Why is cosmetic work not covered by health insurance?
Schedule 2 of the benefits rule names cosmetic procedures individually as non-covered. A functional operation on the same body part can still be covered — but it is a different procedure with a different name.
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National health insurance exists to diagnose and treat illness, so care not aimed at improving essential bodily function is designated non-covered by law.
The law names the procedures
The basis is Schedule 2, category 2 of the Rule on the Standards for Health Insurance Benefits, covering work “not aimed at improving essential bodily function”.
| Named item |
|---|
| Double-eyelid surgery, augmentation rhinoplasty, breast augmentation and reduction, liposuction, wrinkle removal and treatment of their complications |
| Ocular surgery for appearance rather than vision |
| Orthodontics (except for congenital deformity impairing chewing or speech) |
| Orthognathic surgery for appearance |
| Scar removal for appearance where joint movement is unimpaired |
| Vision correction surgery to replace glasses or contact lenses |
| Care aimed simply at increasing height rather than treating disease |
So cosmetic work being non-covered is not a matter of practice — it is written into the rule.
Same body part, different purpose — but the procedure changes name
This is the most misunderstood point. Saying “double-eyelid surgery is covered if you have ptosis” is inaccurate. What gets covered is a differently named procedure.
| Non-covered (cosmetic) | The covered procedure | Criteria |
|---|---|---|
| Double-eyelid surgery | Ptosis correction | Covered when the levator muscle or its innervation is at fault. Age-related ptosis and dermatochalasis are covered only with visual field impairment — the eyelid encroaching on the pupil in a front-facing photograph |
| Augmentation rhinoplasty | Septoplasty | Correction of a functional septal deviation confirmed on imaging. Reshaping the external nose stays non-covered |
| Cosmetic strabismus surgery | Strabismus surgery | Under age 10, or after 10 with diplopia and visual confusion, or abnormal head posture |
| Cosmetic breast reduction | Gynecomastia surgery | Confirmed tissue proliferation at Simon Classification Grade IIA or above |
| Simple phimosis | Circumcision | Only when accompanied by disease |
| Cosmetic jaw correction | Orthognathic surgery | For chewing or speech function — congenital deformity, tumor or trauma sequelae, or a pre-treatment anteroposterior occlusal discrepancy of 10 mm or more |
The dividing line is not the body part but purpose, diagnosis, and whether an objective criterion is met. Have both done together and the bill splits into covered and non-covered portions.
Why prices vary so much
Non-covered work is priced by each provider — there is no fixed fee schedule, so the same procedure differs between clinics.
The freedom is not unlimited. Article 45 of the Medical Service Act bars providers from charging more than the price they posted, and HIRA publishes non-covered price information at hira.or.kr/npay, with disclosure mandatory for hospital-tier institutions. The wider structure is in covered versus non-covered care.
Sources: Rule on the Standards for Health Insurance Benefits Schedule 2, category 2; MOHW notices on detailed benefit criteria; Medical Service Act Article 45. Benefit criteria reflect HIRA’s consolidated July 2025 edition; later amendments should be re-checked against HIRA’s benefit criteria search. Last checked 2026-08-30.
Frequently asked questions
If I have ptosis, is double-eyelid surgery covered?
Not quite. What is covered is ptosis correction, a separate procedure. Congenital or neurogenic ptosis is covered outright; age-related ptosis and dermatochalasis are covered only when a front-facing photograph shows the eyelid encroaching on the pupil.
If I have a deviated septum, is rhinoplasty covered?
No. Septoplasty is covered; augmentation rhinoplasty is named in Schedule 2 as non-covered cosmetic work. Done together, the two are billed separately as covered and non-covered.
Does non-covered mean private indemnity insurance will not pay?
That depends on your policy. Cosmetic purposes are usually excluded, but you need to check your specific contract.