Health Insurance Jargon Buster

Many people are unsure of what’s covered by Private Health Insurance, the costs involved and how to go about arranging private cover.

Read on for our 'Jargon Buster' that describes some of the terminology that is frequently used when discussing Private Health Insurance. 

Private Health Insurance Terminology Explained

Friends

What is Private Health Insurance?

The Private Health Insurance policies offered by General & Medical aim to fund private medical treatment of acute conditions. The policies will cover the costs of eligible treatment within the UK, up to the limits of your chosen cover, by our recognised consultants, medical practitioners or therapists.

The benefits include cover for initial private consultations, in-patient, out-patient and day-patient investigations and treatment up to the limits of your chosen cover. Our Private Health Insurance policies provide cover for eligible treatment at any of the Participating Hospitals within the hospital choice you make.

Find out more about our range of Private Health Insurance covers.

What is an Excess?

An excess is an amount, agreed in advance, that you or each person on your policy pays towards the cost of treatment that you receive that would otherwise have been covered under the scheme. For example, if you choose a £250 excess per claim and your treatment for one eligible claim costs £5,000, you would pay the first £250 and we would pay the rest.

At the start of the policy, you choose whether the excess applies once per policy year or to each claim. If you choose an excess per policy year and your treatment for an eligible claim carries on into the next policy year, another excess will apply. Remember - the higher the excess, the lower your monthly premium. The important thing is to choose a level of excess that you can comfortably afford.

What is an Exclusion and/or Endorsement?

Exclusions and/or Endorsements are restrictions applied individually to your cover and are in addition to the standard exclusions, and apply to all benefits under your chosen cover.

What is a Cash Benefit?

A Cash Benefit is an agreed payment made by an insurer to a covered person in relation to a specific benefit.

What is a Qualifying Period?

A Qualifying Period is a period of time, which must pass after inception of the policy, before cover commences for a particular benefit.

What is a Cooling-Off Period?

A limited period of time (14 days, from the commencement of your cover) when you can cancel cover, provided you have not used any of the services or attempted to make any claims.

What is a General & Medical Participating Hospital?

A Participating Hospital is any hospital shown in the General & Medical Hospital List at the time you receive your treatment.

To see available medical facilities in your area, try our interactive UK Hospital Finder.

What is the General & Medical Hospital List?

A Hospital List is the list of participating hospitals that General & Medical publishes for the purpose of the cover they provide. This list may change from time to time, so check with us before any admission to a hospital that is listed.

 

Types of Conditions Explained

Medication

What are Acute Conditions?

Acute Conditions are diseases, illnesses and injuries of rapid onset that respond quickly to medical or surgical care and are not recurrent or long term in nature.

What are Chronic Conditions?

Chronic Conditions are diseases, illnesses or injuries (including a mental or addictive condition) that has at least one of the following characteristics:

a) Is of gradual onset.

b) Has no known cure, or recurs.

c) Leads to permanent disability.

d) Is caused by changes to your body which cannot be reversed.

e) Requires you to be specially trained or rehabilitated.

f) Needs long-term supervision, monitoring and/or treatment.

g) Requires a prolonged course of drug therapy/treatment.

What is a Pre-existing Condition?

A Pre-existing Condition is any disease, illness or injury for which you have received medication, advice or treatment; or you have experienced symptoms, whether or not a medical opinion has been sought; before the start of your cover.

With General & Medical, you have the option to include cover for some pre-existing medical conditions from a pre-defined list, for an additional premium. Find out more about our optional pre-existing conditions cover.

What is a Congenital Condition?

A Congenital Condition is a condition recognised at birth, or that is believed to have been present since birth even if not immediately evident at the time of birth, whether inherited or caused by an environmental factor.

What is a Psychiatric Condition?

A Psychiatric Condition is a mental and/or addictive conditions, including alcoholism, drug addiction, eating disorders, post-traumatic disorders or any other illness or condition of psychogenic origin.

What does Remission mean?

Remission is a period during which there is an absence of symptoms previously present but the underlying condition remains. A remission does not constitute a cure.

 

Types of Treatment Explained

Hospital Treatment

What is In-patient Treatment?

In-patient Treatment is treatment that, for medical reasons, normally requires you to occupy a bed in hospital during the day, or to stay overnight or longer in hospital.

What is Out-patient Treatment?

Out-patient treatment is treatment given at a hospital, consulting room or out-patient clinic that does not normally require you to occupy a hospital bed, as either a Day-patient or In-patient.

What is Day-patient Treatment?

Day-Patient Treatment is treatment that, for medical reasons, normally requires you to occupy a bed in hospital during the day, but not overnight. This is also often referred to as Day-Case Treatment.

What is an Unplanned Admission?

An Unplanned Admission is when you are required to go immediately to a hospital for admission following illness. It may be following a visit to your GP, consultant or hospital, or it may be directly from the community e.g. your home.

What is an Emergency Admission?

An Emergency Admission is when you are required to go immediately to a hospital for an unplanned admission following an illness/accident. It may be following a visit to your GP, consultant or hospital, or it may be directly from the community e.g. your home.

What is Intensive Care Treatment?

