There are many terms within the medical insurance market place that can be confusing and ultimately make your decision making process more difficult as you try and make sense of the insurers literature. The list below gives an idea of some of the common words and phrases used and the terms you may come across.

Acute Conditions

– A disease, illness or injury that is likely to respond quickly to treatment, which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

Alternative Therapies

– Refers to treatments including osteopathy, chiropractic, acupuncture and homeopathy

Ancillary Charges

– Costs associated with your treatment such as the operating theatre, admission, drugs, dressing and surgical appliances.

Banding

– The process of applying A, B or C bands to the hospitals that reflects the accommodations charges. With A the most expensive and C the least, the banding does not classify the standard of medical care, but simply the cost of the hospital bed.

Cash Plan

– Cash Plans pay out set amounts of money when treatment is needed. They are not designed to cover a multitude of medical treatments and are commonly associated with dental and optical costs.

Chronic Conditions

– A condition (including mental or addictive) that has one of the following characteristics:

• has no known cure, or recurs
• leads to permanent disability
• is caused by changes to your body that cannot be reversed
• requires you to be specially trained or rehabilitated
• needs prolonged supervision, monitoring or treatment.

Day Case Treatment

– When you undergo surgical or medical procedures, complex medical tests or complex radiological procedures requiring you to be in bed in hospital but not on an overnight stay basis.

Diagnostic Tests

– Investigations such as X-rays or blood tests, to find or to help find the cause of your symptoms.

Excess

– A set amount that you agree to pay towards your treatment in order to reduce the cost of cover. This may be applicable to each and every claim or may be payable on the first claim in a given period of insurance.

Exclusion

– A medical condition that your policy will not cover.

Full Medical Underwriting

– Requires you to provide details of your medical history and to allow the insurer permission to seek further information from your GP. Pre-existing conditions that occurred prior to the commencement of cover will normally be excluded from cover.

In-patient treatment

– When you remain in hospital overnight for a surgical or medical procedure the purpose of which is the cure or relief of acute illness or injury.

Medical History

– Your medical history, usually going back 5 years prior to policy application, takes the form of any medical treatment or advice you have previously sought from your GP or Specialist. This is required by some insurers for the purposes of underwriting.

Moratorium

– This is an alternative method of joining a scheme that removes the need to disclose evidence of medical history. You would not be required to declare your history on application, but any pre-existing condition suffered in (usually) the previous 5 years will eventually be covered in no symptoms, treatment, medication, tests or advice is received for that condition for a further period of (usually) 2 years.

Out-patient treatment

– When you attend a hospital, consulting room, or out-patient clinic and are not admitted as a day patient or an in-patient.

Palliative

– Refers to treatment that relieves pain symptoms but makes no attempt to cure the illness.

PMI

– Private Medical Insurance

Pre-existing Conditions

– Any disease, illness or injury for which:

• you have received medication, advice or treatment; or
• you have experienced symptoms, whether the condition has been diagnosed or not.

(Usually in the 2 years before the start date of the cover, although the same periods is not common to all insurers)

Related Conditions

– A medical condition arising from or associated with a pre-existing condition

Repatriation

– The process of returning the policyholder or member to their home land in an emergency

Specialist

– A medical or dental practitioner registered under the Medical Acts who is or has been a Consultant in an NHS hospital or holds a certificate of Higher Specialist Training.

Treatment

– Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease and illness, injury or disease.

Underwriting

– The assessment and agreement of an insurance risk. The process involves the disclosure of medical history that enables the insurer to assess your risk. Once the assessment is complete you will be notified of any special terms and given the opportunity to agree these.