Will my medical aid pay for cataract surgery?

Will my medical aid pay for cataract surgery?

The short answer is: Yes! Cataracts are a PMB (Prescribed Minimum Benefit) condition. This means that medical aids are by law required to cover basic cataract surgery. 

There are three parties involved in surgery: your ophthalmologist, your anesthetist and the hospital. If all these parties charge medical aid rates or have a contract with your medical aid, there should be no copayment. Medical aids cover lenses to a specific amount and the lens you choose may have a copayment. Some medical aid options have designated providers and you may have a copayment if you choose a different provider. 

If you choose premium surgery and spectacle independence you will most likely have a copayment on your multifocal lenses and laser assisted cataract surgery. The rest should be covered by your medical aid as discussed above. Freedom from spectacles means you will save on spectacles in the long run and have an improved quality of life.

You will have to visit your ophthalmologist prior to surgery. This is covered from your day to day or savings benefits by your medical aid. If you visit a doctor who does not have a contract with your medical aid, they may charge above scheme rate and you could have a copayment.

The medical content provided is not intended to replace a consultation with a qualified health care provider.

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