Is Laser Eye Surgery Covered Under Care Health Insurance?

Laser eye surgery, including LASIK, is a fantastic way to correct one's vision and is more permanent than the alternatives of glasses and contact lenses. With such procedures becoming increasingly mainstream, many individuals wonder if their health insurance pays for it or does not. To this end, the following article will examine whether Care Health Insurance covers laser eye surgery, and if so, the terms under which the insurance pays for this treatment

Why Insurance Coverage Matters for Laser Eye Surgery

Laser eye surgery can cost upwards of ₹30,000 to ₹1,00,000 or more, according to the procedure. But while the surgery usually falls into the elective or cosmetic category, many patients go for it on medical grounds since a lot of them have huge refractive errors which hit hard at their quality of life. Health insurance can ease the financial burden and make it accessible to all those who need it.

Does Care Health Insurance Cover Laser Eye Surgery?

Care Health Insurance Plans offers specialised policies, such as Care Super Mediclaim, that provide coverage for refractive error treatments, including laser eye surgery. The coverage applies in cases where the patient's vision exceeds 7.5 dioptres, and the surgery is deemed medically necessary. It’s important to check the policy brochure and consult with Care Health Insurance or an InsuranceDekho representative to confirm the coverage details, as claim settlement is subject to policy terms and the insurer's discretion.

List of Health Insurance Plans By Care Health Insurance

Care Health Insurance offers different health plans to fulfil different needs, possibly laser eye surgery included, under the eligibility criteria. Some of the significant health plans offered at Care Health Insurance are as follows:

• Care Supreme Plan: The Care Supreme plan has been designed to provide comprehensive medical coverage to the insured with a bunch of unique benefits. The sum insured offered by the plan is Rs 5 lakh, Rs 7 lakh, Rs 10 lakh and Rs 15 lakh.
• Care Advantage: Care Advantage Health Insurance is a Rs 1 crore health insurance policy, offering comprehensive coverage to individuals and families. It is designed to meet the healthcare needs of the insured against the planned and emergency medical expenses. The product has no sub-limits and also comes with an optional cover for copayment waiver
• Care Health for Senior Citizens- The insurance company offers a health insurance policy for senior citizens - Care Health, which is devised with the motive of keeping the elderly secured financially in case of medical emergencies along with the liberty to access quality healthcare facilities.
• Pre-Existing Diseases Cover: Covers pre-existing diseases after a certain waiting period; hence, it helps much when one has prevailing health issues.
• Maternity Health Plan: The plan covers the maternity expenses, thereby supporting the overall financial burden during pregnancy and childbearing.
• Super Top-Up Health Plan: It provides additional coverage over and above the base plan, which suits high expenses related to surgery.
• Heart Health Insurance: The plan targets heart-related conditions through financial protection against the expensive cost of cardiac care.

Special Conditions Where Laser Eye Surgery is Covered  

Laser eye surgery is usually covered under Care Health Insurance Plans if it is medically advised rather than cosmetic. For example:

• Severe Refractive Errors: In these, the vision is considerably poor, and glasses or contact lenses are insufficient. Laser surgery may be recommended in this case.
• Post-trauma/Injury: In case of some accident or trauma causing impairment in vision that needs a laser surgery to get rectified, Care Health Insurance will cover it.
• Medical Necessity: A physician feels that eye surgery with a laser is crucial for the sake of one's quality of life or to prevent further deterioration of vision. In such cases, it is covered under insurance

Types of Laser Eye Surgery Covered 

The Care Health Insurance provides various options for different types of laser eye surgeries that may be deemed medically necessary. The following are:

• LASIK (Laser-Assisted In Situ Keratomileusis): The most popular laser eye surgery, known as LASIK Laser-Assisted In Situ Keratomileusis, is frequently used to treat refractive problems such astigmatism, hyperopia, and myopia.
• PRK Photorefractive Keratectomy: When a patient has thin corneas or other circumstances that make LASIK unsuitable, PRK is performed as an alternative to LASIK.
• SMILE (Small Incision Lenticule Extraction): This is a more recent advancement that requires less downtime than LASIK and is sometimes preferred for specific refractive disorders.

Eligibility Criteria for Covering Laser Eye Surgery 

In general, the following criteria will apply under Care Health Insurance to be eligible for laser eye surgery:

• Doctor's Prescription: The surgery is prescribed by a licensed ophthalmologist or a medical practitioner on health but not cosmetic grounds.
• Medical History: Patients are those with a medical history of some problem in the eye or disorderly condition that can be treated only with laser surgery.
• Policy Waiting Period: Generally pre-existing conditions are not covered in most health insurance policies and laser eye surgery might come under this exclusion, and hence their policy's waiting period should be checked.
• Pre-Approval from the Insurance Company: Many a times, it would be necessary to obtain pre-approval from the Health Insurance Company, ‘Care Health Insurance’ in this case, to get the surgery done, failing which the claim might stand rejected.

Conclusion

Laser eye surgery can, at times, prove quite traumatic for people suffering from the slightest vision impairments, and even Care Health Insurance covers it if the surgery is deemed medically necessary. It is always necessary to carefully read through your health insurance plan with your doctor and then also confirm from Care Health Insurance before proceeding with the surgery. This will save you a lot of time and money by finding out what kind of coverage you have.

FAQs

Ques 1. Whether Care Health Insurance covers LASIK surgery?

Ans. Yes, it does, but for the specified medical conditions, meaning severe refractive errors or post-trauma corrections.

Ques 2. What can be done in anticipation of including laser surgery in the schedule?

Ans. See an ophthalmologist and get a medical recommendation-the surgery must be medically necessary and prior authorization from Care Health Insurance needs to be obtained.

Ques 3. Are there any waiting periods before laser eye surgery is covered?

Ans. There is a waiting period for pre-existing diseases under most of these policies. This all depends on the terms of your Care Health Insurance policy.

Ques 4. Cosmetic laser eye surgery: Is that covered?

Ans. No, cosmetic surgeries are generally not covered. Only medically necessary laser eye surgery shall be covered.

Ques 5. How to claim for a laser eye surgery?

Ans. The supportive documents that you will have to include are your doctor's recommendation, proof of a medical necessity, and other documents that you must refer to and provide for claim approval to Care Health Insurance.