Health insurance glossary

A guide to some of the key words and phrases commonly used in health insurance.

This glossary is an aid to help you understand some common insurance terms and some WPA specific terms.

A customer should always refer to their specific Policy or Scheme documentation to check their level of cover, benefits, terms and conditions and Policy or Scheme definitions.

On this page

A

B

C

D

E

F

G

H

I

L

M

N

O

P

Q

R

S

T

U

V

W

X

A


A&E

NHS Accident and Emergency Department.

Absolute Health

A comprehensive company paid Health Insurance Scheme for 150 - 1,000 employees. Designed to be flexible whilst maintaining core benefits you would expect to receive in an insurance package. For more information visit: Business Healthcare Schemes

Active Treatment

Treatment that is intended to cure or relieve acute conditions or symptoms, stop disease progressing or to remove or destroy cancer cells.

Acupuncture

An alternative treatment derived from ancient Chinese medicine. Fine needles are inserted in sites of the body to stimulate sensory nerves in the skin and muscles.

Acute Condition or Symptom

A symptom, disease, illness or injury that is likely to respond quickly to treatment which aims to return a patient to the state of health they were in immediately before suffering the symptom, disease, illness or injury, or which leads to their full recovery.

Anaesthetist - Anaesthetics

A medical specialist who administers anesthesia.

Anaesthetics are used during surgical operations and some tests to provide a loss of sensation and awareness in certain areas of the body or to induce sleep. This prevents pain and discomfort, and enables a wide range of medical procedures or tests to be carried out.

Angiogram

An x-ray photograph of blood or lymph vessels to look for blockages.

B


Benefit

What a person can claim reimbursement for under the Policy or Scheme, for eligible treatment.

Benefit Schedule

The list of benefits available on a Policy or Scheme, which are in force for the Policy or Scheme Year, and which details all applicable monetary and non-monetary limits.

Bilateral

When we refer to 'bilateral' we mean 'both sides'. For example, bilateral leg pain means pain that is affecting both the left and right leg.

Broker

A person or company registered as an adviser who can give advice on insurance. May also be referred to as an Intermediary.

C


Cancer

A term for a group of diseases where abnormal cells divide uncontrollably and can spread to nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems.

For case studies which demonstrate how our Cancer Care benefit works in practice please visit: Cancer Care - In Practice

Cardiologist/Cardiology

A physician who is an expert in the treatment and care of cardiovascular issues including the heart and blood vessels.

Cardiology is a specialty that studies and deals with diseases and abnormalities of the heart. This may look at conditions including but not limited to chest pain, coronary heart disease, heart failure, valvular heart disease, high blood pressure and electrophysiology.

CAT Scan

An x-ray image made using a form of tomography in which a computer controls the motion of the x-ray source and detectors, processes the data and produces the image. See also Tomography.

CCSD Code

Operations/procedures carried out by a Specialist are classified using the industry standard CCSD (Clinical Coding and Schedule Development) codes. These CCSD codes are used by insurance companies to identify a medical procedure. For more information visit: www.ccsd.org.uk

Certificate of Insurance

The certificate for a Policy or Scheme in force for the Policy or Scheme Year giving details of:

  • The Policyholder, Scheme Holder or Scheme Member;
  • Registered family member(s);
  • The benefit options;
  • Any optional extras;
  • Underwriting terms;
  • Any personal exclusions that apply; and
  • A payment schedule (where applicable).

Chemotherapy

Treatment that uses drugs and/or combinations of drugs to stop the growth of cancer cells, either by stopping the cells from dividing or killing the cells.

Chiropody

Treatment of the feet and lower leg specific to a health issue or one-off injury. Some of the conditions include but are not limited to foot ailments such as corns, calluses, fungal infections, ingrown toenails and verrucae.

Chiropractic

An alternative form of medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine. The main technique used is manipulation to make controlled and precise movements.

Claim

A request for payment of a benefit for expenses that a person is able to claim for, that have been or will be incurred under the terms and conditions of the Policy or Scheme and in line with the available benefits.

Colorectal Surgeon

A physician who is an expert in the care of the bowel, colon and rectum. They may oversee the treatment of conditions including but not limited to inflammatory bowel disease, bowel and anal cancer, pelvic floor conditions, bowel cancer and stoma care.

Complaint

Oral or written expression of dissatisfaction, whether justified or not, about a service or product. If a customer is unhappy and wishes to make a complaint, they can do so verbally, by email or other written correspondence. A line manager will investigate any complaint and on conclusion of our findings, a response will be issued. We strive to offer the highest standards of service, but if we fail, we will endeavor to put things right promptly and improve our service. For more information visit: Complaints

Complete Health

Complete Health is WPA's tailored, flexible health insurance Plan for individuals and families, which features set core benefits and an extensive range of Optional Extras that will enhance the cover to meet the customer's physical and mental health needs. For more information visit: Complete Health

Compliment

Oral or written expression and recognition of praise, satisfaction and appreciation about a product or service.

Condition

A disease, illness or injury. Something which gives a degree of disruption to the body or mind's normal function and structure.

Consultant

A Consultant is a senior doctor/physician who has completed specialised training and has been placed on the current GMC Specialist Register in their chosen field of expertise. Sometimes also known as a Specialist.

Consultation

A meeting between a patient and a medical professional. This meeting generally follows a request from one medical professional such as a GP to another medical professional such as a Specialist, for further opinion and assistance in seeking a diagnosis and treatment plan for the patient, when primary care has not resulted in a cure or improvement.

Continued Moratorium Underwriting

A transfer from one insurer to another, where cover had been underwritten on a Moratorium basis. The previous insurer's Moratorium period would apply to a new Policy with WPA. For more information please visit: What is underwriting?

Continued Personal Medical Exclusions Underwriting (CPME and sometimes referred to as Switch)

A transfer from one insurer to another where cover had been medically underwritten based on the information disclosed to that insurer. Any personal exclusions (or similar) would continue to apply to a new Policy with WPA. For more information please visit: What is underwriting?

Cooling Off Period

A legal requirement of insurers that must be given when a person buys a new Policy so they can consider their cover and cancel if they change their mind, with no penalty or loss of premium paid. This will be a minimum of 14 days from the start date of cover. Also known as a Notice Period.

Corporate Deductible

For most large companies, claims costs are predictable year-on-year. This is a cost-effective and award-winning alternative to a traditional insured arrangement where a group may take the expected claims costs as a large corporate excess, reducing overall premiums and still benefit from the protection offered by a traditional insurance contract. For more information visit: Business Healthcare Schemes

Corporate Healthcare Trust

A cost-effective vehicle approved by HMRC for the provision of healthcare benefits to generally 500 or more employees, often used as an alternative to usual private health insurance. WPA Protocol Plc, a wholly owned subsidiary of WPA, act as the specialists for administration including the running of a customer helpdesk, consideration and payment of claims and dedicated account management support. For more information visit: Business Healthcare Schemes

Cosmetic Treatment

Improvement of a person's appearance. Cosmetic/aesthetic procedures are most commonly elective and not always therefore medically necessary. Cosmetic treatment may consist of for example a surgical procedure like breast implants or non-surgical procedures like dermal fillers or botox.

Critical Care

A specialised hospital bed or unit/ward for the treatment of patients who are critically ill and require constant or high-level monitoring. This may follow an accident, complex surgery or for a life-threatening illness. The Intensive Care Society provide 'Classification of Critical Care' guidance. For more information visit: www.ics.ac.uk

CT Scan

Computerised Tomography uses x-rays and a computer to create detailed images of the inside of the body. See also Tomography.

Curative Intent

Applies to treatment that is given with a reasonable expectation that it will restore the patient close to the state of health enjoyed before the condition was diagnosed and that the patient will become symptom free.

Customary and Reasonable Cost

The level of fees for a consultation or a procedure that we consider to be a reasonable cost. These costs are set to reflect consultation fees, the complexity of a procedure, the time and skill involved in its performance and that which is a fair financial return for services given.

We have cost and fee agreements with almost every hospital, and we publish our schedule of fees for Specialists - these may be viewed at any time at Medical fees. The benefit levels for each procedure are regularly reviewed by WPA's Medical Advisory and Clinical Governance Committee, whose medical members have both private and NHS consultant experience. We take professional advice from our Specialist advisers and have regular discussions with both the medical profession and professional Specialist bodies.

D


Day-patient

A patient who is admitted to a hospital or day-patient unit for medical reasons, because they need a period of medically supervised recovery, but do not occupy a bed overnight.

Deferment Period

A period of time during which a Policy or Scheme is in force, but no benefit is payable. After the end of the deferment period, a person is covered for the eligible treatment of any eligible symptom or condition, but not if the symptom or condition began, whether diagnosed or not, within the deferment period.

Dental Injury

An injury to a person's teeth caused by an extra oral impact (an external blow to the teeth, face or jaws). We reimburse to the maximum amounts listed in our WPA Dental Schedule.

Dentist

Specialises in the prevention, diagnosis and treatment of oral health problems. A Dentist should be registered to practice with the General Dental Council.

Dermatologist - Dermatology

A physician who is an expert in the care of the skin, hair and nails. Dermatology is a speciality with both medical and surgical aspects. Conditions can include but are not limited to eczema, psoriasis, moles, warts, acne and birthmarks.

DEXA Scan

Bone Density Scan. Uses x-ray, CT or ultrasound to measure the amount of calcium and mineral content in bone.

Diagnostic Tests

Investigations, such as x-rays or blood tests, to find or to help to find the cause of symptoms. For the purposes of WPA Policies or Schemes, diagnostic tests also include ultrasound scans.

Dietitian / Nutritionist

A health professional who assesses, diagnoses and treats dietary and nutritional issues to improve a person's health or to help diagnose a condition. They can help with conditions including but not limited to cancer, diabetes, nutrients via feeding tubes and eating disorders.

Digital Health

A digital platform for large companies to help employees manage their physical and mental health conditions. For more information visit: Digital Health

E


ECG - Electrocardiogram

Used to check the heart's rhythm and electrical activity. Sensors are attached to the skin which detect electrical signals produced by the heart each time it beats. These signals are recorded by the machine and reviewed to check for any abnormalities.

Echocardiogram

An ultrasound type of scan used to look at the heart and nearby blood vessels. Routinely used to diagnose and assess heart valve problems, congenital heart disease and often used following a heart attack or diagnosis of heart failure to see how much of the heart muscle is affected.

EHIC

European Health Insurance Card (which is being phased out). Please also see GHIC.

Eligible Treatment

Established treatment for which the Policy or Scheme provides benefit. It must be given by a provider of treatment we recognise, for the sudden onset of an illness or injury, which is not excluded by any personal or general exclusion and is within the terms and conditions of the Policy or Scheme.

Emergency Treatment

Unplanned and unexpected treatment that is due to a sudden acute condition that for medical reasons cannot be delayed. This may be an accident or sudden deterioration of a condition. In an emergency the NHS is best equipped to provide this treatment.

Employee

Director, partner, owner, employed member of staff or other individual authorised by a Scheme Holder.

End of Life Care

Support, care and treatment of people with life-limiting conditions. Treatment to manage the physical aspects of a condition or injury which concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life, and where active treatment for the condition or injury is no longer considered effective or appropriate. This may be undertaken in a hospital, hospice or at home.

Endocrinologist - Endocrinology

A physician who is an expert in the care of the endocrine system and conditions related to the body's hormones.

Endocrinology looks at conditions which include but are not limited to thyroid diseases, growth issues, metabolic disorders and disorders of the adrenal glands.

Enterprise Flexible Benefits (EFB)

A Group Scheme offering essential core health cover including a Remote GP Service, with optional cash and dental benefits plus further optional extras to enhance the package such as structured counselling and overseas treatment for groups of 2 to 14 employees. Tailored to a company's budget and business requirements. For more information visit: Enterprise Flexible Benefits

Established Treatment

Treatment that is considered to be acceptable recognised clinical practice by WPA's medical advisers and/or:

  • It is approved by the National Institute for Health & Care Excellence (NICE) for routine use in the NHS without restriction or it is routinely used in the NHS for this condition without restriction; or
  • If it involves the use of drugs, they are used within their licensed indication for the stage of the condition being treated. This may be either single or stipulated combination(s).

Excess

The amount a person pays towards the costs of their eligible treatment before WPA contribute to their treatment costs. An excess is applied per person, per Policy or Scheme year.

Once the excess has been paid in full, WPA will pay eligible treatment costs (subject to the applicable terms and conditions and any benefit limits) until renewal when the excess resets. For more information please visit: Shared Responsibility and Excess options

Experimental Treatment

Which is any treatment:

  • That NICE does not recognise; or
  • Which makes use of a drug outside of its licensed indication for the stage of the condition being treated; or
  • Is any form of clinical trial whether formally designed or not.

Also known as Non-established Treatment.

F


Family Member

A person covered by the Policy or Scheme who is the partner of or who is related to the Policyholder or Scheme Member and lives at the same address (unless in full-time education).

Fee Schedule

A WPA list of the accepted, customary and reasonable fees for a surgeon, physician and/or anesthetist that we will pay within the terms, conditions and benefits of cover. For more information please visit: Medical fees

Financial Ombudsman Service (FOS)

FOS provide an independent and impartial method of resolving complaints. If, following complaining to us, a customer remains unhappy they may complain to FOS. The FOS will need to know that we have been given the opportunity to put things right first and will not investigate a complaint if this has not happened or if a complaint is already the subject of legal proceedings or arbitration. For more information please visit: www.financial-ombudsman.org.uk

Full Medical Underwriting (FMU)

This is a full declaration of medical history and benefit will not be available for symptoms or conditions which exist at the point of joining or within the first 14 days of cover (unless accepted by us in writing). For more information please visit: What is underwriting?

