Does Health Insurance Cover Cosmetic Surgery?

Posted on: Dec 16, 2024 | 3 mins | Written by: HDFC ERGO Team

Does Health Insurance Cover Cosmetic Surgery?

The concept of beauty is quite subjective, and we all wish that we could have been a little taller or a bit more muscular or get rid of the scars that we got during an accident. While many keep this limited to only wishful thinking, some want to take steps to make a change, at times surgically. From budding actors getting body contouring to brides and grooms getting liposuction to look fit for their wedding, there are different cosmetic surgeries that people are opting for. However, these surgeries are not cheap. So, can you bank on your health insurance policy to pay for it? Let’s find out.

Does Health Insurance Cover Cosmetic Surgery?

Cosmetic surgery is a medical procedure usually done to enhance one’s physical appearance or any body part. Some popular cosmetic surgeries include liposuction, facelifts, hair transplants, skin tightening, or rhinoplasty.

If the surgery is performed for aesthetic purposes only, health insurance does not cover it. However, if cosmetic surgery is medically necessary to address any medical condition or deformity, health insurance will cover the costs associated with the procedure. For instance, reconstructive surgeries performed to correct congenital abnormalities or deformities due to accidents, injuries, or trauma are covered. The terms and conditions can vary from insurer to insurer, so you must review your policy to understand what is covered and what is not.

Cost of Cosmetic Surgery

The cost of cosmetic surgery can vary significantly based on multiple factors, such as type of procedure, location, type of hospital, expertise of the surgeon, post-operative care, etc. It can range between Rs 50,000 and Rs 5 lakhs in India.

When Does a Mediclaim Policy Cover Plastic Surgery?

A Mediclaim policy covers plastic surgery only under specific circumstances, such as –

• For correcting birth defects like cleft lips/palate or nasal deformities which affect a person’s health or functionality

• Reconstructive surgery after an accident, injury, or trauma

• Surgeries to treat severe burns, such as skin grafts, skin tightening, or scar reduction procedures

• Cancer and tumour treatment surgeries

The best way to know if your Mediclaim policy covers plastic surgery is to talk directly to your insurer by providing the details of the procedure and why it is required. For cancer treatments, critical illness insurance will be the safest way to save your finances in addition to standard health insurance.

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

This depends on your current insurance provider, the type of plan that you have, and whether your insurer covers plastic and cosmetic surgeries. So, the first thing to do before upgrading your current plan is to check if the existing policy covers such procedures because most healthcare plans cover cosmetic surgeries only if they are medically necessary. Medically necessary procedures are reconstructive surgeries after a trauma or accident, correcting congenital defects, or cancer treatments. When you plan to upgrade, do check the waiting period along with all the conditions of the upgrade.

Conclusion

Cosmetic surgeries performed purely for aesthetic reasons to enhance your physical appearance, such as facelifts or liposuction, are not covered by a health insurance policy. In order to be eligible for coverage, the surgery should be medically necessary.

FAQs related to Cosmetic Surgery Health Insurance

1. Can I claim insurance for cosmetic surgery?

If cosmetic surgery is a medical necessity due to an underlying medical illness, for correcting birth abnormalities like cleft lips, or if you have to undergo reconstructive surgery due to an accident or trauma, you can claim insurance. However, if performed purely to enhance your appearance, it must be your out-of-pocket expense. Insurance will not pay for it.

2. What are the cosmetic procedures which are not covered by health insurance?

Health insurance does not cover any procedure that is not deemed a medical necessity and is performed only to enhance a person's physical appearance. Some popular cosmetic surgeries not covered include facelifts, liposuction, rhinoplasty, hair transplant, otoplasty, etc.

3. How do I know which type of cosmetic surgery is covered by my insurance?

Any cosmetic surgery which is not a medical necessity is not covered. However, checking your policy document or contacting your insurance provider for clarity is better.

4. Will my standard health insurance policy cover cosmetic surgeries, or do I have to buy a rider?

This can vary from insurer to insurer. While some insurers may include it in the plan, others may offer it as an add-on. So, before buying the policy, you should review the coverage, benefits, inclusions, and exclusions.

5. I want to go for liposuction. Will health insurance cover the expenses?

No. Liposuction is a cosmetic procedure performed to enhance your body's shape and appearance. It is not a medical necessity. Health insurance will cover only those cosmetic surgeries considered medically necessary and prescribed by your doctor.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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