Sun Life Insurance: Cataract Surgery Coverage Explained

Cataract surgery is a common medical procedure that can be life-changing for those suffering from impaired vision. While it is the only treatment for cataracts, it is often a successful one, with 95% of patients achieving a successful result. Sun Life offers health insurance plans in Canada, the US, the UK, and the Philippines, and cataract surgery is typically covered by health insurance. However, it is important to note that vision insurance, which covers routine eye care, usually does not cover cataract surgery. The availability and extent of coverage for cataract surgery depend on the specific insurance plan and the patient's location.

Sun Life's coverage for cataract surgery

Cataract surgery is often covered by health insurance providers, including Sun Life, when it is deemed "medically necessary". This means that a cataract is causing noticeable vision problems and surgery is the best treatment option.

Sun Life's personal health insurance plans offer coverage for vision care, including cataract surgery. However, it is important to note that there may be limitations and out-of-pocket expenses depending on your specific plan.

Coverage Details:

Sun Life's health insurance plans typically cover the following:

• Traditional cataract surgery: Phacoemulsification, the most common type of cataract surgery, uses ultrasound waves to break up and remove the cloudy lens.
• Standard artificial lens (monofocal lens): This type of lens corrects your vision at one distance, usually set for focusing on farther objects.
• Doctor visits: Sun Life may cover ophthalmologist consultations before and after surgery.
• New glasses after surgery: In some cases, Sun Life may cover a pair of standard prescription glasses or contact lenses after cataract surgery.

What is Not Covered or Partially Covered:

There are certain expenses that Sun Life's health insurance plans may not fully cover:

• Premium intraocular lenses (IOLs): These include multifocal, accommodating, and toric lenses, which can help reduce the need for glasses or contact lenses after surgery. Sun Life may consider these lenses optional, and you may have to pay additional costs.
• Laser cataract surgery: This type of surgery uses lasers to create precise incisions and break up the cloudy lens. It is often not covered by insurance and can result in higher out-of-pocket costs.
• Out-of-pocket expenses: You may be responsible for deductibles, coinsurance, copayments, and other charges not covered by your specific plan.

Important Considerations:

• It is essential to review your specific Sun Life health insurance plan to understand the coverage limitations and expenses.
• Cataract surgery is typically covered by health insurance, not vision insurance.
• The cost of cataract surgery can vary, and you may need to pay a portion of the expenses depending on your plan's coverage.

In conclusion, Sun Life's health insurance plans offer coverage for cataract surgery and related expenses. However, it is important to carefully review your specific plan to understand what is covered and what additional costs you may incur.

The cost of cataract surgery

The type of surgery can impact the cost, with traditional techniques such as phacoemulsification ("phaco") and extracapsular cataract extraction surgery (ECCE) being less expensive than laser-assisted cataract surgery. The choice of lens can also affect the cost, with premium intraocular lenses (IOLs) such as toric and multifocal lenses costing more than standard monofocal lenses.

The surgeon's experience and the location of the procedure can also influence the price. More experienced surgeons may charge more, and having the surgery in a hospital outpatient setting is typically more expensive than an ambulatory surgical center.

Insurance coverage can significantly offset the out-of-pocket expense. Medicare beneficiaries, for example, may only pay a few hundred dollars for the surgery, while those with high-deductible health plans may be financially responsible for the full amount. Private insurance plans and Medicare typically cover standard cataract surgery with monofocal lenses but may not cover newer lenses and surgical techniques.

It's important to carefully review your insurance plan's coverage and understand any out-of-pocket expenses you may be responsible for before undergoing cataract surgery.

The different types of intraocular lenses (IOLs)

Intraocular lenses (IOLs) are synthetic lenses that replace the natural lenses in your eyes. They are made of clear plastic and are typically a third of the size of a dime. IOLs are implanted during cataract surgery, correcting a range of vision issues, including nearsightedness and age-related farsightedness.

• Monofocal IOLs are the most common type. They have a single focusing power, which can be set to improve either your distance, mid-range, or close-up vision. Most people opt to have monofocal lenses set for distance vision, but you may still need glasses for close-up tasks. Monofocal lenses with monovision are a variation where each eye has a different focusing power, allowing you to see both distant and close-up objects without glasses.
• Multifocal IOLs have multiple focal zones, improving both close-up and distance vision. Your brain adjusts to these zones, selecting the appropriate focusing power for different tasks. While multifocal lenses may reduce your need for glasses, they can cause side effects like halos or glare around lights.
• Extended depth-of-focus (EDOF) IOLs have a single long focal point that expands your corrected range of vision and depth of focus. They provide excellent distance vision and improved mid-range vision but may not eliminate the need for glasses for close-up tasks.
• Accommodating IOLs are flexible lenses that act more like your natural lenses, adjusting their shape to help you see objects at different distances. They reduce your dependence on glasses but may not be ideal for extended close-up work.
• Toric IOLs are designed for people with astigmatism. They improve the way light hits your retina, resulting in sharper and clearer vision. Toric lenses can be monofocal, multifocal, EDOF, or accommodating.
• Light-adjustable IOLs (LALs) are fine-tuned by your ophthalmologist after the surgery through a series of UV light treatments. This allows for a more customized prescription, but you will still need glasses for certain tasks.
• Phakic IOLs are typically implanted in younger individuals to correct nearsightedness when they do not qualify for laser refractive surgery. These lenses help preserve your natural ability to focus but will eventually need to be removed during cataract surgery.

