In general, group health or employee benefits do not cover plastic surgery or cosmetic surgery that is performed for purely cosmetic reasons. These types of surgeries are considered elective procedures and are not considered medically necessary to treat a specific medical condition or injury.
Group health or employee benefits may cover reconstructive plastic surgery that is performed after an accident or medical condition, provided that the surgery is deemed medically necessary. You’ll want to contact Health Estimates if you are currently shopping for new company benefits for your employees. Reconstructive plastic surgery is different from cosmetic surgery in that it is performed to restore function or appearance following an injury, illness, or congenital defect.
Examples of reconstructive plastic surgery that may be covered by group health or employee benefits include:
- Breast reconstruction surgery after mastectomy for breast cancer
- Reconstruction surgery following a severe burn or traumatic injury
- Correction of a birth defect, such as a cleft lip or palate
- Reconstruction of the nose or facial features following trauma or cancer treatment
However, it is important to note that coverage for reconstructive plastic surgery can vary depending on the individual insurance plan and the specific circumstances surrounding the surgery. Some plans may have restrictions or limitations on coverage for certain procedures or require pre-authorization or documentation of medical necessity.
If you are considering reconstructive plastic surgery after an accident or medical condition, it is important to carefully review your insurance policy and consult with your healthcare provider to understand your coverage options and potential out-of-pocket costs.
It is important to carefully review your group health or employee benefits plan to understand what types of plastic surgery or cosmetic surgery are covered, if any. If you are considering a plastic surgery or cosmetic surgery procedure, it is also important to discuss your options with your healthcare provider and your insurance company to understand the potential costs and coverage options.