Does Health Insurance Cover Cosmetic Surgery?

Cosmetic surgeries and procedures are getting extremely popular in today’s era. People are looking for ways and methods to enhance their beauty and physical attributes based on their choices. The overall cost of these procedures is quite high as it includes numerous charges added together. Typically, the cost of cosmetic surgeries includes the fee of medical practitioners, cost of implants, cost of operating rooms, post-procedure expenses, and anaesthesia.

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    Indian pharmaceutical and medical industry has witnessed rapid growth within the past few decades making it one of the best all across the globe. As a result, there has been significant development in the field of medical tourism. However, a lot of people in India want to undergo cosmetic procedures but are hesitant mainly due to the high cost, and exclusion in several health insurance policies

    Technically, Mediclaim policies are not designed and developed to cover the cost of cosmetic surgeries. However, if the procedure is classified as a reconstructive then the medical expenses incurred will be covered by your health insurance policy. The primary reason due to which insurance providers do not cover cosmetic procedures and surgeries under a health insurance policy is that these are not considered vital to maintain quality of life or ensure the right functioning of a body part or system. 

    If you are willing to undergo cosmetic surgery to beautify an external part or organ of your body, there are some factors that you should be aware of. In this article, we will shed light on the inter-relation between health insurance plans and cosmetic surgeries along with various important points to be kept in mind if you choose to undergo one. 

    Bearing the Cost of Cosmetic Procedures

    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’re 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 health insurance providers 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 at the same time. 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, physical defects, ailments, or diseases. The physical trauma might be caused due to an accident or genetic anomaly. Usually, these surgeries focus on improving the overall aesthetics of the affected organ/body part normalizing 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 policy cover reconstructive surgeries, but not cosmetic surgeries. An interesting fact to be considered here is that both the 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 insurance policy depends upon the criteria of your provider and the definition of the medical procedure. In order to understand and 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 under the health insurance policy. The best way to determine is to directly contact your insurance provider with all the details of the procedure to get a thorough understanding of the nuances of the coverage. 

    If you’ve chosen a mediclaim policy that covers reconstructive and plastic surgeries, some of the common procedures that are covered are as follows- 

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

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

    Yes, you can upgrade your current health insurance plan to cover cosmetic and plastic surgeries as long as the provider offers coverage against the mentioned procedures. An important point to be considered is that a waiting period of 12 months is applicable for maternity services or pre-existing medical conditions or ailments. However, it may vary from insurer to insurer.

    In a Nutshell!

    With the increasing popularity of cosmetic and plastic surgeries, there has been an increase in the number of providers that provide coverage. You can analyse, compare, and shortlist different providers and plan online based on your needs to get the best plan at the best price. 

    Written By: PolicyBazaar - Updated: 29 June 2021

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