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Private health insurance - cutting through the jargon

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4 min read

by LifeSearch,

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Guide last reviewed 31 Mar 2024

Confused by health insurance jargon? Navigating the landscape of private health insurance can be daunting, especially when faced with a myriad of unfamiliar and confusing terms.

Before we dive into the jargon, you might be thinking that there’s ‘private health insurance’, ‘private medical insurance (PMI)’, and ‘private health cover’… and what’s the difference?

These are three common ways to describe the same kind of insurance policy. Different insurers and brokers have their own preferences.

Private health insurance helps to pay for some, or all, of the medical treatment that someone needs. Typically, it includes cover for costs of treatment, medical tests and diagnostic scans, elective surgery, hospital accommodation, consultant fees, treatment drugs and nursing care.

Now we’ve cleared that up, here are our top 10 common jargon terms explained, simply.

Acute conditions

An acute condition is a disease, illness or injury that is likely to respond quickly to the 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

These are diseases, illnesses or injuries that have one or more of the following characteristics:

  • ·needs long-term monitoring, control and relief of symptoms
  • continues indefinitely, and
  • or is likely to come back.,has no known cure

alongside that. cover ‘chronic conditions’. Although initial diagnostic tests are usually covered, if such test then leads to a diagnosis of a chronic condition, the long-term treatment needed won't be coverednotTypically, an insurer will

Coverage

This refers to the specific medical services and treatments that are included in your insurance policy. It's important to review your coverage carefully to understand what is and isn't covered.

Excess (also referred to as a ‘deductible’)

This is the amount you agree to pay towards a claim. For example, if your excess is £500, you'll need to pay the first £500 of covered expenses before your insurance starts to pay. The higher your excess, the cheaper your premium.

Underwriting

Underwriting is the term that insurers use to describe assessing risks and then offering a policy, based on those risks. There are two main types of underwriting approaches insurers adopt – full underwritten and moratorium. Your medical history might affect which types are available to you from each insurer.

Fully underwritten

This is a type of underwriting, where you disclose your full medical history from the start, the insurer then assesses this information and complex exclusions where they think it's necessary. While it may take a little longer, the benefit of this is you know from outset what is and what isn't covered.

Moratorium underwriting

This is a type of underwriting. It’s generally seen as the most straightforward approach, as he insurer will not cover treatment for any condition that existed in the past few years (usually, this is in the last five years, but the period of time may vary). It works on the basis that you need to prove you're eligible to make a claim is and when you make that claim. T you do not need to tell the insurer about your medical history when you apply for the policy.

Network

If you need treatment, it helps to be as close to home as possible. Also, it’s reassuring to be treated by specialists and a hospital that are recognised for their expertise in specific conditions.

Each insurer prefers their customers to use a defined group or network of hospitals and specialists. Usually, this is because the insurer has a pricing agreement in place with that network. Your insurer may also offer network options, from a very limited range to more extensive.

Pre-existing condition

This is a disease, illness, or injury that you've had treatment advice or medication for, or seen signs or symptoms of, before you took out the policy (whether or not that condition has been diagnosed). Depending on your insurer and your policy a pre-existing condition may be excluded entirely, or there may be a waiting or qualifying period before a claim can be made.

Qualifying period (sometimes called a wating period)

Some policies have a ‘qualifying’ or ‘waiting period’ which is an agreed amount of time that needs to pass after you've bought your health insurance policy before certain benefits, such as coverage for pre-existing conditions, can take effect


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