Compare Health Insurance For Cosmetic Surgery^*

While there is no specific health insurance product for cosmetic surgery, some forms of plastic surgery are covered under private health insurance, depending on your policy. 

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

Cosmetic surgery is just one aspect of plastic surgery.¹ Plastic surgery encompasses both cosmetic surgery and reconstructive surgery. Here’s how the Australian Society of Plastic Surgeons defines cosmetic surgery and reconstructive surgery:² 

• 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 necessary (i.e. the treatment is elective), whereas non-cosmetic plastic surgery involves treatments that are considered to be medically necessary. 

Generally speaking, no. Not if it’s for purely cosmetic surgery. 

Health funds aren’t required to cover treatments for which Medicare doesn’t pay a benefit. This means that health insurers won’t pay benefits for purely cosmetic procedures, or the hospital costs associated with them.⁴ 

However, if the surgery is deemed medically necessary, then the treatment could be covered by your policy — so long as your policy covers plastic and reconstructive surgery.⁵   
For instance, even if a treatment alters your appearance, it might be covered by your policy if there’s a medically necessary reason to have it performed (such as breast reconstruction surgery following breast cancer).⁶ However, when it comes to plastic surgery that isn’t medically necessary, you’ll have to foot the bill yourself. 

Keep in mind that some surgical procedures might include MBS item numbers from both the medically necessary plastic and reconstructive surgery category, and the category the body part comes under (such as podiatric surgery).  Complicated stuff!  

If you choose a Private Health insurance policy that covers plastic and reconstructive surgery, the following treatments may be covered:⁷ 

• Surgery to repair traumatic injuries, e.g. facial bone fractures
• Surgery to treat burns, such as skin grafts or tissue expansion
• Surgery following the removal of cancers or tumours, such as breast reconstruction after a mastectomy
• Surgery for congenital abnormalities, e.g. club foot, cleft palates or nasal deformities causing breathing problems
• Laceration and scar repair

However, many Health Insurance policies that cover plastic and reconstructive surgery may also have restrictions or exclusions on these types of treatments so it’s essential you check your policy carefully so you know exactly what you’re covered for. 

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 Schedule,⁸ so if your policy doesn’t cover you for these treatments—or if there are exclusions or restrictions—it could pose a problem if plastic surgery becomes medically necessary for you. 

Hospital Cover in both the Silver and Gold product tiers is required to pay benefits for medically necessary plastic and reconstructive surgery.⁹

Lower levels of hospital cover, such as Basic and Bronze policies, don’t cover plastic or reconstructive surgery.  

Let’s say you’ve found a policy you like that covers plastic and reconstructive surgery. Great! But maybe you’re still curious about the different terms and jargon that show up on the policy. Maybe you want to dig a bit deeper and see if it’s suitable for you. 

There are a few things you might want to look over. These are important to consider when it comes to how your policy operates:  

• Excess: This is a set amount you pay towards your hospital treatment, . This helps reduce some of the risk for your insurer. As such, a higher excess usually means that you’ll pay lower premiums.¹⁰
• Waiting period: You’ll need to hold your policy for a certain amount of time before you can make a claim for certain treatments. These waiting periods can vary from insurer to insurer, but for plastic and reconstructive surgery the  waiting period is two months (unless it relates to a pre-existing condition, which both have 12-month waiting periods)¹¹.
• Restrictions: Some policies come with certain restrictions. For instance, a ‘ policy might cover some of the costs for plastic and reconstructive surgery, but only if you’re admitted as a private patient in a public hospital.¹² 

Again, reading the policy  brochure is essential here. This brochure can usually be found on your insurer’s website and should tell you everything you need to know about the terms of your policy. 

Yes, you can either upgrade your Private Health Insurance policy with your existing provider to cover the services you need or switch to a different provider who covers plastic and reconstructive surgery procedures.¹³ However, it’s important to be aware that a 12-month waiting period still applies if the treatment is for a pre-existing condition.¹⁴

The iSelect team is here to help! We’ll help you compare* health insurance from a range of providers and policies to try help find the right level of cover for your needs. Call us now on 1800 784 772 to find out more about Health Insurance with plastic surgery.