I have 12 lack Diamonds plain from orintal insurance company medicliam policy I want to know how much amount issue for lens for cataracts surgery
Ans: Your effort to maintain a high-value health insurance cover of Rs.12 lakh is very good. Many people realise the importance of medical insurance only during a hospitalisation. Because you already have a strong cover with The Oriental Insurance Company Limited, you have created an important financial protection layer for your family.
However, when it comes to cataract surgery and lens cost, health insurance policies usually have specific limits. It is important to understand these limits clearly.
» Understanding Cataract Surgery Coverage
– Cataract surgery is normally covered under mediclaim policies.
– The policy usually pays for hospitalisation, surgeon fee, OT charges, medicines, and intra-ocular lens (IOL).
– But most policies keep a limit on cataract treatment, even if the total sum insured is higher.
This means even if your policy cover is Rs.12 lakh, the cataract claim may be restricted to a smaller amount.
» Typical Cataract Limits in Health Insurance
In many mediclaim policies in India:
– Cataract surgery may be limited to around Rs.25,000 to Rs.40,000 per eye, depending on policy terms.
– Some upgraded plans allow up to Rs.50,000 or slightly higher per eye.
– Premium imported lenses, laser techniques, or advanced multifocal lenses may cost more and the extra amount has to be paid by the patient.
So the lens cost alone may range from Rs.8,000 to Rs.60,000 or more depending on the type selected. Insurance will usually reimburse only within the cataract limit mentioned in the policy
» How Lens Charges Are Treated
– Standard mono-focal lenses are generally covered within the cataract limit.
– Advanced lenses such as multifocal or toric lenses are treated as upgraded choices.
– The difference between the hospital bill and the policy limit becomes out-of-pocket payment.
Because hospitals sometimes suggest premium lenses, it is important to check the insurance approval amount before surgery.
» Practical Steps Before Surgery
– Ask the hospital to send a pre-authorisation request to the insurer.
– Confirm the maximum cataract limit per eye under your policy.
– Ask the hospital for a detailed estimate showing lens cost separately.
– Check whether the surgery will be cashless or reimbursement.
This small step avoids confusion during discharge.
» Financial Planning Perspective
From a Certified Financial Planner’s view, you have already taken a wise step by maintaining a large medical insurance cover. Cataract surgery is a common age-related treatment, and insurance helps reduce the financial burden.
Still, remember:
– Health insurance works with sub-limits for certain treatments.
– The sum insured does not always mean the entire bill will be paid.
– Understanding these limits in advance helps you plan your medical expenses calmly.
» Finally
Your Rs.12 lakh mediclaim cover is a strong safety net. For cataract surgery, the insurance company will normally pay only up to the cataract treatment limit mentioned in your policy, and any premium lens upgrade may need personal payment.
So the best action is to check the exact cataract limit in your policy schedule or call the insurer’s customer care before the surgery.
Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner,
www.holisticinvestment.in
https://www.linkedin.com/in/ramalingamcfp/