The Association of British Insurers (ABI) is the voice of the UK’s world leading insurance and long-term savings industry. It is the public voice of the insurance sector and helps to encourage understanding of the sector and its practices. It is not the insurance industry regulator.
Absence management solutions are programmes designed to help businesses reduce the level of employee absences caused by sickness. They work by offering employees access to health-related advice, support and treatments.
Accident, sickness and unemployment cover is designed to provide low cost short term protection against the unexpected. It is useful if you’re worried about how you and your family would cope financially if you lost your job through unexpected redundancy or ill health.
Your accumulation period is the time period in which your out-of-pocket expenses and deductibles are calculated.
For most private health insurance policies, the accumulation period is a year.
An acute condition refers to the sudden onset of an illness or disease, which progresses rapidly and needs urgent care, but is normally treatable and doesn’t last long.
The maximum amount an insurance plan will pay out for a healthcare service. It is also sometimes referred to as payment allowance or eligible expense.
The Association of Medical Insurers and Intermediaries (AMII) is a trade association for independent medical insurance advisers in the UK. It has around 120 members.
A beneficiary is the person, company or estate that receives the payouts from an insurance policy. For health insurance, this is usually yourself or the healthcare supplier who needs to be paid. For a life insurance policy it will be the person you named to receive the payout in the event of your death.
In insurance terms a benefit is the money your insurers pay you, or the healthcare provider owed, upon making a successful claim.
Employee benefits however, are perks a company may offer its staff in addition to their normal salaries, such as private medical insurance, or life insurance.
An insurance broker is an independent adviser who searches the market on behalf of their clients to obtain the best insurance product to meet their needs.
Business loan protection is a type of insurance policy. It provides funds to allow a business to settle a debt should a key employee (for example a CEO or Director) pass away. A company’s overdrafts, loans and even commercial mortgages would all be covered by this type of insurance.
Cancellation occurs when you decide to stop your insurance policy. Most policies come with a cooling off period of around 14 days, during which you can cancel and receive a full refund, provided you haven’t claimed.
Case management is where your insurance provider will use medically qualified staff to help support and manage your claim, making sure your policy is working in the most cost effective way for you.
Cash plans, are also known as healthcare cash plans, are designed to cover the cost of everyday healthcare treatments such as dentist, physical therapies, eye tests and glasses. They are not the same as private medical insurance as they only cover day-to-day treatments, or excess payments and not unexpected or emergency health treatments.
CAT scans (also known as computerised tomography scans) are a type of diagnostic test that helps your medical team see a two dimensional image of part of your body.
They are an outpatient procedure, which means you can have a CAT scan and go home the same day. CAT scans can help diagnose or monitor a number of health conditions.
A chronic medical condition is an ongoing disease or illness which requires regular treatment and relief of symptoms, and is long-term, with no known cure.
A claim is when you call on your insurance policy to pay for a treatment or cost. For example, under a health insurance policy, a claim could ask the insurers to pay for the cost of an operation.
These are the costs incurred by your insurance provider whilst investigating and settling your claim, for example, legal fees.
Complementary therapies and alternative therapies are treatments which exist outside of general medicine, for example homeopathy or acupuncture.
Complex major operation is a type of surgical operation which generally takes longer than four hours and requires a highly skilled medical team, such as heart surgery or an organ transplant.
Consultant fees relate to the amount private doctors will charge you or your insurer for your care, which could include consultation fees, diagnostic test fees and surgical fees.
Corrective surgery is used to restore normal function and appearance in the body. This might be in response to disorders from birth, burns or diseases. Examples of corrective surgery could include:
- Removal of severe birthmarks
- Ear reshaping
- Breast reduction
- Congenital defect repair, including cleft palates
Whether a health insurance policy would cover corrective surgery is often decided on a case-by-case basis, so if this is something you’re looking for we strongly recommend speaking to our insurance advisers about which policies might be suitable for you.
Corrective surgery is often mistaken for cosmetic surgery, which is more aesthetically focused on enhancing appearance, for example a breast enhancement or facelift. Cosmetic surgery is very rarely covered by health insurance policies.
In some instances an insurer may be prepared to offer a ‘switch’ whereby cover offered by one provider is switched to another. When this is agreed the insured person supplies the new insurer with a copy of their insurance documents so the new insurer can replicate and provide that cover.
Critical illness cover will pay out a lump sum if you are diagnosed with a certain illness that is named in the policy. Each insurer will have its own criteria for critical illness but typically it might include cancer, heart or kidney failure, and diseases like Parkinson’s and Motor Neurone Disease.
A CT scan is a diagnostic scan that uses computed x-rays to produce a 3D image of the inside of your body. As an outpatient procedure, you can have a CT scan and go home the same day.
CT scans can help diagnose or monitor a number of health conditions.
