Glossary of terms
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.
Annual review Date
The date your policy is renewed and from when your premiums may be changed and any new terms and conditions applied. This date will be 12 months after the policy start date and each anniversary after that date.
Benefit Limit
The maximum paid in any insurance period to your under the policy by your insurer. These amounts are shown under each section of cover.
Chemotherapy
The term that usually describes the use of drugs to treat cancer. Chemotherapy works by destroying cancer cells or by preventing them from multiplying.
Chronic Condition
A disease, illness or injury which has at least one 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
Claim
The amount of benefit payable to an insured member for an episode of treatment for a single medical condition whilst the policy is in force.
Co-Payment
This is a type of excess on claims made, where the insured person agrees to pay x% of each claim, usually subject to an overall annual cash payment. With some insurers, the co-payment may only be applied to specified benefits.
Continued Personal Medical Exclusion (CPME)
CPME underwriting is offered at an insurers discretion to companies (and sometimes individuals) who wish to change cover from one insurance company to another. Under this arrangement the insured person supplies the new insurer with a copy of their most recent insurance certificate and the new insurer copies across (or “continues”) any personal medical exclusions stated on the certificate and does not add any new ones. All other normal policy benefits, terms and conditions of the new insurer will apply even if they differ from those of the previous insurer.
CPME is also sometimes known by the following terms:
- Switch
- No Worse Terms
- Protected Underwriting Terms
CT Scanning (Computerised Tomography)
A diagnostic technique in which the combined use of a computer and x-rays passed through the body at different angles produces cross-sectional images of tissues, often in 3-D.
Day-Patient
Day-patient or day-case is the description of treatment where the patient is admitted into hospital (often occupying a hospital bed) for treatment which does not involve an over-night stay.
Deductible
See Excess
Diagnostic Tests
Investigations, such as x-rays or blood tests, to find or to help to find the cause of your symptoms
Eligible Treatment
Treatment specified in the benefits schedule for a condition that is not excluded, either within the policy wording, or by a personal exclusion shown on the Certificate of Insurance.
Excess
An excess (or deductible) on a policy is the amount of eligible medical costs which the insured person has to pay before the insurance company will pay benefits. For example, where a customer agrees to a £100 excess under a PMI policy, they agree to pay the first £100 of their medical expenses in the event of claim under the policy. Some PMI policies may have a compulsory excess, but with most there will be a discount available on premiums if you agree to pay an excess in the event of a claim. Most insurers operate the excess per person, per policy year, although in some cases the excess is payable per claim or per course of treatment. An excess may also be in the form of a co-payment.
Full medical underwriting
A method of underwriting whereby the insurer requires from each applicant covered by the policy, details of their previous medical history and current state of health. This usually involves the completion of a health questionnaire as part of the application for cover.
From this information, the insurer’s underwriter can then decide whether to:
- allow cover on standard terms with no personal exclusions applied;
- exclude cover for a specified medical condition and any associated medical conditions;
- exclude cover as above, but with the proviso that the insurer will review the decision at a stated time in the future; or
- offer standard terms but charge a higher premium (an option that is only offered on a relatively small number of policies)
In-Patient
A course of treatment in a hospital which involves occupation of a bed for at least one night.
Medical History Disregarded (MHD)
A type of underwriting which is usually applied to larger group schemes, where pre-existing medical conditions are covered. All eligible medical expenses that occur after the inception date of the policy will be met by the insurer, subject to the standard terms and conditions of the plan.
Moratorium
Moratorium is a style of underwriting used by insurers where you do need to give details of your medical history at the time of application. Instead, the insurer does not cover treatment for any medical condition or related condition that you have received treatment for, taken medication for, asked advice on or had symptoms of, during a period of time (usually five years) before the policy started. These are called “pre-existing” conditions. Although you do not have to tell the insurer about your medical history when you take out the policy, your insurer may ask for medical notes in the event of a claim to ensure that the treatment you are receiving is not related to a pre-existing condition that would be excluded under the moratorium.
These pre-existing conditions may automatically become eligible for cover after a period of continuous membership. There are two types of moratorium:
- Rolling Moratorium – Under a rolling moratorium cover for pre-existing medical conditions will be given, subject to a qualifying period (usually two years) during which the member does not need to seek medical advice or receive treatment for the pre-existing condition. However, if medical advice is sought and/or treatment received (this usually includes regular check-ups for medical reasons) during the qualifying period, then the qualifying period will start afresh from the date the advice or treatment is received. Therefore, under this method of underwriting, there will be some conditions that will never be covered, because you will always need treatment, medication, or advice on them.
- Fixed Moratorium – Under a fixed moratorium cover for pre-existing medical conditions will be given after completion of a continuous qualifying period of membership (usually two years), regardless of whether any further treatment, advice or medication has been sought for that condition during the initial qualifying period.
With both types of moratorium underwriting, you should be aware that claims will always be assessed in accordance with the insurer’s standard policy terms and conditions for assessing eligible treatment.
MRI (Magnetic Resonance Imaging)
A diagnostic technique, using powerful magnets, radio waves and computer equipment, to build-up cross-sectional 3-dimensional images of organs and other body structures.
Pathology
Pathology is the study of disease – it’s causes, mechanisms, and effects on the body. Within PMI this term is used to describe the tests that would be undertaken to diagnose a disease or illness and follow-up on the effects of treatment. Examples of pathological tests would include blood tests, urine tests and analysis of tissue samples.
No Worse Terms
See Continued Personal Medical Exclusions
Out-Patient
This describes medical treatment, consultations or diagnostic tests that do not involve admission to a ward or the allocation of a bed. These types of out-patient treatments can take place at an out-patient clinic within a hospital setting or a separate dedicated out-patient facility.
Pre-existing Conditions
A medical condition or symptoms that the insured person differed from prior to inception of the policy
Protected Underwriting Terms
See Continued Personal Medical Exclusions
Radiology
The medical speciality that makes use of x-rays, ultrasound, MRI and CT scanning for investigation, diagnosis and treatment.
Radiotherapy
Treatment of cancer and, occasionally, some noncancerous tumours, by x-rays or other radiation, which is attempting to destroy or slow down the development of abnormal cells.
Related Condition
Any condition, symptom, disease, illness or injury which is medically considered to be associated with another condition, symptom, disease or injury.
Switch
See Continued Personal Medical Exclusions