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Mediclaim & Cataract Operation:


//Post based on Email Query.

I think low vision is the common problem in the older age & since now a days cataract operation has become very much simple most of the peoples are inclined towards it rather than avoiding.

Cataract is a simple operation where clouded original lense is replaced by artificial intraocular lense(IOL).

Most of the insurance companies pay cataract reimbursement & we will take view of the same:

  1. Hospitalization is not required for cataract operation.Its day care process & condition of compulsory 24 hrs hospitalization do not apply for cataract.
  2. Most of the health insurance companies pay claim only after completion of two policy years.Its mostly excluded for first 2 policy years & its considered as pre-existing if policy holder is operated within first two years.Its policy holders duty to know the exclusion period.
  3. Cataract reimbursement is mostly settled in lumpsum way…most of insurers pay limited reimbursement in between Rs.15,000 – Rs.20,000 depending on nature of policy.
  4. Cashless facility can be availed for cataract if hospital is network hospital.
  5. One need to seek reimbursement if hospital is non-network hospital.
  6. Please inform customer care of company at least 48 hours prior to the operation date.
  7. Following documents are generally required to claim the cataract reimbursement:
  • Claim settlement form:
  • IOL Specification Report in original:Before going for cataract surgery its important for eye surgeon to draw lense specifications.This report contains all specifications of artificial intraocular lenses (IOLs) which needs to be submitted in original.
  • IOL┬áSticker:┬ásticker comes alongwith the lenses & its important to stick this IOL sticker while submitting the claim form.
  • Discharge Summary : Discharge summary in original which have details like patients name,date of operation,type of operation etc.
  • Hospital Bill: Hospital bill in original.
  • Medical certificate by treating doctor with details like name / registration number.

Cataract operation is common now a days..if we aware of the process for mediclaim reimbursement then I think we will able to organise the documents from initiation & it will surely reduce our headache afterwards..isn’t it?


Category: Insurance

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