At SMP Healthcare Ltd we are committed to helping our customers and clients understand the jargon used within the Health Insurance industry. We have created a handy A-Z guide to help give a clearer understanding of some of the terminology that is used.
Our Health Insurance Jargon Buster
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.
Cash benefit; as part of your Health Insurance:
This is an agreed payment made by an insurer to a covered person in relation to a specific benefit.
A disease, illness or injury that has one or more of the following characteristics:
- The condition needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests.
- Needs ongoing or long term control or relief of symptoms.
- Requires your rehabilitation or for you to be specially trained to cope with it.
- Continues indefinitely.
- It has no known cure.
- Comes back or is likely to come back.
This is an underwriting method you can apply under if you are transferring from an existing scheme which was originally underwritten on a Moratorium underwriting basis. Your original moratorium start date will be honoured and therefore the moratorium ruling will apply from the original start date, not the date you transfer your cover. Some insurers can apply personal medical exclusions to your cover when transferring under this underwriting method. Continued Moratorium is sometimes referred to as CMORI.
Continued Personal Medical Exclusions/ Continued Medical Exclusions:
An underwriting method you can apply under if you already hold a Private Medical Insurance policy. This underwriting option will carry forward the underwriting you have with your current provider. This is sometimes referred to as CPME or CME. Any personal medical exclusions listed under your current plan will also be carried forward. Some insurers can apply personal medical exclusions to your cover when transferring under this underwriting method.
Cooling Off Period :
A limited period of time (usually 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.
Customer Authorisation Form for Health Insurance:
This form is for customers to complete and sign and is a way of advising their insurer who they would like to obtain their advice from. If you already have a Private Medical Insurance policy in place brokers will ask you to complete, sign and return this form before undertaking a review of your policy. There are two options provided within this form. One will provide brokers with authority to discuss your plan with your current insurer and the other option will allow you to appoint the broker to your plan. Appointment allows the broker to discuss the details of your policy with the provider and also allows the broker to receive direct access to future renewal information automatically. Unless a broker is appointed to your policy, they will be unable to negotiate any discount from your current insurer.
When a patient 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.
Investigations, such as Ultrasound, X-rays or blood tests, to find or to help to find the cause of your symptoms.
Fee approved :
A specialist or other practitioner who at the time of your treatment:
● is recognised by the insurer, and
● has agreed to the insurers guidelines for consultation fees.
This refers to an acute worsening or sudden deterioration of a previously diagnosed long-term chronic condition likely to respond to treatment in the short term.
Financial Ombudsman Service:
An independent service that you can contact to help settle any disputes you may have with your private medical insurer or adviser when you are not satisfied with how the complaint has been handled.
Full Medical Underwriting :
An underwriting method where you will be required to complete an application form containing your medical history. The insurer will ask a number of medical questions which must be answered truthfully. The Insurer will then assess the answers provided and may choose to permanently exclude pre-existing medical conditions. This would include illness / injury or disease that has not been diagnosed prior to the date of application if there have been symptoms, treatment, medication or even advice sought for the condition. This is sometimes referred to as FMU.
A percentage that an insured agrees to pay towards their claims, up to a maximum amount per policy year.
An amount of money that an insured agrees to pay should they need to claim either each policy year or each claim.
Exclusion / Endorsement applied to Health Insurance:
Exclusions and/or Endorsements are restrictions applied individually to your cover. The insurers standard general exclusions will still apply to all benefits under your chosen cover.
A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.
Insurance Premium Tax; applicable to Health Insurance:
The tax that applies to general insurance premiums. This is known simply as IPT.
Medical History Disregarded:
An underwriting method that is usually only available under larger group or corporate schemes. As its name sounds, the insurer agrees to take the members on cover regardless of their previous medical history. No personal medical exclusions will apply to the members cover. This underwriting method is sometimes referred to as MHD. Even if you have MHD underwriting, the chronic conditions terms still apply to your cover.
Increases that are linked to medical trends and developments to support them. Insurers will take this into account when calculating premiums at future renewals. This is not the same as the standard rate of inflation.
An underwriting method where you are not asked to give details of your medical history when setting up the policy. Instead the insurer does not cover treatment for any medical condition that you have received treatment for, taken medication for, asked advice on or had symptoms of five years prior to the setup of the policy. These conditions may become eligible for cover in the future. This would only happen when you do not have symptoms of, receive treatment for, medication, tests and advice (from your GP, a healthcare professional or a specialist) for that condition, or a related condition for a continuous period of two years after your policy has started. This is sometimes referred to as MORI.
If you make a claim, the insurer might ask for medical notes that are needed to decide if your claim is covered.
There are some conditions, for example chronic conditions, that will probably never be covered. This is because you would always need treatment, medication, tests or advice for them.
The specified group of facilities and/or specialists or other practitioners that are the only providers that a specific insurer recognises to provide the treatment required for your particular condition or suspected condition. Although networks are becoming more popular, not all insurers use them for every condition.
No claims discount (NCD):
A discount scaling system some insurance plans incorporate. For each year you are insured without making a claim, you will earn another years NCD and move up a level on the specific insurer’s scale, until reaching the maximum NCD level. However, if a claim is made this could impact the NCD. The amount claimed will depend how many levels on the specific insurers scale your NCD will reduce by and in turn will make your premium at renewal higher.
Both omission and misrepresentation of material information that the insurer has asked for.
NHS Cash Benefit; available on your Health Insurance:
A monetary amount that is payable to an insured person where they receive eligible treatment that is covered under the terms of the plan in a public NHS hospital. Insurers usually require you to be in hospital for a minimum number of nights before this benefit becomes payable.
A patient who attends a hospital, consulting room or out-patient clinic and is not admitted as a day-patient or in-patient.
A document issued by an insurer which forms part of the contract of insurance, and provides information including the period of insurance, the sections of the policy that apply and information relating to any applicable excesses/exclusions and or endorsements.
Pre-authorisation; for your Health Insurance claim:
Approval given either orally or in writing by the insurer prior to any treatment or consultation taking place, as a guarantee that the insurer will meet your treatment/consultation costs as part of an eligible claim – providing you are still paying premiums at the time of treatment/consultation.
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.
Protected No Claims Discount (PNCD):
Some insurers allow insured members to protect their NCD for an additional premium, meaning if a claim is made their NCD remains at the same level they were at prior to making the claim.
Insurers use fee guidelines to confirm how much they’re willing to pay for a treatment. If the cost of that treatment turns out to be higher, then you’ll be asked to cover the difference – which is known as the shortfall.
Six Week Option:
A benefit option that some insurers offer meaning the member insured will not be able to receive any eligible in-patient or day-patient treatment if the NHS can treat you within six weeks from the date the your specialist recommends it.
A Qualifying Period is a period of time, which must pass after inception of the policy before cover commences for a particular benefit.
Underwriting for Health Insurance:
Underwriting is the term that insurers use to describe assessing risks and then offering a policy, based on those risks. There are several different types of underwriting available when it comes to Private Medical Insurance. Your age may affect which underwriting option is available to you and depending on your medical history you may find one underwriting option more suitable.
If you want to find out more about any of the definitions listed above or have a query about a term we may have missed, you can either refer to our new Health Insurance FAQ’s or simply get in touch.
We can be reached via telephone, 01245 929 129 or email, firstname.lastname@example.org and will be more than happy to assist you.