About us | Unimed Covers | General Exclusions | Service Providers

The SCHEME’s liability shall be limited to expenses in respect of the relevant health services as provided for in the rules of the SCHEME. Any expenses in connection with any of the following will not be paid for by the SCHEME:

• Compensation for pain and suffering, loss of income, funeral expenses or any other claim for damages.
• Services for benefits that are in excess of the maximum benefits to which the MEMBER is entitled in terms of the rules.
• Expenditure incurred by the MEMBER or his DEPENDANTS arising from willful, self-inflicted injury, attempted suicide, the excessive use of an intoxicating substance or drug.
• Expenses arising from injuries sustained as a result of participation in sport not organized by the employer.
• Examinations, treatment and/or operations for cosmetic purposes, obesity, infertility, artificial insemination, impotency and any complication that may arise from such examinations or treatment.
• Expenses incurred for recuperative or convalescent holidays.
• Any expenses incurred by a MEMBER or DEPENDANT during any waiting period imposed by the SCHEME in terms of the rules.
• The SCHEME will have no liability for “Endoscopic Disposable Stapling Devices when used for laparoscopic ally assisted vaginal hysterectomies.
• All expenses in respect of the treatment for learning, marital and family problems.
• Patent and household remedies.
• Contraceptive preparations and devices.
• Medical examination for insurance and employment purposes.
• Reduction mammoplasty.
• Travel and subsistence.
• Anti-addiction and anti-habit agents, with the exception of Anti-abuse.
• All cosmetic items inclusive of hair-restorers.
• Diagnostic preparations and instruments, soaps, shampoos and other topical applications (of a cosmetic nature), medicated or otherwise but excluding those intended for treatment of lice, scabies and other parasitic or fungal infections.
• Sun screening and sun-tanning agents except those intended for the treatment of skin disorders.
• Homeopathic and herbal medicines and remedies purchased other than from a registered homeopath.
• Food supplements including all patent and baby foods and special milk preparations.
• Household bandages and dressings.
• Syringes and needles except those for use in the treatment of diabetes.
• All vitamins, mineral supplements, growth hormones and tonics including Efamol G and similar products, stimulants e.g. Reactivan, except vitamins needed in conjunction with antibiotics, e.g. Vitamin B. However, benefit will be granted on the following:

- Pre-natal vitamins and geriatric vitamins;
- Vitamin B tablets and ampoules if prescribed for neurological disorders e.g. Neurobion;
- Calcium supplements when prescribed specifically for the treatment of Osteoporosis.

• Contact lens preparations.
• Demand prescriptions.
• Expenses for which a third party is liable including expenses associated with occupational injuries and diseases, motor vehicle accidents and medical services covered by other forms of insurance, provided that the SCHEME may provide benefits until the third party liability has been established at which stage the expenditure shall be recouped from the third party or the member as the case may be.
• Injury arising from any form of public disorder.

This list is not exhaustive and the Board reserves the right to add or delete exclusions at its own discretion.