Benefit
Benefit entitlement
Maximum cover
AIA Private Health Cover and AIA Private Health Plus
Covers the cost of a prophylactic mastectomy and/or oophorectomy where the life assured has: > been diagnosed with breast or ovarian cancer ; and > where the prophylactic surgery is directly related to an acceptable breast or ovarian cancer claim under the Surgery or Cancer Care Benefit of this policy, or where a claim for breast or ovarian cancer would have been acceptable had the treatment not taken place in a public hospital; and > tested positive for the BRCA1 or BRCA2 gene mutation after the risk commencement date . The surgery does not need to be medically necessary . Prior approval must be obtained before the surgery takes place. Under no circumstances is a claim payable under this benefit where the life assured has an exclusion on this policy for either breast cancer and/or ovarian cancer , or where the life assured has an exclusion on this policy for any disease or disorder of the breast and/or female genital tract where this relates to a personal history and/or family history of breast or ovarian cancer .
Prophylactic surgery following cancer
Breast reconstruction:
> following a mastectomy for the treatment of diagnosed breast cancer ; and/or > following a prophylactic mastectomy which has been covered under the Prophylactic surgery following cancer benefit of this policy; or > where a claim for prophylactic mastectomy would have been acceptable under the Prophylactic surgery following cancer benefit of this policy, had the procedure not taken place in a public hospital . Prior approval must be obtained before the procedure takes place. Covers costs for procedures on the unaffected breast to achieve breast symmetry following a mastectomy of the affected breast. This will be available either during or following a mastectomy to treat diagnosed cancer of the affected breast, which has been covered by your AIA Private Health policy. Procedures covered under this benefit may include breast reduction surgery, but does not include prophylactic mastectomy surgery of the unaffected breast or breast reconstruction following mastectomy. The procedures to achieve breast symmetry do not need to be medically necessary .
Breast reconstruction following mastectomy
Breast symmetry surgery following mastectomy
Prior approval must be obtained before the procedure takes place.
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1300 APH-UMB version 6 Effective 17 April 2025
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