Jargon Buster: R
A helpful tool we’ve created to guide you through some of the insurance terms that are often used.
A handy jargon buster to help you understand some health insurance terminology.
DENIAL OR REJECTION OF CLAIM
A Denial or Rejection of Claim occurs when an insurance company refuses to pay for the cost of health care claimed for.
There are a couple of reasons why this could happen:
- Non-Disclosure: This means that the insurance providers did not receive all the information they needed to pay out on a claim. For example, you could have failed to supply all the relevant documents, or could have left out vital information about pre-existing medical conditions when taking out the policy.
- Conditions not met: This is when the event of the claim wasn’t covered by the insurance policy in the first place. For example, a basic private medical insurance policy that covered in-patient treatment only would likely deny or reject a claim for the cost of seeing a private GP.
REFERRAL
A referral is a written order from your GP to go and see a specialist or consultant, or to undergo medical tests and treatments. It’s their way of agreeing you need additional care and attention, and confirming they’re happy for you to go ahead.
Most health insurance policies would need you to obtain a referral in the first instance, in order for your plan to ‘kick in’ and start providing cover.
RENEWAL
A renewal is when you extend your insurance policy beyond its original term. Typically, health insurance policies have annual renewals, which means that at the same time every year you have the choice to extend and renew your existing policy, or to change to a different policy.
Your insurance premiums can increase at renewal, which is why we always recommend talking to your Towergate Health & Protection advisor to make sure your current policy is still the best fit for you.
RESIDENT OF THE UNITED KINGDOM
To be classed by health insurers as a ‘Resident of the United Kingdom’, you must live in the UK for at least 6 months or more every year.
RISK
Insurance is all about risk.
For your insurance provider, risk represents the chance that they will make a profit or a loss on offering to protect you. Risk is how your insurance premiums are calculated – the more likely you are to claim on medical costs, the more risk you pose and the higher your premiums are, to offset that potential cost. Risk is the reason insurance companies are interested in whether you have any pre-existing medical conditions.
For you, risk represents the probabilities of medical complications or side effects. It can also be the probability of getting ill because of your lifestyle – for example if you smoke you have a higher risk of developing cancer or lung diseases.