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, Violence, and Social Disruption

• Any condition resulting from acts of war (declared or undeclared), insurrections, terrorism, or military operations.
• Injuries sustained while participating in riots, civil unrest, public disobedience, or domestic violence.
• Medical consequences directly arising from officially declared epidemics or pandemics, unless expressly included in the coverage.

B. Cosmetic and Elective Procedures

• Cosmetic, aesthetic, or elective treatments not medically necessary.
• All dental or orthodontic cosmetic services, including consultations, teeth whitening, dental prosthetics, surgical implants, and related examinations or medications.

C. Non-Standard or Non-Essential Care

• Alternative, herbal, or unorthodox treatments not approved by the National Health Insurance Authority (NHIA).
• Domiciliary care, hospice services, or home-based treatment.
• Neonatal care not explicitly included in the defined neonatal services covered by the plan.

D. Self-Inflicted, Genetic & Lifestyle-Related Conditions

• Injuries resulting from suicide attempts, self-harm, or reckless behavior.
• Congenital anomalies in children not born while the plan was active.
• Obesity-related services or treatments primarily for weight reduction without clinical indication.

E. Substance Misuse & Behavioral Exclusions

• Any treatment, rehabilitation, or medication for substance abuse, including alcohol or narcotics.
• Hormonal therapy involving anabolic steroids, testosterone, or related agents for non-medical purposes.

F. High-Risk Activities and Unlisted Services

• Injuries sustained from professional sports or high-risk activities with willful exposure to danger.
• School admission or administrative tests not medically necessary.
• Investigations, management, or medical procedures not explicitly stated in the Retail Plan brochure.
• All donor-related expenses associated with transplant surgeries, including evaluation and procurement.
• Autopsies or post-mortem evaluations unless legally mandated.
• Occupational injuries or diseases arising from job-related hazards.

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.