Health insurance can be a useful tool, but sometimes it can miss the most basic things. Critical diseases, hospitalisation, transplants and even expensive diagnostics can be covered by health insurance. That said, there are aspects where health insurance can be restrictive. Cataract is one such issue.

Cataract predominantly affects the aged. In one study conducted in India, cataract was found to be prevalent in close to 60 per cent of patients over the age of 60. If left untreated, the condition can lead to severe visual impairment, and even blindness. Cataract can be aggravated by diabetes. With India facing a high incidence of diabetes, the risk of cataract impacting the elderly is significantly higher in the country. The high incidence may partly explain why insurers often impose tighter coverage conditions. Because cataract is common and often age-related, insurers tend to impose tighter limits and waiting periods.

The key limits on cataract coverage are outlined here. Alongside, we cite comments by Siddharth Singhal, Head of Health Insurance at Policybazaar, on the concerns, and a few ways by which these can be checked.

Coverage

The basic restriction pertains to the waiting period. Most policyholders would be aware of the pre-existing waiting period or PED which generally is three years for most policies. But, cataract coverage falls under the lesser-known ‘specific disease’ waiting period of two years. Generally, slow-growing diseases fall under this category including, not just cataract but also, pancreatitis, cirrhosis, osteoarthritis, and knee replacement. Even if a policyholder is not impacted by the disease at the time of policy issuance, the coverage for these diseases will start only after two years of continuous policy cover. If the sum insured is raised, this two-year waiting period will be applicable to the incremental amount. However, in case of porting a policy, the period served carries over just as with PED waiting period.

In addition to the waiting period, which is present in most of the policies, monetary restriction too is a hurdle and can take several forms.

Firstly, many newer policies issued in the last couple of years do not mention any form of sub-limits for cataract coverage. Not only cataract, but room rent, disease sub-limits, day care procedures, do not face sub-limits in these policies. This could also be attributed to sum insured being ₹10 lakh or higher in these policies.

Policyholders are recommended to read the fine print in the customer information sheet and policy wording. Even after the purchase, there is a 15-day free-look period during which the policy can be reviewed and cancelled if the terms do not match what was promised. On the other hand, policyholders who bought insurance earlier may have sub-limits on cataract. The most common sub-limit prescribes an amount of ₹20,000-50,000 for cataract procedure on a single eye. Compared with an average cost of ₹50,000-60,000 per eye for cataract procedure, this sub-limit protects the policyholder only to an extent.

For one of Star Health’s insurance plans, the policy prescribes ₹30,000 per eye per person and does not exceed ₹40,000 per policy period for a cataract procedure. Some policies set the sub-limit for cataract surgery at 10 to 25 per cent of the sum insured along with a maximum cap of ₹20,000-50,000 per eye.

Some insurance policies, such as Niva Bupa for instance, prescribe providing cover for monofocal lens for the treatment of cataract.

The treatment for cataract often involves monofocal lens at the lower end of cost or multi-focal at the higher end of cost. The range can be ascribed to medical necessity or lifestyle choices. As insurance covers only medically necessary costs, the latter are generally not covered.

Siddharth Singhal, Head of Health Insurance at Policybazaar, mentions as cataract is a slowly advancing disease, insurance companies can place a two-year waiting period for coverage.

But he says most of the monetary sub-limits are being done away with. He suggested a rider that shortens the waiting period (both PED and slow-growing disease waiting period) as a measure to improve utilisation of health insurance policies.

Policyholders facing a slew of sub-limits mostly found in older policies including cataract, may consider porting to a new policy which has mostly done away with sub-limits on most issues.

Published on April 25, 2026