By Farooq Ahmed Farid | 19 May 2021

Can I pay for cosmetic treatment with a private health plan?

Numerous plan limits and exclusions apply to private health plans, but is cosmetic treatment among them?

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There is much to consider when choosing a private health plan.

Ensuring you have the right cover for your needs means you need to consider and be aware of things like:

One question many people have is whether they can use their plan to cover cosmetic treatment costs.

Let’s explore the answer.

Can I use my private health plan to cover the costs of cosmetic treatment?

A private health plan will typically not cover the costs of any elective cosmetic treatment. This generally also includes cosmetic surgery needed to correct a previous cosmetic procedure.

There are several reasons why health insurers don't cover elective cosmetic treatment. From a consumer perspective, the most critical of these is cost. Insurance premiums would have to be astronomical to provide cover and fund treatment costs every time a plan holder wanted to undergo a treatment or procedure

!

So, most - if not all - health plans won't cover elective cosmetic treatment costs. However, there are some limited circumstances where you might be able to get the costs of cosmetic treatment covered.

What types of cosmetic treatment will my private health plan cover?

Although you will find it almost impossible to get cover for elective cosmetic surgery, your insurer will usually cover your costs if you need to undergo cosmetic treatment to restore function or appearance following a disfiguring accident, for example.

Your costs will also usually be covered if you require cosmetic surgery following treatment for another medical condition that has altered your function or appearance.

However, most insurers will only cover such treatment if the initial accident or treatment occurred during your plan term or membership. For example, if you had an accident and were covered by insurer A, you would need to stay with insurer A to get the costs of subsequent cosmetic treatment covered. If you moved to insurer B before having reconstructive surgery, for example, this might leave you paying 100% of the costs yourself.

Are any types of cosmetic treatment considered medically necessary?

How this question is interpreted depends on the insurer. Some insurers will cover the costs of treatment for procedures like rhinoplasty, for example, if your doctor prescribes this as the solution to breathing problems. Likewise, some insurers may cover cosmetic dentistry and hair restoration treatment costs if you are diagnosed with a specific medical condition.

However, procedures such as weight loss surgery are typically not covered by insurers. As such, you would need to consider how you would pay for this if you could not access such treatment via the universal healthcare system in your location.

While these treatment types are often not considered by individuals when looking for a private health plan, ask about them when looking for a plan if you feel you may need such cover.

Some insurers may offer “Lifestyle Surgery” options as part of your plan or benefits

Some insurers offer a “Lifestyle Surgery” cover element or benefit as part of their private health plans.

Depending on the specific terms of the cover, such a plan may cover you for things like weight-loss surgery, ear reshaping, male and female breast reduction, and cosmetic treatments required after a weight-loss procedure like a gastric bypass or sleeve fitting.

However, even these plans tend to require your treatment to have been deemed clinically necessary. In addition, you will typically also have to contribute to treatment costs yourself. The contribution is usually a specific percentage of the total costs rather than your deductible.

Paying for cosmetic treatment with a private health plan

As you can see, you will usually find your options severely limited when it comes to paying for cosmetic treatment with a private health plan.

However, this isn’t a bad thing - private health plans aren't designed for this purpose! Instead, they're designed to give you the cover and access to the medical treatment you need, when you need it.

If you’re interested in undergoing elective cosmetic surgery, you should thoroughly research the costs involved and consider the best ways to make such a procedure affordable in your circumstances.

By Farooq Ahmed Farid

Farooq is a qualified actuary, a risk & underwriting management professional, strategist and data scientist. During his career, Farooq has been instrumental in helping to develop international best practices across underwriting, technical pricing, actuarial, analytics, product development, risk management, reinsurance, and business intelligence in order to implement successful strategic business plans.

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