Private health insurance (also known as private medical insurance, PMI) can help you avoid long waiting lists, enabling you to access essential treatment at a time and place convenient to you. But what about cosmetic surgery? To clarify where you stand, we look at whether or not private health insurance covers cosmetic surgery so you can get the right policy for your needs.
Cosmetic surgery and plastic surgery are often considered the same, but when it comes to medical treatment, there’s an important distinction.
Plastic surgery covers the repair or reconstruction of body parts and skin. The goal is to restore function and appearance because of a birth defect or through trauma or illness. This could include skin grafts after burns, correcting a cleft lip and palate, or reconstructing breasts after a mastectomy.
In contrast, the primary reason for cosmetic surgery is to improve or enhance your physical appearance in order to make features more ‘attractive’. For example, having rhinoplasty (a nose job) if there’s nothing wrong with your nose, apart from the fact you don’t like the way it looks. Other popular cosmetic procedures include breast implants, facelifts and hair transplants.
As a general rule, private health insurance does not cover cosmetic surgery where the intention is to enhance your appearance.
However, policies will usually provide cover if there is a reconstructive element to the procedure. For example, breast reconstruction after a mastectomy or rhinoplasty if your nose was broken in a car accident. But even if your policy does cover this type of cosmetic reconstructive surgery, providers will have very clear terms and conditions.
In most cases, you will need to have had continuous cover in order to claim. So, in the example of rhinoplasty after a car accident, your policy must have been active when the accident happened and when you have the surgery. You can’t take out a policy after the accident and then make a claim for rhinoplasty.
You’ll also be expected to discuss your cosmetic surgery needs with your private health insurer before a procedure takes place. Having surgery before it’s been agreed with your insurer could invalidate your claim and they can refuse to cover your costs. To help ensure you’re not caught out, it’s vital to be clear about what your own policy covers and under what circumstances.
The specific procedures covered by your insurer will very much depend on the stance they take, as well as the level of cover offered by the policy you have.
Typically, private health insurance only covers reconstructive procedures necessary after an accident or surgery. In cases of breast cancer, some policies will cover reconstructive surgery to both the cancerous and non-cancerous breast in order to provide symmetry.
Cosmetic surgery with the sole purpose of improving or enhancing your physical appearance is rarely covered by private health insurance.
However, a number of insurance providers including Bupa, Axa, and Aviva do cover the cost of some reconstructive cosmetic procedures if you’ve had surgery for cancer or been involved in an accident.
One of the few exceptions is Vitality who offer weight loss surgery and corrective surgery as standard with their Healthy Living Programme. The procedures available include:
Despite these procedures being offered as standard, Vitality will only cover 75% of the cost (you’ll be responsible for covering the remaining 25%). Surgery is also only available if you (or someone else covered by the policy) meet certain criteria. Limitations to be aware of include:
Some cosmetic procedures offered by Vitality are limited by age. For example, to have a port wine birthmark removed from the face, patients must be under five years old and for pinnaplasty procedures, they must be between five and 14 years old (in other words, children will need to be an insured dependent under an adult’s policy).
Vitality will only provide weight loss surgery if other non-surgical options have failed. You will also need to have a body mass index (BMI) of more than 40kg/m². Or, if your BMI is between 35kg/m² and 40kg/m², you must also have been diagnosed with one of several conditions, including obstructive sleep apnoea, hypertension or coronary artery disease.
Remember that health insurance providers can alter their terms and conditions. So, no matter which provider you’re considering, it’s worth double checking any current limitations before committing to a policy.
The NHS’ priority is clinical need, so cosmetic surgery in order to alter your appearance is rarely provided. The exception is if there is medical need – whether that’s physical or psychological. For example, breast reduction surgery may be offered if you’ve developed back pain because of their size. Similarly, if the way a particular feature looks (such as your nose or ears) causes extreme low self-esteem or psychological distress, the NHS will consider offering surgery to correct the issue.
On the other hand, the NHS does provide plastic (reconstructive) surgery where there is clinical need. This can include skin grafts for severe burns, cleft palate correction or reconstruction after cancer surgery or trauma.
If you’re considering cosmetic surgery to change your appearance, you’ll normally have to pay for the procedure yourself. A number of private hospitals offer payment plans so you can pay for surgery in instalments.
As with any type of surgery, there are risks involved so before you go ahead with anything, here’s what to think about:
Consider why you want the surgery in the first place. For example, will surgically changing your physical features help improve your quality of life or self-esteem?
If you feel cosmetic surgery is right for you, it’s still important not to rush into a decision. Research your options and don’t feel pressured, reputable clinics and hospitals shouldn’t push you into a decision at your first consultation.
You’ll need to factor in total costs including any consultation fees, the procedure itself, follow-up sessions and potentially, time off work.
Don’t be afraid to ask for and check relevant qualifications. Clinics and hospitals in England that offer cosmetic surgery must be registered with the Care Quality Commission (CQC). Similarly, only registered doctors and surgeons are allowed to perform surgery.
Surgeons can also join professional associations which can give you extra reassurance that they have the appropriate qualifications and experience.
There are few official statistics to show how many British people travel abroad specifically for cosmetic surgery. However, the number of people leaving the UK to seek treatment does seem to be growing.
Professional body BAAPS, say that of the people who travel abroad, an increasing number are coming back to the UK with complications. The issues are wide-ranging from problems with healing to sepsis, a life-threatening condition. Complications are generally treated by the NHS at an average cost of £15,000 per person.
However, surgeons are keen to point out that all operations carry risk, regardless of where they take place. But surgical procedures that take place abroad are potentially riskier because of the additional travelling involved, as well as different medical regulations. Language can also be an issue, particularly if details are lost in translation.
If you are thinking about travelling abroad for surgery (cosmetic or otherwise) it’s crucial to do your homework and thoroughly research surgeons, clinics and local regulations. The NHS has put together clear advice about cosmetic surgery abroad which takes you through what to consider.
If you want more information about private health insurance in general, you can take a look at our comprehensive guides. Alternatively, you can call us, and we’ll put you in touch with a regulated broker who’ll be able to take you through all your options.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
Broadly, a tummy tuck would be considered elective surgery – a procedure that you’ve chosen to have done. As a result, it usually won’t be covered under private health insurance.
Breast reduction surgery is generally not covered under health insurance policies. If their size is causing other health complications, for example, backache, neck pain or psychological distress, it may be available.
Vitality is one of the few health insurance providers that does cover breast reduction surgery (for both men and women) but there are limitations, such as age. Policies also typically only pay out 75% of the cost with the remaining 25% paid by you.
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*Based on 461 quotes between 01/22-01/23