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Health insurance for major eye surgery

Compare health insurance that will cover cataracts and laser eye surgery.

Andrew Munro
Andrew Munro

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More and more insurers are covering major eye procedures like cataract and corrective laser eye surgery. You don't even need a top-level policy for medically-necessary procedures like certain cataract treatments.

Some insurers even offer a range of rebates and other discounts toward laser eye surgery through their extras policies.

How much does insurance for major eye surgery cost?

You'll find major eye surgery in hospital cover. Below are a few policies from Finder partners that cover this treatment, prices quoted are for a single policy in Sydney

Major eye surgery that includes cataracts falls into a Gold tier, although some funds also offer it in silver.

Data indicated here is updated regularly
Name Product Cataract Surgery Tier Price Per Month Hide CompareBox
ahm deluxe silver plus
ahm deluxe silver plus
Silver
$152
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Qantas Silver Plus Hospital
Qantas Silver Plus Hospital
Silver
$150.80
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AAMI Silver Advantage Hospital Plus
AAMI Silver Advantage Hospital Plus
Silver
$153.43
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HCF Hospital Silver Plus
HCF Hospital Silver Plus
Silver
$161.70
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*Quotes are based on single individual with less than $90,000 income and living in Sydney.

What if you have multiple major eye surgery options?

In the case of major eye surgery, you will sometimes be faced with a choice as to how you would like the procedure to be carried out, and your decision will have health insurance implications. For example, you may be given the choice of:

  • Femtosecond laser cataract surgery, which is quicker and safer although may require a high level of extras cover.
  • Manual cataract surgery. Which is cheaper and therefore may be your only option if you have basic extras cover.

Should this happen, it’s a good idea to check with your health fund and your doctor before agreeing to any procedure to ensure that you understand all the insurance implications of your decision.

Looking to compare laser eye surgery clinics and costs? Check out our guide here

How does the public and private health systems handle major eye surgery?

Medicare, Australia’s public health system, only covers essential procedures like cataract removal surgery. It does not cover optionals like corrective laser eye surgery.
What does Medicare cover you for?What isn't covered?
  • Costs of treatment as a public patient in a public hospital
  • Partial costs of being treated as a private patient in a public hospital
  • Essential eye procedures required for the patient to maintain their sight
  • Corrective surgery
  • Unessential elective or optional procedures done for cosmetic purposes
  • Procedures carried out to prevent a patient from needing to wear glasses or contact lenses
Private health insurance, by contrast, can cover all major eye surgeries to a certain extent, even corrective laser surgery. Most private health funds offer combined hospital and extras policies, as well as hospital-only and extras-only policies. The level of cover you have depends on the comprehensiveness of your health insurance.
Health insurance policy typeWhat can it cover?
  • Hospital Cover
  • Treatments undertaken as a private patient in a private hospital.
  • Treatments undertaken at private ophthalmology (eye-related) surgery centres.
  • Ancillary costs associated with eye surgery such as anaesthesia and operating theatre fees.
  • Extras Cover
  • Corrective laser eye surgery.
  • Additional treatments such as eye therapy.
  • Subsidies for glasses and contact lenses.

What should I look for when comparing insurance policies?

When comparing health insurance policies for major eye surgery, or for that matter any type of medical service, you should be aware of the terms and conditions, as well as the fine print stating exactly which procedures are covered.

  • Exclusions. These are what the insurer will not pay a benefit for. Exclusions might be for specific procedures, such as corrective surgery, or under specific conditions, such as if you get treatment outside of Australia.
  • Restrictions. These are services that are covered to a limited extent, meaning greater out-of-pocket expenses for you. Restrictions are relatively common in major eye surgery, and you may see certain policies with eye surgery restrictions at the basic level and none at the comprehensive level.
  • Waiting periods. This is the minimum amount of time you must wait between taking out a policy and claiming benefits with it. For in-hospital major eye surgery this is typically two months, while for extras corrective eye surgery it is usually about 12 months.
  • Excess. This is a fee you must pay when claiming benefits. Not all health insurance policies include excesses, but some do. You may be able to opt for a higher excess and lower premiums, or a lower excess and higher premiums. It’s good to make sure that your excess is not so high as to prevent you from making any claims.
  • Limits. All private health funds have annual limits, which are the maximum amount you can claim in benefits per year. There might be more than one applicable limit. For example, you might have a policy that lets you claim a maximum of $1,000 per year for all hospital surgery, or $1,000 for all eye surgeries. Limits will always apply so make sure to read your policy’s product disclosure statement closely.

When determining which eye surgeries are covered by your private health insurance policy, you should look for terminology including:

  • Corrective surgery, refractive surgery or laser eye surgery. These are all different ways of reshaping the lens to correct vision and remove the need to wear glasses. Depending on the nature of your impaired vision, a different corrective procedure might be undertaken. These procedures vary in cost, and it is possible that only some will be covered by either your hospital or extras policy.
  • Major eye surgery. This encompasses a wide variety of surgical procedures undertaken for the purpose of fixing medical issues, such as glaucoma, rather than simply correcting vision. Each insurer may have their own definition of major eye surgery. Some will pay for any major eye procedure recommended by an ophthalmologist, others will only cover specific treatments or parts of the eye.

Compare health insurance for major eye surgery

When you get your quotes, just click refine search and then choose major eye surgery under hospital cover and optical under extras cover to view the range of cover available to you.

Picture: Shutterstock

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2 Responses

    Default Gravatar
    AndrewJuly 12, 2019

    I’m wondering if any private health funds would have any hospital or extras policies that cover any cost for a 37 year old single man in Tasmania to get Implantable Contact Lenses to correct longsightedness (very high script of +5.25 and +6.25) and stigmatism in one eye. According to Medibank (example), a item number from a medical practitioner/related business is needed to determine if an insurer’s policies has the right type of cover for such surgery.

    Reply
      Avatarfinder Customer Care
      FayeJuly 13, 2019Staff

      Hi Andrew,

      Thanks for contacting Finder.

      Most private health funds offer combined hospital and extras policies, as well as hospital-only and extras-only policies. They can cover all major eye surgeries to a certain extent, even corrective laser surgery. The level of cover you have depends on the comprehensiveness of your health insurance.

      While we do not provide specific product recommendations, we can help guide you through the process of comparing options. Here is a handy link to check out a list of private health insurance companies. On that page, please complete the table to search for the right policy for you.

      Before applying, please ensure that you meet all the eligibility criteria and read through the details of the needed requirements as well as the relevant Product Disclosure Statements/Terms and Conditions when comparing your options before making a decision on whether it is right for you. You can also contact the provider if you have specific questions.

      Kind Regards,

      Faye

      Reply
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