The Simplyhealth Glossary

We want to make things as simple as possible for you. That's why we explain the meaning of key terms used in the healthcare industry and across Simplyhealth here. If there is a word you're unsure of you may find it here. If you need more help just give us a call.

Please note this glossary is designed to provide you with a broad understanding of the terms used within the industry. This list does not include the specific definitions for your health plan terms and conditions. To see these it is always best to consult your policy document. 

Acupuncture
Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body. There is currently no government legislation in the UK covering acupuncture. This means that anyone can provide acupuncture treatment without any professional acupuncture training. The following bodies maintain standards of education, ethics, practice and discipline for their members.

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. This definition is an industry standard endorsed by the Association of British Insurers (ABI).

Association of British Insurers (ABI)
The Association of British Insurers was first set up in 1985 to be the voice of the entire insurance industry. It is now the UK's leading financial services trade association. They represent a wide rage of insurers to ensure that both they and the public receive the best security and risk protection.

BCWA
Bristol Contributory Welfare Association.  A private medical insurance company with mutual values dating back to 1935. Simplyhealth acquired it in 2005.

Cancer
A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Cash plan
See health cash plan

Chiropody and podiatry
There is no difference between a chiropodist and a podiatrist, they both diagnose and treat abnormalities and diseases of the lower limb. They assess and treat foot problems such as verrucas or deformity. Chiropodist and Podiatrist are titles protected by law. Only professionals registered with the Health Professions Council (HPC) can use these titles.

Chiropractic
Chiropractic treatment specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves, especially related to the spine.
Chiropractic treatment mainly involves specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. The title chiropractor is protected by law and as a result only those professionals who are registered with the General Chiropractic Council (GCC) can call themselves chiropractors.

Chronic condition
A disease, illness, or injury that has one or more of the following characteristics:

  • It needs ongoing or long term monitoring through consultations, examinations, check-ups, and/or tests
  • It needs ongoing or long term control or relief of symptoms
  • It requires your rehabilitation or for you to be specially trained to cope with it
  • It continues indefinitely
  • It has no known cureIt comes back or is likely to come back

This definition is an industry standard endorsed by the Association of British Insurers (ABI).

Continuation of pre-existing medical exclusions (CPME)
This means that we accept the underwriting conditions of your previous insurer. This makes it possible for you to change cover between insurers without the need for additional medical underwriting. This is sometimes referred to as switch cover.

Counselling
Counselling is a form of talking therapy where a patient is guided by their counsellor to talk through problems. Patients are encouraged to understand where the source of the problems and how to cope with their reactions to future difficulties. Counselling can be either a short or long term form of therapy. There is currently no government legislation in the UK covering counselling. The following sites bodies maintain standards of education, ethics, practice and discipline for their members.

CT Scan (Computerised Tomography)
A diagnostic tool that uses a rotating x-ray beam to take cross sectional images of body structures.

Day-patient / Day case
A patient who is admitted to hospital or day-patient unit because they need a period of medically supervised recovery, but does not occupy a bed overnight.

Denplan
Denplan was founded in 1986 to provide UK patients with an alternative to NHS dentistry. They offer several different plans including a simple membership plan and a capitation plan which is where you pay monthly instead of claiming money back after treatment. Denplan covers preventative care and includes general maintenance and emergency appointments.

Dental
Dental refers to all things to do with the teeth, diagnosis and treatment by a dentist. The title dentist is protected by law and as a result only those professionals who are registered with the Health Professions Council (HPC) can call themselves dentists.

Dependant
Wife, husband, partner or child.

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

Exclusion
Something that is not covered by your health plan, for example pre-existing conditions.

Fee Schedule
A fee schedule is for any treatment that is received that exceeds the cover by Simplyhealth

General Practitioner (GP)
A doctor who is on the GP Register (a register of doctors who are able to work in general practice in the health service in the UK) of the General Medical Council and who has a current Licence to Practise.

Health cash plan
A health cash plan offers money back on everyday healthcare bills, like trips to the optician, dentist or physiotherapist, up to annual limits.

Health Screening
A health screen is a test done before there are symptoms to help catch potential  or developing diseases early. The tests vary depending upon age, weight, sex and family history. They come in the form of countrywide screenings and individual tests recommended by a doctor.

Homeopathy
An alternative medicine that is based on the principle of 'like with like', and that a substance which causes symptoms when taken in large doses, can be used in small amounts to treat those same symptoms. There is currently no government legislation in the UK covering homeopathy. This means that anyone can provide homeopathy treatment without any professional homeopathy training.
The following bodies maintain standards of education, ethics, practice and discipline for their members.

Hospital
Any hospital in the current Simplyhealth Hospital Directory.

Hospital In-patient Benefit (HIP)
Hospital in-patient, parental stay and day case benefit.

Hospital Saving Association (HSA)
Leading cash plan provider founded on mutual values in 1922. Included within the Simplyhealth brand from 2009.

Indemnity
The promise to return the insured to the position they were before a loss.

In-patient
A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.

Insurance Premium Tax (IPT)
A tax on general insurance premiums. There are two rates:

  • a standard rate of 6 per cent (increased from 5 per cent on the 4 January 2011)
  • a higher rate of 20 per cent (increased from 17.5 per cent on the 4 January 2011) for travel insurance and some insurance for vehicles and domestic/electrical appliances

Leeds Hospital Fund (LHF)
A cash plan provider with mutual values dating back to 1887. It joined HSA to form the Simplyhealth Group in 2003.

