Health Insurance Glossary

Permanent Insurance

Coverage that can be continued relatively indefinitely (such as to age 65 for most permanent health insurance policies) as long as the policyholder makes scheduled premium payments and refrains from actions that would invalidate the policy (such as misrepresentations on the application).

Policy

The insurance agreement or contract

Policy Year

The twelve month period beginning with the effective date or renewal date of the policy.

Policyholder

The insured person named on the insurance policy.

Portability

The ability for an individual to transfer from one health insurer to another health insurer with regard to pre-existing conditions or other risk factors.

Pre-Admission Review

A review of an individual's health care status or condition, prior to an individual being admitted to a hospital or inpatient health care facility. Pre-admission reviews are often conducted by case managers or insurance company representatives (usually nurses) in cooperation with the individual, his or her physician or health care provider, and hospitals.

Pre-Admission Testing

Medical tests that are completed for an individual prior to being admitted to a hospital or inpatient health care facility.

Pre-Authorization

Under a pre-authorization provision of a health insurance policy, the insured must contact the health insurance company prior to a hospitalization or surgery, and receive authorization for the service.

Pre-Certification

This is a requirement that a insured person call their health insurance company and advise them a doctor has stated certain medical treatment is required. This is done before receiving treatment from the doctor or hospital. A health insurance policy will normally list the medical conditions that require pre-certification before receiving treatment. When pre-certification is not received, benefits will be reduced or possibly not covered.

Pre-existing Condition

A health problem that existed before the date your insurance became effective. Each health insurance company uses its own particular definitions of pre-existing condition. However, the following statement is in line with most insurance company provisions: "A pre-existing condition is a medical condition that would cause a normally prudent person to seek treatment during the twelve months prior to the beginning of coverage.".

Premium

The amount you or your employer pays in exchange for health insurance coverage.

Preventive Care

An approach to health care which emphasizes preventive measures and health screenings such as routine physicals, well-baby care, immunizations, diagnostic lab and x-ray tests, pap smears, mammograms and other early detection testing. The purpose of offering coverage for preventive care is to diagnose a problem early, when it is less costly to treat, rather than late in the stage of a disease when it is much more expensive, or too late to treat.

Prior authorization

Review of need for health care items or services before services are rendered or products are provided. This refers to a decision made by the health plan to cover or not cover the charges before the services are provided.

Provider

Any person (doctor or nurse) or institution (hospital, clinic, or laboratory) that provides medical care.



Contact Information

Medical Insurance Consultants
Park House
45 The Park
Yeovil
Somerset
BA20 1DF

T: 0800 163 870
E: [email protected]


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Accreditations

Medical Insurance Consultants Ltd is authorised and regulated by the Financial Conduct Authority and is entered on the Financial Services Register under reference 309026.

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