Clearly Explained Insurance
Insurance jargon can complicate things. We don't like that so we've put together a guide to explain all the key phrases and terms associated with Private Medical Insurance.
Charges for your hospital room, meals and nursing directly related to your treatment.
An ancient Chinese treatment using needles which stimulate different energy channels in the body.
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 you to full recovery.
Refers to treatments such as Acupuncture and other complimentary treatments.
A cash payment to the policyholder (normally payable when a policyholder or member stays in a non-fee paying NHS hospital).
Not to be confused with PMI! Cash plans pay out set amounts of cash when medical treatment is needed. They are not designed to cover the full costs of private medical treatment.
A disease, illness or injury which has at least one of the following characteristics:
a) it continues indefinitely and has no known cure
b) it comes back or is likely to come back
c) it is permanent
d) you need to be rehabilitated or specially trained to cope with it
e) it needs long-term monitoring, consultations, check-ups, examinations or tests.
The amount of benefit paid (after taking off any excess) for providing treatment for a medical condition.
An injury, illness and or associated symptoms.
Critical Illness Benefit
A benefit payable to a policyholder upon diagnosis of a critical illness (eg: cancer, heart attack, coronary artery disease, stroke or multiple sclerosis etc). Please note that medical “treatment” for a critical illness is usually covered by PMI.
A policyholder’s wife, partner or child (or any member covered under the policy who is Financially dependent on the policyholder).
Investigations, such as X-rays or blood tests, to find or to help to find the cause of your symptoms.
The process of providing information to an insurer for underwriting purposes (eg: age and medical history for example).
Electocardiagram - a recording of the electrical activity of the heart.
A set amount of money which you agree to pay towards your claim. This may be applicable to each and every claim or may be payable on the first claim in a given period of insurance. An excess usually results in the lowering of your premium.
A medical condition which your policy will not cover.
Full Refund (or Full Cover)
Means that an insurer will pay out on a claim in full (ie: in theory this means no shortfalls). However, in general, most insurers will make sure that any bills settled are not more than what is regarded as “customary and reasonable” for the procedure/treatment. Some insurers maintain their own fee guidelines and will pay bills “in full” but only up to their guideline maxima.
Full Medical Underwriting
The process of assessing and agreeing an insurance risk. Disclosure of medical history is required.
a) A private hospital in the UK which is registered in accordance with UK legislation and which has specialist facilities for carrying out major surgical operations.
b) Pay-Beds in an NHS hospital.
Treatment which, for medical reasons, means you have to stay in hospital overnight or for longer.
Insurance Premiun Tax
Tax levied on general insurance premiums. Currently this is 6%.
The process of filling out details of medical history for underwriting purposes.
Your medical history (usually going back 5 years prior to taking out the policy). This takes the form of any medical treatment or advice you have previously had from your GP or Specialist. This is required by some insurers for the purposes of underwriting.
The rate of increase in the cost of healthcare treatment per year. It is expressed as a percentage for the year. It is usually higher than the RPI (Retail Prices Index).
This is an alternative method of dealing with pre-existing conditions which removes the need to disclose evidence of medical history. In effect, it is a blanket pre-existing condition clause. The mechanics are essentially as follows:
The clause excludes cover during an initial period (usually 2 years) of membership for any conditions or related condition for which medical treatment was received, advised on or was known about during a time period (usually 5 years) prior to cover commencing. However, after completing the initial period, all pre-exsiting conditions then become eligible for benefit (provided that at the time of receiving treatment the member has been free from treatment and advice for that condition during the period).
Head and bodily screening using a magnetic resonance imaging (MRI) scanner.
No Claims Discount Facility
Refers to the “no claims discount” offered by a provider when the policyholder has made no claims during a cover year.
Refers to research into tumours.
When you receive treatment at a hospital or at the specialist’s consulting rooms or other facility and you do not remain there over night (i.e. you do not need to sign an admission form).
An NHS hospital bed for use by paying private patients.
Period of Cover
The period of your insurance commencing with the Inception Date and finishing at the renewal Date.
Refers to treatment of disease or injury by massage, heat and exercises using ultrasound machine and lasers amongst other media.
Any disease, illness or injury for which: a) you have received medication, advice or treatment; or b) you have experienced symptoms; whether the condition has been diagnosed or not (usually in the 2 years before the start date of the cover - this period can vary between insurers).
Refers to the benefit payable for the use of a private ambulance.
Insurance against the cost of treating a mental disease. Psychiatric cover can be applied to inpatient and out-patient treatment. Some insurers specifically exclude psychiatric cover on PMI policies.
Six Week NHS Policies
Six Week NHS policies are commonly referred to as budget schemes. These policies operate on the basis of the NHS waiting list in your area for a required operation or treatment. If the operation or treatment is available on the NHS in your area within a 6 week period, from the date of seeing your Specialist, you are obliged to have that operation/treatment on the NHS. If it is established that the waiting list is over 6 weeks then you get immediate access to private treatment. Most 6 week plans apply the rule to in-patient and out-patient treatment but sometimes you might find an insurer who only applies the rule to in-patient treatment (ie: all out-patient treatment is available immediately irrespective of the NHS waiting list).
A medical or dental practitioner registered under the Medical Acts who is or has been a Consultant in an NHS hospital or who holds a Certificate of Higher Specialist Training.
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.
The assessment and agreement of an insurance risk. The process involves the disclosure of medical history which enables the insurer to assess your risk. Once the assessment is complete you will be notified of any special terms (eg: exclusions) and given the opportunity to agree these terms.