Your insurance policy will have an end date and if you choose not to renew for another year, the end date, or date of expiry, will be the last date you are covered by the policy.
A patient who goes into a hospital for treatment, returns to a bed to recover, but doesn’t need to stay in overnight, is known as a day patient.
A death in service policy is often offered as a benefit by employers. If an employee was to pass away while still employed, their family receives a lump sum from the policy, which gives employees some financial peace of mind.
A denial of claim is when an insurance company refuses to pay for the cost of the healthcare being claimed for. It could be because they haven’t had all of the information required, or that the claim was for something not covered by the policy.
A dental insurance policy allows you to choose your own private dentist and access treatment quickly and without the worry of unexpected costs.
A dependant is someone who depends on you for financial support – for example, a child.
A diagnostic test is how your doctor or consultant gathers information to find out more about your condition. Diagnostic tests can include:
- Physical examinations
- Blood tests
- CT, PET, EEG or MRI scans
Diagnostic tests are usually classed as ‘outpatient treatments’, so are not always covered by private health insurance policies.
This refers to an arrangement whereby the medical costs are settled directly by the insurer so the policyholder doesn’t have to settle bills and then reclaim them.
The European Health Insurance Card (EHIC) is a free document which allows holders to get state healthcare at a reduced cost, or occasionally for free, in European Economic Area countries. It is not an alternative to travel insurance as it does not cover private medical care, mountain rescue, or being flown back to the UK.
An illness, injury or symptom which is severe enough to put your health at risk if you don’t get immediate medical attention is considered an emergency medical condition.
European Health Insurance is a type of private medical insurance plan for expats living in the EU.
It’s not the same as an EHIC, and is often recommended to work alongside the European Health Insurance Card, which would help you access emergency medical treatments in Europe.
An employee assistance programme (EAP) is an employee benefit, whereby a business offers its employees support to help with personal, emotional or financial problems that may affect their performance at work. This could include phone support lines, counselling, online resources and access to medical advice.
Sometimes also known as a deductible. The amount you may need to contribute towards settlement of a claim. With some policies you may be able to reduce your premium by agreeing to a higher excess when you take out your policy. Not all policies carry an excess.
Someone living abroad permanently or long term, who does not have citizenship in the country they live in. It usually refers to professionals working abroad or retirees.
A fact find is a document insurance brokers use to gather information about you, your family, your dependants and your current state of health to provide you with the right advice to meet your particular needs.
The FCA is the conduct regulator for 58,000 financial services firms and financial markets in the UK.
The set amount of time which an insurance policy will last for – a fixed term means the policy has a defined end date.
The FOS is anindependent arbitrator set up to settle complaints against financial services companies. You can use the FOS if you have gone through a company’s complaints procedure but remain dissatisfied.
A free cover limit is the amount of cover a policy member can have on a group protection scheme without any medical evidence or underwriting.
The FSCS protects customers of financial services firms which have failed. If you’ve been dealing with a company and they are unable to pay claims due to bankruptcy or insolvency, the FSCS can step in to pay compensation.
A full blood profile is an extensive blood test which gives a top-level overview of your health. It screens for cholesterol levels, kidney and liver function, calcium, iron, glucose and potassium levels, signs of infection or inflammation and your blood cell count.
FBPs are used to identify health problems before they occur, so are more of a preventative rather than diagnostic test. They can help flag any underlying, difficult-to-diagnose medical conditions, including anaemia, diabetes, and osteoporosis.
FMU is a form of underwriting that requires you to submit a medical application and declare any previous and existing health conditions to an insurance company before you are able to take out a health insurance policy. Based on this, the insurer may then apply medical exemptions which could prevent you from claiming against declared pre-existing conditions.
A group policy is an insurance policy which is offered by a company to more than one employee, and is usually paid for by the employer. Group policies often form the basis of an employee benefits package and can include group health insurance and group risk insurance, among others.
Group risk insurance is a form of employee benefit offered by the employer, which can provide protection for employees should they need it, for example, group life insurance or group critical illness insurance would come under a group risk umbrella.
Private health screening programmes provide a check-up on your overall health and can be used to spot any health issues early on, ideally before they get serious. They can be offered as a benefit by employers, and can offer great peace of mind if you’re worried about your health.
Home nursing is when your consultant decides your medical support would be better administered to you at home, rather than staying in a hospital. It could involve anything from having medication delivered to your door, to being on an IV drip at home.
A hospice is a special care facility for people who are terminally ill, where they are looked after with a focus on comfort rather than treatment or cure. Hospices offer medical and physical care, as well as emotional counselling for the patient and their loved ones.
Your insurer will have its own specified list of hospitals where you can receive private medical treatment in line with their policy. Different insurers will offer different hospital lists.
If a patient requires hospital treatment and has to stay in overnight or longer they are classed as an in-patient.
