Looking for health insurance that will cover plastic surgery? Know your options first.
When you hear the words plastic surgery, most people start thinking about nose jobs, breast enhancements and tummy tucks. But plastic and reconstructive surgery can actually cover many essential medical procedures, from repairing cleft palates to reconstructive surgery following traumatic injuries and severe burns.
While many plastic and reconstructive surgery procedures are covered by Medicare and private health funds, some procedures are not.
How is plastic and reconstructive surgery defined?
Reconstructive plastic surgery is performed to correct abnormalities, whether they are congenital or acquired, and repair damage as a result of trauma. Reconstructive plastic surgery usually refers to essential medical procedures rather than elective ones, and many procedures are covered by Medicare and Australian health funds.
Reconstructive plastic surgery is different to cosmetic plastic surgery, which is typically carried out to improve appearance and refers to elective procedures.
Which health funds cover medically necessary plastic surgery?
Here is a sample of policies from Finder partners that include private cover for plastic surgery. You can find the treatment in a bronze level policy or above. All the prices listed are based on a single policy.
| Provider | Policy Name | Treatments included | Price | Apply |
|---|---|---|---|---|
 |
Bronze Hospital |
|
$85.89 | Go to site |
 |
Bronze Hospital Plus |
|
$87.45 | Go to site |
 |
Bronze Hospital Plus |
|
$87.45 | Go to site |
 |
Hospital Bronze Plus |
|
$91.60 | Go to Site |
 |
Core Bronze Plus |
|
$97.10 | Go to Site |
Quotes are based on single person living in Sydney earning less than $90,000 per year. Quotes include a $500 excess.
What is generally covered by private health insurance?
If you need to undergo reconstructive plastic surgery, you may be able to receive cover for the following types of procedures from Medicare and your health fund:
- Surgeries on congenital abnormalities. A congenital abnormality is a condition that exists at or before birth, such as a cleft palate or a nasal deformity that results in breathing difficulties.
- Surgeries following burns. Skin grafts, reduction of skin tightening and treatment of scarring are all covered.
- Surgeries following traumatic injuries. For example, facial bone fractures that need to be repaired or reset.
- Surgeries following the removal of cancers or tumours. Some common examples of covered procedures include breast reconstruction following a mastectomy, and skin grafts following the removal of a tumour.
- Surgeries to repair scars. This refers to procedures to repair skin injured by lacerations or scarring.
Health Insurance Reforms coming April 2019
As part of the reforms to the Australian health insurance system, we will see hospital policies placed in four categories: gold, silver, bronze and basic.Each of these tiers includes cover for a minimum number of clinical categories. If you wish to continue to claim benefits for cosmetic surgery, you will need a policy of Bronze tier or higher. Keep in mind that this will only cover medically necessary cosmetic surgery, such as breast implants following a mastectomy or required skin grafts.
Compare policies from 30+ Australian health funds
How can restrictions and exclusions affect you?
Some health funds will provide full cover for all costs associated with your hospital admission for reconstructive plastic surgery, although you may have to pay an excess or co-payment as part of your policy arrangement. However, other policies will restrict or exclude certain services in return for offering lower premiums, so this may affect the level of cover available to you.
Exclusions refer to services that are not covered at all by your health insurance, while restricted services are those for which you will receive only a limited benefit. If restrictions or exclusions apply to the reconstructive plastic surgery cover offered by your private health insurance policy, there are more than 1,600 procedures listed on the Medicare schedule for which you will not be able to receive full coverage.
Don’t be so quick to exclude plastic surgery cover from your policy
While you may wish to exclude or restrict your plastic surgery coverage in order to save on premiums, remember that it’s impossible to predict what the future holds and what sort of medical treatment you may require. If reconstructive plastic surgery is excluded from your cover, you may have to pay significant out-of-pocket costs if you require an excluded service. And even if you have restricted cover in place, this may only cover the treatment itself and no other expenses, so you may be left with sizeable bills to cover the cost of your hospital accommodation.
What are your options?
Your options when it comes to private health insurance for plastic and reconstructive surgery are simple. You can:
- Choose a comprehensive policy that covers reconstructive plastic surgery
- Choose a policy that offers restricted cover for reconstructive plastic surgery and pay lower premiums
- Choose a policy that excludes reconstructive plastic surgery altogether
The option you choose is entirely up to you, but be aware that not having any cover in place could lead to significant out-of-pocket expenses if you require plastic reconstructive surgery. Consult your health fund for further details about the type and level of cover it offers.
It’s vital that you fully understand your options when it comes to private health insurance and plastic surgery. Consider your cover needs and discuss the policies available with your health fund before deciding on the right policy for you.
Picture: Shutterstock
Query: re:Breast reduction surgery when medically needed for health reasons, how does this work regarding costs? I have HAD hospital cover?
Hi Karren,
Thank you for your comment.
Generally, health insurance covers surgical and accommodation costs under the hospital cover policy if the breast reduction surgery is medically necessary and not only for cosmetic purposes. You may learn more on how health funds work with breast reduction surgery if you check our guide here. To compare the policies, you may fill out the form on the page provided and click Search Policies button. Once done, you’ll see the quotes from different health insurance providers with the list of detailed benefits.
Please make sure to read the eligibility criteria, features and details of the policy, as well as the relevant Product Disclosure Statement PDS/T&C’s of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.
Regards,
Jhezelyn