Australians have a close relationship with cosmetic surgery. According to Sculpt, a plastic surgery based in Perth, Aussies spend around 40 per cent more than the United States on plastic surgery per 10,000 people.
However, for anyone hoping to make a claim on their private health insurance policy for such surgical procedures, it's important to understand the difference between 'reconstructive plastic surgery' and 'cosmetic surgery'.
While a health insurance policy may pay out for a range of benefits for reconstructive surgery following an accident or defect, cosmetic surgery for aesthetic purposes cannot be claimed upon.
To explain this a little more, we look at the differences, restrictions and limitations of most private health insurance policies around plastic surgery.
What is reconstructive plastic surgery?
Reconstructive plastic surgery is, in many cases, the type of operation that private health insurance policyholders can claim upon. It is usually regarded as a necessary procedure, and follows some defect or accident that requires surgical attention.
The Australian Society of Plastic Surgeons describes it as "an operation, treatment or procedure performed on an abnormal structure, deformity or tissue of the body arising as a consequence of congenital defects, developmental or acquired abnormalities, trauma, disease, tumour, including surgery or other treatments for such conditions or defects".
Some of the types of surgery considered to be reconstructive include:
- Operations for traumatic injuries (facial reconstruction following bone breakages or fractures);
- Operations for burns (skin grafting; skin tightening; work on scarring or contractures);
- Those around the removal of cancers or tumours (skin grafts and skin flap surgery after the removal of a tumour or breast reconstruction following a mastectomy);
- Those on congenital abnormalities (cleft palate or cleft lip repairs, nasal deformities that cause breathing problems, etc.);
- Repair of a laceration or scar;
- Gender reassignment surgery.
However, policyholders are urged to check with their health fund if they wish to be covered for such procedures, as not all private health insurance policies include such benefits.
How does this differ from cosmetic plastic surgery?
Cosmetic plastic surgery is typically defined by an absence of medical necessity.
As the Society of Plastic Surgeons also explained: "cosmetic plastic surgery is an operation, treatment or procedure undertaken to improve appearance where no prior injury from trauma, disease, congenital disorder, congenital or acquired deformity exists".
As such, a private health insurance policy will not cover:
- Lipoplasty (liposuction)
- Eyelid surgery
- Breast implants
- Nose jobs
- Botox injections
Finding the right health insurance policy
The only way to ensure that you will be covered for a certain medical issue, such as the ones defined under reconstructive plastic surgery, is to fully understand the benefits and limitations of your individual or family health insurance policy.
Many policies will fully cover the costs of most medically necessary hospital admissions, depending on the fine print. Some policies are designed to be paid at a lower premium in return for restricted benefits or the inclusion of an excess payment should surgery be needed, while other policyholders may agree to make a co-payment.
Ultimately, we never know what types of afflictions could affect us in life, so it's difficult to plan for insurance benefits that we may never need. However, if you want your policy to cover the costs of certain procedures – either in part or entirely – it's best to discuss this with your health insurance broker.
HICA specialists are on hand to provide free help, advice and assistance when buying or renewing a private health insurance policy. If you would like to discuss your coverage for plastic surgery or any other medical procedure, contact a HICA professional today on 1300 44 22 01.