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Health Insurance For Cosmetic Surgery

Name: Health Insurance For Cosmetic Surgery
Creator: Savvy
Published: 2023-03-27T17:05:01+10:30

Compare health insurance quotes which may cover cosmetic or plastic surgery through Savvy.

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Written by , updated on July 6th, 2023

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Australia’s Medicare system doesn't cover any of the costs of cosmetic surgeries carried out purely for aesthetic reasons. This means that private health insurance won’t cover such procedures either. However, there is plastic and reconstructive surgery which is medically required to either correct abnormalities or to reconstruct parts of the body that have been damaged through injury or necessary surgery.

You can compare health insurance policies covering medically-necessary cosmetic or plastic reconstructive surgery with Savvy. Our panel of trusted Australian insurers can provide free online quotes for you to compare in one place. Start the process of considering your available offers through us today.

What type of health insurance covers medically-necessary plastic and reconstructive surgery?

If you’re after a tummy tuck or would like your nose straightened, there are no private health insurance policies available in Australia which will cover their cost, as they aren’t considered medically necessary. Other types of cosmetic surgery which aren’t covered by private health insurance include:

Breast implants or reductions
Face, brow and buttock lifts
Tummy tucks
Eyelid surgery
Rhinoplasty
Chin or jaw re-shaping
Tattoo removal, laser resurfacing
Botox injections and facial fillers

However, many people require surgery to repair their bodies after devastating injuries, burns, accidents and surgery. Some babies are born with deformities that require reconstructive surgery to help them live a normal life, such as those born with a cleft palate. This is known as medically-necessary cosmetic or reconstructive surgery and may or may not involve plastic surgery.

There are health insurance policies which can assist such people with the cost of their surgery. These policies tend to be on the top tier of hospital cover and may offer cover for over 1,600 procedures which are listed under the Medicare Benefits Schedule as medically-necessary plastic or reconstructive surgery procedures.

Gold and silver hospital cover policies can assist with the cost of such surgeries. This is one area of clinical cover which all silver and gold hospital cover policies must offer under Private Health Legislation. This determines which clinical categories must be offered with each tier of health cover offered, so the Australian public has a clearer idea of what treatments are offered at each level of private health insurance cover.

What cosmetic or plastic surgery procedures can be covered by private health insurance?

There are many occasions where the human body is damaged, either at birth or through accident, injury, illness or surgery which is necessary to save a life. Such surgeries may include:

Surgery to repair congenital abnormalities such as cleft lips or palates or nasal deformities
Skin grafts and release of skin tightening following traumatic burns
Surgery to remove cancers or tumours (such as mastectomies to treat breast cancer)
Laceration and scar tissue repairs after limb injuries
Reconstruction following surgery, or acute vehicle or industrial accidents
Amputation and limb repairs

If you do have a silver, silver plus or gold hospital cover policy, you can be covered for some of the cost of plastic or reconstructive surgery. These can typically cover:

The cost of your stay in hospital, including in a private room if available
The cost of fees charged by your doctor, oncology specialist, surgeon or anaesthetist for consultations whilst you’re an in-patient
Theatre, recovery ward and room fees for your hospital stay
Allied health services provided whilst you’re in hospital, such as pain management, physiotherapy and remedial massage
Tests performed while you’re in hospital, such as blood tests, x-rays, MRI and CT scans
The cost of medicines and pharmaceuticals provide during your hospital stay

However, you may still have out-of-pocket expenses, such as an excess or co-payments you may be required to pay for your hospital stay. However, not all insurers and policies will come with a requirement to pay an excess or co-payment.

You can compare silver and gold hospital cover policies through Savvy. You’ll be able to see a variety of health policies side-by-side so you can compare their benefits and choose which one may best suit your current health needs.

How do I compare health insurance policies for cosmetic surgery?

These are some of the areas you should look at to help find a policy from our panel of trusted insurers which may cover medically-necessary plastic or reconstructive surgery:

Level of cover – make sure you're comparing similar silver or gold hospital cover policies when considering quotes. If you’re also looking at extras cover, this type of insurance may assist you with some non-hospital healthcare treatments you may need after your surgery, such as physiotherapy.
Excess and co-payments – an excess is the amount you’ll have to pay as a contribution towards your hospital stay. It can range from zero to $750, with cheaper policies having a higher excess. A co-payment may also be required if you do have a hospital admission. This can range from zero to $100 a day, but there is often a cap placed on the co-payment you’ll be required to contribute.
What's available in your area – think about the health facilities that are available to you in your local area and whether having private health insurance will assist you in using those facilities.
Inclusions and exclusions – check that you’re aware of what is and isn’t covered when comparing policies. It pays to read the product information documents which are available for each policy, as they can detail what’s being offered with the policy and what’s excluded.

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about health insurance for cosmetic surgery

Is weight loss surgery considered cosmetic surgery?

Weight loss surgery has plenty of conditions attached when it comes to Medicare coverage. To qualify for bariatric surgery under Medicare (and therefore get assistance from your private health insurance) there are strict conditions which are applied, such as:

You must have a BMI over 35 or more
There must be medical documentation that you’ve been severely overweight for at least five years
You must have a co-morbidity which results in a major health risk, such as sleep apnoea, diabetes, heart disease, osteoarthritis or high blood pressure
There must be evidence that you have unsuccessfully tried other weight loss methods and programs under medical supervision
There must be no other cause for obesity such as adrenal, thyroid or pituitary gland issues
You must be assessed by a team of healthcare professionals

Who decides if my cosmetic surgery is medically necessary or not?

Reconstructive surgery can be a grey area when it comes to Medicare funding, as mental health considerations come into play. Your doctor is best placed to make this decision.

Is liposuction covered by private health insurance?

No – liposuction is considered to be purely cosmetic surgery with no medically necessary reasons to carry out the procedure, so it isn’t covered by Medicare and therefore won’t be covered by private health insurance either.

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