Remedi Exclusions

 What Remedi does not cover

There are certain medical expenses Remedi does not cover. We call these exclusions.

General exclusions

Remedi will not cover any costs that are more than the benefit to which a member is entitled in terms of the rules, unless otherwise agreed to by the Board of Trustees.

No claim shall be payable by Remedi if, in the opinion of the Medical Advisory Committee, the healthcare service in respect of which such a claim is made, is not appropriate and necessary for the symptoms, diagnosis or treatment thereof and/or rendered at an acceptable and reasonable level of service.

Specific exclusions

Remedi will not cover the following procedures or the direct or indirect medical consequences of the following events, except if it is required by law as stated under the Prescribed Minimum Benefits:

• Injuries sustained during participation professional sport, speed contests and speed trials
• Wilful, self-inflicted illness or injury, like alcoholic liver cirrhosis
• Injuries sustained during wilful participation in war, terrorist activity, riot, civil commotion, rebellion or insurrection
• Cosmetic procedures, like ear surgery (otoplasty) for jug-ears, removal of port wine stains and eyelid surgery (blepharoplasty), treatment of alopecia
• Breast reductions unless medically necessary
• Artificial insemination
• Infertility
• Erectile dysfunction
• Gender realignment
• Holidays for recuperative purposes
• Experimental, unproven or unregistered treatments or practices
• Purchase of: unregistered medicines, household remedies, diagnostic agents, aphrodisiacs, anabolic steroids, toiletries, cosmetics, surgical items such as bandages, nutritional supplements, tonics and slimming preparations
• Treatment of Obesity
• Frail care unless in lieu of hospitalisation
• Search and rescue events

What Remedi does not cover as Chronic Illnesses

Remedi will not cover the following conditions/ailments from the Chronic Illness Benefit, except as stipulated in the Prescribed Minimum Benefits:

• Acute bacterial and viral infections
• Alcoholic liver cirrhosis
• Alopecia
• Athlete’s foot
• Arthralgia
• Backache
• Constipation – unless diagnosis is Diverticular disease or because of chemotherapy
• Contraception
• Dandruff/Seborrhea
• Dermatophytes, Oncomomycosis, Dermatophytic onchia
• Diarrhoea
• Disorders of the conjunctiva
• Dysmenorrhoea/menorrhagia
• Dyspepsia
• Dysuria
• Erectile Dysfunction
• Fever blisters
• Fibromylgia/Myalgia
• Fibrositis
• Flatulence
• Folate deficiency
• Follicitis
• Haemorrhoids
• Halitosis
• Headaches; non- specific
• Hirsutism
• Hyperacidity/Indigestion
• Hypotension
• Insomnia
• Irritable bowel syndrome
• Mastalgia
• Obesity
• Oedema, except for cardio-vascular conditions
• Oral and vaginal thrush/Candida
• Pain, non-specific
• Restless legs/cramps
• Senile dementia/cognitive dysfunction
• Sinusitis
• Solar keratosis
• Superficial fungal infections
• Unspecified cough
• Urticaria
• Varicose veins