Medical underwriting
To underwrite your policy we, as the insurer, will ask you to  give details of your medical history. We may write to their doctor for more information, but do not do so in every case. You must give all the information you are asked for, because if you don't, we may refuse to pay any claim that you make in the future, or may cancel your policy.

Membership Certificate
Provides details of the chosen form of medical underwriting and any personal restrictions that apply to your policy.

Modular
An insurance product that offers you the choice to purchase different options depending on your needs.

Moratorium
The period of time during which existing conditions are excluded.

Moratorium underwriting
A form of medical underwriting that removes the need for a full medical history declaration to be completed. If a moratorium applies we would not pay benefit for any medical condition that had symptoms or treatment in the five years before the date cover started. We would expect you as a customer to be symptom and treatment free for two years before the condition is eligible for cover.  This two year period rolls forward from the last date of treatment or symptoms were experienced.
 
MRI scan (Magnetic Resonance Imaging)
A diagnostic tool that uses magnets and radio frequency waves to take cross sectional images of body structures.

NHS
The National Health Service (NHS) first started in 1948, it was designed to provide free health care to all in the United Kingdom. It has expanded rapidly, funding research and providing care for people in all medical fields.

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

Optical
Optical refers to sight and the treatment of the eyes to improve sight. This involves the diagnosis of vision problems and the correction through the use of optical aids.  The title optometrist is protected by law and as a result only those professionals who are registered with the General Optical Council (GOC) can call themselves optometrists.

Osteopathy
Osteopathy is a form of medicine that involves a practitioner realigning the muscles, bones, ligaments and connective tissue in the body. This is done by manipulating the muscles and joints. It works on the premise that when the whole body is properly aligned it can begin to heal itself. It is used as an alternative to medical drugs and surgery where possible. The title osteopath is protected by law and as a result only those professionals who are registered with the General Osteopathic Council (GOsC) can call themselves osteopaths.

Out-patient
A patient who attends hospital, consulting room or out-patient clinic and is not admitted as a day-patient or in-patient.

Physiotherapy
Physiotherapy uses physical methods such as massage and manipulation to help restore movement and function when someone is affected by injury, illness or by developmental or other disability. The title physiotherapist is protected by law and as a result only those professionals who are registered with the Health Professions Council (HPC) can use it.

Private Medical Insurance (PMI)
Private medical insurance is designed to cover the costs of private medical treatment, for what are commonly known as 'acute conditions' that start after the policy begins.

Policy
A contract of insurance between you and Simplyhealth. At Simplyhealth we refer to our products as health plans.

Policy Document
The full terms and conditions that relate to a health plan. For private medical insurance this may include a Membership Certificate.

Pre-existing condition
Any disease, illness or injury for which you the customer

  • has received medication, advice or treatment or
  • has experienced symptoms, whether the condition has been diagnosed or not in the five years before the start of your cover

Preferential
A comprehensive private medical insurance plan from Simplyhealth for company groups with fewer than 100 members. 

Reflexology
Reflexology is based on the theory that different points on the feet and/or hands correspond with different areas of the body. There is currently no government legislation in the UK covering reflexology. This means that anyone can provide reflexology treatment without any professional reflexology training. The following bodies maintain standards of education, ethics, practice and discipline for their members.


Self funded health plan
Self funded health plans are suitable for larger companies. A typical self funded health plan is set up as a trust. The employer determines what benefits should be available and any limits that should apply. The likely cost of providing those benefits over the next year is then calculated.

Next, the employer places funds into the trust to meet the cost of claims as they arise. The employer may pay in the estimated first year's expected claims, or may pay in a float or deposit, with claims costs fed into the trust, typically monthly in arrears.

An administrator (sometimes called a third party administrator or TPA) is appointed to run the plan. The administrator gives advice, manages all claims and other administration, manages provider networks and all intervention with healthcare professionals and ensures that the scheme's objectives are met.
Simplyhealth provides this administration for a number of large organisations. As of 2012, this includes British Airways, Honda, EON and Astra Zeneca among many more.

Simplyhealth Independent Living
Simplyhealth Independent Living offers a range of mobility products and daily living aids through its Independent Living centres and the 'Store' area of www.simplyhealth.co.uk. It also provides free home mobility assessments for those who are not able to visit an Independent Living centre.

Specialist/consultant/surgeon
A doctor who holds or has held an NHS consultant post, is on the Specialist Register held by the General Medical Council and has a current Licence to Practise.

Subrogation
Acting on behalf of the insured person in the event of a claim.

Treating Customers Fairly (TCF)
An FCA initiative to ensure we treat customers fairly at all times. The FCA expects firms to:

  • be able to demonstrate that senior management have instilled a culture whereby they understand what the fair treatment of customers means; where they expect their staff to achieve this at all times; and where (a relatively small number of) errors are promptly found, put right and learned from
  • be appropriately and accurately measuring performance against all customer fairness issues materially relevant to their business, and be acting on the results
  • be demonstrating through those measures that they are delivering fair outcomes
  • have no serious failings - whether seen through management information (MI) or known to the FCA directly - including in areas of regulatory interest previously publicised by the FCA

Treatment
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.

Underwriting
See Medical underwriting and Moratorium underwriting.

Utmost Good Faith
The responsibility of the insured person and insured company to provide the correct information at all times.