Health Insurance Jargon Buster

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Health insurance can be confusing, but we can help you understand the policies and their terms. Here are some standard terms to help you better understand health insurance:

  • 6-week option: Some policies require that you use the NHS for in-patient or day-patient care before making a claim. You can claim on your policy if you cannot receive NHS treatment within 4-6 weeks and have an eligible claim.
  • Acute flare-up: This is a sudden deterioration of a chronic condition that is likely to respond to prompt treatment and return you to your previous state of health.
  • Acute conditions occur suddenly, are curable, and respond quickly to treatment.
  • Chronic conditions have developed over time and may have no known cure. They often require ongoing or long-term monitoring or control of symptoms.
  • Continued Personal Medical Exclusions (CPME): This allows you to switch from one insurer to another while maintaining your existing exclusions. Insurers only allow this if you meet specific criteria.
  • Day-patient: You receive hospital care for one day without staying overnight.
  • Eligible condition: This refers to a condition covered by your policy.
  • Fee schedule: This is the amount an insurer pays for a procedure or consultant’s services.
  • Full cover promise: The insurer makes this promise to cover any shortfalls in agreed cover for eligible in- or day-patient treatment.
  • Full Medical Underwriting: This detailed underwriting process requires you to provide extensive information about your medical History, current conditions, and treatments. This process may result in medical exclusions being added to your policy.
  • In-patient: This is when you need an overnight stay in a hospital bed.
  • Medical History Disregarded: This type of underwriting does not consider pre-existing conditions.
  • Moratorium Underwriting: This is a more straightforward underwriting process that requires you to prove your eligibility for a claim when you make it. You may not be covered for medical or related conditions you’ve had in the previous five years unless you’ve been symptom-free for two straight years.
  • Continued Moratorium Underwriting: This is similar to Continued Personal Medical Exclusions and allows you to maintain your existing moratorium exclusions when switching insurers.

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