Issue link: https://www.hub.camaf.co.za/i/1512932
2024 NETWORK CHOICE 27 Exclusions & Limitations In terms of the CAMAF registered rules the following is a summary of services which are excluded from benefit or limited - for a complete list consult the registered rules on www.camaf.co.za: • 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 check 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 Limitations Advanced Dentistry - the benefits of R7 755 per beneficiary is limited for use - can only be used for bridges or dentures; no benefit for osseo - integrated implants. BACK TO CONTENTS PAGE