Health insurance jargon buster

To counter the seemingly never-ending storm of jargon we have penned this Health Insurance Jargon Buster, which we hope will at least afford you a more rudimentary and un-ambiguous verbal account of a glut of popular and well-used phrases frequented in the health insurance providing industry.

Admittedly some choice words and phrases might sound self-explanatory, yet others might have you reaching for the Encyclopedia Brittanica. Or if still in any lingering doubt, some form of medical journal and/or heavyweight insurance terminology tome. But not any more.

Not now we have completed the hard work for you and delivered this virtual ‘cut-out-and-keep’ health insurance jargon-busting guide. It might not necessarily be just what the doctor ordered, however in terms of clarity and better grasping of the health insurance lingo nettle, it really should be available on prescription.

A

Acute Condition – This tends to cover any disease, illness or injury which typically results in appropriate medical treatment in a short space of time, and normally returns the patient to the full state of health they were enjoying directly before succumbing to this transient medical scare. The definition as such is fully endorsed by the Association of British Insurers and is a universally accepted health insurance industry standard.

Annual Renewal – The acknowledged anniversary of the date in which the health insurance policyholder originally instigated the existing plan to start, in unison with the dedicated insurance provider.

Association of British Insurers (ABI) – Brought into being as of 1985, the ABI acts as the voice for the entire insurance industry here in the UK, and has over time become recognized as the country’s leading financial services trade association as such. The Association of British Insurers champions the needs of two predominant parties, focusing primarily on ensuring that the best interests in terms of security and risk management and protection for both independent insurance providing companies and individuals looking for/arranging insurance products are at the top of its on-going agenda.

C

Chronic Medical Condition – Be it presented in the guise of an injury, illness or disease, a chronic medical condition is, essentially, an unforeseen health-compromising manifestation which fulfils the following criteria. Something which requires long-term observing, on-going examinations and management so as to determine its every stage, something which necessitates the regular relief and/or control of its key symptoms, something which is destined to continue for an indefinite passage of time, something which offers no known cure or something which has a medical history of returning at an unpredicted time in the future.

Claim – As per the health insurance policyholder’s counter-signed agreement, a claim is an official approach to your insurance provider with a legitimate request for them to pay for/reimburse for medical expenditure resulting from an unforeseen circumstance which effectively compromised the insured party’s health.

Co-payment – In certain cases the health insurance policyholder can minimise the overall cost of their bespoke plan/subsequent premium paid, by agreeing to pay a percentage towards any claim you may make on your policy at a later date, courtesy of a unique initiative rolled-out by some health insurers.

Critical Care – This term refers to the level of treatment carried out in either a high dependency or intensive care unit or a resuscitation room, which necessitates the specialist supervision, support and care by specialist nursing staff.

CT Scan – In this instance the terminology is with direct regard to a widely acknowledged medical diagnostic tool which takes detailed images of the human body’s internal structures by way of facilitating state of the art rotating X-ray beam equipment.

D

Day Patient – Patients whose required level of healthcare is of a more transient manner, in as much as they are admitted to hospital, health clinic or medical centre to receive treatment as a matter of routine and normally long-standing arrangement; and whereby overnight or prolonged stays are not mandatory.

Dependant – Normally the word used in health insurance terms to describe the person (or persons) with closest links/blood ties to the policyholder, and who are usually uniquely dependent on the insured party (typically from a financial standpoint). Dependants tend to be next of kin, and therefore likely to be the policyholder’s legal or civil partner, children, step-children, parents, grandparents or what the law considers to be a legal guardian.

Diagnostic Tests – Covering a multitude of means of determining the root cause of a policyholder’s symptoms, diagnostic tests are often a series of investigations which can include the likes of ECG and blood tests through to X-rays and CT/MRI scans and more.

E

Emergency Treatment – Seemingly self-explanatory as this health insurance policy wording historically refers to the treatment and/or medical procedures which would take place in an Accident and Emergency unit of a hospital, and therefore with reference to life-threatening scenarios which a policyholder might unexpectedly find themselves in. also it may bear policy significance to assessing or repairing a particular health/medical symptom/condition presenting itself.

Excess – The paying up front of a previously arranged monetary percentage of any claim which the policyholder files with their health insurance provider during the term of the agreement, which in turn reduces the cost of the overall policy either annually or monthly, depending on the repayment schedule.

Exclusion – This wording candidly refers to any articles NOT routinely covered by the policyholder’s health insurance package at the outset, and which are discussed and decisions ratified at the point of signature/policy instruction. In this instance the best example would be the exclusion of medical treatment payment/recompense from the insurer should the policyholder suffer an illness or injury directly sustained from drug abuse.

G

General Practitioner (GP) – A registered member of the General Medical Council and who is in receipt of a License to Practice and a Certificate of General Practice Training, a GP is the health insurance policyholder’s first port of call should they have a health worry or concern which isn’t deemed of a medical emergency, and who will try to ascertain the underlying conditions based on the symptoms the insured party describes to them.

F

Full Medical Underwriting (FMU) – This is a policy originally underwritten after being based on the evidence of the policyholder’s submitted medical history; and moreover one where it’s common practice to exclude any pre-existing conditions.

