The Medical Aid Society of Malawi is a member owned organization whose funds are through member contributions hence the funds are limited and in dire need of good stewardship. MASM offers its services only through its various products which have a well defined scope of coverage. The Medical Aid Society of Malawi shall not be liable for payment of the following:-

1. ADMISSIONS

• Admitting MASM members without Pre-authorization
• Private wards
• Cost of food and lodging for guardians.
• Meals if charged separately for admitted patients.
• Admission costs incurred during the first three months from date of  account activation
• Unauthorized Private Nursing fee in or out of hospital.
• Guardian’s fees.

2. TREATMENT BY GENERAL PRACTITIONER

Treatment provided to member by a Panel Doctor whom he/she is not registered with.

3. MEMBERSHIP

1. Any person above the age of 55 years cannot be registered on any of our schemes as a new member.
2. Any MASM account that has not been paid for will automatically be suspended.
3. If the MASM account has not been paid for 3 consecutive months it will be closed.

4. SPECIALIST TREATMENT

• RESIDENT
• Specialist treatment given to members without referral from a GP, another specialist or a medical institution.
• Minor or major procedures rendered without pre-authorization or pre-booking.
• Where a referral letter has no medical indication and is evidently provided on member’s request. MASM reserves the right to have a second opinion from another MASM panel General Practitioner.
• Treatment rendered to members who have been on MASM for less than 3 consecutive months.

• VISITING FOREIGN SPECIALIST
• Treatment rendered to members who have been on MASM for less than twelve consecutive months.
• Where a member does not have a letter of guarantee of payment from MASM.
• Treatment provided to non qualifying members.
• Where referral letter is evidently provided on member’s request.
• Where applicable sub-limits have been exhausted.

• FOREIGN SPECIALIST REFERRALS
• Treatment is available locally, for example physiotherapy, maternity, dental etc.
• Medical treatment or services received in countries outside the SADC region and India
• Specialist treatment given to members without referral letter from a local Specialist of appropriate and relevant discipline.
• Minor or major procedures rendered without pre-authorization letter.
• Where a referral letter has no medical indication and is evidently provided on member’s request. MASM reserves the right to have a second opinion from another MASM panel specialist
• Miscellaneous expenses which are non-medical in nature; for example, telephones, sales tax, bank charges, hotel accommodation etc

5. MATERNITY SERVICES

• Accessing maternity services without prior approval from MASM.
• In cases where maternity limit has been exhausted.
• Where member/dependant has not been on MASM for 12 consecutive months.
• Where member/dependant conceives and delivers within 24 consecutive months of the last delivery.
•  Foreign Maternity Services

6. DENTAL TREATMENT

• Dental floss & Mouth wash.
• Accessing specialized dental treatment before 12 months waiting period has elapsed .
• Orthodontic treatment provided without booking/pre-authorization by MASM
• Accessing Orthodontic treatment after the age of 21years.
• Foreign Dental Services

7. MEDICINES/DRUGS

• ARVs (antiretroviral drugs) not covered by NAC or MBCA
• Prophylactic treatment e.g. malarial prophylaxes, contraceptives, vaccines covered by government for free, travel vaccines
• Slimming/weight loss tablets.
• Antiseptics and disinfectants e.g. Dettol and Betadine solution.
• Cosmetics.
• Over the counter drugs e.g. food supplements, Vitamins, Herbal remedies, Immune boosters etc.
• Chronic medicines claimed before the member has clocked twelve consecutive  months on the schemes.

8.  ORTHOPAEDIC APPLIANCES

No awards will be made in respect of:-

1. Repairs or adjustments.
2. Labour charges and technicians fees related to excluded appliances.
3. Footwear raises, inserts wedges pads, toe-tips and caps.
4. Walking sticks, bath aids, etc.
5. Toilet raisers.

9.  OTHER OUTPATIENT APPLIANCES OR EQUIPMENT

• Equipment commonly used for non- medical purposes
• Blood pressure monitoring machines
• Blood sugar monitoring machines
• Air humidifiers, CPAP machines
• Oxygen concentrator or cylinder
• Any equipment not explicitly stated that it is covered under a MASM product

10. GENERAL EXCLUSIONS

• Treatment or equipment not specified that it is covered under different products
• Treatment of cosmetic nature e.g. faces lifts, breast reductions, Keloid removal, Liposuction etc.
• Medical Examinations for employment, insurance, education, immigration  travel purposes or  vacation.
• Treatment for which cost is recoverable in law from any other body, party or an Insurance Policy.
• Treatment and death arising from any willful or deliberate self inflicted injury or any attempted threat, negligence, suicide, injuries from domestic violence, abuse of alcohol or drugs.
• MASM will not cover injuries arising from breaking the law e.g injuries arising while you are robbing, or during an industrial strike..
• Injuries arising from participation in hazardous sport or any sport for monetary gain.
• Services which are available free or at a nominal charge e.g. family planning services, under-five clinic services, Under-five vaccines, Travel vaccines e.g. Yellow Fever.
• Treatment or services for which Limit of Benefit in a specified period has been exhausted by the beneficiary.
• Treatment or services which have been specifically excluded as a benefit under the scheme.
• Local treatment rendered by a service provider who is not accredited with the Society.
• Geriatric care.
• Out of date claims i.e. claims submitted to the Society by either service provider or member for payment after 90 days from date of treatment
• Provider queries submitted after 90 days of payment.
• Occupational or routine Medical checkups.
• Air Tickets.
• Treatment of services given by hypnotic, herbalists, traditional healers, homeopaths, naturopaths, osteopaths, acupuncturists.
• Treatment by family member or any auto therapy.
• Treatment for pre-existing conditions or their complications e.g. Cancer, Diabetes, Hypertension, Renal Failure, Pregnancy, Joint Replacements etc.
• Accommodation or treatment received at health/slimming or similar clinics. Treatment exclusions include bariatric surgery for weight loss or its variations for example gastric (stomach) bypass, sleeve gastrectomy, adjustable gastric band, stomach stapling and liposuction. These are all excluded whether or not there are other medical conditions related to or caused by obesity.
• Novel treatments of questionable validity or treatments in experimental stages for example, stem-cell treatment.
•  Mental retardation and learning disabilities arising from congenital abnormalities

10. MISCELLANEOUS EXPENSES

1. Birth reports.
2. Death reports.
3. Medical Reports
4. Genetic (DNA) testing/screening for existence of hereditary problems. Paternity tests.
5. Work-related examinations and reports.