Cosmetic Services: services that are intended primarily to change or maintain your appearance are allowed under this plan.
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• Face lifts, body lifts, tummy tucks, liposuctions or removal of fat deposits considered undesirable, including fat accumulation under the male breast and nipple, removal of excess skin, removal or reduction of non-malignant moles (except biopsy), blemishes, varicose veins, cosmetic eyelid surgery and other surgical procedures;

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• Procedures to remove healthy cartilage or bone from the nose (even if the surgery may enhance breathing) or other part of the body;
   

• Chemical peels, dermabrasion, laser or light treatments, bleaching, creams, ointments or other treatments or supplies to alter the appearance or texture of the skin;
   

• Nutritional procedures or treatments;
   

• Insertion or removal of any implant that alters the appearance of the body (such as breast or chin implants); except removal of an implant will be covered when medically necessary;
   

• Removal of tattoos or scar removal or revision procedures (such as Sal abrasion, chemosurgery and other such skin abrasion procedures) (except for tattoos applied to assist in covered medical treatments, such as markers for radiation therapy);
   

• Hair removal or replacement by any means; treatments for skin wrinkles or any treatment to improve the appearance of the skin; treatment for spider veins; skin abrasion procedures performed as a treatment for acne; treatments for hair loss; varicose vein treatment of the lower extremities Surgery to correct gynecomastia;
   

• Replacement of an existing intact breast implant if the earlier breast implant was performed as a cosmetic procedure
   

• Otoplasty
   

• Wigs or other scalp-hair prosthesis regardless of the reason for the hair loss, except for loss of hair resulting from treatment of a malignancy or permanent loss of hair from an accidental injury. Wigs will be covered for alopecia or hair loss due to injury or disease. Any combination of in- network and out-of-network benefits is limited to two wigs or other scalp hair prosthesis per calendar year.
   

Please check your plan booklet to more detailed benefits.