ₹40,000 or a percentage of the sum insured. If your surgery and lens cost more than that cap, you pay the difference. Check the policy wording or ask your TPA: "What is my cataract limit per eye?"
Premium lenses and insurance
Insurers generally pay up to the limit whatever lens you choose. With a toric or multifocal lens, the extra cost above the limit is yours. See premium cataract lenses.
Cashless or reimbursement?
- Cashless: the hospital requests pre-authorisation from your insurer; allow 2–5 working days for planned surgery. You pay only non-covered items.
- Reimbursement: you pay, then claim with the discharge summary, bills, prescriptions and reports within the policy's deadline.
CGHS, WBHS and ESI
Government schemes cover cataract surgery at scheme rates with a standard lens; a premium lens costs extra. Bring your card and referral. See CGHS, WBHS & ESI.
Documents to bring
- Policy number and insurer or TPA card
- Photo ID (Aadhaar or PAN)
- Doctor's advice for surgery and the eye measurement reports
What does it cost without insurance?
At Spectra Eye Hospital, cataract surgery starts from ₹7,500. Typical prices by lens are on our cataract surgery cost page.
Questions
Is there a waiting period for cataract under health insurance?
Many individual policies have a 1–2 year waiting period for cataract. Group policies from employers often have none. Check your policy wording.
Does insurance pay for both eyes?
Yes. Each eye is a separate claim, and the cataract limit usually applies per eye.