Can phaco with foldable IOL be done cashless in private hospitals?

Hello,

Yes, Phacoemulsification with a foldable Intraocular Lens (IOL), commonly known as cataract surgery, is available as a cashless treatment at a private hospital under Ayushman Bharat PM-JAY or private health insurance. However, coverage depends on your eligibility, the hospital's empanelment status, the approved treatment package and the type of lens used.

Eligible beneficiaries receive cashless cataract surgery at a private hospital that is actively empanelled under PM-JAY and offers the approved cataract treatment package.

• Hospital charges: Surgery and other services included in the approved package is covered.
• Foldable IOL: The lens must meet the requirements of the applicable PM-JAY package. Confirm the approved lens type with the hospital's Ayushman desk.
• Premium lenses: Multifocal, toric, EDOF or other premium lenses not be covered under the standard package. Ask the hospital which lens options are permitted.
• Cashless approval: The hospital must verify your eligibility and obtain any required pre-authorisation before treatment.

Cashless treatment is not automatic for every patient or every lens. Confirm the exact package and any possible out-of-pocket expenses before surgery.

How to Check Ayushman empanelled hospital?

1. Open the official Ayushman Bharat hospital search portal.
2. Select your state and district.
3. First check the complete list of PM-JAY-empanelled hospitals in your district.
4. Select the hospital type, such as Government or Private, if this option is available.
5. Choose the relevant specialty, such as Ophthalmology or Eye Care, if listed.
6. Enter the exact hospital name and complete the captcha if required.
7. Click Search and check the hospital's current empanelment status.
8. Contact the hospital's Ayushman Mitra or PM-JAY helpdesk to confirm whether cataract surgery using Phaco with a foldable IOL is covered under the applicable package and whether cashless approval is available.

Private health insurance coverage

Yes, private health insurance cover Phaco cataract surgery with a foldable IOL if your policy includes cataract treatment and the hospital is part of your insurer's cashless network.

• Waiting period: Some policies have a waiting period for cataract treatment. Check your policy terms.
• Coverage limit: Your policy may have a maximum amount payable for cataract surgery per eye.
• Lens charges: The insurer may cover a standard lens but may not cover the additional cost of a premium lens.
• Cashless approval: The hospital and insurer must approve the claim according to your policy.

What documents are required?

• Ayushman Bharat card or beneficiary eligibility details, if applying under PM-JAY.
• Aadhaar card or another accepted identity document.
• Doctor's prescription recommending cataract surgery.
• Eye examination reports and other relevant medical reports.
• Previous treatment records and prescriptions, if available.
• For private insurance, your health insurance card, policy details and any documents requested by the hospital or insurer.

Visit an ophthalmologist for an eye examination and confirmation that cataract surgery is required. Before admission, ask the hospital to verify your eligibility, the approved treatment package, the type of foldable lens covered and whether the procedure can be completed without payment from your side.

If you share your city, state and the name of the private hospital you want to visit, we can help you understand how to check its Ayushman empanelment and what to ask about cashless cataract surgery.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth