When such terms are used in private medical insurers' policy documents, the insurers? definitions should be relied upon rather than those given below, which have been provided only for your initial guidance. The ABI PMI guide which can be downloaded from our Useful Links page should also be consulted.
| Acute Conditions |
Curable, short-term illness or injury. |
| Alternative Therapies |
May include osteopathy,
chiropractic, acupuncture, and homeopathy. |
| Cash Benefit for Treatment by the NHS |
Money back payment from
the insurer for electing to have treatment by the NHS instead
of exercising the right to private treatment. |
| Cash Plan |
Partial cash reimbursement of insured’s costs
of optical, dental, alternative therapies, and
chiropody, etc. and cash benefits for admission to hospital and
maternity benefit etc. |
| Chronic Conditions |
Long-term illnesses that cannot currently be cured! |
| Claims procedures |
Increasingly, leading insurers agree claims
by telephone, whenever possible, rather than by
claim form. |
| Consequences of non-disclosure |
When making a medical history
declaration, it is essential that a full disclosure is made,
otherwise the insurance provider may reject any subsequent claims. |
| Continuing medical exclusions (CME terms) underwriting |
When switching cover from one insurer to another on CME terms, medical conditions excluded from cover by the previous insurer as detailed on the membership certificate, will continue to be excluded by the new insurer, but conditions suffered while covered by the previous insurer will continue to be covered by the new insurer subject to the terms of cover provided by the new insurer. Advice should be sought before cancelling cover with your present insurer and switching to a new one. |
| Day-patient |
Admission to hospital for a day without the need
to stay overnight. |
| Dentistry |
Routine dental treatment not involving oral surgery. |
| Excess |
The amount the insured person agrees to pay towards his/her
treatment in order to reduce the cost of
cover. (Usually paid only once on the initial claim per person
per policy year). Some policies apply the excess for the initial claim for each different medical condition claimed for in a policy year. |
| Full Medical Underwriting |
Requires the proposer to provide
details of his/her previous medical history and to give the
insurer permission to seek further information from the proposer’s
GP. Pre-existing conditions that occurred prior to the commencement
of cover, will normally be excluded from cover. |
| Inflation of Medical costs |
The increasing cost of medical treatment
year on year resulting partly from the increasing
sophistication of treatments and diagnostic tests. |
| In-patient |
A person who is admitted to hospital for treatment and for medical reasons has
to stay for
one or more nights. |
| Medical History Disregarded |
For groups of 20/25 or more directors
and employees and for an additional cost, any pre-
existing medical conditions suffered by members of the scheme
will be covered, provided they fall within the terms and conditions
of the scheme. |
| Moratorium |
The proposer is not required to declare his/her
medical history on application, but any pre-existing condition suffered in
(usually) the previous five years will eventually be covered
if no symptoms, treatment, medication, tests or advice is received
for that condition for a further period of (usually) two years |
| Out-patient |
A person treated in a hospital, consulting room
or clinic, but not as a day-patient or in-patient. |
| Overseas Cover |
Cover for treatment and if necessary, repatriation
if you are ill or injured overseas. |
| Parent accompanying a child |
The cost of accommodation in hospital
for a parent accompanying a child under the age of 9
(for some policies under the age of 14). |
| PMI |
Private Medical Insurance |
| Pre-existing Conditions |
Any conditions (disease, illness or
injury) for which the applicant has received medication, advice
or treatment or has experienced symptoms, whether diagnosed or
not, before insurance cover commenced. |
| Private Hospital |
A hospital that charges fees for all its services. |
| Private Wing of an NHS hospital |
Private fee-paying wards within
NHS hospitals. |
| Related Conditions |
A medical condition, (symptom, illness,
disease pre-existing conditions or injury) arising from or associated
with a pre-existing condition. |
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