Like any technical and highly detailed products, private medical insurance can have some, well, confusing terminology. Some have meanings that seem wildly different from what you thought they were and even the ones that seem straightforward at first often have incredibly specific definitions.
At Lifepoint Healthcare, we do our best to always ensure that our clients understand what is going on. This includes explaining ourselves in clear, jargon-free language and checking understanding at every step of the process.
However, private medical insurance in the UK uses lots of technical terminologies so we can’t avoid it altogether. We’ve put together a list of some of the most commonly misunderstood, misinterpreted words in this essential glossary for health insurance in the UK!
An unexpected incident that causes injury or illness requiring medical treatment.
A type of alternative medicine that must be administered by a member of the British Acupuncture Council, a chartered physiotherapist or a medical practitioner with a Diploma of Medical Acupuncture issued by the British Medical Acupuncture Society. The treatment involves inserting fine needles at certain sites in the body for therapeutic purposes.
An illness, injury or disease that responds quickly to treatment, returning you to the state of health you held immediately prior to the condition and leading to your full recovery.
Sudden deterioration of a chronic condition which is likely to respond quickly to treatment and restore your previous state of health. For example, a heart attack resulting from chronic heart disease.
The date 1 year (12 months) after the start of your plan, and every year after that you continue to hold the policy.
The money paid to your health care provider for your medical treatment by the insurance company.
A health insurance broker is an independent adviser and usually works with a variety of health insurance providers. Your broker’s job is to act as an intermediary, help you navigate the complexities of finding a suitable policy and simplify the process with suitable guidance and research.
A disease characterised by malignant tumours, tissues or cells which demonstrate uncontrolled growth, spread and invasion of tissues.
An agreed payment made by an insurer to the person covered in relation to a specific benefit.
The area of medicine dedicated to disorders, diseases and treatment related to the feet. Treatment will be administered by a podiatrist or chiropodist who is a member of the HCPC.
A type of complementary medicine focused on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, the spine in particular.
An illness, disease or injury that can be categorised as one or more of the following:
- Requiring ongoing/long-term monitoring via examinations, check-ups, tests or consultations
- Requires ongoing/long-term control/relief of symptoms
- Requires rehabilitation/adaptation
- Has no known cure
- It will continue indefinitely/is likely to come back
A request by the policyholder for the insurance company to pay medical expenses which are covered by the insurance policy.
A mental health professional trained in the diagnosis and psychological treatment of mental illness. They use psychological treatments rather than medication. Should be registered with the HCPC.
A practitioner of an area of complementary medicine such as homoeopath, osteopathy, acupuncture, chiropractic treatment or hydrotherapy.
A condition that is recognised at birth and has been present since birth. It can be inherited (genetic) or caused by an environmental factor.
Experienced medical or dental practitioner whose name appears on the General Medical Council/General Dental Counter and who has a license to practise. They should also currently hold, or have held within the last five years, a non-locum and substantive appointment of consultant or senior lecturer in an NHS or Defence Medical Services hospital.
The moratorium underwriting term of your current insurer will apply and the start date of the moratorium underwriting does not start again. Please note that the benefits and terms and conditions of your new policy will apply and it is only the dates of underwriting with your current insurer that will be matched.
There must be no break in insurance cover since underwriting. A switch declaration will also need to be completed to facilitate the transfer. These are questions and criteria that need to be satisfied and allow the new insurer to assess your eligibility to access this method of underwriting. If the eligibility for transfer is not met, the insurer may refuse to offer cover on this form of underwriting.
Plans include continuous cover for pre-existing conditions and are as shown on your current insurer’s medical certificate. Exclusions shown on the current certificate will be continued (subject to the terms and conditions of the policy itself).
As clients have had prior medical insurance, they will be covered on CPME (Switch) terms. If there are any declarations made when answering the switch questions, exclusions may be applied. A copy of the current certificate(s) will be required with the application.
The agreement between yourself and your insurance provider. It outlines your rights, obligations and cover, including payment terms.
A period of 14 days after the commencement of your cover during which you can cancel your cover, assuming you haven’t used any services or made any claims.
