Underwriting
The process an insurer uses to decide the terms on which it will cover a person or group, including how existing medical conditions are treated.
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Moratorium underwriting
A type of individual underwriting where you do not usually complete a full medical questionnaire at the start. Recent or ongoing conditions are normally excluded initially and may become eligible later if the insurer’s required symptom-, treatment- and advice-free period is met. Exact rules vary by insurer.
Full medical underwriting
Each person provides medical history at the outset. The insurer then confirms any personal exclusions or restrictions before cover starts.
Medical history disregarded (MHD)
A group underwriting basis where eligible pre-existing conditions may be covered, subject to the policy terms and benefit limits. It is usually available only where insurer eligibility and group-size rules are met.
Continued personal medical exclusions (CPME)
When moving insurer, existing personal exclusions may be carried across rather than reassessed, subject to the new insurer accepting the transfer and its terms.
Member addition / joiner
Adding an eligible employee or other permitted person to the scheme. The insurer normally needs their details, requested start date and confirmation that eligibility rules are met.
Leaver / member removal
Removing someone who is no longer eligible for the scheme, usually because they have left employment or the company benefit has ended.
Dependant
An eligible spouse, partner or child added to an employee’s cover. Age, relationship and residency rules vary between schemes and insurers.
Scheme eligibility
The agreed rules defining who can join the policy. For example, all employees, directors, a defined seniority group or employees after a qualifying period.
Benefit
A service or treatment the policy may pay for, such as consultations, diagnostic tests, surgery, therapies or mental health treatment, subject to the policy terms.
Outpatient cover
Cover for treatment where the patient does not stay in hospital overnight, such as specialist consultations, scans, tests and some therapies. It may be full, limited or excluded.
Inpatient cover
Cover for eligible treatment requiring an overnight hospital stay.
Day-patient cover
Cover for eligible hospital treatment where a bed is used but the patient is discharged the same day.
Therapies
Treatments such as physiotherapy, osteopathy or chiropractic care. Access routes, practitioner requirements and benefit limits vary.
Excess
The amount a member pays towards eligible claims before the insurer contributes. It may apply per person, per policy year or per claim depending on the scheme.
Hospital list
The hospitals and treatment facilities available under the policy. Broader lists usually give more choice but may cost more. Some London hospitals may sit on separate options.
Guided hospital option
An arrangement where the insurer guides a member to an eligible hospital or specialist when treatment is needed, rather than providing a fixed broad list from the outset.
Six-week option
Private inpatient or day-patient treatment may be available only when the NHS cannot provide it within the policy’s stated waiting period, commonly six weeks. Exact wording varies.
Chronic condition
A long-term condition that generally requires ongoing monitoring or management rather than treatment expected to cure it. PMI commonly limits or excludes routine chronic-condition management, although acute flare-ups may sometimes be eligible.
Acute condition
A condition expected to respond to treatment and return the person broadly to their previous state of health. PMI is mainly designed for eligible acute treatment.
Pre-authorisation
Contacting the insurer before treatment to confirm whether it is eligible and to obtain an authorisation reference. Members should follow the insurer’s claims process before arranging treatment.
Renewal date
The annual date on which the policy terms and premium are reviewed and the scheme renews, if the client accepts the new terms.
Market review
Comparing the current scheme against suitable alternative insurers and benefit structures, considering cover, underwriting, service and price.
Premium
The amount charged by the insurer for the policy. It may be shown monthly or annually and can change at renewal or following membership changes.
Claims experience
Information about the cost and pattern of claims on a scheme. Insurers may use it when setting renewal terms, particularly for larger groups.
These are general explanations, not your policy wording.Benefits, eligibility and underwriting rules vary. Check your scheme documents or ask the Secure Choice team about your exact cover.
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