Policyholder Services

Covered Elective Cosmetic Procedures

OMIC’s policy is designed to cover (within the appropriate coverage classification) all oculofacial plastic surgery procedures considered ordinary and customary for the specialty. Although it would be nearly impossible to list every procedure covered, procedures covered include (but are not limited to) the following. Please refer to OMIC’s Coverage Classification descriptions to determine which procedures are permissible under your coverage classification.

1. Autologous fat/dermis transfer to the face (transfer to areas other than the face requires underwriting review)
2. Biopsy or excision of skin or superficial soft tissue masses (anywhere on the body)
3. Blepharoplasty
4. Blue light acne treatment (with or without use of photodynamic therapy)
5. Botulinum toxin injections for treatment of cosmetic indications of the face and neck (use for cosmetic indications on other areas is subject to underwriting review), dystonia and other approved spastic disorders, headaches, and hyperhidrosis
6. Brow lift
7. Cellulite reduction using radio frequency/light energies
8. Chemical peels (peels using Phenol Acid in concentrations greater than 15% require underwriting approval)
9. Chin augmentation, including implants, mentoplasty, and genioplasty
10. Dermabrasion
11. Earlobe repair
12. Epilation (electrical, mechanical, or photo)
13. Endoscopic sinus surgery
14. Eyelash extensions
15. Facial reanimation
16. Forehead lift (lifts limited to the upper 1/3 of the face)
17. Frontal sinus obliteration
18. Full facelifts for cosmetic purposes (lifts involving the lower 1/3 of the face)
19. Hair removal using a laser, ILP, or radio frequency/light energies
20. Hair transplantation (for alopecia or cosmetic purposes) and other approved medical/surgical treatments for alopecia
21. Harvest of bone graft, including harvest of rib graft
22. Harvest of ear cartilage
23. Implantation of eye jewelry
24. Implants for facial features other than the chin (e.g., malar augmentation, nasolabial folds, temple, etc.)
25. Injections/implantation of FDA-approved soft tissue fillers
26. Laser tattoo removal
27. LatisseTM (prescribing or dispensing of)
28. Lip augmentation
29. Liposuction
30. Microdermabrasion
31. Micropigmentation (“permanent makeup”)
32. Mid-face lifts, including excision of redundant skin around the eyelids and ears
33. Neck lift
34. Orbital decompression
35. Orbital reconstruction, including bone maneuvers and soft tissue maneuvers
36. Osteoplastic reconstruction of facial deformities
37. Otoplasty
38. Placement of arch bars on teeth
39. Platysmaplasty
40. Post-Mohs reconstruction surgery (above the clavicle)
41. Prescription of Retin-A
42. Removal/repair of facial skin cancers
43. Removal of nasal polyps
44. Repair/reconstruction of facial fractures, including orbital fractures
45. Rhinoplasty
46. Scar revision, including injections of antimetabolite agents or steroids to scars
47. Septoplasty
48. Skin bleaching
49. Skin resurfacing, rejuvenation, or tightening using lasers, IPL, radio frequency, plasma energy, and/or ultrasound
50. Teeth whitening
51. Treatment of spider veins or varicose veins using sclerotherapy, IPL, or lasers

If you intend to perform a procedure not listed above and would like to confirm whether coverage is available under the OMIC policy and if any additional application or review is required, please contact an underwriting representative at (800) 562-6642.

Updated 5/29/2018