Exclusions

Medication

Household type bandages and dressings, cotton wool and similar requisites unless supplied to or used in a clinic or doctor's room or during the patient's stay in a hospital or a nursing home.
Contact lens preparations specifically used for the care and cleaning process of contact lenses, including wetting agents.
Cosmetic and toilet preparations, medicated or otherwise.
Unless prescribed by a medical specialist.
Soaps, shampoos, and other topical applications (of a cosmetic nature) medicated or otherwise.
Medicines and products not registered with the Namibian Medicine Control Council including complimentary medicine.
Costs incurred in respect of any medical condition (whether chronic or otherwise) or a combination thereof, which in the exclusive opinion of the board, warrants to be excluded from benefits, for treatment of injuries, where such costs are the responsibility of another party unless the rules of NMC provide otherwise.
Preparations or devices generally supposed to improve or increase libido, or to induce, enhance, maintain and promote penile erection or to address erectile dysfunction, such as erectile appliances, auto injectors, and including, but not limited to drugs such as Viagra.
Medicines used specifically to treat Acquired Immune Deficiency Syndrome (AIDS), unless the patient is registered for Case Management.
Medicines used specifically to treat alcoholism and drug addiction other than Protector Health, Ruby, Sapphire and Diamond options.
Unless prescribed for medical reasons (full motivation letter required).
All preparations designed specifically to treat or stop the smoking habit (unless approved by the Wellness Programme).
Foam preparations, jellies and condoms.
Single or combined mineral preparations and electrolytes: Oral preparations intended as dietary supplements when intake is considered inadequate unless:
  • Prescribed together with diuretics e.g. Slow K (full motivation required);
  • Prescribed for Electrolyte replacement therapy with diarrhoea (full motivation required);
  • Prescribed together with hormonal replacement therapy in the case of calcium supplements; provided that the elemental calcium dose is greater than 300mg per tablet.
  • Prescribed for osteoporosis in the case of calcium supplements; provided that the elemental calcium dose is greater than 300mg per tablet
    Prescribed for patients older than 50 years of age (full motivation required).
Nutritional supplements including patent foodstuffs, baby food and special formulas.
Preparations used specifically to treat and/or prevent obesity or overweight or any slimming preparations.
Patent and secret medicines and preparations, household remedies, and preventative preparations Generally promoted to the public to increase consumption unless prescribed in the form of a mixture together with any medicated cream or ointment e.g. a topical steroid.
Medicines used specifically for the treatment of sterility, impotence and infertility.
Sun screening and sun tanning agents, unless prescribed by a dermatologist in the form of a mixture together with any medicated cream or ointment e.g. a topical steroid. Unless prescribed by a dermatologist for medical reasons (full motivation letter required). Products used to relieve or treat sunburn unless prescribed by a doctor
Vitamins, multivitamins, vitamin combinations and tonics (unless bought from self-medication benefit). Payable by the Fund only under the following conditions:
  • Prescribed for patients older than 50 years of age and children aged 5 and younger; Vitamin B supplementation when prescribed as an adjunct to antibiotic therapy. Thirty (30) days supply only;
  • For supplementation during pregnancy and lactation;
  • Injections (unless prescribed for the treatment of obesity);
  • Haematinics;
  • Vitamin C 500mg or more prescribed together with cold and flu treatments. Thirty (30) days supply only.

Preparations not easily classified including complementary medicine.

NMC will not pay for the medical expenses arising directly or indirectly from the following:
  • Acupuncture, Acupressure, Reflexology & Massages.
  • Accommodation and treatment in headache and stress-relief clinics, spas and resorts whether deemed medically necessary or not.
  • Accommodation other than a recognised hospital/medical institution for treatment, investigation, operations and procedure outside the borders of Namibia unless: such treatment, investigation, operations and procedure cannot be done in Namibia;
  • Part of Case Management; with prior approval.
  • Accommodation in old age homes and similar institutions.
  • Appointments with suppliers of services not kept by the patient & charged for by such suppliers.
Costs relating to the taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a medical practitioner or any examination, investigation, addiction other than Protector Health, Ruby, Sapphire and Diamond options.
Gold in dentures and fillings. Dental devices and materials such as dental floss, tooth brushes and tooth paste. Bleaching of teeth or any dental procedures that are recommended for cosmetic purposes.

Oral hygiene instructions. Nutritional or tobacco counselling. Laboratory costs where associated dental procedure is not covered.
Any procedure intended to induce, enhance, maintain and promote penile erection or to address erectile dysfunction.

Examinations, routine physical examinations, procedures and/or treatment, any procedure of a purely diagnostic nature, any other examination where there is no objective indication of impairment in normal health or no actual presumed illness exists, and laboratory diagnostics or x-ray examinations, except in the course of a disability establishment by prior call or attendance of a medical practitioner.
The purchases or hire of external appliances other than those specified on the list of External Medical Appliances covered by NMC.
Group counselling, group therapy or group rehabilitation. Holidays for recuperative purposes, whether deemed medically necessary or not.
Examinations, investigations, treatment or surgery for infertility, sterility, impotence and artificial insemination or hormone treatment for infertility, including all costs relating to surrogacy.

Medical examinations for insurance purposes, school camps, visa employment or for litigation purposes.

Medical expenses for any planned or non-emergency consultations, examinations, procedures and treatment incurred in foreign countries other than the Republic of South Africa.
Examinations, investigations, treatment or surgery for obesity and overweight including gastric bypass, reversal of gastric bypass and any other procedures performed in combination with gastric bypass. Gastric bypass is only covered as part of gastric protocol.
Ophthalmic examinations by anyone other than an eye specialist or registered optician.
Sunglasses and spectacle cases.

Tinting of prescription lenses by 35% or more.

Physical fitness tests, other than for members or dependants registered under the Wellness Programme offered by the fund.

Plastic surgery and cosmetic treatments (excluding, dental implants and refractive surgeries) of a member's own choice or which are recommended for psychological reasons only or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery.
Hospitalisation or accommodation in an institution similar to a hospital for breastfeeding mothers for the sole benefit of their newborn babies.

All costs pertaining to pregnancies for the first 9 months of membership in the case of members who are registered as individuals.

Specific exclusions upon entry to the Fund.
Suicide, attempted suicide or intentional self-inflicted injury, unless the patient qualifies in terms of the suicide protocol.