Does Health Insurance Cover Cosmetic Surgery?

Is Cosmetic Surgery Covered in Health Insurance?

Technically, health insurance does not provide coverage for cosmetic surgeries. However, if the procedure is classified as a reconstructive, then the medical expenses incurred will be covered by your mediclaim policy. The primary reason why health insurance companies in India do not provide cosmetic surgery insurance is that these are not considered vital to maintain quality of life or to ensure the right functioning of a body part or system.

Cosmetic Procedures Coverage in Health Insurance

When it comes to cosmetic procedures, the first thing that strikes your mind is the cost and the safety of the process. Whether the cosmetic surgery you are planning to undergo is covered under the health insurance policy will be solely based on the provider and the plan. However, the major factor that insurance companies consider at the time of making the claim is whether the procedure was a reconstructive surgery or cosmetic surgery.

Both of these medical procedures are similar yet quite different from each other. In order to make things clear, let us take a look at both of these processes.

• Reconstructive Surgery: This medical procedure refers to surgical methods carried out with the objective of correcting trauma, ailments, physical defects, or diseases. The physical trauma might be caused due to genetic anomaly or accident. Usually, these surgeries focus on improving the overall aesthetics of the affected organ/body part, normalising its appearance and functioning.
• Cosmetic Surgery: Contrary to reconstructive surgeries, cosmetic procedures are carried out with the objective of beautifying the appearance of a particular body part. These procedures improve the patient’s self-esteem and confidence.

Most of the mediclaim insurance policies cover reconstructive surgeries, but not cosmetic surgeries. An interesting fact to be considered here is that both processes are carried out by the same kind of medical practitioners.

When Does Mediclaim Policy Cover Plastic Surgery?

The coverage of plastic surgery under your health policy depends upon the criteria of your insurance provider and the definition of the medical procedure. In order to determine whether the process is covered under your mediclaim policy, it is crucial to know whether:

• The process is cosmetic
• The process is reconstructive
• The process is life-saving

If the process is reconstructive or life-saving, then in most cases the medical expenses incurred will be covered by the health insurance policy. The best way to determine is to directly contact your insurance provider with all the details of the procedure. It will help you get a thorough understanding of cosmetic surgery insurance coverage.

If you have chosen a mediclaim policy that covers reconstructive and plastic surgeries, it typically covers the following common procedures:

• Surgeries performed to normalise congenital anomalies such as repair of cleft lips, cleft palates, nasal deformities that cause breathing difficulty
• Surgeries carried out following incidents of burns such as reconstruction, skin tightening, grafting
• Reconstructive surgeries or procedures carried out to normalise traumatic injuries
• Laceration
• Scar repair
• Surgeries followed by treatment of tumours or cancer

Cosmetic Surgeries Excluded from Health Insurance

Before opting for cosmetic surgery, it is important to understand that many procedures are not covered by health insurance plans. Here is a quick overview of some common surgeries that typically fall outside the scope of mediclaim coverage:

• Liposuction: This surgery is aimed at removing excess fat from areas like the abdomen, thighs, hips, or buttocks to reshape the body. While effective for body contouring, it is a costly procedure and is usually not included in medical insurance policies.
• Facelift Cosmetic Surgery: Often done to reduce signs of aging, a facelift cosmetic surgery removes excess face fat and tightens the skin to give you a more youthful appearance. However, this procedure is considered cosmetic and is excluded from Mediclaim insurance plans.
• Rhinoplasty: Commonly known as a "nose job," rhinoplasty enhances the nose's shape to improve facial aesthetics. While primarily considered a cosmetic procedure, health insurance may cover it if it is performed to correct breathing difficulties or nasal deformities caused by injury.
• Hair Transplant: Increasingly popular among individuals dealing with pattern baldness, the cost of hair transplant depends on the number of grafts used. Despite its demand, hair transplants are not covered by health insurance.

Can I Upgrade My Health Plan to Cover Plastic and Cosmetic Surgeries?

Yes, you can upgrade your current health insurance plan to cover cosmetic and plastic surgeries required due to accident or health issues. Notably, the plan can be upgraded as long as the provider offers coverage against the mentioned procedures.

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