Frequently Asked Questions (FAQs) – Private Health Insurance
1. Can eye treatments be covered under health insurance?
Yes. Many eye surgeries and procedures are covered if they are medically necessary.
2. Which eye surgeries are commonly covered?
Most insurance policies cover:
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Cataract surgery
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Glaucoma surgery
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Retinal surgeries (vitrectomy, retinal detachment)
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Corneal surgeries
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Ocular trauma and emergency eye surgeries
3. Is cataract surgery covered by insurance?
Yes, cataract surgery is usually covered, but:
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There may be a waiting period
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There may be a package limit fixed by the insurer
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Premium lenses (multifocal, trifocal, toric) may require additional payment
4. Are LASIK or refractive surgeries covered?
Usually NO. Procedures like LASIK, SMILE, and PRK are considered cosmetic/elective and are not covered in most policies.
5. Is OPD consultation covered for eye problems?
Most insurance policies do not cover OPD consultations, refraction, or routine eye check-ups unless OPD coverage is specifically included.
6. Are investigations like OCT, fundus photo, or scans covered?
These tests are usually covered only if done during hospitalization or as part of a covered surgery.
7. What is a cashless facility in an eye hospital?
If the hospital is a network hospital, the insurance company pays the approved amount directly to the hospital.
The patient pays:
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Non-medical charges
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Non-covered items
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Any amount beyond policy limits
8. What documents are required for cashless eye surgery?
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Insurance card / policy details
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Government photo ID
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Doctor’s consultation note
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Previous medical records (if any)
9. What is reimbursement in eye treatment?
If cashless is not available:
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Patient pays the bill first
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Submits documents to insurance company
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Gets the approved amount later
10. Is diabetic retinopathy treatment covered?
Yes. Treatments like
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Laser
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Intravitreal injections
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Retinal surgeries are generally covered when medically indicated, subject to policy terms.
11. Is glaucoma treatment covered?
Yes.
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Medications during hospitalization
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Laser or surgery are usually covered, depending on the policy.
12. What expenses are NOT covered in eye insurance claims?
Usually not covered:
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Spectacles
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Contact lenses
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Routine refraction
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Premium IOL cost beyond package
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OPD medicines
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LASIK / cosmetic procedures
13. What is a package rate for eye surgery?
Insurance companies often fix package rates for eye surgeries (especially cataract), which may include:
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Surgery charges
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Basic lens
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Hospital stay
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Any extra cost must be paid by the patient.
14. Can both eyes be operated on under one insurance claim?
Usually one eye at a time is covered. Second eye surgery may require:
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Separate approval
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Waiting interval as per policy
15. Whom should I contact for insurance help in the eye hospital?
Please contact:
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Hospital Insurance Desk
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TPA / Insurance Company helpline
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Your insurance agent