{"id":1216,"date":"2017-03-28T12:37:43","date_gmt":"2017-03-28T10:37:43","guid":{"rendered":"https:\/\/www.namfisa.com.na\/educates\/?p=1216"},"modified":"2025-07-18T10:26:08","modified_gmt":"2025-07-18T08:26:08","slug":"healthcare-expenditures-that-medical-aid-funds-do-not-cover","status":"publish","type":"post","link":"https:\/\/www.namfisa.com.na\/educates\/healthcare-expenditures-that-medical-aid-funds-do-not-cover\/","title":{"rendered":"Healthcare Expenditures that Medical Aid Funds do not Cover"},"content":{"rendered":"\t\t
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Understanding Medical Aid Exclusions<\/h3><\/span><\/div>
The objective of medical aid\ncover is to guarantee access to\nessential healthcare, for fund\nmembers. However, there are threats to\nthe sustainability of private healthcare\ncoverage, such as affordability.\nHealthcare costs increase at rates\nwhich are substantially higher than the\ngeneral inflation rate and that may require\nmember contributions to increase each\nyear. The financing available for healthcare\nexpenditure is not infinite, therefore one\nof the measures employed by medical aid\nfunds to mitigate the threat of affordability,\nis exclusions on benefits covered for certain\nmedicines, treatments and procedures.\nMedical aid funds must nonetheless ensure\nthat there are good reasons for these\nexclusions, otherwise they may lead to the\nunreasonable denial of healthcare benefits\nto the members of medical aid funds.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Understanding Medical Aid Exclusions Part 2<\/h3><\/span><\/div>
All medical aid funds have a list of\ntreatments, medicines and procedures that\nthey will not cover. Therefore, to ensure\nthat all members have a fair and equitable\nrationing of healthcare benefits, medical\naid funds have limits to the items and\ntreatments covered for members.\nThe principles that are considered\nby medical aid funds when deciding\nwhether exclusion is justified or not are:\nbest practice, evidence-based healthcare,\nclinical protocol, cost-effectiveness\n(affordability), and the prevailing laws of\nthe country.\nIt would, for example, be inappropriate to\nexclude the treatment of acute appendicitis\nbecause of its life threatening nature,\nwhile exclusion for cosmetic surgery in the\nabsence of clinical indications would be\nappropriate.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Understanding Medical Aid Exclusions Part 3<\/h3><\/span><\/div>
Each medical aid fund\u2019s benefit\nexclusions are listed in detail in the\nrespective Fund Rules. Excluded products\nor services as stipulated in the exclusion\nlists will not be paid for by the medical\naid funds. It is thus the responsibility of\nmembers to ensure that they are familiar\nwith the products and services that are\nexcluded from their medical aid fund\ncover. Members should ensure that the\nmedicines, treatments and procedures\nthey receive or require, will be paid for by\ntheir medical aid fund before obtaining\nthe service. Otherwise, they will be solely\nresponsible for paying the costs of the said\nproducts or services.\nExamples of medical benefits that are\ngenerally excluded by most of the registered\nmedical aid funds in Namibia include, but\nare not limited to:<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Common Medical Aid Exclusions in Namibia<\/h5><\/div>
Below are examples of services and products generally not covered by most registered medical aid funds:\n\nExamples of medical benefits that are generally excluded by most of the registered medical aid funds in Namibia include, but are not limited to:<\/strong>

\n\n\u2022<\/strong> Cosmetic preparations, emollients, moisturisers, medicated or otherwise, soaps, scrubs and other cleansers, sun-tanning preparations, medicated shampoos and conditioners, except for the treatment of lice, scabies and other microbial infections and coal tar products for the treatment of psoriasis<\/strong>;

\n\n\u2022<\/strong> Nutritional supplements including patent foodstuffs, baby food and special formulas;

\n\n\u2022<\/strong> Preparations used specifically to treat and\/or prevent obesity or overweight or any slimming preparations;

\n\n\u2022<\/strong> Medicines not included in a prescription from a medical practitioner or other healthcare provider who is legally entitled to prescribe such medicines, except for schedule 0, 1 and 2 medicines supplied by a registered pharmacist<\/strong>;

\n\n\u2022<\/strong> Patent and secret medicines and preparations, household remedies and preventative preparations;

\n\n\u2022<\/strong> Medicines used specifically for the treatment of sterility, impotence and infertility;

\n\n\u2022<\/strong> Vitamins and multivitamins alone or in combination with stimulants (tonics);

\n\n\u2022<\/strong> Medicines used specifically to treat alcohol or drug addiction;

\n\n\u2022<\/strong> Treatment of an illness or injury sustained by a member or a dependant where such illness or injury is directly attributable to failure to carry out the instructions of a healthcare provider or to negligence on the part of the member or dependant;

\n\n\u2022<\/strong> Suicide, attempted suicide or intentional self-inflicted injury whether the patient concerned is of sound mind or not;

\n\n\u2022<\/strong> Plastic surgery and cosmetic treatments of a member\u2019s own choice or which are recommended for psychological reasons or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery;

\n\n\u2022<\/strong> Medical expenses for any planned or non-emergency consultations, examinations, procedures and treatment incurred in foreign countries other than in South Africa.

\n\nThe above examples are not a complete list of medical aid funds exclusions.<\/strong>
\nTo read the full list of exclusions, one should request it from their medical aid fund.
\nSome medical aid funds have also put the exclusion list on their respective websites.
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<\/h3><\/span><\/div>
Note: This list is not exhaustive. Members should request the full list of exclusions from their fund or check the official website.<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Understanding Medical Aid Exclusions The objective of medical aid cover is to guarantee access to essential healthcare, for fund members. However, there are threats to the sustainability of private healthcare<\/p>\n","protected":false},"author":1,"featured_media":1219,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"footnotes":""},"categories":[435],"tags":[],"class_list":["post-1216","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-aid-and-freindly-societies"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/comments?post=1216"}],"version-history":[{"count":7,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1216\/revisions"}],"predecessor-version":[{"id":35620,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/posts\/1216\/revisions\/35620"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/media\/1219"}],"wp:attachment":[{"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/media?parent=1216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/categories?post=1216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.namfisa.com.na\/educates\/wp-json\/wp\/v2\/tags?post=1216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}