In 2021, India had the highest number of acne vulgaris cases among adolescents and young adults, affecting 30.7 million people. Apart from being physically uncomfortable, acne can impact an individual’s quality of life and psychological well-being. Moreover, based on the person’s condition and type of treatment, the medical bills can be pretty high, leading to financial stress.
Wondering whether health insurance covers acne treatments?
Keep reading to find out!
Yes, but not in all medical circumstances. Health insurance plans in India usually do not cover cosmetic acne treatment, such as chemical peels, facials, or laser treatments for aesthetic purposes.
But when acne is diagnosed as a medical condition, for example, cystic or nodulocystic acne that causes pain, infection, or scarring, then treatments such as dermatological consultations, prescription medication, and some minor procedures might fall under:
The key is medical necessity, which must be documented thoroughly by a registered medical practitioner.
Cosmetic dermatological procedures are not covered by health insurance. They include the following:
These procedures are considered non-essential and hence are not applicable for coverage under health insurance. Coverage would only be possible if these treatments were part of a more comprehensive therapy package to treat a medically diagnosed skin disorder.
Policies that cover OPD (outpatient department) benefits can cover dermatologist consultations as well. This includes:
However, OPD cover is not a standard feature in all policies. You need to choose plans that have OPD benefits clearly mentioned or are available as an add-on.
An OPD cover under a health insurance plan is important, as most acne treatments do not require hospitalisation. So, you must check your existing health policy for OPD coverage before planning to make claims for dermatologist visits.
You can file claims in cases of severe acne, such as cystic acne or acne conglobata, that causes:
Depending on what is medically required, the cost of treatment is usually covered under inpatient hospitalisation or daycare procedures by most health insurance plans. You’re more likely to get your claim accepted when your dermatologist provides:
Oral or topical acne medications that are prescription-based could be covered if:
Items not covered, even with a doctor's recommendation, are over-the-counter (OTC) products, such as face washes, non-prescription creams, and general skincare items.
In case acne is a sign of an underlying health issue, it is eligible for coverage under health insurance plans. Conditions include:
In such cases, acne treatments may be part of the treatment of the primary disease. In these scenarios, insurance will treat the root cause, while acne management, despite being a lower priority, becomes a covered service under most plans.
If you want to successfully get acne treatment covered by your health insurance, do the following:
Hospitalisation or procedure-related claims generally require pre-approval, whereas OPD claims are reimbursed post-submission of documents.
Yes, waiting periods apply if:
Acne treatment may not be covered under a health insurance plan, and even a claim that is covered could have applicable exclusions and/or waiting periods.
If you're in the market for a policy that provides acne treatment coverage, prioritise:
In that sense, Star Health’s policies have OPD as a benefit, and certain dermatological consultations are covered under defined medical conditions. It doesn’t cover cosmetic acne treatments but does support the treatment of acne when it’s part of a larger health concern.
Coverage will tend to vary based on the selected plan. Thus, always ensure to check the policy documents to have a clear idea of the inclusions and exclusions.