Health insurance common terms

A.

Accident or emergency admission

An unplanned admission to hospital or a hospital ward after an injury, acute illness, or condition, either:

• directly following an accident
• directly from the emergency department for urgent or unplanned treatment
• or on the same day as a referral from a GP or specialist for immediate treatment or tests.

Acupuncturist

A licensed healthcare practitioner, registered with the General Medical Council (GMC) and recognised by us, who uses very thin needles in specific points of the body to relieve pain and improve health. They'll also either be a Medical Member or Accredited Member of the British Medical Acupuncture Society, or a registered member of the British Acupuncture Council.

Acute condition

A disease, illness, or injury that's likely to respond to treatment quickly, getting you back to the state of health you were in immediately before or to a full recovery.

Advice

Any consultation, advice, or prescription from a licensed medical practitioner about your health.

C.

Cancer

A group of abnormal cells that have grown uncontrollably into a malignant tumour that can spread into nearby tissues.

Chemotherapy

A type of cancer treatment that uses drugs to destroy cancer cells or prevent tumours from growing. These can include targeted, or biological therapy drugs.

Chiropractor

A licensed practitioner, included in the Register of Chiropractors, who diagnoses and treats musculoskeletal problems.

Chronic condition

A long-lasting disease, illness, or injury that often needs ongoing management or treatment, having one or more of the following characteristics:

• needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests
• needs ongoing or long term control or symptom relief
• needs rehabilitation, training to cope with it, or lifestyle adjustments
• continues indefinitely
• has no known cure
• comes back or is likely to come back.

D.

Day-patient

A patient who's admitted to a hospital or clinic for a medical treatment, procedure, or medically supervised recovery and goes home the same day, without staying the night.

Diagnostic centre

A hospital or facility providing diagnostic services such as CT, MRI and PET scans.

Diagnostic tests

Investigations, such as CT or MRI scans, X-rays, Ultrasound or blood tests, that find or help figure out what's causing your symptoms.

Dietitian

A qualified practitioner, registered with the Health and Care Professions Council and recognised by us, who specialises in food, nutrition, and diet therapy. 

E.

Exclusions

Specific situations, conditions or treatments that aren't covered by your policy. The policy will list standard exclusions that apply to the policy underwriting.

F.

Full Medical Underwriting (FMU)

How we assess and review your medical history before a policy starts, so we can consider your information and tell you what symptoms and conditions are or aren't covered.

G.

GP

A general medical practitioner, included in the GP register kept by the General Medical Council, who provides primary healthcare for their patients.

H.

Hospice

A hospital, part of a hospital, or facility (that we recognise as a hospice) that specialises in end-of-life care, devoted to patients with life-limiting or terminal illness, either as an in-patient or at home.

Hospital

A healthcare facility where you receive medical care, from tests to treatment. 

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

If you have a hospital list, eligible hospitals are included on your chosen hospital list, as shown on your policy schedule. Alternatively, it could be an NHS pay-bed we recognise or any establishment we agree is an appropriate facility, before your treatment is carried out.

I.

Insurance certificate

The official document you're given that confirms your insurance policy and key details of what's covered. The certificate details the group member, any eligible family members, the benefit options you've chosen, as well as other information.

In-patient

A patient who's admitted to hospital and stays overnight or longer for medical reasons.

Insurance Premium Tax (IPT)

A tax the government charge on general insurance premiums for most types of insurance policies.

M.

Medical Inflation

The rate at which the cost of healthcare services goes up as advances in medicine, like new treatment and procedure, progress.

Medically necessary

A medical service, treatment, or procedure a qualified medical practitioner or specialist has deemed appropriate to diagnose, treat, or manage your symptoms or medical condition. And, if withheld, it could negatively affect your condition or the quality of medical care you receive.

Member

A person who's named as an insured individual in your policy schedule.

Moratorium Underwriting (Mori)

An option to take out health insurance without needing to share your full medical details at the start of the policy, including pre-existing conditions. So, making a claim may take longer as we’ll look at your medical history and may ask for more information from your GP.

N.

Network

A group of treatment units that specialise in managing specific conditions, with clinicians and medical facilities that meet our quality care standards.

Find out more about our Networks.

Nurse

A qualified healthcare practitioner, registered with the Nursing and Midwifery Council (NMC) and with a valid NMC personal identification number, who provides care, support, and treatment to their patients.

O.

Open referral

A type of medical or healthcare referral that only details the service or type of specialist you need without naming a specific clinician, specialist or hospital. It should include your medical condition/symptoms, the specialism, and the sub-specialism of the consultant you need to see.

Osteopath

A trained healthcare professional, included in the Register of Osteopaths and recognised by us, who detects, prevents, and treats a range of health problems by focusing on the musculoskeletal system.

Out-patient

Someone who goes to hospital, a consultation, or outpatient clinic for an appointment, procedure or test and leaves the same day, without staying the night.

P.

Physiotherapist

A qualified healthcare professional, registered with the Health and Care Professions Council as a physiotherapist and recognised by us, who helps restore, maintain, and improve movement and physical function through physical therapy.

PMI

Private Medical Insurance

Policy

Our contract of insurance with the policyholder, providing you with the cover detailed in the policy document.

Policyholder

The person named as policyholder in the policy schedule.

Policy schedule

A document that's part of your insurance policy and sets out the specific details that apply to your policy, including the policyholder, members, amendments, and any exclusions.

Policy year

The period of time where you policy is active, from your policy start date (or your renewal date) until the day before your renewal date.

Pre-existing condition

A disease, illness, or injury you've had symptoms, medication, advice, treatment, or diagnostic tests for before taking out your policy, whether it's been diagnosed or not.

Psychiatric therapist

A mental health practitioner, fully qualified and accredited with any counselling register overseen by the Professional Standards Authority (PSA) and recognised by us, who helps people manage mental health conditions, emotional difficulties, and psychological distress through therapy.

R.

Related

Diseases, illnesses, or injuries that are the result of one another, or are the result of the same condition.

Renewal date

The annual anniversary of the date your policy started.

S.

Specialist

A registered healthcare professional with advanced training and expertise in a specific area of medicine, who: 

• has previously worked as a substantive NHS consultant and is still eligible for such a role
• holds a Certificate of Higher Specialist Training from the Committee of the relevant Royal College or faculty
• and is included on the General Medical Council’s Specialist Register. 

With the Expert Select hospital option, we confirm a specialist is eligible for cover before your treatment. With the hospital list, this is a specialist that’s recognised by us.

Speech therapist

A qualified healthcare practitioner, registered as a speech and language therapist with the Health and Care Professions Council and recognised by us, who assesses, diagnoses, and treats problems with speech, language, voice, and swallowing.

T.

Treatment

Medical care that diagnoses, relieves, or cures a disease, illness or injury, including diagnostic tests.

U.

UK

For our policies, this includes England, Scotland, Wales, Northern Ireland, the Channel Islands, and the Isle of Man.

UK resident

Someone who has the legal right to live in the UK, either by holding a UK citizenship or an appropriate Visa, for the duration of the policy year, and who lives in the UK during this time (other than for trips abroad that don’t go beyond three months overall).