Income protection insurance is a policy that protects you against loss of income due to unemployment, illness or accident. Group income protection can be offered as an employee benefit which can be offered as a group scheme by businesses.
The insurance provider is the company which provides the cover to protect you against medical or other expenses. Each provider will offer a range of insurance products and different types of insurance.
An intermediary is another name for an insurance broker.
An intermediary sits between an insurance provider and the customer, offering independent advice and helping the customer find and purchase cover.
International health insurance aims to provide access to first class medical care, wherever you are in the world. If you’re planning to live or work abroad for long stretches of time, this type of policy could be vital, particularly in areas of the world where the local healthcare is poor.
A joint plan is any insurance policy that’s designed to cover two people. Within this, the policy will refer to the ‘first’ and ‘second person covered’.
A key employee is someone in a business who is considered indispensible, such as a shareholder, partner, director, proprietor or key salesperson. Key employee insurance provides the business with financial reassurance should that person be unable to work, or pass away.
This is a specialist insurance cover for employees who are working in high risk countries, to help support them and their families if they were to be kidnapped for a ransom.
An insurance policy will lapse if it’s not paid for, and cover will be terminated, which means any claim made after the lapse would be declined.
This is another name for life insurance. It is a policy which will pay out a lump sum to designated beneficiaries upon the death of the policyholder. Group life insurance is when this policy is provided by an employer to many employees, as a benefit.
Lifestyle surgery includes both corrective surgery and weight loss surgery.
- Corrective surgery could include ear shaping or removal of birthmarks in children, or breast reductions and gynecomastia in adults.
- Weight loss surgery could include gastric banding or gastric bypasses in obese patients.
Whether lifestyle surgery is covered by private medical insurance really does vary between policies and providers. Most health insurers do not include lifestyle surgery as a benefit.
This is the maximum amount your health insurers will pay for all of your health and medical expenses altogether. After this maximum is reached, your policy effectively ends.
It’s quite rare so see lifetime maximum benefits included in health insurance policies these days, but your Towergate Health & Protection advisor will tell you if a policy you are considering involves this.
A lump sum is a single large payment of money received from an insurance policy.
These are devices which are both prescribed and medically necessary for you to return to your everyday living standard. Examples of medical aids include insulin pumps, wheelchairs, hearing aids and compression stockings.
An emergency medical evacuation will take place if you fall ill or are injured, and cannot receive the necessary treatment locally. You will be medically transported (evacuated) to the nearest appropriate medical centre by ambulance, helicopter or aeroplane, and then returned home after treatment.
MHD is a form of underwriting on a health insurance policy. It usually applies to group or individual private health schemes where all pre-existing conditions are covered, meaning there is no requirement to go through medical assessments or to declare conditions.
Mental health refers to our emotional, psychological and social wellbeing. A broad range of medical conditions and issues come under mental ill health, including anxiety, depression, stress and addictions.
Moratorium underwriting is when your private health insurance policy excludes and won’t cover you for treatment for medical conditions you’ve suffered from over a recent time period – usually two to five years.
Many insurance providers will talk about their network which refers to the group of hospitals and healthcare providers who work within the offered health plan.
If you decide you would rather have your treatment on the NHS, some health insurance policies will give you a cash sum for not claiming – this is called an NHS cash benefit.
National Institute for Health and Care Excellence. Independent organisation which provides guidance on the most effective ways to prevent, diagnose and treat illnesses. Its recommendations inform which treatments are offered by NHS organisations. Sometimes private health insurance firms will provide access to treatments which NICE has not recommended for NHS use.
This is a discount offered when you renew or take out a new policy, based on the number of years of you have held a policy without making a claim.
Non-disclosure means not declaring information. When it comes to health insurance non-disclosure means you have failed to tell your insurers something important when applying for your policy, such as leaving out a current medical condition. As a result you may be refused cover or your claim could be rejected.
Occupational health refers to helping to keep employees healthy while at work and managing any risks in the workplace which could lead to work-related illness or poor health. Employers can offer occupational health schemes as part of an employee benefits package.
Occupational therapies are treatments designed to help people re-gain the ability to perform everyday physical activities, including walking, eating, dressing and bathing following an illness or injury.
An open referral is when you agree to have private health insurance cover only when you see certain pre-approved hospitals or consultants. It can make the premiums lower but it also limits your choice on where you can go for treatment.
Out of pocket refers to money you have to pay yourself, which isn’t covered by your insurance policy. It could be your excess or fees.
If a patient has treatment within a hospital or clinic but is then released straight home, with no need for supervised recovery time, they are called an out-patient.
Palliative treatment or care is designed to relieve the pain or discomfort of symptoms at the end of life. Palliative care is used for terminally ill people to help them live more comfortably.
Parent accommodation is when a policy covers the cost of parents staying within a hospital or nearby should their child be kept in overnight. This feature will have an upper-age limit for the child, varying between 9 and 16 years of age, and the child (not necessarily the parent) must be on the insurance.