G


Gastroenterologist - Gastroenterology

A physician who is an expert in the care of the digestive system, oesophagus, stomach, large intestines, gallbladder, pancreas and the liver.

Gastroenterology looks at conditions which include but are not limited to colon polyps, Celiac disease, irritable bowel syndrome, heartburn and reflux.

Geriatrician - Geriatrics

A physician who is an expert in the health and social care of the elderly.

Geriatrics is focused on but not limited to aging, dementia, frailty and mobility.

GHIC

UK Global Health Insurance Card or any future similar reciprocal health funding agreement. The UK has reciprocal healthcare agreements with the EU and some non-EU countries which means that when visiting these countries, a person is often treated as if they were a resident rather than a visitor. Please also see EHIC which the GHIC currently replaces.

GMC

General Medical Council. An independent regulatory body for the medical profession responsible for overseeing training, registering and licensing and setting standards for good medical practice to maintain patient safety.

GP (General Practitioner)

A doctor who is qualified in general medical practice and a first point of call for all common medical conditions. A GP may treat and/or refer patients to hospital or other medical services for further tests, investigations, treatment and/or surgery. The GP should hold a current licence to practice and their name should appear on the GMC General Practitioner Register. References to GP include, where applicable, the WPA GP Service Provider.

GP Service Provider for WPA

The third party who provides Remote GP Services subject to their terms and conditions which may be amended from time to time.

WPA reserve the right to change the Remote GP Services provider without prior notice.

Group Deductible

WPA's Group Deductible helps reduce costs without reducing benefits. A group deductible is likened to a group scheme excess, with the advantage of the balance of the payment being reimbursed by means of a rebate if the deductible is not used in full.

Guide

The Policy or Scheme document which contains a member's benefits, terms and conditions.

Gynecologist - Gynecology/Obstetrics

A physician who is an expert in the care of female reproductive health.

Gynecology looks at areas which include but are not limited to reproduction, menstruation, pregnancy, childbirth, fertility issues, sexually transmitted diseases and hormone disorders.

H


HCPC

Health and Care Professions Council. A statutory regulator of professionals from health and care professions in the United Kingdom.

The HCPC set and help maintain standards for these professionals with the objective of protecting the public.

Health Insurance

A contract with an insurer. In return for paying premiums for the unknown, in the event of illness or injury, subject to the Policy or Scheme terms and benefits, the insurer will pay benefit from diagnosis through to treatment. Also often referred to as Private Medical Insurance. For more information about health insurance please visit: What is health insurance? To find out why you might want it please visit: Why have health insurance

Health Screening

A process of checking for diseases and health conditions before there are any signs or symptoms. A person may opt to have a health screen as they may be at a higher risk of certain conditions and diseases.

Healthcare Partners

WPA Healthcare Practice Plc, a wholly owned subsidiary of WPA, oversees a network of franchisees known as Healthcare Partners throughout the UK all of whom can promote, advise and tailor WPA's products and services to meet personal and business healthcare requirements. For more information please visit: www.healthcarepractice.co.uk. See also WPA Healthcare Practice/Partners.

Healthcare Provider

A licensed or certified health professional who assists in providing a diagnosis, treatment plan and treatment services. Can also be referred to as a Treatment Provider.

Helpline Provider for WPA

The third party who provides the 24/7 helpline subject to their terms and conditions which may be amended from time to time.

WPA reserve the right to change the 24/7 helpline provider without prior notice.

Hematologist - Hematology

A physician who is an expert in the care of blood and its components such as blood cells, platelets and coagulation.

Hematology looks at conditions which include but are not limited to leukemia, sickle cell anemia, myeloma and lymphoma.

Homeopathy

An alternative complementary system based on the theory the body can cure itself. Highly diluted, small amounts of natural substances such as plants and minerals are used in the belief these stimulate the healing process.

Homeopathy can help some people with minor ailments such as cuts, bruises, coughs and colds. Homeopathy can also help some people with long-term problems, particularly those which have failed to respond to conventional medicine for ailments such as but not limited to arthritis, asthma, migraine, chronic fatigue syndrome, depression, eczema and irritable bowel syndrome.

Hospice

A facility providing care for the sick or terminally ill, also supporting end-of-life care.

Hospital

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;
  • Overseas is locally recognised by the appropriate authority of the country outside the UK in which the hospital is situated or the Specialist or Therapist practices (only applicable where the benefit for Overseas Emergency Treatment applies).

