Health insurance jargon explained

Posted on July 13, 2012 by Guest Writer
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The Roman poet Virgil said: “the greatest wealth is health” and you might well agree. It’s only natural therefore to want to have good quality medical insurance in place just in case your health takes a turn for the worse.

When shopping around for the right health insurance policy, you might find that wading through the jargon is baffling to say the least. But don’t give up. We’ve put together a jargon-buster which should help you get to grips with some of the most frequently used health insurance terminology.

Private Medical Insurance (Private Health Insurance)

Also known as “Private Health Insurance”, Private Medical Insurance (PMI) covers a wide range of cover options which supplement those offered by the National Health Service (NHS).

PMI caters for people with or without pre-existing medical conditions so it can cater for everyone personally. An important thing to note about Private Medical Insurance is that because it is tailored to individual needs, you are unlikely to find a generic quote online. You will need to answer various questions about your health, medical history and individual needs before a quote can be calculated. This ensures you get exactly the right level of cover for your particular needs.

Benefits also include no waiting lists and access to some treatments and drugs that are not necessarily offered on the NHS. Other perks can include a choice of hospitals with private rooms and unrestricted visiting hours.

Excess

At the time you take out your cover, you agree to an amount you will pay towards the cost of your medical care in the event of a claim; a sum not paid for by the insurance policy but by you, the policy holder – this is known as excess. For example: you agree to a £250 excess amount per claim and the cost of your treatment totals £5,000. You will need to pay the first £250 only and the insurance company will pay the rest.

Cash benefit

A cash benefit is an agreed additional payment made direct to policy holders in relation to costs which are already covered by another insurance policy (perhaps social insurance or another private policy). You can use the money for whichever purpose you see fit – usually for out-of-pocket costs in the aftermath of your treatment.

Qualifying period

This is an agreed period of time which must have passed after purchasing your health insurance policy, before cover can commence.

Cooling-off period

If you have a change of heart or something else causes you to cancel your policy, the cooling-off period (usually 14 days from the commencement of your cover) enables you to do so; provided you have not used any of the services or made a claim.

Participating hospital

Insurance companies have access to extensive lists of facilities all over the world where you can receive treatment under the cover you have purchased. Participating hospitals are the ones on this list and enable the insurance company to proceed with your claim in the simplest way possible.

The costs of treatment in different hospitals worldwide can vary enormously, so insurance companies will usually reduce their premiums accordingly to reflect the lower costs of treatment at some facilities.

Acute conditions

Acute conditions are rapid onset and respond quickly to medical care or surgery. These can be diseases, illnesses or injuries and are temporary in nature.

Chronic conditions

Chronic conditions include disease, illnesses or injuries with at least one of the following symptoms: they take hold gradually; they lead to permanent disability; there is no cure for the condition; they cause irreversible changes to your body; they require professional rehabilitation treatment; they need long term care and supervision; they require an on-going course of treatment/medication.

Pre-existing medical conditions

A pre-existing condition is any disease, illness or injury for which you have received treatment or experienced symptoms of (even if you have not sought medical intervention), before you start your cover.

Congenital conditions

A congenital condition is one that was recognised at birth, or an initially undiagnosed condition that’s believed to have been present since birth, whether inherited or caused by an environmental factor.

Psychiatric conditions

A psychiatric condition includes a range of mental illnesses such as anxiety, depression and stress.

Remission

Remission is a period of time when your previous symptoms are not present but the underlying condition remains. A remission never constitutes a cure.

In-patient treatment

If you are staying overnight or longer, or occupying a bed in hospital during the day, you will be classed as receiving in-patient treatment.

Out-patient treatment

Out-patient treatment is given at a hospital or clinic that does not normally require you to occupy a hospital bed as day-patient or in-patient.

Repatriation

If you are unfortunate enough to have a medical emergency when away from home and require transportation for medical reasons, your policy can assist with arranging it and paying for you to be taken by commercial carriers to either your home/primary residence/location of your choice, or to a medical facility near your home for you to receive the necessary treatment.

Some health insurance policies also include bringing a friend or family member to the medical facility where you are being treated and returning dependent children to your home or a location of your choice.

In the event of death, repatriation arranges and pays for embalming expenses and the cost of transporting your body via the most direct and economical route.

Unplanned admission

An unplanned admission is when you are medically required to go to a hospital for immediate admission following an illness. It may be that you have just visited to your GP, consultant or hospital or it may be directly from your home or wherever you happen to be.

Emergency admission

An emergency admission is when you must go immediately to a hospital for unplanned admission following an illness or accident.

Palliative treatment

The main aim of palliative treatment is to provide temporary relief of symptoms, rather than to cure the medical condition that causes the symptoms.

Underwriters

Underwriters are employed by insurance companies to help set the price of health insurance policies. They use actuary data and computer programmes to determine risk and the likelihood and size of claims during the lifespan of a policy. As such, they decide how much coverage clients should receive and how much they should pay for it.