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glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Accident

This is when you sustain bodily injury caused by accidental external violent and visible means or as a result of a recorded act of negligence.

Acute condition*

A disease, illness or injury that is likely to respond quickly to treatment which 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.

Agreement

An agreement we have with each of the private hospitals, day-patient units and scanning centres listed in the Directory of Hospitals. Each Agreement sets out the standards of clinical care, the range of services provided and the associated costs.

Appointed doctor

A medical practitioner chosen by us to advise us on your medical condition and need for the evacuation or repatriation service.

B

Benefit(s)

The benefit(s) that we will pay to you depending on your cover level. The table of benefits shows the maximum benefits you can receive.

Benefit year

This is:

the 12 month period after you qualify for benefit, either after first becoming a member of the scheme or after you change your cover; and
every 12 month period after that for which you pay and we accept your premiums.

Benefits table

The table applicable to this policy showing the maximum benefits we will pay you.

C

Chronic condition*

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

it continues indefinitely and has no known 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

A claim for benefit under this policy.

Clinical practitioner

A practising member of certain professions allied to medicine who, because of their qualifications, we recognise for benefit purposes and in respect of whose services we will therefore pay benefits. However, we will only pay out-patient treatment benefits for such services when a specialist refers you to them (except where the benefits table allows otherwise).

When such persons provide such services to you as part of your in-patient treatment or day-patient treatment those services will form part of the private hospital charges.

The professions concerned are dieticians, qualified nurses, orthoptists, physiotherapists, psychologists, psychotherapists and speech therapists.

A full explanation of the criteria we use to determine these matters is available on request.

Complementary practitioner

A medical practitioner with full registration under the Medical Acts, who specialises in homeopathy or acupuncture or a practitioner in osteopathy or chiropractic who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice, and who we have told in writing that we currently recognise them as a complementary practitioner for benefit purposes in that field for the provision of out-patient treatment only.

A full explanation of the criteria we use to decide these matters is available on request.

Computerised tomography - a form of x-ray that produces a three-dimensional computer generated image of a section of the body.

D

Day-patient treatment*

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

Day-patient unit

A centre in which day-patient treatment is carried out. The units we recognise for benefit purposes are listed in the Directory of Hospitals.

Dental accident

A sudden and unexpected injury to the mouth, which causes damage to the teeth and/or gums, and results from a direct extra oral impact.

Dentist

A dental surgeon who is currently registered with the General Dental Council.

Diagnostic tests*

Investigations, such as x-rays or blood tests, to find or to help to find the cause of your symptoms.

Directory of Hospitals

Directory of Hospitals - a document we publish which lists the private hospitals, day-patient units and scanning centres in the United Kingdom covered by the policy. The facilities listed may change from time to time so you should always check with us before arranging treatment.

E

Eligible

Those treatments and charges which are covered by your policy. In order to determine whether a treatment or charge is covered all sections of your policy should be read together, and are subject to all the terms, benefits and exclusions set out in this policy.

Evacuation or repatriation service

Moving you to another hospital which has the necessary medical facilities either in the country where you are taken ill or in another nearby country (evacuation) or bringing you back to the United Kingdom (repatriation).

This service includes any necessary treatment administered by the international assistance company appointed by us whilst they are moving you.

Excess

You can choose to have an excess as a way of reducing your premium. It means that you pay a certain amount of your claim. An excess is calculated on your yearly premium and is only payable once per person and not for every claim.

Exclusions

Treatment or charges which are not covered by your policy.

F

Family member

The policyholder's partner and his/her unmarried children (or those of his/her partner) living with the policyholder when the policy is taken out or when it is renewed. By partner we mean the husband or wife or the person (whether or not of the same sex) the policyholder lives with permanently in a similar relationship.

H

Hospital

Any establishment which is licensed as a medical or surgical hospital in the country where it operates.

I

In-patient treatment*

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

M

Medical condition

Any disease, illness or injury, including psychiatric illness.

MRI

Magnetic resonance imaging - diagnostic technique producing computerised images of internal body tissues.

O

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.

P

PET

Positron emission tomography - diagnostic technique producing comuterised images showing the chemical functioning of an organ or tissue.

Physiotherapy

Physical treatment such as massage or exercise.

Policy

The insurance contract between you and us. Its full terms are set out in the current versions of the following documents as sent to you from time to time:

any application form we ask you to fill in
these terms and the benefits table setting out your cover
your membership statement and our letter of acceptance
the Directory of Hospitals.

Policyholder

The first person named on the policy membership statement.

Private hospital

A hospital listed in the current Directory of Hospitals.

Q

Qualified nurse*

A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

R

Radiotherapy/Chemotherapy

The use of radiation and drugs to treat cancer.

Receipt

The original receipt provided by the healthcare provider. All receipts for treatment must show the full name of the person who received the treatment. We will not accept receipts made out in joint names. The receipts should also fully describe the treatment received or the items paid for, the date of the treatment, the full cost and the date the account was paid.

We will not accept till slips, credit card sales vouchers, photocopied or altered receipts.

S

Scanning centre

A centre in which out-patient CT (computerised tomography), MRI (magnetic resonance imaging) and PET (positron emission tomography) is performed. The centres we recognise for benefit purposes are listed in the Directory of Hospitals.

Schedule of membership

The document showing the policy start date, premium due and those covered by the policy.

Specialist

A medical practitioner with particular training in an area of medicine (such as consultant surgeons, consultant anaesthetists and consultant physicians) with full registration under the Medical Acts, who meets our criteria for specialist recognition for benefit purposes, and whom we have told in writing that we currently recognise them as a specialist for benefit purposes in their field of practice.

For out-patient treatment only: a medical practitioner with full registration under the Medical Acts, who specialises in psycho-sexual medicine, orthopaedic medicine, manipulative or sports medicine, or a practitioner in surgical dentistry or podiatric surgery who is registered under the relevant Act; and who, in all cases, meets our criteria for limited specialist recognition for benefit purposes in their field of practice, and who we have told in writing that we currently recognise them as a specialist for benefit purposes in that field for the provision of out-patient treatment only. A full explanation of the criteria we use to decide these matters is available on request.

Sports activities covered abroad

There is no cover for sports activities marked with a + when they constitute the main purpose of your trip. There is no cover for sports activities marked with a # when you participate in the sport in any competitive capacity.

+Abseiling, Archery, Badminton, +Ballooning, Baseball, Basketball, Bowls, +Bungee Jumping, #Canoeing, #Catamaran Sailing, Clay Pigeon Shooting, Cricket, Cycling, Dinghy Sailing, Dry Skiing, Fell Running, Fell Walking, Fencing, Fishing, Football, Golf, Gymnastics, +Hang Gliding, +High Diving, Hiking, Horse Riding (but not hunting), Ice Skating, Lacrosse, Land Skiing, Marathon Running, #Mountain Biking, +Mountaineering (unless requiring ropes and guides or freestyle climbing), Orienteering, Paint Balling, +Parachute Jumping (except freefall), +Paragliding, +Parascending, Pony Trekking, Racquetball, Rambling, Roller Skating, Rounders, Rowing, Safari Trekking, #Sailing, Scuba Diving to a maximum depth of ten metres, Shooting, Skiing on Piste, Snorkeling, Squash, Surfing, Swimming, Tennis, Trekking, Volley Ball, War Games, Water Polo, #Water Skiing, +White Water Rafting if part of a Tour Operators excursion, Windsurfing, #Yachting within coastal waters.

Surgical procedure

An operation or other invasive procedure.