Medical Insurance Jargon Explained
There are many words and phrases used in Medical insurance policies that you may not understand, but it is important that you do otherwise you may be agreeing to something, or not stating important information which may leave you uncovered.
Here is our guide to the most common words and phrases, what they mean and why you must know about them.
This is the amount of money that you have to pay towards any claim. For instance, if you were covered for a claim for £2000 with an excess of £1,000 you would only receive a payment of £1,000. Make sure you understand your excesses when you take out a new policy so you are clear about how much you must contribute towards any claim. Excess amounts can vary from one policy to another and you will often be asked to choose the level you want (usually a higher excess means a lower premium).
This is the amount you pay for your plan for your insurance. This could be paid monthly; quarterly or annually. It is usually cheaper to pay your premium in one annual amount.
An illness, injury or related medical condition which existed before you bought your insurance policy.
Any illness or condition occurring between the time of signing and submitting your application and your insurer accepting it will also be considered a pre-existing medical condition.
When declaring your medical history to an insurer it’s important to be truthful and honest or your policy may be invalid when you need it the most – insurers don’t have to pay if you have not been truthful.
These are illnesses, diseases or injuries that happen suddenly and respond quickly to treatment. They are not recurring or long term illnesses.
These are illnesses, diseases or injury’s that are at least one of the following:
- Do not have a cure (but can be controlled by medication or therapies in some cases)
- Gradually worsening
- Lead to a permeant disability
- Require long term treatment or supervision
- Require you to be rehabilitated or undergo training to help manage them
You are considered to be an in-patient when you need to occupy a bed for treatment in a hospital during the day or overnight. It generally involves you being admitted into the hospital for your treatment.
You are considered to be an out-patient when treatment is given to you in a hospital, clinic or consulting room but where you are not admitted and do not need to occupy a bed or stay overnight.
Full Medical Underwriting
This is where your insurer will ask you a series of questions about your medical history which you must answer truthfully and honestly. It is important to fully disclose all of your medical history otherwise your policy may become invalid.
This is a period of time where you are not covered for a medical condition you may already have (a ‘pre-existing’ condition) but which may be covered at a future date provided you can prove that you have been free of any symptoms or treatments for a specified period of time. Moratorium periods can vary from one insurer to another, so make sure you understand how yours works. For example, some medical conditions may need to be symptom and treatment free for two years before they can be covered, while for others it may be five years.
If your insurer asks that you declare any ‘material facts’ is means that you must tell them about anything you know that may impact their decision to cover you. For example, this could be a medical condition that you already suffer from. The insurer would want to know about this as it may impact their decision on what cover to offer and any terms that may apply.
The best thing to do it disclose everything that you feel they may need to know. It’s better to be safe and covered than sorry!
Reasonable & Customary Charges
Medical insurers often use this term, or variations of it (‘Fair & Reasonable’ is another example) when considering claim costs - but what does it mean?
Medical providers around the world do not charge the same price for the same treatment. So, to protect themselves and their clients from large varying costs within a local area, insurers state that they will pay medical costs which are reasonable and customary.
This essentially means costs which are about average for that specific treatment in that area where it is being provided. This average figure is arrived at by comparing the prices of various treatment providers in an area and considering things like quality, experience and so on.
They want to pay fair prices and to avoid unreasonable overcharging because that ultimately leads to having to increase all clients’ premiums, which is something no one wants.
This is where a patient that is receiving treatment occupies a hospital bed but is not medically needing to stay overnight.
A Co-Pay is like an excess – it’s an amount you have to contribute towards the cost of a claim. The difference between a Co-Pay and an excess (or deductible) is that the co-pay is expressed as a % of the cost of the claim, whereas an excess is a fixed sum.
So, for example, if you had a £250 excess and the claim was £300, you would only get back £50 (£300-£250). But if you had a 20% co-pay you’d get back £240 (£300-20%). If it was £10,000 the excess would still be £250 so you’d get back £9,750 whereas the 20% co-pay would be £2,000 and you’d get back only £8,000.
Visit the expat medical insruance page on our website here for more information on the services we provide or call one of our London based sales staff on +44 (0)207 590 8800