I


Immunotherapy

A type of treatment which stimulates or suppresses a person's immune system to help their own body to fight their cancer.

Indication(s)

An authorised treatment used in cancer care supported by the appropriate licensing authorities. For malignant conditions, the specific type of cancer and stage of the disease needs to be stipulated because WPA only consider the use in active treatment (not symptomatic or preventative).

In-patient

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

Intermediary

A person or company registered as an adviser and arranger on matters of insurance with an insurer on behalf of a customer. May also be referred to as a broker.

Invoice

A dated document with a unique identification number used to notify a person that a payment is due for medical services received.

L


Licensed

Any drug or medical or surgical appliance must be licensed for use in the UK. This means it can only be available when it has been assessed and approved for use by the Medicines and Healthcare products Regulatory Agency (MHRA) to meet quality, safety and efficacy standards for its intended use and has been granted a Marketing Authorisation (MA) in the UK.

LifeStage Health

A group scheme, complementing the NHS and facilitating treatment pathways for a range of conditions for everyone regardless of gender identity, as people's bodies change through the key life stages. Packages that can be tailored to suit a company and their employee's specific needs. For more information visit: LifeStage Health

Long-term (Chronic) Condition

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

  • It needs on-going or long-term monitoring or management through consultations, examinations, check-ups, and/or tests;
  • It needs on-going or long-term control or relief of symptoms;
  • It requires rehabilitation or for a patient to be specially trained to cope with it;
  • It continues with no fixed timeframe;
  • It has no known cure;
  • It comes back or is likely to come back.

For more information please visit: Long-Term and Related Conditions

M


Medical History Disregarded Heart and Cancer Underwriting (MHD H&C)

MHD H&C underwriting follows the MHD term above, but with additional checks around any existing heart and cancer conditions, that may not then be covered by the Policy or Scheme. The declaration is usually within a defined period, prior to the Policy or Scheme start date. For more information please visit: What is underwriting?

Medical History Disregarded Underwriting (MHD)

A person does not disclose previous medical history when joining or at the point of a claim. A person would be eligible to claim for conditions that existed before the date of joining a Scheme (not available on personal/individual Policies). For more information please visit: What is underwriting?

Medical Professional

A licensed or certified provider of a healthcare service such as but not limited to a GP, Specialist, Therapist, Nurse, Nurse Practitioner, Midwife etc.

Medical professionals belong to many healthcare subcategories and WPA has criteria for each subcategory such as an Acupuncturist should have fully accredited membership of the British Medical Acupuncture Society (BMAS) or British Acupuncture Council (BAC) to be recognised with us for benefit reimbursement of a patient's fees.

Medically Necessary

Not cosmetic or aesthetic but required as active treatment to cure a symptom, disease, illness or injury.

Moratorium Underwriting

A person is not eligible to claim for at least two years for any condition(s) which exist during the five years before joining or within the deferment period if one exists. If a customer does not have any symptoms, treatment, medication or advice for a pre-existing condition for two continuous years after the Policy or Scheme starts, benefit will be available within the Policy or Scheme terms, conditions and benefits. This is known as a two-year clear period. Other providers may offer alternative versions of Moratorium Underwriting. For more information please visit: What is underwriting?

MRI Scan

Magnetic Resonance Imaging. Uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

My WPA

A 24/7 secure online portal for members, containing their Policy or Scheme details. This provides the ability to make claims, view claims, find a medical professional or treatment centre, send and receive secure messages, view documents, see member offers and more. For more information please visit: Existing members

N


Nephrologist – Nephrology

A physician who is an expert in the care of the kidneys and their function.

Nephrology looks at conditions which include but are not limited to polycystic kidneys, kidney infections, blood or protein in the urine, kidney stones and kidney failure.

Neurologist – Neurology

A physician who is an expert in the care of the brain and nervous system.

Neurology studies the diagnosis and treatment of the nervous system which includes the brain, spinal cord and peripheral nerves. It covers conditions including but not limited to Parkinson's disease, Multiple Sclerosis, sleep disorders and Alzheimer's disease.

NHS

The National Health Service is the Government-funded medical and health care services that everyone in the four countries of the UK can use without being required to pay the full cost of the service.

NHS Hospital Cash Benefit

Available on many of WPA's private health insurance Policies and Schemes. If a person chooses to receive in-patient, day-patient or out-patient complex diagnostic tests or procedures as an NHS patient instead of as a private patient, they may claim a cash benefit, subject to the benefits, terms, conditions and limits of their cover.

