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Glossary of Insurance and Medical Terms and Definitions

Some words and phrases used in WPA policies have a particular meaning and this is explained below.

These definitions may not all apply to your particular policy, depending on the cover it offers.

Active treatment
Treatment that is of curative intent.
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 n immediately before suffering the disease, illness or injury, or which leads you to your full recovery.
Advanced therapeutics (Targeted/Biological therapies)
Drugs that stop cancer cells from multiplying or developing a blood supply to sustain themselves and spread. These new agents usually cause fewer side effects than traditional chemotherapy.
Annual renewal date
Normally the anniversary of the date you joined the policy except that for some group policies it will be the anniversary of the day when the group policy was first registered.
A malignant process of tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.
Certificate of Registration
The Certificate of Registration issued by us or the certificate which confirms:

* The level of cover;
* The people covered by the policy;
* Their dates of birth;
* The policy start date;
* The main address;
* How you have chosen to pay, the amount and when the premiums are due;
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, checkups, 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 cure;
* It comes back or is likely to come back.
A request for payment of a benefit for which qualifying expenses have been incurred under the terms of the policy and in line with its rules.
Claim declaration
The document that you and the provider of your treatment sign telling us the details of your claim which we will use to confirm that it is covered.
Clinical trial
An NHS based research trial that has local research and ethical approval and is registered by a non-commercial organisation such as the Medical Research Council or UKCCR. Any side effects or complications that result from the trial would not be covered as they are funded by the NHS.
Consultant Oral/Maxillo Facial Surgeon
A medical practitioner whose name appears on the GMC Specialist Register;
The policy consists of your completed, signed and dated application, this Guide, your Certificate of Registration and any other document setting out information affecting the rights and obligations of each of us concerning policy membership. Your family members will also be treated as party to the policy and so are bound by its terms.
Corporate healthcare trusts
WPA´s health insurance scheme for companies with 400+ members who wish to self fund their employee´s healthcare.
Cosmetic/aesthetic treatment
This is treatment intended to improve the patient´s appearance.

* Cosmetic or aesthetic treatment whether or not for psychological purposes;
* Any form of cosmetic dentistry (e.g. bleaching, veneers or further treatment relating to cosmetic surgery).
The benefit under your policy;
Curative intent
Curative intent applies when treatment is administered with a reasonable expectation, both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and the patient will be alive and disease free 5 years after commencement of the treatment.
Customary and reasonable
The level of fees that are charged by the specialist´s medical colleagues to the majority of our policyholders for the same treatment and which is considered reasonable and fair by our Medical Advisory and Clinical Governance Committee.
Dangerous activities/circumstances
Care and/or treatment arising from or related to you or any family members taking part in winter sports of any kind, scuba diving and motor sports of any kind. If you are not sure whether an activity you plan to do falls within this rule you should check with us first. You are strongly advised to take out the appropriate specialist insurance if you are undertaking a particular sport or activity;
* Care and/or treatment arising from or related to engaging in professional sport that is a sport where any fee, donation or benefit in kind is received either directly or indirectly for playing, training or coaching;
* Conditions arising out of war, invasion, riot, revolution, act of terrorism, act of piracy, nuclear, biological or chemical contamination or any similar event.
A patient who is admitted to a hospital or day patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.
Dental conditions
Conditions which primarily involve a tooth or teeth and their roots and their surrounding tissue attachment;
A WPA recognised dentist who is registered with the General Dental Council. The dentist must not be related to you/the patient or recommended by a dentist who is a member of your/the patient´s family.
Diagnostic tests
Investigations, such as x-rays or blood tests, to find or to help to find the cause of your symptoms.
Eligible treatment
Treatment for which your policy provides a benefit, given by a provider of treatment we recognise for a condition which is not excluded by the rules of your policy or by any personal medical exclusion.
Director, partner, proprietor or employed member of staff.
Enterprise Flexible Benefits
Our small business health insurance policy, suitable for companies employing 3 - 400 people
Established Treatment
Treatment that is:

Approved by NICE for routine use in the NHS;
* For which there is substantial clinical evidence of benefit;
* Accepted and practised by more than one group of specialists in the field in the UK;
* Involving the use of drugs that are recognised and licensed in the UK for safe use and for the stage of the condition being treated;
* Considered to be acceptable recognised clinical practice by our Medical Advisory and Clinical Governance Committee
Group leaver
An employee who leaves a Group Policy because he/she is no longer employed by the company (the Group policyholder) but where the Group Policy remains in force.
Group policy
An annual contract of insurance which must consist of a minimum membership of 3 employees (not including family members) who are actively involved with the company and of whom at least 2 must reside at different addresses.
Histologically distinct
Every cancer has a unique ´footprint´ that can be identified by histological pathology demonstrating if it is a spread of an existing cancer or a new disease. Histology is the microscopic study of tissues and cells.
A hospital included in our list of recognised hospitals that is:

* A private hospital which charges fees for its services with facilities for providing private medical and surgical treatment; or
* An NHS hospital in the UK which is registered in accordance with United Kingdom legislation which is not a nursing home which provides convalescence or geriatric care;
* Or overseas is locally recognised.
A patient who is admitted to hospital and who occupies a bed overnight or longer for medical reasons.
Insurance Premium Tax (IPT)
IPT is a tax levied by the UK government on the value of insurance premiums and is applied on this policy. Irrespective of the date your policy starts, the rate of IPT that applies to your premium is that prevailing at the date your payment is due. We may alter premiums to reflect any changes in the tax charged on them or services for which benefit is paid, provided we give you at least 3 weeks written notice of the change.
Locally recognised
If you have the emergency abroad extra, locally recognised means recognised by the appropriate authority of the country outside the UK in which the hospital is situated or the specialist or therapist practices.
NHS Consultant Podiatric Surgeon
A Fellow of the Surgical Faculty of the College of Podiatrists whose qualification is registered under the Health and Care Professions Council (HCPC) and who is employed as a consultant by the NHS.
National Institute for Health and Clinical Excellence.
A qualified nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.
Oncology is the specialist treatment of cancer, which includes radiotherapy and chemotherapy. WPA provides benefit for Consultant Oncologists. Best Clinical Practice expects that your Consultant Oncologist will form part of a Multi-disciplinary Team overseeing your cancer care.
A patient who attends a hospital, consulting room, or out-patient clinic and is not admitted as a day-patient or an in-patient.
Out-patient drugs/dressings
This includes drugs and dressings you are given to take home from dentist/hygienist/hospital unless they are provided upon discharge from hospital and needed to complete a short course of treatment (i.e. antibiotics);
Personal medical exclusions
Exclusions or conditions that we may apply to your policy if you are fully medically underwritten on taking out your policy or on transfer. These will appear on your Certificate of Registration.
Pre-existing condition
Any 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) before the start of your cover.
Provider recognition
We reserve the right to withdraw or amend our list of recognised providers (without prior notice if necessary) in such a way as we feel is reasonably and commercially necessary - this may include hospitals, specialists, dentists etc.
Related condition
Any symptom, disease, illness or injury which reasonable medical opinion considers to be associated with another symptom, disease, illness or injury.
A clinical state where a disease is suppressed and under control, or the patient is symptom free and apparently cured.
Remission of cancer
A clinical state in which there is no objective evidence of disease or the disease is under control and the patient is symptom free and apparently cured.
Small business medical insurance
Defined by WPA as the suitable insurance policy for a business employing between 3 and under 400 employees.
A medical practitioner holding a licence to practise whose name appears on the current GMC Specialist Register and is certified as a specialist by the appropriate college or specialty body providing a regulatory function.
Terminal treatment
When treatment concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate.
When a group policy member or family member(s) moves from one group policy or level of cover or from one group policy to another.
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.
England, Wales, Scotland, Northern Ireland, the Channel Islands and the Isle of Man.
Us, we, our
Western Provident Association (WPA) Limited, Rivergate House, Blackbrook Park, Taunton, Somerset, TA1 2PE.
The person named on the Certificate of Registration and any registered family members.