Group healthcare plans generally do not cover procedures that are considered cosmetic. A group health insurance policy is designed to treat symptoms and cure diseases that affect its beneficiary population. Cosmetic procedures are considered voluntary procedures that do not advance a patient's general, physical health.

For a procedure to be considered cosmetic, it must have no medical benefit. This means it does not relieve physical symptoms. Breast augmentation is considered a cosmetic benefit, while breast reduction of native tissue to reduce low back pain does provide a medical benefit. Complications following prior breast implants generally fall within the range of services that insurers consider non-covered since there was no justifiable medical need for the implants to be placed.

Breast reconstruction following mastectomy is considered an integral part of cancer treatment and, under these circumstances, many states mandate coverage of this procedure and group health insurance policies follow suit. Breast implants following radical mastectomy are considered the standard of care and, as such, are a covered benefit.

Patients who have undergone gastric bypass surgery are often left with excess skin following rapid weight loss. When this skin is removed for cosmetic reasons, it will not be a covered procedure. If the patient experiences recurrent fungal infections and dermatitis due to the skin's location, its removal serves a bona fide medical purpose and should be covered under the terms administered by group healthcare plans. The key to coverage is that the skin is affecting the health of the patient. A patient who undergoes an asymptomatic panniculectomy is receiving a non-covered cosmetic surgery.

Scar revision is one of the most common cosmetic procedures performed that may not be covered by group healthcare plans based on justifiable medical benefits. As with any procedure that is commonly considered strictly cosmetic, scar revision can be undertaken for legitimate medical reasons, but these must be clearly documented and supported in the medical record. A scar, regardless of location or how unsightly, that does not affect a patient's physical health and does not require surgical intervention. There are exceptions to this general rule as well. Burn victims often require extensive repair of damaged tissue under the care of a plastic surgeon. This is not considered cosmetic since the scars that result from extensive, full thickness burns limit mobility and patient function.

Breast augmentation, panniculectomy, and scar revision are not covered by group health insurers if they do not meet the medical necessity guidelines of the group's policy. Purely cosmetic procedures will be exempt from coverage under any circumstance while those that promote the physical welfare of a beneficiary will meet established coverage criteria and be paid according to the level of subscribed coverage.