Most family health insurance policies will allow for parent accommodation, but some include this only as an additional or optional benefit.
A pended claim is when an insurance claim has been submitted to the insurance provider but is still pending as more information is required before payment can be made.
Personal health funds or PHFs are used by businesses to help employees cover their everyday health expenses. It’s a personal ‘pot’ of money (usually between £70-£100) that each employee can access throughout a year to pay for expenses including sight tests, dental check-ups, dental fillings or chronic prescriptions.
Personal health funds are included as an additional benefit for business health insurance policies.
A PET scan (positron emission tomography scan) is a diagnostic scan that focusses on how your body tissues are working together. As an outpatient procedure, you can have a PET scan and go home the same day.
PET scans can help diagnose or monitor a number of health conditions.
Your policy document contains all the information about your policy, including your membership number, the terms and conditions and any payment conditions.
The Prudential Regulation Authority is run by the Bank of England and is responsible for the prudential regulation and supervision of banks, building societies, credit unions, insurers and major investment firms.
This is where your insurer needs to be contacted to confirm a proposed treatment is covered before it is provided. If your policy requires pre-authorisation you must do this, otherwise you could risk being liable for the cost of your own treatment.
A premium is the amount you pay for your insurance policy – this can be an annual or monthly fee and doesn’t include any required excess.
With a focus on preventing health problems from occurring or worsening, preventative care involves programmes such as health screening and monitoring.
Some private medical insurance policies include private ambulance cover which allows for transportation between treatment centres and your home, if needed for planned treatments.
An insurance provider is the insurance company which is providing your healthcare policy either directly to you or to your employer.
A healthcare provider is the place which is providing your care or treatment, such as a hospital or clinic.
Psychiatry is the treatment of mental health conditions by a psychiatrist and is usually covered in a comprehensive private medical insurance policy.
A quote for health insurance is an estimate of how much your policy will cost. Insurers will take into account a range of information including your age, lifestyle and medical history before providing you with a quote so prices can vary between policies and between providers.
A medical referral is a written request from your GP for you to go and see a specialist or consultant, or to undergo medical tests and treatments. A GP referral is often the first port of call for any ongoing health treatment. Some healthcare policies require a GP referral before they will pay for treatment or services received.
These are specialist health services which help restore the function or mobility needed to get back into daily life, after sickness or injury. Services might include physiotherapy, speech and language therapy and psychiatric rehabilitation services.
A renewal is when you decide to extend your insurance policy after its original term has finished. Generally health insurance policies renew on a yearly basis.
Insurance is all about mitigating risk. The more likely you are to claim on medical costs, the more risk you pose to your insurance provider, so the higher your premiums will be, to offset that potential cost.
Schedule is the name of the document which outlines the cover provided by your insurance policy, including cover limits and other terms and conditions.
Screening refers to health screening, which is a preventative approach providing tests and examinations to detect any problems or abnormalities. Screening can make you aware of any health issues so you can address them before they become health problems.
Self-referral is the process when you put yourself forward for medical tests, treatment or care, without seeing a GP first. You need to check if your insurance cover requires a GP referral before you make your claim.
A six-week wait on your insurance can help to lower the cost. It means you agree to be treated within the NHS provided the wait is six weeks or less. If the waiting list is longer you would go for private medical treatment as normal.
See CPME (Continued Personal Medical Exclusions) to find out about switching from one health insurance policy to another.
A total permanent disability means your insurer believes that, through accident, injury or illness, you are no longer able to work in your existing occupation or any other to which you are suited through your experience and qualifications.
Travel insurance is designed to protect you and your belongings whilst abroad and can cover areas like lost luggage, flight cancellation, lost passports and travel money.
TCF is part of the regulatory obligation upon a financial services business to pay due regard to the interests of its customers and treat them fairly. Companies have to demonstrate that treating their customers fairly is at the heart of their corporate culture. It is a key part of the Financial Conduct Authority’s regulatory regime.
This is the process which health and protection insurance providers use to assess your application and decide how much cover they will give you, and the cost. Underwriting can require a medical history or a medical examination.
If a company offers a group insurance scheme to its employees but they have to pay the premium out of their salary, this is known as a voluntary plan. It provides a benefit to the staff but at no cost to the business.
Some insurance cover includes a waiting period which is a time frame between taking the policy out and being able to make your first claim – this is to make sure you are not trying to claim on a pre-existing condition.
This is a policy add-on which will help to pay your life or critical illness policy premiums, should you be sick or unable to work.
An x-ray is a type of diagnostic test which looks at what is happening inside your body. Most private medical insurance policies would include these as part of a diagnostic test benefit.
This is the maximum limit your health insurance policy will cover for each illness or injury over the course of a year.