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Medicines, Products and Services that 
are excluded by the Fund


NMC will not pay for the following MEDICINES and PRODUCTS:

1) Preparations used specifically to treat and/or prevent obesity or overweight or any slimming preparations.
   

2)

Patented 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.
   
3) 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 hospital or nursing home.
   

4)

Nutritional supplements including patented foodstuffs, baby food and special formulas
   

5)

Medicines used specifically for the treatment of sterility, impotence and infertility
   

6)


Aphrodisiacs
Preparations generally purposed to improve or increase libido or induce/maintain penile erection.

   

7)


Anti-smoking preparations
All preparations designed specifically to treat or stop the smoking habit

   

8)

Soaps, shampoos and other topical applications (of a cosmetic nature) medicated or otherwise. Items other than those intended for the treatment of lice, scabies and other parasitic infestations or fungal infections, as indicated by the doctor's Diagnosis.
   

9)

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.

   

10)

Anabolic steroids unless prescribed for medical reasons (full motivation letter required).
   

11)

Vitamins, Multivitamins, Vitamin combinations and tonics.
 
Payable by the Fund only under the following conditions:
   

• Prescribed for patients older than 50 years of age.
• For children aged 5 and younger.
• Vitamin B supplementation when prescribed as an adjunct to antibiotic therapy. Thirty (30) day supply only.
• For supplementation during pregnancy and lactation.
• Injections (Neurobion Injection is not payable by the Fund if prescribed for the treatment of obesity).
• Heamatinics
• Vitamin C 500mg or more, together with cold and flu treatments. Thirty (30) day supply only, if claimed as self-medication.
• If claimed as self-medication.


Please note:
Products that are not listed in MIMS (example: Golden Products, Sportron, Vitaforce) are not Payable by the Fund. Please consult your doctor for vitamins to be paid out.


12)


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 hormone replacement therapy in the case of calcium supplements.
• Prescribed for osteoporosis in the case of calcium supplements.
• Prescribed for patients older than 50 years of age (full motivation required).


13)

Contact lens preparations used for the care and cleaning of contact lenses, including wetting agents.
   

14)

Cosmetic and toilet preparations, medicated or otherwise.
   

15)

Immunosuppressives unless prescribed by a medical specialist.
   

16)

Medicines used specifically to treat acquired immune deficiency syndrome (aids) unless the patient is registered for case management.
   

17)

Contraceptive Device
Foam preparations, jellies, condoms , or any other contraceptive devices apart from IUCD's.
   

18)

Preparations not easily classified.
For example, Evening Primrose or Efamol G if not prescribed for medical reasons (full motivation letter required).
   
 

Namibia Medical Care will not pay for Medical Expenses arising directly or indirectly from the following:
   

1)

Suicide, attempted suicide or intentional self-inflicted injury, whether the patient concerned is of sound mind or not.
   

2)

Medical examinations:
  • for insurance purposes
• for and with regard to employment
• for litigation purposes
   

3)

Medical examinations and/or treatments where no actual or presumed illness exists.
   

4)

Physical fitness tests
   

5)

Plastic surgery and cosmetic treatments (excluding breast reductions, dental implants and refractive surgeries) of a member's own choice or which are recommended for psychological reasons only.
   

6)


Examinations for and/or treatment of:
infertility, sterility, impotence and artificial insemination
obesity and overweight

   

7)

Telephonic consultations/ prescriptions
   

8)

Appointments with a supplier of services not kept by the patient and charged for by such supplier of services.
   

9)

Breathing exercises
   

10)

Holiday for recuperative purposes
   

11)

Traditional healing
   

12)

Forensics
   

13)

Acupuncture, acupressure reflexology and masseurs.
   

14)

Accommodation in old age homes and similar institutions.
   

15)

Hospitalisation or accommodation in an institution similar to a hospital for breastfeeding mothers for the sole benefit of their newborn babies.
   

16)

All costs pertaining to pregnancies for the first 12 months of membership in the case of members who are registered as individuals.
   

17)

All costs incurred for treatment of injuries, where such costs are the responsibility of another party unless the rules of nmc provide otherwise.
   

18)

Ophthalmic examinations by anyone other than an eye specialist or registered optician.
   

19)

Any instrument to correct/ enhance vision other than a pair of spectacles or contact lenses.
   

20)


Operations to correct vision defects, where the lack of refraction is less than:

• in the case of myopia, (-) 3,00 dioptre
• in the case of hyperopia, (+) 6 dioptre
• in the case of astigmatism, (-) 2,50 dioptre
• in the case of combined myopia and astigmatism ,(+) 4,00 dioptre unless preceded by keratoconus.

   

21)

Sunglasses
   

22)

Tinting of prescription lenses of 35% or more.
   

23)

Gold in dentures and fillings.
   

24)

Dental devices and materials such as floss, tooth brushes and tooth paste.
   

25)

Any dental procedures that are recommended for cosmetic purposes.
   

26)

Specific exclusions
   

27)

Sleep therapy and hypno-therapy.
   

28)

Cost incurred in respect of injuries sustained by a member or a dependant participating in a sport as a professional or any hazardous sport or activity which is inherently hazardous including but not limited to active voluntary service in any military or paramilitary organisation or the namibian police services, martial arts, parachuting, hang gliding, paragliding, bungee jumping, advanced mountain climbing, skydiving, water skiing, all underwater sports, (snorkeling, breath hold diving, scuba diving, etc.), professional /diamond diving, snow-skiing, show jumping, horse polo, river rafting, aquaplaning, boxing, wrestling ,enduro racing, motocross racing as well as other activities where the member or dependant of a member deliberately exposes himself or herself to substantial danger.
   

29)

Any procedure or device intended 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.
   

30)

Family and marriage counselling please consult your membership card for the list of exclusions (if any) applicable only to you and/any of your dependant/s.
   
 
Who is responsible for the payment of claims that Namibia Medical Care will not pay?
   
  In the case of exclusions, Members must pay the service provider, i.e. the pharmacists or dispensing doctor directly for any excluded treatments, medicines or items.