Where you and the insurer share treatment costs.
The date shown on your insurance when your cover begins.
Care given within the setting of an Intensive Care Unit, Intensive Therapy Unit, Coronary Care Unit, High Dependency Unit, Paediatric Intensive Care Unit, Neonatal Intensive Care Unit or a unit offering a similar level of care.
When you are admitted to hospital on a day-patient unit because you require a period of medically supervised recovery, but do not stay overnight.
A claim that is denied by the insurance provider when the healthcare services aren’t covered under the agreed contract.
Any clinically necessary dental procedures undertaken by your dental practitioner.
Investigative tests like blood tests or x-rays that are used to help identify the source of your symptoms.
A registered healthcare professional who helps to treat medical conditions and promote good health through the science of nutrition.
The misuse of any drug prescribed by a doctor or any use of a non-prescription drug, substance or solvent.
If you have health services under multiple plans.
A pre-agreed amount that you pay towards the cost of treatment that you receive. For example, you could choose a £100 excess per claim and your treatment costs £7,000, you would pay the first £100 and the insurance company would pay the rest.
When you begin your policy, you can opt to pay an excess for each claim or once per policy year. Generally speaking the higher the excess, the lower your monthly payments will be.
Restrictions that are applied individually to your cover. They are in addition to standard exclusions and apply to all benefits under your cover.
Restrictions that are applied individually to your cover. They are in addition to standard exclusions and apply to all benefits under your cover.
A more flexible policy that has a variety of cover options to best suit your individual health needs.
A health questionnaire is completed on the application form. After reviewing the employee’s completed questionnaire, the insurer will let them know at the outset the basis on which they can offer cover, listing any pre-existing conditions they may have that would not be covered on the policy.
A general dental practitioner who is registered on the Dentists Register and who is regulated by the General Dental Council.
A medical practitioner whose name appears on the GP register and who is registered and license by the General Medical Council.
Activities and sports that put you at a greater risk of suffering an injury or making an existing medical condition worse.
Health and Care Professions Council – regulatory board.
Nursing care provided in your home by a registered nurse.
A type of alternative medicine that must be carried out by a member of one of the following: The Faculty of Homeopathy, Society of Homeopaths or Alliance of Registered Homeopaths.
A hospice focuses on caring for people who are terminally ill.
A private hospital or private wing of an NHS hospital that is included on your hospital list. The list should be agreed upon in advance.
A list of hospitals where you can receive private medical treatment. The list will be agreed upon in advance.
A therapist who treats and rehabilitates disorders by using water. This takes the form of exercise in a pool at a specific hydrotherapy treatment centre.
The date from which your health insurance policy becomes active.
A patient who is admitted to hospital and who requires an overnight stay.
Your insured partner who was aged between 16 and 79 at the beginning of the plan start date or their cover start date (whichever is applicable) and who lives at the same address as you. Your insured children who are under the age of 25 at the start of the cover. Once children are accepted for cover, children will only be removed if requested. Children who are over 21 will be charged the adult rate from the first renewal after their 21st birthday.
The insurance company that provides medical insurance.
When a customer stops paying premiums or when a policy is not renewed. Health insurance cover will cease.
This method of underwriting allows for pre-existing conditions to be covered without medical exclusions but is still subject to the terms and conditions of the policy.
There is a minimum membership number required to set an MHD scheme up and it usually costs more than the above methods of underwriting.
A common type of insurance that allows you to purchase different aspects of cover based on your individual needs.
The insurer excludes any pre-existing conditions. This means conditions for which you have received medication, advice or treatment or for which you have experienced symptoms, whether the condition has been diagnosed or not in the five years before the start of your cover. Related conditions (those which are medically considered to be associated with a pre-existing condition) will also not be covered.
However, if you have not had any such symptoms, treatment, medication or advice for pre-existing conditions or any related conditions for a continuous period of two years after the start date of your policy, the condition will become eligible for cover. This period is known as the Moratorium. Though the two-year moratorium is most common, some insurers offer other lengths of moratorium.
National Institute for Health and Care Excellence. It provides guidance and advice to improve health and social care and regulates many aspects of healthcare including drugs.