Intensive Care Treatment is treatment in an Intensive Care Unit (ICU), Intensive Therapy Unit (ITU), High Dependency Unit (HDU) or Coronary Care Unit (CCU) which gives constant monitoring after an operation or illness.

What is Palliative Treatment?

Palliative Treatment is treatment where the primary purpose is only to offer temporary relief of symptoms rather than to cure the medical condition causing the symptoms.

What is Hospice Care?

A Hospice is an institution that specialises in the care of people who are terminally ill with special concern for death and dignity.

What is Co-share Treatment?

Co-share Treatment is a provision by which you share the percentage of the treatment costs.

 

Types of Medical Practitioner Explained

Doctor

(for the purposes of medical insurance schemes provided by General & Medical)

What is a Complementary Medicine Practitioner?

A Complementary Medicine Practitioner is an acupuncturist, chiropractor, homeopath, osteopath or hydrotherapist under the age of 70 who is recognised by us as a complementary medicine practitioner.

What is a Consultant?

A Consultant is a General Medical Council (G.M.C.) registered medical practitioner under the age of 70 who holds, or has held, a substantive consultants post in the NHS and who is recognised by us. You may phone or write to us if you wish to ascertain whether a practitioner is recognised by us as a consultant.

What is a General Practitioner or GP?

A General Practitioner or GP is a medical practitioner recognised in accordance with the Medical Act 1983 (as amended) registered on the GP Register introduced under The General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003 and regulated by the General Medical Council. With whom, for the purposes of your cover with us, you must have been registered as an NHS patient for a minimum of 60 months immediately preceding the commencement of your cover.

What is a General Dental Practitioner or GDP?

A General Dental Practitioner or GDP is a dental practitioner engaged in dentistry practice in accordance with section 37 of The Dentists Act 1984 (as amended), registered on the Dentists Register and regulated by the General Dental Council.

What is a Hydrotherapist?

A Hydrotherapist is a practitioner qualified to treat disorders by the use of water (externally) in the form of exercise in a pool, undertaken at one of our recognised participating hospitals.

What is an Ophthalmic Practitioner?

An Ophthalmic Practitioner is an Ophthalmologist, a Dispensing Optician or an Ophthalmic Optician.

What is a Physician?

A Physician is a General Medical Council (GMC) registered medical practitioner under the age of 70, who practices general medicine as distinct from surgery and who is recognised by us.

What is Special Nursing?

Special nursing is the provision of a nurse in a hospital on a 1:1 basis with the patient.

What is a Therapist?

A Therapists is a Physiotherapist, Occupational Therapist or Orthoptist registered with the Health & Care Professionals Council. Also, any other practitioner under age 70 who has written confirmation from us that we recognise them as a therapist for the purpose of our medical insurance schemes.

 

Underwriting Explained

Medical Records

What is Moratorium Underwriting?

For Moratorium underwriting, we do not need a medical declaration completed. Instead, we will not cover treatment of any pre-existing condition or any related conditions if there have been symptoms (even if a medical opinion has not been sought), medication, treatment, diagnostic tests or advice relating to that condition or any related condition in a 60 month period prior to the member joining the scheme.

However, we may agree to cover a pre-existing condition, providing the condition or any related condition does not remain present, including latently or in remission and only if there have been no symptoms, medication, diagnostic tests, treatment or advice relating to that condition or any related condition during a continuous 24 month period after joining the scheme.

What is Full Medical Underwriting?

This means we ask medical declaration questions about past health. Any pre-existing conditions and related conditions will be excluded unless we agree to accept them. These exclusions will be shown on your Certificate of Cover.

What is Continued Moratorium (Continued Mori) Underwriting?

You can apply on this basis if you are transferring from an existing scheme, which is underwritten on a Moratorium basis. Your original moratorium period must not already have expired and must still be in force with at least 12 months remaining. We apply our Moratorium conditions as above with effect from the commencement date of the scheme from which you are transferring.

What is Continued Personal Medical Exclusions (CPME) Underwriting?

You can apply on this basis if you are transferring from an existing fully medically underwritten insurance scheme. We will apply the same personal medical exclusions to your cover with us that were applied to your previous scheme.

If your cover is subject to CPME Underwriting either as an individual or a group of up to 19 members, certain treatments are excluded from your transfer of cover for a minimum period of 60 months where you have had any condition, including latently, or in remission, prior to the start of your cover with us which would require any of these treatments after the start of your cover with us. These are heart surgery (including by‐pass surgery), cancer care or treatment, psychiatric care or treatment, joint replacement or revision surgery. Any Existing Personal Medical Exclusions you have on your cover at the time of transferring to us from your previous insurer take precedence and remain excluded from your cover with us for the duration of your policy with us.

What is Medical History Disregarded (MHD) Underwriting?

Means that any pre-existing medical conditions will be covered providing they fall within the terms and conditions of the policy. Underwriting conditions apply.

What do I need to provide for Continued Underwriting Options?

For all continued underwriting options proof of previous insured terms will be required and you may need to state whether anyone on the scheme has suffered from cancer, heart, psychiatric or orthopaedic joint conditions in the past, depending on the size of the scheme.

 

If after reading our Jargon Buster you need more information, or have any unanswered questions, please contact us. We will be happy to help.