NHS Top-Up Corporate

NHS Top-Up Corporate is a simple cash plan provided by WPA that lets you claim money back on everyday healthcare expenses. It can be company paid or employee paid and is for groups of 3 to 49 employees. For more information visit: NHS Top-Up Corporate

NHS Top-Up Personal

NHS Top-Up Personal is a simple cash plan provided by WPA that lets you claim money back on everyday healthcare expenses. For more information visit: NHS Top-Up Personal health cash plan

NICE

National Institute for Health & Care Excellence (or the equivalent of NICE in England and Wales). NICE carries out assessments of the most appropriate treatment regimes for different illnesses and diseases. It helps medical practitioners and commissioners to get the best patient outcomes whilst also ensuring value for the taxpayer's money.

Non-disclosure

Failure to provide a relevant fact about medical history and circumstances likely to result in a claim, when applying for cover. Failure to declare all existing symptoms and conditions may result in a member's claim not being paid or termination of their Policy or Scheme membership.

Non-established Treatment

Which is any treatment:

  • That NICE does not recognise; or
  • Which makes use of a drug outside of its licensed indication for the stage of the condition being treated; or
  • Is any form of clinical trial whether formally designed or not.

Also known as Experimental Treatment.

Notice Period

A legal requirement of insurers that must be given when a person buys a new Policy so they can consider their cover and cancel if they change their mind, with no penalty or loss of premium paid. This will be a minimum of 14 days from the start date of cover. Also known as a cooling off period.

Nurse

A qualified Nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number. A nurse is responsible for providing care and support to patients in various healthcare settings such as hospitals, nursing homes and clinics.

O


Oncologist - Oncology

An Oncologist is a medical professional who diagnoses, assesses, treats and manages people with cancer, with an overall aim of providing the best possible outcome for that person. They help design treatment plans, coordinate treatment with other medical professionals and offer supportive care.

Oncology studies, diagnoses, prevents and is also the Specialist treatment of cancer, which includes radiotherapy and chemotherapy.

Ophthalmologist/Optometrists - Ophthalmology

A physician who is an expert in the care of the eye/s and visual disorders.

Ophthalmology is a surgical specialty that offers medical and surgical eye care.

Optional Extra

An extra benefit a member may choose to add to enhance their Policy or Scheme. The Certificate of Insurance will detail any Optional Extras which have been chosen.

Oral Cancer

Cancer of the lips, tongue, major salivary glands, gums or from the pharynx down to the top of the oesophagus.

Orthopaedic Surgeon - Orthopaedics

A physician who is an expert in the care of the musculoskeletal system including but not limited to the correction of deformities of bones or muscles, spinal disease, degenerative disease and trauma.

Orthopaedics is a medical specialty concerned with the preservation, restoration, and development of form and function of the musculoskeletal system.

Osteopathy

A system of diagnosis and treatment for a wide range of medical conditions. It uses physical manipulation, stretching and massage to treat and prevent health problems by affecting the bones, muscles, ligaments and connective tissue.

Otorhinolaryngologist - Otorhinolaryngology (ENT)

A physician who is an expert in the care of conditions which affect the ear, nose and throat, also extending to the head and neck.

Otorhinolaryngology looks at conditions associated with but not limited to a severe sore throat, swallowing disorders, laryngitis, chronic ear infections, impacted ear wax, Meniere's disease, middle ear fluid and hearing loss.

Out-patient

A patient who attends a hospital, consulting room, or out-patient clinic for medical reasons but is not admitted as an in-patient or a day-patient.

P


Paediatrician - Paediatrics

A physician who is an expert in the primary care of infants, children and young adults.

Paediatrics looks at conditions which include but are not limited to developmental, learning and/or behavioural problems, childhood nutrition and congenital disorders.

Palliative Care

Care and/or treatment with the intent to provide quality of life rather than a cure for a patient with a life-limiting illness or injury.

Personal Exclusion(s)

Specific term(s) that we may, in our discretion, apply to a Policy or Scheme membership meaning they are excluded from cover under the Policy or Scheme. These are determined on areas such as lifestyle, medical history or a family's medical history and are applied either when the Policy or Scheme is first taken out or on transfer to an alternative WPA Policy or Scheme, and will appear on the Certificate of Insurance. If a person is joining on a moratorium underwriting basis they will see their moratorium terms outlined in the personal exclusions section on their Certificate of Insurance.

We reserve the right to cancel or add retrospective personal exclusions to a Policy or Scheme membership if we become aware of information that was not given on the medical declaration but should have been.

PET Scan

Positron Emission Tomography. Uses a dye containing radioactive tracers to produce three dimensional images of the inside of the body. See also Tomography.

