Yes, Oriental Insurance covers LASIK surgery if the refractive error is equal to or more than 7.5 dioptres.
Expenses related to the correction of eyesight under these conditions fall within the scope of their health insurance policies, ensuring that policyholders can access financial support when needed.
Vision correction is a necessity, not merely a luxury. Yet, for years, individuals seeking LASIK surgery have faced challenges with securing insurance coverage as it has often been classified as a cosmetic procedure. Thanks to advancements in insurance policies and regulatory updates, this scenario has transformed many individuals, especially with providers like Oriental Insurance.
Understanding Oriental Insurance and Its Stance on LASIK Surgery
The Oriental Insurance Company is known for its commitment to providing diverse and dependable health insurance solutions. From covering medical, surgical, and hospitalisation expenses to focusing on specific needs such as LASIK surgeries under certain conditions, their plans offer holistic support to policyholders.
However, when it comes to LASIK surgery, coverage depends on specific eligibility criteria and underlying conditions. Oriental Insurance follows guidelines set forth by the Insurance Regulatory and Development Authority of India (IRDAI), which has introduced clarity around LASIK as part of health insurance plans. If an individual’s refractive error meets the stated conditions, financial protection for the procedure is included.
Why Was LASIK Surgery Previously Excluded?
LASIK, or Laser-Assisted in Situ Keratomileusis, is a surgical procedure to correct refractive vision errors like myopia, hyperopia, or astigmatism. Historically, these surgeries were considered elective or cosmetic, not medically essential, and thus excluded from many standard health insurance plans. This left individuals covering the significant costs of LASIK surgery out of pocket, despite the benefits of improved eyesight.
The good news? Oriental Insurance, along with other providers, now acknowledges the medical necessities tied to severe refractive errors, providing coverage under select conditions.
Criteria for LASIK Surgery Coverage
LASIK surgery coverage under Oriental Insurance is not universal; specific guidelines outline who qualifies. To determine whether coverage may apply, the following conditions are commonly assessed:
1. Refractive Error Equal to or More Than 7.5 Dioptres
For individuals meeting this threshold, LASIK surgery is recognised as a medical necessity rather than an elective cosmetic choice. Oriental Insurance provides coverage for such cases, ensuring the policyholder is not burdened with the entire cost of the procedure.
2. Refractive Error Resulting from an Injury or Accident
If the need for LASIK surgery arises following an injury or accident that affects vision, the procedure may be covered. This distinguishes medically required LASIK from voluntary surgeries performed to enhance comfort or convenience.
3. Refractive Error Caused by a Previous Surgery
Surgery-related complications can lead to refractive errors, necessitating LASIK correction. Oriental Insurance recognises the relevance of addressing such medical challenges and provides support for subsequent surgeries.
4. Physical Deformities Preventing Use of Glasses
If a person has a deformity or condition that makes wearing glasses highly uncomfortable or impossible, LASIK may be deemed essential. Coverage may be granted in these exceptional cases.
5. Intolerance to Contact Lenses
Individuals unable to tolerate contact lenses due to physical limitations or adverse reactions may qualify for coverage. This further extends financial support for those who cannot manage with traditional corrective approaches.
Importance of Checking Individual Policies
While Oriental Insurance offers coverage under these conditions, it’s crucial to read and understand the fine print of your health insurance policy. Different plans include varying terms, coverage limits, and exclusions. For example:
- The policy may specify certain age groups for eligibility.
- Some plans might require additional riders for advanced surgical procedures.
- A waiting period for specific treatments, including LASIK, might apply.
If you are unsure about your policy’s stance, the best approach is to consult directly with Oriental Insurance or your insurance advisor to understand specific inclusions and exclusions.
The Impact of IRDAI Guidelines on LASIK Coverage
The IRDAI has significantly contributed to clarifying LASIK-related coverage for policyholders. Under their guidance, basic health insurance plans from established providers now include LASIK surgery when certain medical conditions exist, such as high refractive error (7.5 dioptres or above). This ensures fair access to medically necessary procedures while promoting transparency within the insurance sector.
For customers, this means a reduction in out-of-pocket expenses for those who genuinely need corrective vision surgery and a better alignment between their medical requirements and insurance benefits.
How to Avail LASIK Surgery Coverage?
If you’re a policyholder with Oriental Insurance and planning LASIK surgery, here’s a step-by-step guide to avail coverage:
1. Check Your Policy Terms
Begin by reviewing the specific terms of your health insurance policy. Identify whether your circumstances, such as the refractive error level or other conditions, qualify for coverage under the LASIK provision.
2. Obtain Medical Evaluation
Get a detailed medical assessment from an ophthalmologist. They will measure your refractive error and evaluate whether LASIK surgery is essential. Ensure that you secure their professional recommendation for the procedure.
3. Consult Oriental Insurance
Contact Oriental Insurance directly or speak to your advisor to confirm coverage eligibility. Ask for written clarification about the reimbursement or cashless options available for LASIK surgery.
4. Submit Required Documents
Before undergoing the procedure, prepare and submit the necessary documentation. This typically includes:
- A doctor’s prescription or recommendation.
- Medical reports specifying your refractive error.
- Health insurance policy details.
5. Proceed with the Surgery
Once your claim is pre-approved (if applicable), schedule the surgery with a qualified healthcare provider. Keep all bills and additional documentation for reimbursement (if not a cashless policy).
Why Choose Oriental Insurance for LASIK Coverage?
Oriental Insurance stands out for its comprehensive health plans tailored to meet evolving healthcare needs. Here’s why policyholders value their LASIK coverage:
- Financial Easement: With LASIK surgery costs ranging between ₹30,000 and ₹1,00,000, Oriental Insurance eases the financial burden by covering eligible expenses.
- Transparent Policies: The company provides clear terms, helping customers understand what is and isn’t covered.
- Trusted Support: Policyholders can depend on professional customer service for guidance throughout the claims process.
Final Thoughts
LASIK surgery can be life-changing for those struggling with visual impairments. Under Oriental Insurance, coverage is available if specific conditions are met, particularly for refractive errors of 7.5 dioptres or higher. This assurance not only enhances health outcomes but also provides much-needed peace of mind.
Before proceeding, carefully review your policy details or consult Oriental Insurance directly to avoid surprises during the claims process. If you’re eligible, you’ll benefit from both improved vision and financial security.
Remember, clarity is key—not just for sight, but for navigating health insurance.
