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LMS
Medical Fund
Exclusions List
Like other medical schemes, there are certain medical costs that LMS does not cover. These are called exclusions and the most common
ones that apply to all option choices are listed below.
If you are a member of TRADITIONAL Standard, please see the following page for additional exclusions that apply to your option choice.
Summary of the most common exclusions - All option choices
4D and 3D pregnancy scans (unless pre-authorised for appropriate medical
conditions)
Infertility treatment, reversal of vasectomy and reversal of tubal ligation
Abdominoplasties
Insulin and morphine pumps (Unless you are on the COMPLETE Plus and
TRADITIONAL Ultimate option choices)
Accommodation and services provided in a geriatric hospital, old age home,
frail care facility or similar institution
Intestinal flora (Unless you are on TRADITIONAL Ultimate, or you have
positive Savings available)
All costs related to wilful and/or self-inflicted injuries
Iridology
Anabolic steroids
Keloid surgery and revision of scars, except following burns or for functional
impairment
Anti-addiction and anti-habit agents
Massages
Any institution, nursing home or similar institution, not registered in terms of
any law
Medicated shampoos and conditioners
Any medical or surgical treatment of impotence and sexual dysfunction
Medicines used to treat alcohol and substance abuse
Appointments not kept
Nebulisers
Aphrodisiacs
Obesity-related surgical treatment
Aromatherapy
Orthodontic treatment over the age of 21 years
Art therapy
Orthognathic surgery (to correct jaw misalignment)
Autopsies
Otoplasties (Bat Ears)
Ayurvedics
Pain-relieving machines
Back rests, chair seats, beds, mattresses, orthopaedic shoes and boots,
arch supports and shoe inserts
Persons not registered with a professional body constituted in terms of an
Act of Parliament
Biological and specialised medicines used for both oncology and chronic
indications unless considered a Prescribed Minimum Benefit (PMB) and
pre-authorised.
Physiotherapy not covered under admission to a psychiatric facility
CPAP machine
Reflexology
Blood pressure monitors
Registered tonics and stimulants
Breast augmentations, reductions and reconstruction
Repairs to devices or prostheses
Bulk-forming and stimulant laxatives
Cochlear implants other than for beneficiaries born into the Scheme and who
are beneficiaries of the TRADITIONAL Ultimate option choice
Contact lense preparations
Contraceptives and devices to prevent pregnancy (Unless you are on the
TRADITIONAL Ultimate option choice)
Cosmetic procedures
Cosmetic preparations, emollients/moisturisers
Dental implants
Epilation treatment (hair removal)
Erythropoietin
Evening primrose oil and fish-liver oil preparations and combinations
Food, nutritional supplements
Gender realignment, including counselling
Growth hormones
Holidays for recuperative purposes;
Homeopaths and homeopathic medicines
Humidifiers
Hyperbaric oxygen treatment
Immunosuppressives and immunostimulants
LMS 10028 CDG 13.07.16
Repairs of any appliances (excluding dentures), external accessories or
orthotics
Rhinoplasties for cosmetic purposes
Services for the treatment of any sickness, condition or injury sustained by a
beneficiary for which any other party may be liable
Sleep therapy
Sleep studies/Polysomnogram
Slimming preparations
Soaps, scrubs and other cleansers
Sunglasses, readers, repairs to spectacle frames, coloured contact lenses
Sunscreen and sun-tanning preparations
Surrogate pregnancies
Telephone consultations
Topical and oral acne preparations
Travelling expenses
Veterinary products
Vitamin and mineral supplements
Treatment/tests related to Integrative Functional Medicine or ‘Anti-Ageing
Medicine’
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Additional exclusions specific to TRADITIONAL Standard
Allergy testing
Any non-Network generated claim apart from those covered under “out of Network”
Injuries arising from participation in professional sport, bungee jumping, parachute jumps or any extreme sport
Root canal treatment, dentures and other advanced dentistry
Services obtained from acupuncturists, biokineticists, chiropractors, herbalists or naturopaths
Services for chronic psychiatric conditions and mental disorders except as stated in the Scheme Rules
Treatment and operations of choice, and non-essential medical items
Teaching aids for handicapped children
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