Physiotherapy

A science-based treatment which aims to restore movement and function when someone is affected by injury, illness or disability.

Podiatrist - Podiatry

A physician who is an expert in the care and disorders of the foot, ankle and structures of the lower leg.

Podiatry looks at conditions which include but are not limited to bunions, hammertoes, foot and ankle surgery and diabetic foot care.

Policy

The Policy is the contract of insurance between the Policyholder and WPA as the insurer as set out in the terms and conditions contained in the Guide, the Benefit Schedule, Certificate of Insurance and where applicable any other endorsement or memorandum issued by WPA.

Policy Address

The UK address given to us. If a person has one or more addresses, they should give us their usual residence where they and any family member(s) live for at least six months of the year. The Policy Address and the address registered with a NHS GP must be the same.

Policy Year

The Policy lasts for 12 months beginning on the start date set out in the Certificate of Insurance.

Policyholder

The person who enters into the contract of insurance with WPA.

Pre-Authorisation

A check with us before costs are incurred as to whether a test, investigation, drug, procedure or other form of treatment is covered under a person's Policy or Scheme membership.

Precision Corporate Healthcare (PCH)

A Group Scheme offering health insurance, cash and dental benefits within one Scheme for 10 or more employees. Can be tailored to a company's budget and business requirements. For more information visit: Precision Corporate Healthcare

Pre-existing Condition

Any physical or mental health condition, disease, illness or injury, whether symptomatic or not, that exists before the start of a Policy or Scheme membership. This includes anything for which someone has received medication, advice or treatment; or where they have experienced symptoms, even if the condition has not been diagnosed.

Premium Hospitals

Premium Hospitals are primarily based in and around Central London, and on some WPA Policies or Schemes, we only cover treatment in these establishments if the 'Premium Hospitals' optional extra has been chosen. For further details please visit: Premium Hospitals

Premiums

A regular monthly or annual payment made by an individual or a company in exchange for eligible health benefits that a chosen Policy or Scheme provides. WPA has several types of pricing dependent upon the product and benefits chosen. Premiums are calculated on factors such as risk, age, claims history and area of residence.

Primary Care

Under the care of a GP and includes tests and investigations to help treat a condition or enable referral to an appropriate Specialist or Therapist.

Private Healthcare Information Network (PHIN)

All providers of private healthcare in the UK are required by law to submit data to PHIN, as do some NHS hospitals. We encourage people to visit the PHIN website: www.phin.org.uk to help make informed decisions about treatment.

Private Medical Insurance

A contract with an insurer. In return for paying premiums for the unknown, in the event of illness or injury, subject to the Policy or Scheme terms and benefits, the insurer will pay benefit from diagnosis through to treatment. Also often referred to as Health Insurance. For more information about private medical insurance please visit: What is health insurance?. To find out why you might want it please visit: Why have health insurance?

Procedure

A procedure (which must be classified by a CCSD code) includes any of the following:

  • Making a cut to gain access to the inside of a patient's body;
  • Using an instrument (such as an endoscope) to gain access to view the inside of a patient's body;
  • Using electromagnetic energy to treat a condition, e.g. lithotripsy to treat kidney stones.

Prostheses/Prosthesis

Protheses may be passive or active.

  • Passive - replacements of joints, blood vessels or other organs, e.g. hip or knee replacements or an aortic graft;
  • Active - electronic implantable medical devices which are usually implanted permanently within the body to correct or modify an abnormal bodily function caused by an acute condition, e.g. pacemakers or defibrillators.

Prosthetic

Also commonly known as 'artificial limbs'. A functional replacement for an amputated, congenitally malformed or missing limb. Most are attached to the exterior of the body in a non-permanent way though some types can be attached in a permanent way.

Providental

Providental is a dental cash plan provided by WPA that covers routine, preventative and emergency dental treatment. For more information visit: Providental cash plan

Provider Search

WPA provides an extensive choice of over 1,000 hospitals, clinics and scanning centres across the UK, including large private hospital groups, independent private hospitals and clinics and private wings of NHS hospitals. Please visit: Find a healthcare provider to search for a hospital or treatment provider in your area.

Psychiatrist - Psychiatry

A physician who is an expert in the care of mental health conditions.

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioural disorders.

Psychologist - Psychotherapy

A physician who is an expert in the study of human behaviour, emotions and mental processes. They help understand the complex workings of the mind and its impact on individual and collective wellbeing and mental processes such as thoughts, feelings and motives.

Psychotherapy is the scientific study of the human mind and its functions, especially those affecting behaviour in a given context.

Q


Qualifying Period

A period at the start of the insurance contract, during which cover is in force but no benefit is payable. When the qualifying period has expired, eligible treatment received after the end of the qualifying period can be considered for reimbursement.

