Health insurance common terms

The language of Health insurance can be confusing, so here’s a simple guide to some of the key terms.

A to Z of terms

A - G

A

Accident or emergency admission

An admission to:

• hospital directly following an accident

• a hospital ward directly from the emergency department for urgent or unplanned treatment, or

• a hospital ward on the same day as a referral for treatment is made either by a GP or specialist, when immediate treatment or diagnostic tests are medically necessary.

Acupuncturist
A doctor registered with the General Medical Council (GMC) who is also either: a Medical Member or Accredited Member of the British Medical Acupuncture Society or a registered member of the British Acupuncture Council, who is recognised by us.

Acute condition
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 to your full recovery.

Advice
Any consultation, advice, or prescription.

C

Cancer

A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chemotherapy
Drugs that are used to treat cancer. These include drugs used to destroy cancer cells or prevent tumours from growing (these could be cytotoxic drugs, targeted or biological therapy drugs).

Chiropractor
A practitioner who is included in the Register of Chiropractors kept by the General Chiropractic Council, and recognised by us.

Chronic condition
A disease, illness or injury that has one or more of the following characteristics:

• it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests

• it needs ongoing or long term control or relief of symptoms

• it requires your rehabilitation or for you to be specially trained to cope with it

• it continues indefinitely

• it has no known cure

• it comes back or is likely to come back.

D G

Day-patient

A patient who is admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.

Diagnostic centre
A hospital or facility recognised by us to carry out a CT, MRI or PET scan.

Diagnostic tests
Investigations, such as X-rays or blood tests, to find or to help to find the cause of your symptoms.

Dietician
A practitioner who is included in the register of the Health and Care Professions Council as a dietician and recognised by us.

Exclusions
The policy will list standard exclusions that apply to the policy underwriting.

Full Medical Underwriting (FMU)
What’s moratorium and full medical underwriting? - Aviva

GP
A general medical practitioner included in the GP Register kept by the General Medical Council.

H - P

H I

Hospice

A hospital or part of a hospital recognised as a hospice by us which is devoted to the care of patients with progressive disease (where curative treatment is no longer possible) on an in-patient or domiciliary basis.

Hospital
If you have the Expert Select hospital option: the hospital or facility that we confirm is eligible for your treatment before the treatment goes ahead.

If you have a hospital list: a hospital included on your chosen hospital list, as shown on your policy schedule, or an NHS pay-bed which we recognise to provide the type of treatment undertaken, or any establishment which we agree is an appropriate facility for the provision of treatment, prior to treatment being carried out.

Insurance certificate
The certificate giving details of (amongst others) the group member and any eligible family members and the benefit options you have chosen.

In-patient
A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.

Insurance Premium Tax (IPT)
This is a tax on general insurance premiums.

M P

Medical Inflation
Medical inflation is the term used when refering to new trends and advances in medicine – like new treatments and procedures - and the increased costs that come with them.

Medically necessary
Treatment or a medical service which is needed for your diagnosis and is appropriate in the opinion of a qualified medical practitioner or specialist. By generally accepted medical standards, if it is withheld your condition or the quality of medical care you receive would be adversely affected.

Member
A person named as an insured person in the policy schedule.

Moratorium Underwriting (Mori)
What’s moratorium and full medical underwriting? - Aviva

Network
A group of treatment units, specialising in managing specific conditions. We only work with clinicians and medical facilities that meet our quality care standards.

More information on networks can be found here.

Nurse
A qualified nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Open referral
A referral for tests or treatment that details the type of specialist you need to see but does not name a specific specialist or hospital. An open referral should include your medical condition/symptoms and the specialism and sub-specialism of the consultant that you need to see.

Osteopath
A practitioner who is included in the Register of Osteopaths kept by the General Osteopathic Council, and who is recognised by us.

Out-patient
A patient who attends a hospital, consulting room or out-patient clinic and is not admitted as a day-patient or in-patient.

Physiotherapist
A practitioner who is included in the register of the Health and Care Professions Council as a physiotherapist, and who is recognised by us.

PMI
Private Medical Insurance.

Policy
Our contract of insurance with the policyholder providing the cover as detailed in the policy document.

Policyholder
The person named as policyholder in the policy schedule.

Policy schedule
The schedule giving details of (amongst others): the policyholder, members, amendments, and exclusions that apply to specific members (if any).

Policy year
The period of time from the date the policy began until the day before the first renewal date or, if the policy has been renewed, from one renewal date to the next.

Pre-existing condition
Any disease, illness or injury for which you have received medication, advice or treatment, or you have experienced symptoms whether the condition has been diagnosed or not before you joined the policy.

Psychiatric therapist
A practitioner who is employed to provide therapy sessions at a psychiatric hospital, or a fully qualified and accredited member of any counselling register overseen by the Professional Standards Authority (PSA) and who is recognised by us.

Q - Z

R U

Related
Diseases, illnesses or injuries are related if, in our reasonable medical opinion, one is a result of the other or if each is a result of the same disease, illness or injury.

Renewal date
The annual anniversary of the date on which the policy began.

Specialist
If you have the Expert Select hospital option:

A registered medical practitioner who:

• has at any time held and is not precluded from holding a substantive consultant appointment in an NHS hospital

• holds a Certificate of Higher Specialist Training issued by the Higher Specialist Training Committee of the relevant Royal College or faculty, and is included in the Specialist Register kept by the General Medical Council and who we confirm is eligible for cover before your treatment goes ahead.

If you have a hospital list:

A registered medical practitioner who:

• has at any time held and is not precluded from holding a substantive consultant appointment

in an NHS hospital

Speech therapist
A practitioner who is included in the register of speech and language therapists kept by the Health and Care Professions Council and who is recognised by us.

Treatment
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.

UK
For the purposes of the policy, being Britain and Northern Ireland, the Channel Islands and the Isle of Man.

UK resident
Having the legal right to reside in the UK (ie. holding UK citizenship or an appropriate visa) for the duration of the policy year and physically living in the UK for the duration of the policy year (other than for trips abroad totalling no more than three months during the policy year).