General Exclusions

Anglovaal Group Medical Scheme will not pay for healthcare services related to the following, except where a condition may form part of the Prescribed Minimum Benefits.

  1. Compensation for pain and suffering, loss of income, funeral expenses or any other claim for damages
  2. Expenditure incurred by a member or his dependants arising from willful, self-inflicted injury, or the excessive use of intoxicating substances or drugs
  3. Examinations, treatment and or operations for cosmetic purposes, obesity, or infertility and any complication that may arise from such examinations, treatment or operations
  4. Expenses incurred for recuperative or convalescent holidays
  5. Expenses incurred outside the Rand Monetary Area
  6. All expenses in respect of health conditions that were subject to waiting periods when the member joined the Scheme
  7. Purchase of:
    • Patent medicines and proprietary preparations;
    • Applicators, toiletries, sunglasses and beauty preparations;
    • Patent food, including baby food;
    • Tonics, slimming preparations, appetite suppressants and drugs as advertised to the public; and
    • Household and biochemical remedies
  8. Purchase of any of the following without a prescription:
    • Vitamins and multi-vitamins;
    • Patent medicines and homeopathic preparations;
    • Contraceptives and apparatus to prevent pregnancy; and
    • Bandages, cotton wool and similar aids
  9. Claims not submitted within four months after the month in which the service was rendered shall not be paid by the Scheme
  10. Expenses for which a third party is liable, including expenses associated with occupational injuries and diseases, motor vehicle accidents and medical services covered by other forms of insurance, provided that the Scheme may provide benefits until the third party’s liability has been established at which stage the expenditure shall be recouped from the third party or the member as the case may be
  11. Chronic renal dialysis
  12. Organ transplants
  13. Growth hormone
  14. Examinations for insurance, school camps, visa, employment or any similar purpose
  15. Charges for appointments not kept
  16. Accommodation in convalescent or old age homes or similar institutions catering for the aged
  17. Costs associated with vocational guidance, marriage guidance, school therapy or attendance at remedial education schools or clinics
  18. Sleep therapy and hypnotherapy
  19. Costs associated with active participation in wars, riots or civil disobedience
  20. Breast reduction
  21. Refractory eye surgery
  22. Expenses arising from injuries sustained as a result of participation in professional sport

Anglovaal Group Medical Scheme covers neither the complications nor the direct or indirect expenses that arise from any of the exclusions listed above.

If you have never belonged to a medical scheme or you have had a break in medical scheme membership of more than 90 days before joining Anglovaal Group Medical Scheme, you will not have access to the Prescribed Minimum Benefits during your waiting period(s). This includes cover for emergency admissions.