Common Private Health Insurance Terms

Insurance policies are full of jargon so getting used to the terms used is helpful. Always seek advice if you are reading something and you are unsure what a term means. Do not feel stupid, most people find policies hard to understand but it is important you do understand has once taken out you may regret not finding out the full terms.

Premium

This is the full amount you have been quoted for your health insurance policy.


Deductible

This is sometimes referred to with other insurances as an ‘excess’. It is an amount of money which you will need to pay before your insurer starts paying for your treatment. For instance, if you need treatment that turns into needing an operation you might pay for the treatment up to the value of £200 and once you have paid that your insurer will start to cover the costs for you. Having a higher deductible or excess can reduce the price of the policy because it makes you at a lower risk for the insurer: they are less likely to have to pay anything out on your policy because you are less likely to need treatment costing above the amount of your deductible.

Acute condition

This term will often be used to describe what is or isn’t covered by your health insurance cover. An acute condition can be defined as a condition where you are most likely to return to full health and be in the same position with regards to your health as you were in previous to suffering from the acute condition.  This could mean a disease, illness or injury but ones which are likely, once treated, not to leave you with longer-term health issues or the serious degradation of your health. These may be conditions (defined as a disease, illness or injury) that can be treated fairly quickly and non-invasively, but these are not necessarily always the case. The main thing to remember with an acute condition is that it is something with which you suffer until you are treated and then you are back to good health. An example might be tonsillitis or severe influenza.

Chronic Condition or Chronic Disease

These are often excluded from cover and are defined as diseases for which there may be a treatment to alleviate discomfort or slow down the condition, but for which there is no known cure. Examples of this include cancer, asthma, diabetes or arthritis. It is possible for a condition to be classed as acute and change to chronic. For example, your insurer may cover many types of cancer, and class this as an acute condition. If however, you have cancer for a long time or do not respond well to treatment the insurer may class this condition as chronic. It is important to check with your insurer what happens if the classification of your condition changes. 

Inpatient

Inpatient is a term which is referred to often in health polices and is used to describe a patient who requires a hospital stay either of just one night, or a longer period for their treatment. In other words an inpatient could be described as a person who is admitted to a hospital or clinic as a patient and requires any overnight stay for medical reasons. Some inpatients can have very short stays of just one night, particularly if you are just going in for a minor operation, or inpatients can have a stay of several months if they require serious ongoing treatment.

Outpatient

Outpatient is a term used to describe a patient who attends a hospital procedure and does not require an overnight stay. This is not limited just to hospitals; the patient could be attending an outpatient clinic or consulting room. Unlike an inpatient the patient is not required to be admitted to hospital or the clinic concerned. The patient can receive treatment on a day visit, and this time meets the requirements of their treatment. Outpatients are usually more common for less serious conditions, injuries or illnesses (for example visits to the A&E department or scans and checkups) but can also involve minor surgery. With advances in technology and staff training more and more serious and complex surgery is now being completed without the need for an overnight stay. This saves both the hospital and your insurer money.

Diagnostic tests

This is a term which is used quite widely in the medical profession, so you may have heard it before and wondered what it meant. It can also be seen in health insurance policies. It is a general term to describe investigative tests to aid diagnosis. For example x-rays, blood tests, urine samples and ultrasound scans can all be described as diagnostic tests and will help the doctor decide what your condition, illness, disease or injury might be. These tests are carried out find out the cause of the patient’s symptoms. Medical professionals also may use the term pre-operative tests, which are used to find out what the patient’s general level of health is like prior to surgery. Pre-operative tests are usually carried out while knowing what the surgery involved will be and after diagnosis whereas diagnostic tests are to help the octor reach a diagnosis.

Nurse

Of course everybody knows what a nurse is, but when the term is used in your insurance policy you may want to know exactly what that entails. The term nurse is a term used for a qualified nurse who should be registered by the NMC (the Nursing and Midwifery Council). Some nurses have responsibility for lower level surgical procedures such as removal of foreign bodies, cleansing and treating wounds, pain control and many more duties. The type of condition, illness, disease or injury you have will determine if you are treated by a doctor or a nurse. All qualified nurses will have a NMC identification number.

Treatment

Treatment is a very general term, which you will probably see widely used in most policies. It refers to the medical services you will need to receive in order to treat a condition, disease, illness or injury. This may mean curing the condition or it may mean alleviating it. The term will be used generally inmost policies however some policies instead use the term ‘active treatment’ which can be confusing but generally means ‘treatment’. Some insurance companies have their own definition of terms, so if the term ‘active treatment’ is used in your policy it is wise to ask your provider to pin point what is meant by this term exactly.

‘In Situ Carcinoma’

‘In situ’ is a Latin term which means ‘it its place’, and carcinoma is a medical term which describes a malignant tumour. In situ carcinoma is usually covered by most policies and is a term to describe an early stage tumour where the cancerous cells are still located in the place that they originated. For a carcinoma to be in situ it must have proliferated within itself, or in its place, and not attacked and invaded the surrounding tissues (ie spreading the cancer).

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