Cosmetic / Aesthetic Surgeries
Circumcision unless necessary for the treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as part of any illness.
Under this clause, circumcision done as part or religious ritual in communities such as Muslims and Jews, then this procedure is not payable by Insurance. Circumcision done for treating an ailment or a disease is only reimbursable by Insurance for eg. Phimosis, Paraphimosis, Urinary Tract Infection etc., but it depends on case to case study on an individual basis. Relevant proof is required for establishing that circumcision is not being performed for cosmetic reasons and is purely for treatment of an ailment.
Vaccinations and inoculations which are mandatory for human beings for their survival and well-being are not reimbursable by Insurance.
Cosmetic or Aesthetic treatments and Plastic Surgery (which forms a part of Aesthetic/Cosmetic treatment) are not reimbursable by Insurance. Surgeries involving liposuction, enlargement of breasts in women, Botox treatment, removal of mole/birthmark, surgery for re-shaping the nose, facial features, chin etc are not reimbursable by Insurance.
Under Cosmetic or Aesthetic treatment, Lasik surgery is also included. As per IRDA regulations, it is termed as cosmetic treatment. Lasik treatment can be reimbursable only if the vision in both the eyes exceeds the vision-limit parameters as specified. (The limits are being withheld for confidentiality purposes and the same are subject to change.)
Under Cosmetic or Aesthetic treatment, certain lenses used in Cataract surgery such as Restor, Accor etc. may not be payable, which are subject to guidelines issued by Insurance companies from time to time. Justification for usage of such expensive lenses is essential before sending the claim for reimbursement process.
Plastic Surgery performed subsequent to any surgical procedure and that too, if it is necessary with suitable justification, can be reimbursed based on case-to-case analytical study. For e.g. plastic surgery done on a scar or a wound subsequent to it’s healing. But note that the plastic surgery can be reimbursed only if the occurrence of trauma or scar has occurred within the policy coverage period. Plastic surgery performed for cosmetic reasons is not eligible for claims reimbursement.
