Glossary

Accidental injury

An injury directly caused by something accidental, outside the body, violent and visible. It does not include sickness, disease or any naturally occurring or deteriorating condition. 

 

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.

Critical care

Any care given in an Intensive Care Unit, Intensive Therapy Unit, Coronary Care Unit, High Dependency Unit, Paediatric Intensive Care Unit, Neonatal Intensive Care Unit, Special Care Baby Unit or similar level of care, wherever provided, is considered critical care. 

 

Claim

A request for payment submitted by a healthcare provider to your insurance company after you receive medical services.

 

Co-payment (Co-pay)

A fixed amount you pay for a covered healthcare service, typically due at the time of service. Co-pays are often specified in your insurance plan.

 

Co-insurance

The percentage of costs for a covered healthcare service that you are responsible for after meeting your deductible. For example, if your co-insurance is 20%, you would pay 20% of the covered costs, and your insurance would cover the remaining 80%

 

Deductible

The amount you must pay out of pocket for covered healthcare services before your insurance plan starts to contribute.

 

Diagnostic tests

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

 

Excess

The maximum amount you will have to pay towards your treatment. The excess can apply in one of two ways. Please refer to your membership certificate to see which one applies to you.

 

Excess per claim – you will pay the excess amount each time you claim for a new condition and have treatment covered by this plan. If treatment for that condition continues for more than 12 months, the excess will apply again to any further treatment after the anniversary of the claim.

 

Excess per plan year – you pay the excess on the first treatment (or treatments) that you have in the plan year. Only one excess is payable for each insured person in each plan year, regardless of how many conditions you claim for.

 

Exclusion

Specific conditions, services, or treatments that are not covered by your health insurance plan. It’s important to understand these exclusions to avoid unexpected costs.

 

Explanation of Benefits (EOB)

A statement from your insurance company explaining what healthcare services were covered, the amount paid, and any costs you are responsible for. It is not a bill but rather a summary of your insurance claim.

 

GP (General Practitioner) 

A medical practitioner registered and licensed with the General Medical Council, whose name appears on the GP register.

 

In-patient

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

 

Insured dependant

Your insured husband, wife or partner, who was aged between 16 and 79 at the plan start date or their cover start date (whichever applies to them) and who lives at the same address as you

OR

Your insured children (including adopted children), health insurance policies in the UK usually cover dependent children until a certain age, typically 18 or 21 years old. However, some policies may extend coverage for adult children up to a specific age limit, such as 25 years old, provided they are in full-time education.

 

Osteopathy

A type of alternative medicine that must be carried out by a member of the General Osteopathic Council (GOsC) who is recognised by us.

 

Out-patient

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

Physiotherapy

Treatment carried out by a person who is registered with the Health and Care Professions Council (HCPC) as a physiotherapist and who is recognised by us. 

 

Plan start date

The date on which the plan began, as shown on your membership certificate.

 

Plan year

A period of 12 months from the plan start date or from any annual renewal date. 

 

Planholder

The person who has a contract with us, as shown on the membership certificate. 

 

Premium

The amount you pay for your health insurance coverage, typically on a monthly basis.