The procedure for cataract surgery

Cataract surgery is a quick, safe, and painless procedure to remove a cloudy lens that's causing vision issues. It is one of the most common types of surgery in the US and globally. The procedure is performed while the patient is awake, but sedated, and typically takes 10 to 20 minutes to complete. Here is a step-by-step breakdown of the cataract surgery procedure:

Numbing the Eye:

The surface of the eye is numbed using topical anaesthesia. Eye drops are applied to ensure the patient doesn't feel any discomfort during the surgery.

Making the Incision:

The surgeon makes a tiny incision in the cornea, either with a laser or a blade. This incision is usually very small and often doesn't require stitches to close.

Breaking Up and Removing the Cataract:

The most common technique for this step is phacoemulsification, where ultrasound waves are used to break up the cloudy lens into tiny pieces. These pieces are then suctioned out.

Inserting the New Lens:

Through the same incision, the surgeon inserts a new intraocular lens (IOL). IOLs are clear, artificial lenses that allow light to pass through and be focused by the eye correctly. The IOL unfolds into the space where the cloudy lens previously rested.

Protecting the Eye:

After the new lens is inserted, the surgeon tapes a shield or eye patch over the eye to protect it during the healing process.

Monitoring and Follow-up:

The patient is monitored for 15 to 30 minutes after the surgery, and the first follow-up appointment is scheduled. The patient can then go home. It is important to note that things may look blurry right after the surgery, but vision gradually improves over the next few days and weeks.

Recovery:

Full recovery from cataract surgery typically takes about four weeks, but many people notice improvements in their vision within a few days. During the recovery period, patients should follow their surgeon's instructions, use prescribed eye drops, avoid getting water or soap in their eyes, and wear sunglasses when outdoors.

The recovery process after cataract surgery

Cataract surgery is a quick, painless procedure to remove a cloudy lens causing vision issues. It is a safe, routine procedure with a high success rate in improving your eyesight. You should be able to go home the same day as your surgery, but it is recommended that you arrange for someone to take care of you until your vision returns.

Limit Strenuous Activity

Avoid rigorous exercise and activities that require heavy lifting for a couple of weeks to lower the chances of increasing your eye pressure. Positions that put your head below your waist, such as bending over, can also increase eye pressure and should be avoided initially after surgery.

Shield Yourself from Irritants or Trauma

Your eyes will be sensitive to the environment for at least a week after surgery. Wear wraparound sunglasses to protect yourself from exposure to dust, dirt, and pollen, and to help with sensitivity to light. Your eye doctor will also provide you with an eye shield to wear while sleeping to prevent touching or rubbing your eyes.

Keep Out of the Pool and Shower Carefully

Exposure to water can put your eyes at risk of infection or irritation until they have healed. Give yourself at least one night of sleep before showering, and prevent the stream of water from hitting your eyes directly. Ask your doctor when it is safe to start swimming or using a hot tub, which is usually a few weeks after surgery.

Follow Doctor's Orders

Be sure to ask your doctor about any precautions you should take and when you can resume normal activities. Contact your eye doctor immediately if you experience any of the following symptoms after surgery:

• Spots or floaters in your vision
• Nausea, vomiting, or excessive coughing
• Increased pain and/or redness
• Crusting or mucus discharge around your eye
• Worsening vision or vision loss
• Eye floaters or flashes

Use Eye Drops as Instructed

Before you leave the hospital, you will be given eye drops to help your eye heal and prevent infection. It is important to use these drops as instructed by your doctor. Unless told otherwise, start the drops the morning after the operation, only use them on the operated eye, and wash your hands before using them. Do not stop using the eye drops without advice from your doctor.

Take it Easy for the First Few Days

For the first few days after surgery, take it easy and avoid any strenuous exercise or housework. You can bathe or shower as usual, but be sure to wear your eye shield when washing your hair. You can also read, watch TV, and use a computer, but be sure to use your eye shield, old glasses, or sunglasses if you need to go outdoors.

Avoid Certain Activities

In addition to strenuous exercise, there are a few other activities you should avoid for a few weeks after surgery:

• Swimming
• Driving until you get clearance from your doctor
• Flying without seeking advice from your doctor
• Wearing eye makeup for at least 4 weeks

Frequently asked questions