Medical aids classify certain procedures as non-essential – meaning that it is not of a life-threatening nature should it not be conducted. LASIK eye surgery and cosmetic surgery are considered as non-essential service. While most medical aids in South Africa will partly cover the costs of the LASIK procedure, almost all medical aids do not pay for cosmetic surgery.
LASIK Eye Surgery Costs and Cover
The LASIK procedure costs vary in South Africa. Depending on the location and practitioner, you can pay anywhere between R10,000 to R16,000 for both eyes. There are some eye clinics that charge more but they retain their services for an exclusive clientele. Most LASIK eye clinics are not contracted into medical aids so you will have to pay cash for the procedure and your medical aid will reimburse you for it. Unfortunately you may not be reimbursed fully so it is best to speak to your medical aid before you undergo the procedure.
Plastic Surgery Costs and Cover
The cost of plastic surgery is staggering, even for simple procedures. Reconstructive surgery is covered by most medical aids if it is due to some accident or illness where there is significant deformity which is hampering your daily functioning.
However, your medical aid may refuse to pay for certain prosthetics that may be part of this surgery or opt for cheaper alternatives. Getting your medical aid to pay for this type of surgery depends on many factors – the extent of the surgery, motivation by the attending physician and even your medical aid plan.
In terms of cosmetic surgery, this is a non-essential service and no medical aid will pay for it. Cosmetic surgery is a patient’s choice and is done for aesthetic purposes. While many patient’s claim that certain features are causing them great emotional stress, medical aids will not consider these contributing factors.
Procedures like breast augmentation, ‘tummy tucks’ and a facelift are considered as non-essential surgery. Certain procedures like a nose job (rhinoplasty) may be partly covered by some medical aids if the structure of the nose is contributing towards a chronic condition. Even in this case, the surgeon may have to motivate for the part payment.
Breast Implants and Prosthetics for Cancer Cover
While medical aids do pay for certain prostheses, a breast implant is not considered as a prosthetic that will be suitable for medical aid cover. Even after a mastectomy (breast tissue removal), many medical aids will not pay for a breast implant and the patient will have to pay for the entire procedure from their own pocket.
There are are certain cancer cases where the removal of tissue, particularly bone, may mean that a medical aid will partly cover the cost of the prosthesis. This is only considered as acceptable if the removal of that tissue is now affecting daily functioning. Even so, with medical aids placing more restrictions on cover, this type of prosthetic cover is rare.
It is important to note that hospital cash back plans or related insurance cover will not consider hospitalisation for cosmetic surgery as a suitable reason for a pay out.