Common use of Reconstructive Surgery Clause in Contracts

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.

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. Benefit-Specific Exclusion: 1. Routine foot care for patients with diabetes or other vascular disease. See the benefit-specific limitation and exclusion immediately below for additional informationServices that are not Medically Necessary.