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Health Insurance For Cosmetic Surgery

In this article, we’ll look at health insurance for cosmetic surgery, including what types of surgeries may be covered by your health insurance policy, and whether you should choose a policy that covers plastic surgery.
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What’s the difference between cosmetic and plastic surgery?

To begin with, it’s important to understand that cosmetic surgery and plastic surgery are not the same thing1, even though many of us use these terms interchangeably.

Cosmetic surgery is just one aspect of plastic surgery1. Plastic surgery encompasses both cosmetic surgery and reconstructive surgery. Here’s how the Australian Society of Plastic Surgeons defines cosmetic surgery and reconstructive surgery2:

Cosmetic surgery: is designed to improve a person’s aesthetic appearance by altering or reshaping a bodily feature.

Reconstructive surgery: is concerned with improving bodily function and performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumours, or disease.

Cosmetic surgery is not medically necessary3 (i.e. treatment is elective), whereas non-cosmetic plastic surgery involves treatments that are considered to be medically necessary.

Is cosmetic surgery covered by Medicare?

As cosmetic surgery treatments aren’t medically necessary, there are no Medicare benefits available for cosmetic surgery1.

Can I get health insurance that covers cosmetic surgery?

Health funds in Australia aren’t required to pay benefits towards treatments for which Medicare doesn’t pay a benefit. This means that health insurers generally won’t pay benefits for purely cosmetic procedures, or the hospital costs associated with them1.

However, if the surgery in question is deemed medically necessary, the treatment itself may be included if your policy covers plastic and reconstructive surgery1. For example, even if a particular treatment may ultimately alter your appearance, it may be covered by your policy if there’s a medically necessary reason to have it performed.

What type of plastic surgery might be covered by my health insurance policy?

If you choose a private health insurance policy that covers plastic and reconstructive surgery, the following treatments may be covered1:

  • Surgeries on congenital abnormalities, e.g. repair of cleft palates or cleft lips, nasal deformities causing breathing problems
  • Surgery following burns e.g. skin grafting and release of skin tightening and scarring (contractures)
  • Surgery following traumatic injuries, e.g. repair of facial bone fractures and breaks
  • Surgery following removal of cancers or tumours, e.g. breast reconstruction following mastectomy, skin grafts and skin flap surgery following tumour removal
  • Laceration and scar repair

However, many health insurance policies which cover these treatments will also have restrictions or exclusions3- it’s essential you check your policy carefully so you know exactly what you’re covered for.

Do I need plastic and reconstructive surgery as part of my health insurance policy?

We can never tell what might happen to us in the future - and if you find yourself in a situation where you need plastic surgery, such as after an accident, knowing it’s covered by your health insurance can give you much-needed peace of mind.

Over 1,600 surgical procedures are listed under the plastic and reconstructive surgery category in the Medicare Benefits Schedule4, so if your policy doesn’t cover you for these treatments - or if there are exclusions or restrictions - it could pose a problem if surgery becomes medically necessary for you.

Can I change my health insurance cover to include plastic surgery?

Yes, you can upgrade your private health insurance policy to cover the services you need, as long as these treatments are available for cover by your provider1. However, it’s important to be aware that a 12-month waiting period applies if the treatment is for maternity services (obstetrics), or a pre-existing condition1.

How can I find a health insurance policy that covers plastic surgery?

The iSelect team is here to help! We’ll help you compare health insurance providers and policies in order to find the right level of cover for your needs. Call us now on 13 19 20 to find out more about health insurance for plastic surgery.

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1. http://www.ombudsman.gov.au/publications/brochures-and-fact-sheets/factsheets/all-fact-sheets/phio/plastic-and-reconstructive-surgery
2. https://plasticsurgery.org.au/
3. https://www.privatehealth.gov.au/faq/glossary.htm#NonCosmeticPlasticSurgery
4. http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Downloads-201811

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