Rhinoplasty, breast reconstruction, breast augmentation, intimate surgery, and so forth. When we talk about plastic and cosmetic surgery, we often think of the cost. These procedures are not generally reimbursed by the French national health system, but some may be at least partially covered by national or complementary health insurance. So, in which cases can you benefit from coverage? Here we explain the terms for coverage, based on the purpose of the procedure, and the different plans available from complementary health insurance providers.
Total or partial coverage? What you need to know
Anyone considering cosmetic surgery wants to know what will be covered by France’s national health insurance. First of all, we have to distinguish between restorative or reconstructive surgery and purely cosmetic surgery.
The rule of thumb is clear for the national health system. The first category (restorative surgery) is performed to restore or repair a part of the body. As such it may be covered by basic national health insurance. Plastic surgery performed to correct a natural defect causing genuine psychological damage may fall into this category, if approved by a medical review board. The national health system provides a clearly defined list of the procedures and conditions that benefit from full coverage, excluding any extra fees charged by medical professionals.
However, purely cosmetic surgery performed to enhance the face or body must be paid entirely by the patient. As these procedures have no medical basis, they are not covered by national health insurance.
Any extra fees charged by medical professionals are not covered by national health insurance. Some complementary health insurance plans may reimburse all or part of these fees.
Certain cosmetic surgery procedures are not reimbursed at all by national health insurance, while other procedures may be covered. To make things clearer, here is a list of procedures recognized by the French national health system:
- Rhinoplasty, when the patient has been diagnosed with respiratory problems due to a deviated nasal septum, either developed naturally or caused by physical trauma;
- Ear pinning surgery to correct protruding ears that cause significant discomfort. The procedure is covered for children, teenagers and young adults;
- On the jaw:
- Jaw surgery to correct difficulty chewing or a receding chin causing a maxillofacial problem,
- Restorative facial surgery such as a cleft lip in children;
- On the breasts:
- Breast reduction – if at least 300 grams of tissue is removed, and glandular gynecomastia,
- Breast reconstruction after breast removal due to cancer,
- Surgery to correct breast hypotrophy, significant asymmetry or inverted nipples;
- Abdominoplasty when the skin from the stomach covers the pubis;
- On the body:
- Surgery on the arms, legs or buttocks following significant weight loss,
- Gastric sleeve or bypass surgery when the body mass index is equal to or greater than 40;
- Surgery to treat skin burns;
- Restorative intimate surgery following an excision or in cases of genital malformations such as hypertrophy of the labia minora.
How can I benefit from healthcare coverage ?
You have to follow a compensation process to benefit from coverage for restorative surgery.
Certain procedures are covered automatically (such as breast reduction when over 300 grams of tissue is removed from each breast), but most of the time, the patient must obtain prior approval from French national health insurance. The approval process includes the following steps:
- You must make an initial appointment with the surgeon to determine the type of procedure and eligibility for coverage. You must then send a request to the medical advisor from the French national health insurance.
- Your request is reviewed and an inspection may take place to determine if your request is valid. You receive notice of the approval or refusal within 15 days.
- You then have about one year to have the operation.
For extra fees charged, you should check the healthcare benefits provided by your complementary health insurance policy. Depending on your insurance plan, you may benefit from partial or total coverage, the latter being quite rare, which can significantly reduce the cost of the procedure. When subscribing to a policy, you should therefore carefully study the terms of the insurance contract concerning coverage of plastic and cosmetic surgery.