Health Insurance Policy: Glossary of Terms

Benefit

The amount we will pay under the Policy and shown in the table of Benefits and Schedule of Procedures

 

Chronic

A disease, illness or injury which has at least one of the following characteristics:

• It continues indefinitely and has no know cure
• It comes back or is likely to come back
• It is permanent
• You need to be rehabilitated or specially trained to cope with it
• It needs long term monitoring, consultations, check-ups, examinations or tests

 

Claim

When you ask us to authorize treatment and we agree to pay benefits

 

Continued Personal Medical Exclusion 

This type of underwriting is only available for corporate clients. 

With Freedom Healthnet, your company can apply for a health insurance policy on a Continued Personal Medical Exclusion underwriting or CPME.  

CPME applications are accepted on the basis that we receive a valid Insurance Certificate from the previous insurer detailing any personal exclusion that may apply to the policy. 

Once the certificate is received by us, any exclusion applied to the policy previously will be transferred to your new health insurance policy with Freedom Healthnet and will appear on the Insurance Certificate issued to you. 

 

Day-patient treatment

Treatment which, for medical reasons, means you have to go into hospital or day-patient unit because you need a period of clinically-supervised recovery but do not have to stay overnight.

 

Compulsory Excess

The amount of money shown on your Certificate of Insurance that you must pay towards the cost of a claim. The excess is payable only once for each course of treatment.

 

Fixed price

Treatment in hospital for which the costs have been negotiated by you prior to treatment taking place.

 

Full medical underwriting

The assessment of the health risk based on the detailed medical history questionnaire completed, where applicable, by you and from which the terms and conditions of our acceptance of the application are decided and applied to the Policy at the commencement date.

 

This type of underwriting is available for both individual and corporate clients. It allows you to know exactly what you are and are not covered for from the onset of your policy commencement. 

We will ask you to complete an application form detailing all medical conditions/ symptoms you have suffered in the last five years. Our underwriters will then assess the information provided on the application and once assessed any personal exclusions will be applied to the policy and shall appear on your Insurance Certificate.

 

General practitioner

A registered medical practitioner with full current registration with the General Medical Council, working in the UK and recognised by us.

 

Hospital

1. Listed hospital: A private hospital registered under the UK’s Care Standards Act 2000.
2. NHS Hospital: A hospital run by the National Health Service which provides specialist facilities for treatment.

Hospital charges

Charges for accommodation, nursing, operating theatres, drugs, dressings, pathology, radiology and any other charges made by a hospital for treatment.

 

In-patient treatment

Treatment which, for medical reasons, means you have to stay in hospital overnight or longer.

 

Medically necessary

Service or supplies which are:

1. Appropriate for the signs, symptoms, diagnosis or treatment of the injury or disease.
2. Provided for the diagnosis or direct care and treatment of the injury or disease.
3. Within standards of good medical practice within organised medical community.
4. Not primarily for the convenience of the Insured Person or any other participating supplier providing appropriate covered services to the Insured Person.
5. An appropriate supply and level of service needed to provide safe and adequate care.

Medical necessity shall be decided by our Chief Medical Officer.

 

Moratorium

This type of underwriting is available for both individual and corporate clients. 

The purpose of a Freedom Healthnet health insurance policy, as with all insurance, is to provide cover for the unexpected. This means cover for the cost of treatment of acute conditions (disease, illness or injuries that are likely to respond quickly to treatment) which arise after the start of the policy. 

We exclude any conditions for which medication has been received, advise or treatment given or any symptoms experienced whether the condition has been diagnosed or not in the five years before the start of the cover. These are known as pre-existing conditions. 

Related conditions, those which are medically considered to be associated with a pre-existing condition, will also not be covered. 

However, if you have not had any such symptoms, treatment, medication or advice for a pre-existing condition or any related condition for a continuous period of two years after the start date of your policy for a particular condition, the condition will become eligible for cover under your Freedom Healthnet insurance policy. This is known as the Moratorium.

Out-patient treatment

Treatment given at a hospital, consulting room or out-patient clinic where you do not go in for day-patient or in-patient treatment.

 

Palliative Care

Any treatment given for the sole purpose of relieving symptoms rather than attempting cure of a medical condition.

 

Pre-existing condition

A disease, illness or injury for which you have received medication, advice or treatment or you have experienced symptoms whether the condition has been diagnosed or not in the five years before the start of your cover.

 

Primary Care

The advice, treatment and investigations provided by your General Practitioner, optician or dentist without any involvement of a specialist (e.g vaccinations and routine medical examinations).

 

Professional sports injury

A sport where an income is received

 

Schedule of procedures

A Schedule of Procedures that we recognize and approve for benefits based on usual and customary charges as determined by our Chief Medical Officer. We reserve the right from time to time, and without notice, to adjust the prices of individual procedures to reflect changes in technology or the cost of treatment.

 

Self pay

Treatment which is entirely paid for by you.

 

Switch Moratorium 

This type of underwriting is only available for corporate clients. 

If your company is currently insured and you wish to transfer your policy to Freedom Healthnet, you can apply for cover under switch moratorium basis and not loose any of your existing moratorium underwriting. 

In order to proceed with such underwriting, we would require a copy of your previous insurer’s certificate. Once received, we input the moratorium date shown on the certificate as your original policy start date. This way, you will carry forward your moratorium terms. Please note we cannot accept policies on this underwriting basis without copies of a previous insurer’s certificate.

 

Voluntary Excess

The amount of money shown on your Certificate of Insurance which you have agreed to pay towards the cost of each treatment. This is in addition to any compulsory excess.