Jargon Buster | FAQs | Tips for buying PMI

Private Medical Insurance Jargon

With any product or service, there can be a lot of new jargon to understand when considering private medical insurance. We believe in keeping things simple, so here are some explanations about some of the most common terms.

• Underwriting

• Moratorium Underwriting

• Acute conditions

• Chronic conditions

• In-patient

• Day-patient

• Out-patient

• Diagnostic tests

• No claims discount

• Medical history disregarded

• Medical inflation

• Excess

• 6 week option

• Pre-existing medical conditions

• Psychiatric cover

• Fee approved specialist

• Fee limited specialist

Underwriting

Underwriting is the process that insurers go through to assess the risk of applicants for insurance policies. Underwriting will determine the cover you have for any pre-existing conditions and the impact and cost of certain policies.

Underwriting options for our MYWellbeing Private Medical Insurance are: Continued Personal Medical Exclusions (CPME), Full Medical Underwriting (FMU), or Moratorium underwriting. CPME underwriting (not always available) will provide cover for pre-existing conditions that are covered under an existing scheme, as well as any new conditions (subject to terms and conditions).

Moratorium Underwriting

Moratorium is a style of underwriting used by insurers where you do not 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.

Acute conditions

An acute condition is typically defined as a disease, illness or injury that is likely to respond quickly to treatment that 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.

Chronic conditions

A chronic condition is typically a disease illness or injury that has one or more of the following characteristics: it needs long-term monitoring, control or relief of symptoms, it requires rehabilitation, it continues indefinitely, and it has no known cure or is likely to come back.

In-patient

An in-patient is someone admitted to hospital for medical reasons and who occupies a bed overnight or longer.

Day-patient

A day-patient is someone admitted to hospital or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.

Out-patient

An out-patient is someone who attends a hospital, consulting room or out-patient clinic and is not admitted as a day-patient or in-patient.

Diagnostic tests

Investigations, such as x-rays, blood tests or scans, to find or help to find the cause of your symptoms.

No claims discount

If you have a no claims discount (NCD) on your policy, this means that certain claims you make on your policy will directly affect the premium that you pay at your following renewal. NCD's also allow you to benefit for not claiming, by increasing your discount, offsetting part or all of the increase you would normally see for age and medical inflation. The NCD's offered by each insurer differ, and we can talk you through how yours works. You shouldn't avoid claiming for the sole purpose of maintaining your NCD; it is recommended that whatever the level of illness, you should use your PMI and other policies and the benefits they offer.

Medical history disregarded

Medical history disregarded is when a client applies for Private Medical or other forms of insurances and cover is provided for pre-existing medical conditions. Where a policy has medical history disregarded, they will not be asked to provide information about any existing medical conditions they have.

Medical history disregarded is not usually available to you as a new customer to individual PMI, but could be available if you are coming off a company paid scheme.

Medical inflation

Medical inflation is an inflationary factor applied to medical insurances each year that takes into account the rising costs of treatment (particularly the more advanced treatments) and the fact that usually increasing numbers of people are claiming each year.

Excess

An excess is the amount of money you must contribute towards eligible treatment costs covered by your policy each year. The excess applies to each person covered by the policy. The excess will be applied either per claim or per policy year. Please see your policy documents for details of how your excess works, or speak to one of our healthcare experts.

6 week option

The ‘6 week option’ offers you the same benefits but only if the NHS cannot provide treatment for any surgical in-patient or day-patient treatment within 6 weeks of the date of diagnosis.

Pre-existing medical conditions

A pre-existing condition is a medical condition that an individual had before they started their medical insurance. This includes any medical condition that they had experienced symptoms for, even if it had not been diagnosed.

Psychiatric cover

Psychiatric cover provides benefit for the treatment of mental health illness such as anxiety, depression and stress.

Fee approved specialist

A medical specialist that has been identified as someone whose fees for eligible treatment the insurers routinely pay in full.

Fee limited specialist

This is a medical specialist that the insurer will only pay up to a set amount towards their treatment fees. Any shortfall in their fees will need to be paid for by you.