The failure of the customer to disclose certain facts to their insurer. This might affect the insurers’ decision to cover the customer or the cost of the cover. Non-disclosure can lead to the insurance company refusing to pay out claims and should be avoided at all costs.
A qualified nurse who is on the register of the Nursing and Midwifery Council (NMC). They must hold a valid NMC personal identification number and any treatment they administer must be under the management of a consultant.
This term covers ophthalmologists, dispensing opticians and ophthalmic opticians who all treat conditions, illnesses and injuries relating to the eyes.
A type of alternative medicine that utilises the physical manipulation of the muscle tissues and bones. Treatment must be carried out by a registered member of the General Osteopathic Council (GOsC).
A patient attending a consulting appointment, out-patient clinic or hospital but who is not admitted as a day or in-patient.
Palliative care is treatment where the primary purpose is to offer the temporary relief of symptoms, rather than curing the medical condition.
Health insurance that pays out an income if the policyholder is suffering from a long term illness or disability that leads to a loss of income. This is also called income protection insurance.
Private health insurance or private medical insurance.
A physician is a doctor who is registered with the General Medical Council (GMC), who is under the age of 70 and who practises general medicine and not surgery.
Treatment to help restore movement and function when someone is afflicted with illness, injury or disability or help to reduce the risk of injury in the future. Practitioners must be registered under the Health and Care Professions Council (HCPC)
The person who holds the contract with the insurance company, as shown on the certificate of insurance.
The period of one year from your plan’s start date or from any annual renewal date.
The contract between you and the insurer.
The person whose name appears on the contract with the insurer.
A disease, illness or injury for which you have received treatment, medication or advice prior to the start of your cover. This also applies to any symptoms you have experienced, whether or not you have sought a medical opinion.
The amount of money that you pay to your insurance company in order to be covered for private medical insurance. This can be paid monthly or annually.
The basic and routine level of healthcare that you’re eligible for under your insurance policy.
A vehicle with the sole purpose of operating as an ambulance and run by a registered private ambulance service.
Any sport in which the plan holder considers it to be their main paid occupation.
A mental and or addiction-related condition of psychogenic origin. This includes alcoholism, drug addiction, eating disorders, post-traumatic stress disorders, amongst others.
A period of time that must pass after the commencement of your policy before cover begins for a particular benefit.
An estimate of what your rate could be for a certain level of cover with a specific insurer. Quotes are always subject to change but are normally a good estimate.
The process by which you are sent between healthcare centres, usually for specialist care or treatment.
Medical treatment that aims to restore a person’s function and independence following treatment of a disease, illness or injury.
A disease, illness, injury or symptom which general medical opinion considers to be associated with another condition. Sometimes referred to as an ‘underlying cause’ or ‘condition arising therefrom’.
A period of time during which the patient experiences an absence of symptoms from a remaining underlying condition. It is not a cure.
The annual renewal of your insurance policy.
A sporting activity for which the plan holder receives payment irrespective of results but which isn’t their main occupation.
Nursing that is provided on a 1:1 basis with the patient in a hospital.
A form detailing all of the information given to an insurer by the customer. It is signed by the customer who declares that all of the information included is factual.
To act on behalf of the insured person in the event of a claim.
The process of moving between insurers but keeping the same underwriting in place. You remain covered for conditions that arose since taking out your policy.
A therapist is a healthcare professional who is registered with the HCPC. This includes physiotherapists, occupational therapists and orthoptists.
Surgical and medical services, including diagnostic testing, that are required to diagnose, relieve or cure a disease, illness or injury.
The United Kingdom. This is made up of Great Britain (England, Scotland, and Wales) and Northern Ireland, the Channel Islands and the Isle of Man.
The process which health insurance providers go through to assess how likely you are to make a future claim.
An unexpected admission to hospital following an illness. It could be directly from the home or after an appointment with your GP, consultant or hospital. Sometimes called an emergency admission when related to an accident.
An urgent care provider helps with health problems that need immediate attention but are not classed as emergencies.
Brokers who are whole of market are not tied to any one insurance provider. This means that they can offer policies from every available insurer.