I

Indemnity – The assurance given by a health insurance provider that the policyholder will be appropriately recompensed in the aftermath of a claim, and returned to the financial status they enjoyed prior to any subsequently claimed loss.

In-patient – Should a health insurance policyholder be admitted to a hospital or clinic, take up a bed and remain in its medical care overnight or longer based on medical circumstances, then they are therefore deemed to be an in-patient, as in the orthodox sense of the word.

M

Medical Underwriting – This is effectively the circumstance-based declaration which forms the legally-binding contractual bond between the parties of health insurance policy provider and the insured individual. This documentation is forged from the would-be policyholder’s medical history which they are asked to submit from the outset of any policy arrangement by the would-be insurer; who also often instruct the proposer that they wish to seek additional information from their GP. No information should be upheld as part of this process as otherwise this could compromise any future pay-outs on potential claims lodged at a later date; or indeed cancellation of a policy.

Moratorium – An often unfamiliar word to many which essentially means a health insurance policy which has come to fruition without medical disclosure. Normal practice is that any health conditions that the policyholder has experienced or succumbed to in the past 5 years are excluded from this specific package – and therefore are not covered from the insured’s perspective should they reappear during the life span of the newly acquired health insurance product. That said, it’s possible to demand a reappraisal leading to actual cover for said conditions in the event of the policyholder remaining free from symptoms, advice, treatment or medication for said ills during the initial 2 years of on-going policies.

MRI Scan – By facilitating magnets and radio frequencies an MRI scan captures data graphically representing cross-sectional images of the human body, courtesy of the advanced technological equipment used as a matter of course, to ultimately establish symptoms and/or qualified presence of illness or disease.

N

Necessary Aftercare – Health insurance policies normally dictate that that policyholders subjected to medical treatment or procedures will be covered for a further 90 day period after the patient has been discharged from hospital or clinic. Within the remit of this ‘Necessary Aftercare’ feature 3 post-operative or follow-up consultations will be included, as well as a pre-agreed period of physiotherapy. Wound care and dressings, alongside of any additional small procedures will also usually fall within the parameters of this health insurance package , providing that they are a direct consequence of the surgery or medical admission relating to the policyholder. Excluded from this industry-accepted protocol are the follow-up diagnostic consultations and further investigative tests which follow on from procedures like endoscopies and/or biopsies. In other opted in or out instances, specialised Heart and Cancer health insurance plan features will perpetuate the ‘Necessary Aftercare’ for another 12 months (for cardiac conditions) and 5 years (for cancer conditions) respectively; subject to pre-authorisation.

O

Out-patient – A policyholder whose health condition doesn’t require a sustained/closely monitored period in a hospital or clinic in the guise of a day-patient or in-patient, and who typically attends an out-patient clinic, consulting room or hospital in the capacity of the aforementioned out-patient.

P

Planned Treatment – This particular targeted terminology rings true of policyholders being admitted to hospital by means of a waiting list or direct referral via a consultant, as opposed to from a hospital Accident and Emergency unit or in the immediate aftermath of a GP request.

Policy – This refers to the binding contract set out and agreed in practice by two consenting parties; namely the health insurance provider and the proposer/insured/policyholder. This contract of insurance for want of a better term is the key to unlocking medical care and attention which is later recompensed by the policyholder (if not covered at the time by the insurer) as part and parcel of the complete package and underwritten/signed documentation; and in respect of a defined term/lifecycle of the policy.

Pre-existing Conditions – This is interpreted in the case of health insurance policies as any injury, illness or disease for which the policyholder/claimant has undergone medical treatment/procedure or received advice and/or medication for in the run-up to arranging a new policy with a health insurer. The run-up period as such is normally the 5 years leading up to the intended start date of the new health insurance policy instruction.

Premium – In insurance vernacular of any persuasion, a premium is nine times out of ten the monetary sum the policyholder pays to their health insurance provider so as to determine and subsequently action suitable cover in terms of healthcare provisions going forward.

Private Medical Insurance (PMI) – Should what’s deemed to be ‘acute conditions’ arise AFTER a health insurance policy term begins, then this automatically triggers a specific clause found in certain individual’s bespoke packages called ‘Private Medical Insurance’ or PMI. This in itself is designed to enable the costs of private medical treatment thereafter to be covered.

S

Six-week Wait – A way in which the health insurance policyholder can reduce the cost of their premiums from the off, by agreeing to wait and be treated on the National Health Service (NHS) for the six weeks which directly follow any medical diagnosis, rather than implement private healthcare plans which form the backbone of any individual health insurance plan. Of course, should the insured party/patient NOT be treated by the NHS within this pre-ordained timeframe then they’ll receive private care for their medical condition.

Switch – The process of changing a health insurance policy provider yet maintaining continuity in terms of the adhering to the same original underwriting of said agreed package. This allows the insured to simply transfer the key elements and features of a plan which works best for the individual yet finding it at a more competitive price once the original policy term has expired. The policyholder can remain protected for the same medical conditions that arose since taking out the original plan too in most cases.

T

Treatment – In a word, any medical diagnostics, surgery or access to medical services and specialist health practitioners that are pre-requisitional to relieve, manage or cure an illness, injury or disease.