Issue link: https://www.hub.camaf.co.za/i/1512927
2024 ALLIANCE PLUS & ALLIANCE NETWORK 27 Exclusions & Limitations In terms of the CAMAF registered rules the following is a summary of services excluded from benefit or limited - for a complete list consult the registered rules: • Costs for which a third party may be liable unless you have fulfilled the requirements - see "THIRD PARTY CLAIMS". • All costs, which are, in the opinion of the medical advisor: - Not medically necessary - Not rendered in a cost effective manner - Not evidence based treatment - Not proven or registered treatment (experimental). • Treatment as a result of negligence on the part of a member or dependant. • Treatment for obesity (excluding morbid obesity as per defined clinical criteria) or for cosmetic purposes. • Treatment of one's own choosing, unrelated to an illness or accident. • Exercise treatment for recuperative purposes. • Institutions or service providers, not registered in terms of any law. • Travelling costs. • Insurance and licence medical checks - ups. • Accommodation or nursing at a Frail Care institution. • The charges for missed appointments. • Hire or purchase of protective equipment or clothing. • Educational or remedial therapy, including school readiness testing, aptitude testing or career guidance. • Hypnotherapy. • Biological medication. • Drug trials. • Costs relating to injuries sustained during participation in wilful and material breach of the law, war, terrorist activity etc. • Unregistered medication. • Costs relating to excessive use of drugs or alcohol. • Costs incurred by acting as a surrogate mother or donor. • FM transmitters. • Matrasses for Oncology patients. • Adult nappies. BACK TO CONTENTS PAGE