Policy Exclusions

The following exclusions apply to all enrollees under the NEM Health Corporate Health Insurance Plan. These exclusions define the limits of benefit entitlement and are set in accordance with regulatory guidelines and ethical healthcare practices. 

All services, treatments, and conditions listed below are not covered, unless otherwise expressly stated in the relevant plan documentation.

A. War, Civil Unrest, and Related Events

• Any condition, injury, illness, or death arising directly or indirectly from acts of war (declared or undeclared), civil unrest, rebellion, insurrection, riot, or terrorism.
• Injuries sustained while participating in riots, civil disobedience, protests, or domestic violence.
• Health conditions or medical complications arising during or due to an epidemic or pandemic outbreak unless expressly covered.
• Injuries sustained while participating in professional sports or willful exposure to needless danger.

B. Cosmetic and Elective Treatments

• Cosmetic procedures undertaken for aesthetic purposes, including but not limited to skin lightening, body contouring, and facial reconstruction (unless medically necessary due to trauma).
• Dental and orthodontic cosmetic procedures, including consultation, examination, medication, follow-up visits, teeth whitening, dental prosthesis, and dental or surgical implants.

C. Alternative and Non-Conventional Treatments

• Any form of alternative, complementary, or unorthodox medicine, such as herbal remedies, acupuncture, naturopathy, or non-NHIA-recognized treatments.
• Domiciliary care and hospice care (home-based nursing or palliative services), unless specifically listed in the plan.

D. Reproductive, Genetic, and Donor-Related Exclusions

• Infertility investigations or treatments, including assisted reproductive techniques (ART) such as IVF, IUI, or surrogacy.
• Any congenital anomaly or birth defect in children not born on the Plan.
• Donor costs associated with organ or tissue transplant surgeries, including harvesting, screening, transport, and related logistics.

E. Pre-Existing and Self-Inflicted Conditions

• Chronic conditions not disclosed at the time of registration or application.
• Any self-inflicted injury, whether intentional or as a result of attempted suicide.
• Autopsies or post-mortem examinations, unless requested by legal authorities.

F. Addiction and Substance Use

• Diagnosis, rehabilitation, or treatment of substance abuse, including drug and alcohol dependency programs.
• Services rendered primarily for weight reduction or the treatment of obesity, where not medically indicated or part of a covered co-morbidity.
• Treatment for substance abuse, including drug or alcohol addiction, detoxification, and rehabilitation.

G. Hormonal and Experimental Treatments

• Hormonal therapy involving anabolic steroids, testosterone, or similar substances unless medically necessary and prescribed for a covered condition.
• Experimental treatments or non-approved procedures not recognized by the Nigerian healthcare authorities or NHIA.

H. Employment, Administrative, and Miscellaneous Exclusions

• Occupational injuries and illnesses arising from the hazards of the enrollee’s job or employment, unless under a work-related plan.
• Medical screenings, school admission tests, and services conducted for administrative or non-medical purposes.
• Any procedures, investigations, consultations, or management plans not expressly listed or covered under the applicable plan tier or product brochure.

I. Acceptance of Exclusions

By enrolling in the NEM Health SME Plan, you confirm that you have read, understood, and agree to these Policy Exclusions as part of your contractual Terms and Conditions.

Note on Privacy and Confidentiality

All enrollee medical information related to excluded conditions will be processed and protected in accordance with the Nigeria Data Protection Act (NDPA) and the internal privacy policies of NEM Health Limited. No sensitive health data will be used for non-medical purposes or shared without lawful basis or the enrollee's consent.