Reconstructive Surgery Clause Samples

Reconstructive Surgery. Reconstructive Surgery is surgery: • Which restores features damaged as a result of injury or illness • To correct a congenital deformity or anomaly. The service area for this plan is Washington State, excluding ▇▇▇▇▇ County.

Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be Covered if performed for the correction of functional disorders. Reconstructive Surgery must be prescribed by a Member’s Practitioner/Provider and requires Prior Authorization. For information regarding Reconstructive Surgery following a Mastectomy and Prophylactic Mastectomy, refer to the Women’s Healthcare Section.

Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be Covered if performed for the correction of functional disorders. Reconstructive Surgery must be prescribed by a Member’s Practitioner/Provider and requires Prior Authorization. For information regarding Reconstructive Surgery following a Mastectomy and Prophylactic Mastectomy, refer to the Women’s Healthcare Section. Reconstructive surgery related to Gender Confirmatory Therapy and Gender Affirming Care are Covered. The Prior Authorization criteria of this Plan is applicable This benefit has one or more exclusions as specified in the Exclusions Section.

Reconstructive Surgery. The insurer will cover the actual incurred medical cost of the reconstructive surgery required to restore natural function or appearance following an accident or following a surgical procedure for an eligible medical condition, which occurred after an insured person’s entry date or start date whichever is later. The maximum benefits should be mutually agreed between the policyholder and the insurer and stipulated in the insurance contract.

Reconstructive Surgery. This is limited to reconstructive surgery, incidental to or following surgery, resulting from injury or illness of the involved part, or to correct a congenital disease or anomaly resulting in functional defect in a dependent child, as determined by the attending physician.

Reconstructive Surgery. We cover reconstructive surgery. This shall include plastic, cosmetic and related procedures required to: (a) to correct significant disfigurement resulting from an injury or Medically Necessary surgery, (b) to correct a congenital defect, disease, or anomaly in order to produce significant improvement in physical function, and (c) to treat congenital hemangioma known as port wine stains on the face for Members age 18 or younger. Following mastectomy, we also cover reconstructive breast surgery and all stages of reconstruction of the other breast to produce a symmetrical appearance, and treatment of physical complications, including lymphedemas. Mastectomy is the surgical removal of all or part of a breast as a result of breast cancer. Reconstructive breast surgery is surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts. Reconstructive breast surgery includes augmentation mammoplasty, reduction mammoplasty, and mastopexy. Reconstructive Surgery Exclusions: • Cosmetic surgery, plastic surgery, or other Services, supplies, dermatological preparations and ointments, other than those listed above, that are intended primarily to improve your appearance, or are not likely to result in significant improvement in physical function, and are not Medically Necessary. Examples of excluded cosmetic dermatology services are: • Removal of moles or other benign skin growths for appearance only. • Chemical Peels. • ▇▇▇▇▇▇▇ earlobe repairs, except for the repair of an acute bleeding laceration.

Reconstructive Surgery. This benefit has one or more exclusions as specified in the Exclusions Section. Reconstructive Surgery from which an improvement in physiological function can reasonably be expected will be provided if performed for the correction of functional disorders. For example, when a scar does not allow full function of a hand and a surgical procedure to remove the scar will achieve full function.

Reconstructive Surgery. (Please refer to the Benefit Schedule for other benefit provisions which may apply.)

Reconstructive Surgery. We cover reconstructive surgery. This shall include plastic, cosmetic and related procedures required to: 1. Correct significant disfigurement resulting from an injury or Medically Necessary surgery, 2. Correct a congenital defect, disease or anomaly in order to produce significant improvement in physical function; and 3. Treat congenital hemangioma known as port wine stains on the face. Following mastectomy, we cover reconstructive breast surgery and all stages of reconstruction of the other breast to produce a symmetrical appearance, and treatment of physical complications, including lymphedemas. Mastectomy is the surgical removal of all or part of a breast. Reconstructive breast surgery is surgery performed as a result of a mastectomy to reestablish symmetry between both breasts. Reconstructive breast surgery includes augmentation mammoplasty, reduction mammoplasty and mastopexy. See the benefit-specific exclusions immediately below for additional information. Benefit-Specific Exclusions: Cosmetic surgery, plastic surgery or other Services, supplies, dermatological preparations and ointments, other than those listed above, that are intended primarily to improve your appearance, are not likely to result in significant improvement in physical function and are not Medically Necessary. Examples of excluded cosmetic dermatology Services are: 1. Removal of moles or other benign skin growths for appearance only; 2. Chemical peels; and 3. ▇▇▇▇▇▇▇ earlobe repairs, except for the repair of an acute bleeding laceration. Coverage is provided for Medically Necessary routine foot care for patients with diabetes or other vascular disease. See the benefit-specific limitation and exclusion immediately below for additional information.