The cost of cataract surgery, especially with advanced technologies like robotic lasers and premium IOLs, can be significant. The good news? Cashless cataract surgery options are widely available in India, making the treatment accessible and stress-free for many patients.
Let’s understand how you can take advantage of insurance coverage, TPA networks, and government health panels to ease your financial burden.
How Cashless Cataract Surgery Works
In a cashless facility, your insurance provider settles the hospital bills directly with the hospital, meaning you don’t have to pay the entire amount upfront. You simply need to show your health insurance card and submit pre-authorization forms before surgery.
Once approved, you can focus entirely on your recovery without worrying about immediate payments.
Key Players in Cashless Cataract Surgery
1. Health Insurance Policies
Most health insurance policies in India cover cataract surgery under a defined limit. The IRDAI (Insurance Regulatory Authority of India) mandates that cataract surgery must be covered after a specific waiting period (usually 2 years).
2. TPAs (Third Party Administrators)
TPAs act as intermediaries between the insurer and the hospital. Popular TPAs like MediAssist, Vidal Health, Paramount, and FHPL help coordinate pre-authorizations, hospital approvals, and claim settlements.
3. Government Health Schemes
Government employees, pensioners, defense personnel, and their families can avail cataract surgery through:
- CGHS (Central Government Health Scheme)
- ECHS (Ex-Servicemen Contributory Health Scheme)
- State Government Panels (Delhi Government, Haryana Government, etc.)
- ESIC (Employees’ State Insurance Corporation)
Many top eye hospitals and clinics are empanelled under these government schemes to offer cashless cataract surgery.
Important Points to Remember
- Pre-authorization is mandatory for cashless claims. Always apply at least 2–3 days before surgery.
- Surgery limits: Insurance often sets a sub-limit for cataract surgery (e.g., ₹20,000 to ₹40,000 per eye). Anything above that must be paid by the patient.
- Premium services like robotic surgery and premium IOLs (multifocal, EDOF, toric) may require additional out-of-pocket payments.
- Network hospitals: Choose a hospital already on your insurer’s or TPA’s network list to simplify approval.
Final Tip
Before finalizing your surgery date, consult the hospital’s insurance desk. They can guide you through documentation, pre-authorization, and maximizing your insurance benefits for a smooth, cashless experience.
Clear vision should be accessible — and cashless options are helping make that a reality for millions of Indians!