Patient undergoing surgery

Health Insurance for Cosmetic Surgery

Health insurance for 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 perform 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 covered. Read on to find out whether you will be eligible to receive financial assistance for your procedure or whether you will have to pay for it out of your own pocket.

Compare policies with cover for reconstructive surgery

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.

This is different to cosmetic plastic surgery, which is typically done to improve appearance and refers to elective procedures.

Which health funds cover medically necessary plastic surgery?

Health fundWhich funds cover cosmetic and plastic surgery?Find out more on your level of hospital cover you may have exclusions or limited cover for cosmetic surgery when not deemed medically necessary.More info
GMHBA health fundDepending on your level of hospital cover you may have exclusions or limited cover for cosmetic surgery when not deemed medically necessary.More info
Transport Health LogoBenefits are only payable for cosmetic surgery or services when it is required for medical purposes and if the surgery or service has a Medicare benefit attached.More info

Want to know what is covered by other funds in Australia? Check out the comprehensive list at the end of this article.

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.

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.

Finally, it’s important to note that some people opt to exclude reconstructive plastic surgery from their cover because they confuse it with elective cosmetic surgery. The two are very different things, so don’t make the same mistake.

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; or
  • 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 they offer.

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.

Get cover today and compare your options online or with help from an adviser

Rates last updated May 30th, 2017
Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
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Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
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Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
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Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
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Combined cover designed to suit young people who want value money health insurance, but don’t want to pay for services that they may not use. Restricted fund: Only current and former members of an education union and their families can join.
  • Cover for 5 key services in a private hospital
  • Access Gap Cover
  • $500 general dental annual limit
  • $150 Healthy Lifestyle annual limit
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Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
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Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
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Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
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Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
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What is covered by health funds in Australia?

Health fundWhich funds cover cosmetic and plastic surgery?Find out more
BupaDepending on your level of hospital cover, you may be able to receive a benefit for type of treatment if it's deemed medically necessary.More info
cdhlogoCDH Gold Hospital policy will cover cosmetic surgery only if it is a procedure for which Medicare pays a benefit.More info
cuaBenefits for cosmetic surgery are only payable if it is for a medical purpose and if it's a treatment for which Medicare benefits are payable.More info
GMHBA health fundDepending on your level of hospital cover you may have exclusions or limited cover for cosmetic surgery when not deemed medically necessary.More info
FrankWhile elective cosmetic surgery is completely excluded, you may be able to receive a benefit if the treatment is medically required.More info
gmflogoIf the treatment is medically required and has a Medicare Benefit Schedule number, GMF will pay a benefit towards cosmetic surgery such as rhinoplasty.More info on your level of hospital cover you may have exclusions or limited cover for cosmetic surgery when not deemed medically necessary.More info
 medibankMedibank Top Hospital and Overseas Student Health Cover policies include a benefit for medically required plastic surgery.More info
peoplecare provider page linkPeoplecare Mid and Premium Hospital policies cover plastic surgery providing the treatment or service has an attached Medicare Benefits Schedule number.More info
phoenix health fund provider linkCosmetic surgery and related services that Medicare pays a benefit towards may be covered.More info
queensland country health fund provider linkMedically required plastic surgery is covered by Queensland Country Health Fund hospital policies. Please note that if you are covered by its Public Hospital policy and are an inpatient in a private hospital or day surgery you will only be eligible for a minimum benefit for accommodation costs.More info
Transport Health LogoBenefits are only payable for cosmetic surgery or services when it is required for medical purposes and if the surgery or service has a Medicare benefit attached.More info
Restricted fund*
Although not included in any of ACA's covers, under exceptional circumstances you may be able receive a benefit for cosmetic surgery. This requires the procedure to have prior approval from the fund committee and be recommended by a Registered Medical Practitioner.More info
doctorshealthfundlogoRestricted fund*Benefits for plastic surgery and related services will only be paid if they are also eligible for Medicare benefits. If chosen for cosmetic reasons only a minimum benefit to cover accommodation will be paid.More info
policehealthlogoRestricted fund*Some benefits may be paid for hospital treatments required following cosmetic surgery. Police Health Fund requires you to contact them directly to see if you will be covered.More info
rthealthlogoRestricted fund*Some plastic surgery procedures will be covered providing they are deemed medically necessary and have a Medicare Benefits Schedule number.More info
tuhRestricted fund*Provides restricted cover for plastic surgery. The procedure must be medically required and have an attached Medicare Benefit Schedule number.More info

*Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.

Picture: Shutterstock

William Eve

Will is a personal finance writer for specialising in content on insurance. While he cannot give personal advice to clients, Will enjoys explaining the intricacies of different types of protective cover to help individuals and businesses find affordable cover that won't leave them underinsured.

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