You are tired of wearing thick glasses. You want Lasik surgery to correct your vision. You visit an eye clinic, and they quote you ₹80,000 to ₹1 Lakh.
You assume, "Health insurance won't cover this because it is cosmetic, just like plastic surgery."
You might be wrong.
While insurers don't pay for you to "look good," they DO pay for you to "see well" if your eyesight is severely impaired. Thanks to IRDAI's standardized guidelines, Refractive Error Correction is now a covered procedure under specific conditions.
Disclaimer: Coverage depends on your specific policy terms and the severity of your refractive error (Diopters). Check your policy wording for "Exclusions."
Don't Pay ₹1 Lakh for Lasik. Here Is How to Make Your Insurer Pay the Bill
1. The "Cosmetic" vs. "Medical" Line
Insurers draw a strict line:
- Cosmetic (Not Covered): If your power is -2.0 and you just want surgery to avoid wearing glasses for style. Claim Rejected.
- Medically Necessary (Covered): If your power is so high that it hinders daily life or cannot be fully corrected by glasses alone. Claim Approved.
2. The Magic Number: +/- 7.5 Diopters
For most standard health insurance policies in India, the benchmark is 7.5 Diopters.
- If your eye power is -7.5 or worse (e.g., -8, -9), the surgery is considered medically necessary.
- The insurer will pay for the procedure, provided you have served the waiting period.
Note: Some modern, premium plans (like those from Niva Bupa or Care Health) have lowered this threshold to +/- 5 Diopters or even less. Read the fine print!
3. Key Conditions to Claim
Even if you have high power, you must check these three boxes:
A. Waiting Period
Lasik is rarely covered from Day 1. It usually falls under "Specific Disease/Procedure" waiting periods.
- Typical Wait: 2 to 3 years.
- If you buy a policy today and get surgery next month, it will be rejected.
B. Type of Surgery
Insurers typically cover standard Lasik or PRK.
If you opt for advanced, ultra-expensive variants (like Contoura Vision or SMILE) purely for "premium comfort" when standard Lasik would suffice, the insurer might only reimburse the cost of the standard procedure.
C. Doctor's Prescription
You need a certificate from your ophthalmologist stating that the surgery is "Medically Recommended" due to intolerance to contact lenses or functional impairment, not just patient preference.
4. What If My Power Is Low (e.g., -3.0)?
If your power is below the limit, standard insurance won't help. However, you still have options:
- OPD Cover: Some plans come with an "OPD (Out Patient Department)" wallet. You can use this limit (e.g., ₹10,000) to pay for a part of the consultation and surgery.
- Corporate Insurance: Check your office Group Health Policy. Corporate plans often have fewer restrictions and might cover Lasik regardless of power limits.
5. Don't Hide It!
If you undergo Lasik, inform your insurer even if you don't claim.
Why? because later in life, if you develop cataracts or other eye issues, the insurer needs to know your history. Non-disclosure of a past surgery could jeopardize future claims.
Check Your Eyes, Then Check Your Policy
If you have been wearing "coke bottle" glasses for years, your surgery might be fully sponsored by your insurance company. Don't pay ₹1 Lakh out of pocket without checking.
Action Plan:
- Visit an ophthalmologist and get your exact Refractive Power (Diopter) measured.
- Open your policy document PDF and search for "Refractive Error" or "7.5".
- If your power is above the limit and your waiting period is over, apply for Cashless Pre-authorization before the surgery.
Helpful Resources:
Star Health: Lasik Surgery Coverage Rules
Acko: Guide to Eye Surgery Claims
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