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Cataract Cover: Insurers' Tight Grip Loosened?
26 Apr
Summary
- Cataract coverage often has a two-year specific disease waiting period.
- Older policies may have sub-limits, capping cataract surgery costs.
- Newer policies with higher sum insured often lack sub-limits.
Health insurance policies often include specific disease waiting periods, with cataract coverage typically subject to a two-year limit, even for individuals without pre-existing conditions. This restriction applies even if the sum insured is increased. Older insurance plans may also impose monetary sub-limits on cataract procedures, often ranging from ₹20,000 to ₹50,000 per eye, which may not fully cover the average procedure cost.
In contrast, many newer health insurance policies, particularly those with a sum insured of ₹10 lakh or higher, have removed sub-limits for cataract and other procedures. These modern policies offer more comprehensive coverage, addressing concerns about room rent and daily care costs. Policyholders are encouraged to carefully examine their policy wording and utilize the 15-day free-look period to ensure their coverage aligns with their needs.
Experts suggest that insurers can implement a two-year waiting period for slowly advancing diseases like cataract. However, the trend is moving away from monetary sub-limits. Policyholders with older policies facing such restrictions may benefit from porting to newer plans that offer broader coverage without these limitations. Additionally, riders can be considered to potentially shorten waiting periods for certain conditions.
