Policy Exclusions

The following exclusions apply to all enrollees under the NEM Health SME Health 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 Social Incidents

• Medical conditions arising from or during any act of war (declared or undeclared).
• Participation in riots, civil disobedience, protests, or incidents of domestic violence.
• Illnesses or treatments required due to officially declared epidemics or pandemics unless specifically covered by the plan.

B. Cosmetic, Elective, and Non-Medically Necessary Procedures

1. Cosmetic treatments and aesthetic surgical or non-surgical procedures.
2. All types of dental or orthodontic cosmetic interventions, including:

• Consultations, examinations, and follow-up care
• Teeth whitening, braces, veneers, aligners, crowns, and tooth replacement
• Dental prosthesis and surgical implants for non-medical purposes

C. Alternative and Unapproved Treatments

• Services rendered through alternative, unorthodox, or non-NHIA-approved medicine.
• Domiciliary care, home nursing, or hospice services performed outside accredited facilities.
• Neonatal care not expressly listed under covered neonatal services.

D. Lifestyle Risks and Pre-Existing Conditions

• Self-inflicted injuries, including attempted suicide or intentional harm.
• Congenital anomalies or abnormalities in children not born during an active plan cycle.
• Treatments for weight reduction or obesity management not clinically necessary.
• Injuries sustained during professional sports or through willful exposure to avoidable risks.
  

E. Substance Abuse and Hormonal Therapy

• Treatment of substance abuse, including alcohol, narcotics, or drug-related conditions.
• Use of anabolic steroids, testosterone, or any hormonal therapy outside approved medical indications.

F. Administrative and Excluded Medical Services

• Medical tests or examinations solely for administrative purposes, such as school admission.
• Autopsies or post-mortem examinations unless legally required.
• Donor-related expenses in connection with organ or tissue transplant surgeries.
• Any procedures, investigations, or treatments not expressly covered in the plan brochure or not pre-authorized by NEM Health.

G. 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.