Health Insurance Glossary

The insurance industry is awash with jargon. This is particularly the case when it comes to health insurance. Set out below are some of the more common terms you may come across together with an explanation of what they mean:

Acute condition

A condition, disease, illness or injury which is serious but which is also likely to respond to treatment in the foreseeable future (as distinct from  a chronic condition - see below)

Agent

An intermediary who acts for more than one insurance company - particularly in the context of selling their insurance products to consumers

Appointed doctor

A qualified medical practioner selected by the insurance company to give advice on the medical condition of the insured party

Chronic condition

A condition, illness, disease of injury which displays one or more of the following characteristics:

 - likely to continue indefinitely
 - recurs or is likely to recur
 - is permanent
 - requires the patient to be rehabilitated
 - requires long term monitoring, regular consultations, check ups or examinations

Clinical practitioner

A medical professional, recognised by his or her professional body, who the insurance company has deemed to be as competent to give advice to or treat the condition of the insured party

Complementary practitioner

A medical practitioner, registered under the Medical Act (or other relevant piece of legislation)  specialising in certain alternative medical treatments (such as homeopathy and acupuncture) who the insurance company recognises as being competent to give advice to or treat the insured party

Condition

As distinct from acute or chronic condition: an event that needs to have occurred before the insurance company is liable to make payments under the policy

Day-patient treatment

Treatment which requires the insured party to go into hospital for the day either for medical treatment or for recovery purposes

Day-patient unit

A medical unit specialising in day patient care

Diagnostic tests

Tests designed to ascertain the cause of the symptoms of the insured party

Directory of hospitals

A list of hospitals, day patient centres and other medical facilities approved by the insurance company as being eligible places for treatment under the terms of the policy

Eligible

Those conditions and treatments for which the insurance company will make payments under the terms of the policy

Family member

The policy holder's partner and his/her unmarried children (and those of his/her partner) living with the policy holder when the policy is taken out. The definition of 'partner' will vary from policy to policy. However, a common definition is: 'the spouse of the insured party (whether or not of the same sex) living permanently with them or in a similar relationship.'

In-patient treatment

A condition that requires the policy holder to stay in hospital (or in any other medical establishment) over night for treatment

Medical condition

Any disease, illness or injury recognised by the medical profession

Out-patient treatment 

Any treatment in a hospital or other medical establishment that is not either in-patient treatment or day-patient treatment

Policy

The contract between the insured party and the insurance company - including any schedules and appendices attached to it

Private hospital

A hospital that accepts private patients and which is included in the insurance company's directory of hospitals

Qualified nurse

A nurse who is on the register of the Nursing and Midwifery Council

Scanning centre

A medical centre specialising in computerised tomography, magnetic resonance imaging and position emission tomography

Specialist

A medical practitioner, registered under the Medical Acts or other relevant piece of UK legislation, who the insurance company has recognised in writing as being a specialist in his or her field of medicine

Surgical procedure

Any operation or other piece of invasive surgery carried out by a medical practitioner who is registered under the Medical Acts or other relevant UK legislation

Treatment

Surgical or medical services that are required to diagnose, relieve or cure a disease, illness or injury