Is Lasik Surgery Covered By National Insurance?

For many, the allure of LASIK (Laser-assisted in situ keratomileusis) surgery is clear – it offers a life unhindered by the dependency on glasses or contact lenses for those struggling with various forms of impaired vision, like nearsightedness, farsightedness, or astigmatism. However, the cost barrier often prompts one critical question for many in India – is LASIK surgery covered under National Insurance?

This blog post aims to delineate the parameters of National Insurance coverage for LASIK surgery in India in detail. We will pore over the exception clauses, explore what influences the insurance coverage decisions, and offer guidance on what steps to take if your policy does not cover the procedure.

Understanding National Insurance in India

The National Insurance Company Limited, stands as India’s longest-standing general insurance provider, has evolved through a century of operations and a landmark nationalisation in 1972. It represents one of the pillars of the social security net in India, offering support for an array of medical expenses.

Yet, insurance is often a labyrinth, with coverage specifics winding through the fine print. In the case of LASIK surgery, its status as an elective procedure can affect its eligibility for insurance coverage.

LASIK: Elective vs. Medically Necessary

Crucially, LASIK is classified as an elective procedure, causing many insurance schemes to hesitate to provide coverage. Distilled to its essence, LASIK aims to correct vision, a process usually not aligned with ‘medically necessary’ treatment labels. 

Nonetheless, a directive from the Insurance Regulatory and Development Authority of India (IRDAI) in 2019 has nudged open the doors to coverage – conditionally.

When Will National Insurance Cover LASIK Surgery?

Under the guidelines provided by the IRDAI, National Insurance will consider covering LASIK surgery costs if:

Diopter Level: The refractive error must measure at or beyond 7.5 diopters (D), suggestive of substantial impairment that extends past the remedial capacity of glasses or contacts.

The company will reimburse the Hospital or the Insured for medical expenses (including Pre and Post Hospitalisation Expenses) related to the treatment of refractive errors leading to eyesight correction, with a waiting period of two (02) years.

While LASIK is typically an outpatient procedure, some complications might require hospitalisation. National insurance coverage for extended hospital stays due to LASIK-related complications but this would depend on your specific policy.

Direct consultation with your eye specialist is paramount to ascertain whether your condition meets this criterion. They could offer further insights and valuable guidance.

Yet, caution must be exercised even if the diopter level seems favourable. Constraints and exclusions abound, and the path toward coverage requires careful policy examination.

Additional Considerations:

• Review Your Policy: Thoroughly review your national insurance policy document, paying close attention to sections detailing any exclusions or limitations pertaining to elective procedures, such as LASIK surgery.
• Contact Your Insurance Provider: If the policy language is ambiguous or lacks details regarding LASIK coverage, do not hesitate to reach out to your insurance company’s customer service directly to seek clarification.

Constraints on LASIK Coverage:

National Insurance in India commonly sets exclusions around LASIK surgery when:

1. Refractive Error Below the Mark: Refractive errors falling below the requisite 7.5-diopter criterion are typically non-qualifying conditions.
2. Pre-Existing Conditions: Certain antecedent eye health issues, like keratoconus (a weakening of the cornea) or glaucoma (increased pressure in the eye), act as disqualifiers.
3. Non-standard Corrections: Requests for LASIK that extend beyond rectifying the recognised trio of vision impairments fall outside the insurance ambit. For example, if you are considering LASIK surgery to enhance your night vision, it would not be covered.

Understanding Claim Processes for LASIK Surgery:

Should you find yourself covered, expect a claim process involving:

Pre-authorisation: Before LASIK, get approval from your insurer to confirm coverage. This ensures they know you plan to have the surgery and helps decide if it’s covered in your plan.

Documentation: After pre-authorisation, keep these documents ready for a smooth process:

• Doctor’s referral for LASIK with diagnosis and recommendation.
• Medical records of pre-operative evaluation and refractive error measurements.
• Breakdown of surgery costs, encompassing the surgeon’s fees, facility charges, and any supplementary costs.
• Hospital bill/receipt copy for LASIK.
• Any pre-operative test results and prescriptions.

Important Tips:

• Keep originals or certified copies of required documents.
• Organise records for easy claim filing.
• Verify with your insurer if additional documents are required beyond the standard list.

Claim Submission: Once you gather documents, submit your claim within the policy timeframe.

Claim Processing: Your insurer will review your claim and might ask for more details. Processing time varies depending on the claim’s complexity and your insurance provider’s protocols.

Claim Outcome: You’ll be notified of:

• Approval: Reimbursement as per policy.
• Partial Approval: Some costs covered.
• Denial: If not meeting criteria.

Appeal Process: If denied, follow your insurer’s appeal process in your policy. Remember, an appeal is within your rights should the claim encounter rejection.

What if Coverage Fails?

If the National Insurance pathway to LASIK surgery seems fraught, other avenues present themselves:

• Upgrade Path: Some private insurers craft vision-care-focused plans that potentially cover procedures like LASIK. Conduct a diligent cost-benefit analysis before stepping onto this path.

• Financing Schemes: Many LASIK clinics and healthcare institutions provide financing plans to ease the cost burden. These options enable you to pay over time, enhancing the affordability of the procedure. Understand the interest rates and repayment terms of any financing choice.

• Savings Strategy: If direct coverage or a finance scheme proves elusive, a disciplined saving strategy remains a viable alternative for many.

Conclusion

Clear and corrected vision is within reach with LASIK surgery, and while insurance coverage may seem labyrinthine, it’s rooted in comprehensible guidelines. Should your condition meet the stringent 7.5-diopter bar, National Insurance may indeed turn from a potential barrier into a supportive ally. 

Review your policy, consult directly with your provider, and always keep abreast of IRDAI mandates to fully understand your coverage stature. And should the insurance route falter, don’t despair – alternative mechanisms to fund your LASIK surgery exist.

With an informed approach and proactive planning, the dream of sharp vision need not remain elusive.