Private health insurance (also known as private medical insurance, PMI) can help you avoid long waiting lists, allowing you to access essential treatment at a time and place that suits you. But what about cosmetic surgery? To clarify your situation, we check whether private health insurance covers cosmetic surgery so that you can get the right policy for your needs.
Are aesthetic and plastic surgery the same?
Cosmetic surgery and plastic surgery are often considered the same, but when it comes to medical treatment, there is an important difference.
Plastic surgery includes the repair or reconstruction of body parts and skin. The goal is to restore function and appearance due to a birth defect or due to trauma or disease. This may include skin grafting after burns, repair of cleft lip and palate, or breast reconstruction after a mastectomy.
In contrast, the primary reason for cosmetic surgery is to enhance or improve your physical appearance to make features more “attractive.” For example, going for a rhinoplasty (nose job) if there is nothing wrong with your nose, except that you don’t like the way it looks. Other popular cosmetic procedures include breast implants, facelifts and hair transplants.
Will private health insurance cover cosmetic surgery?
As a general rule, private health insurance does not cover cosmetic surgery intended to improve 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 covers this type of cosmetic reconstructive surgery, providers will have very clear terms and conditions.
In most cases, you will need to have continuous coverage in order to make a claim. So, in the example of rhinoplasty after a car accident, your policy must be active when the accident happened and when you had the surgery. You cannot take out a policy after an accident and then submit a claim for rhinoplasty.
You are also expected to discuss your cosmetic surgery needs with your private health insurer before the procedure is carried out. Having surgery before it is agreed with your insurer may invalidate your claim and they may refuse to cover your costs. To make sure you don’t get caught out, it’s important to be clear about what your policy covers and under what circumstances.
Which cosmetic surgery procedures are covered by private health insurance?
The specific procedures covered by your insurer will largely depend on their attitude, as well as the level of coverage offered by the policy you have.
Usually, private health insurance only covers reconstructive procedures that are necessary after an accident or surgery. In cases of breast cancer, some policies will cover reconstructive surgery on both the cancerous and non-cancerous breast to ensure symmetry.
Which private health insurance providers cover cosmetic surgery?
Cosmetic surgery with the sole purpose of enhancing or improving your physical appearance is rarely covered by private health insurance.
However, a number of insurance providers, including Bupa, Ax and Aviva, 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, which offers weight loss and corrective surgery as standard with its healthy living program. Available procedures include:
- Connecting the stomach.
- Gastric bypass.
- Gastric sleeve.
- Removal of moles from port.
- Ear reshaping (pinnaplasty surgery).
- Breast reduction and removal of excess male breast tissue (a condition known as gynecomastia).
Despite these procedures being offered as standard, Vitality will only cover 75% of the costs (you will be responsible for covering the remaining 25%). Surgery is also only available if you (or someone else covered by the policy) meets certain criteria. Limitations to be aware of include:
Age
Some cosmetic procedures offered by Vitality are age-restricted. For example, to have a facial port mole removed, patients must be under the age of five, and for pinnaplasty procedures, they must be between the ages of five and 14 (in other words, children will need to be dependents under an adult policy).
Conditions for weight loss surgery
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) greater than 40 kg/m². Or, if your BMI is between 35 kg/m² and 40 kg/m², you must also be diagnosed with one of several conditions, including obstructive sleep apnea, hypertension or coronary artery disease.
Please note that health insurance providers may change their terms and conditions. So, regardless of which provider you’re considering, it’s worth double-checking the current limits before committing to a policy.
Does the NHS pay for cosmetic surgery?
The NHS’s priority is clinical need, so cosmetic surgery to change your appearance is rarely carried out. The exception is if there is a medical need – be it physical or psychological. For example, breast reduction surgery may be offered if you have back pain due to their size. Similarly, if the way a certain feature looks (such as your nose or ears) is causing you extremely low self-esteem or psychological distress, the NHS will consider offering surgery to fix the problem.
On the other hand, the NHS provides plastic (reconstructive) surgery where there is a clinical need. This may include skin grafting for severe burns, correction of a cleft palate, or reconstruction after cancer surgery or trauma.
What are my options if I want cosmetic surgery?
If you are considering cosmetic surgery to change your appearance, you will usually have to pay for the procedure yourself. Many private hospitals offer payment plans so that you can pay for the surgery in installments.
As with any type of surgery, there are risks involved, so before you go ahead with anything, here’s what you need to think about:
Why do you want cosmetic surgery?
Think about why you want the surgery in the first place. For example, will surgically altering your physical characteristics help improve your quality of life or self-esteem?
If you believe that cosmetic surgery is the right thing for you, it is still important not to rush into the decision. Explore your options and don’t feel pressured, reputable clinics and hospitals shouldn’t pressure you into a decision at the first appointment.
Costs
You will need to consider the total cost including any consultation fees, the procedure itself, follow-up sessions and potentially time off work.
Who will carry out the procedure
Don’t be afraid to look 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 operations.
Surgeons can also join professional associations which can give you extra assurance that they have the appropriate qualifications and experience.
Can I travel abroad for cosmetic surgery?
There are few official statistics to show how many Britons travel abroad specifically for cosmetic surgery. However, the number of people leaving the UK to seek treatment appears to be increasing.
This is primarily because cosmetic treatment (including cosmetic dentistry) is often cheaper outside the UK. Popular destinations include Turkey, Lithuania, Hungary and Spain.
Expert body BAAPS says an increasing number of people traveling abroad are returning to the UK with complications. The problems are wide-ranging, from problems with healing to sepsis, a life-threatening condition. The NHS generally treats complications at an average cost of £15,000 per person.
However, surgeons are happy to point out that all operations carry risks, regardless of where they are performed. But surgical procedures performed abroad are potentially more risky due to additional travel and different medical regulations. Language can also be an issue, especially if details are lost in translation.
If you’re considering traveling 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 on cosmetic surgery abroad to guide you through what you need to consider.
If you want more information about private health insurance in general, you can check out our comprehensive guides. Alternatively, you can call us and we will connect you with a regulated broker who will be able to walk you through all your options.
