Does Hospital Insurance Cover Plastic Surgery?

When it comes to an intervention or treatment of a purely aesthetic nature, hospitalization insurance does not intervene. On the other hand, if it is a reconstructive surgery following, for example, an accident or breast cancer, most hospitalization insurances provide cover, at least according to the conditions, ceilings and percentages, compensation, etc. determined in the contract.

If you find your nose to be way too big or your breast size too small, you won’t be able to rely on hospital insurance to satisfy your desire to change your appearance through plastic surgery. Inami does not intervene for this type of intervention, either. In such a case, it is the patient’s deliberate choice to undergo such an operation. From a legal point of view, insurance can only intervene if it is an uncertain risk. A deliberately chosen cosmetic / plastic surgery operation, which is not medically necessary, is not uncertain.

When a woman is recovering from breast cancer, for example, and she wants breast reconstruction, the process is not just limited to “wanting to look more beautiful.” The same goes for someone who comes out disfigured from a serious car accident, etc. In such situations, almost all hospital insurance covers reconstructive surgery. Of course, it is as always necessary to take into account the possible deductible, the compensation limit, and other aspects.

You should therefore read the general and specific conditions of your insurance contract in order to see to what extent your hospital insurer will reimburse your intervention.