a. Surgery to alleviate significant physical symptoms or to restore or improve function to any
area altered by disease, trauma or congenital deformity normally is a benefit under MSP.
Surgery solely to alter or restore appearance is not a benefit of MSP except under the
circumstances listed in the following policy.
b. In establishing this policy, it has been recognized that:
• peer acceptance in our society often is influenced disproportionately by the face,
• children are especially susceptible to emotional trauma caused by physical appearances,
• some procedures traditionally have been accepted as benefits of Health Insurance Plans
in spite of the obvious cosmetic nature of these procedures.
c. Emotional, psychological or psychiatric grounds are not considered sufficient reason for MSP
coverage of surgery for alteration of appearance except in children and under exceptional
circumstances in adults.
On request of the attending medical practitioner, exceptions may be made on an independent
consideration basis if the proposed surgery is to alter a significant defect in appearance
caused by disease, trauma or congenital deformity, and if the surgery is essential to obtain
employment as documented by the attending physician and by an employer with regard to a
specific job.
d. Surgery to revise or remove features of physical appearance which are familial in nature is
not a benefit of MSP.
e. Within the context of this policy, the word "disease" does not include the normal sequelae of
aging. Surgery to alter changes in appearance caused by aging is not a benefit of MSP.
f. Within the context of this policy, the word "trauma" includes trauma due to treatment such as
surgery, radiation, etc.
g. As the phrase “reasonable period of convalescence” is imprecise, independent consideration
will be given to more complex cases or extenuating circumstances.