Quote

An estimate of how much a new Policy or Scheme will cost, subject to a timeframe after which the price may change. It will show details of the Policy or Scheme members, include details of any family member(s) being included on cover, any optional extras chosen, the payment method and interval. A quote also enables comparisons for shopping around.

R


Radiotherapy

Radiotherapy is a treatment where radiation is used to kill cancer cells. It may be:

  • curative radiotherapy which aims to cure the cancer;
  • neo-adjuvent radiotherapy which is used before surgery or combines with chemotherapy;
  • adjuvant radiotherapy which reduces the risk of cancer returning after treatment;
  • palliative radiotherapy which relieves symptoms if a cure is not possible.

Not all WPA Policies or Schemes cover all types of radiotherapy.

Rehabilitation

Rehabilitation helps a person to be as independent as possible in everyday activities following treatment, a procedure and/or hospital stay. It assists in their recovery and helps enable participation in education, work, recreation and other daily activities.

Related Condition

Many commonly known conditions have other conditions related to them, which can impact on the intention of any personal medical exclusion applied to a Policy or Scheme member. For further details please see: Long-Term and Related Conditions

Remission of Cancer

A clinical state in which there is no objective evidence of cancer. When in remission, the signs and symptoms of cancer will be lessened or be undetectable. Remission of cancer can be complete where all detectable evidence of cancer is gone or partial where there is a reduction of at least 50% in measurable size. Remission does not guarantee a full cure but is an important milestone in treatment.

Remote GP

Consultations provided via the telephone or digital media and provided by the WPA GP Service Provider. For further details please see: Remote GP Services

Renewal Date

12 months following the start of the Policy or Scheme as shown on the Certificate of Insurance.

Repatriation

Returning a person back to the UK if they become seriously ill, suffer a life threatening or life altering illness or injury or have passed away.

Respiratory System

The respiratory system is responsible for the exchange of gases between the body and the environment. It transports oxygen from the air we breathe into the bloodstream, while carbon dioxide is removed from the bloodstream and exhaled out of the body.

S


Scans

Carried out by devices which enable examination of the body, or organs of the body, to assist with diagnosis and monitoring of some conditions and their treatment plan.

Scheme

The Scheme is the contract of insurance between the Scheme Holder and WPA as the insurer as set out in the terms and conditions contained in the Guide, the Certificate of Insurance, the Benefit Schedule and where applicable any other endorsement or memorandum issued by WPA.

Scheme Holder

The business/company who enters into the contract of insurance with WPA. With the permission of WPA, the Scheme Holder may include its subsidiary companies or any business, of which it is the controlling entity, within the Scheme.

Scheme Member

Any eligible individual actively involved in the business of the Scheme Holder as an employee or retiree and registered on the Scheme.

Scheme Year

The Scheme lasts for 12 months beginning on the start date set out in the Certificate of Insurance.

Secondary Care

Generally following a GP referral to another medical professional for further tests and investigations to achieve a diagnosis or determine a treatment plan.

Shared Responsibility (SR)

A method of co-payment enabling a person to control the cost of their premium. A person contributes a percentage towards the cost of every eligible claim, capped at an agreed level per Policy or Scheme year. WPA pay the remainder of every eligible claim (subject to any benefit limits). Once a person has reached their chosen SR, WPA pay 100% of any eligible claims subject to the Policy or Scheme terms, conditions and any benefit limits which may apply, until renewal. For more information please visit: Shared Responsibility and Excess options

Specialist

A Specialist is a senior doctor/physician who has completed specialised training and has been placed on the current GMC Specialist Register in their chosen field of expertise. Also known as a Consultant.

Speech and Language Therapy

Provides help for people with communication, eating, drinking and swallowing difficulties sometimes referred to as dysphagia.

Symptom

A symptom is evidence of potential disease, illness or a physical disturbance within the body or mind, indicating a disorder.

T


Targeted Cancer Therapies/Targeted Therapies

These are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer.

These drugs can also be used for the treatment of some benign inflammatory conditions of the joints, the bowel, the nervous system and the skin.

Therapist/Therapy

A medical professional fully registered with the appropriate professional body who provides medical treatment intended to relieve or cure an impairment, injury or disorder. 'Therapist' is a broad term that refers to professionals who are trained to provide treatment and rehabilitation in a specialised area.

The treatment these professionals provide is known as Therapy. See also Physiotherapy, Chiropractic, Osteopathy, Chiropody, Podiatry, Acupuncture, Homeopathy, Speech and Language Therapy and Dietician or Nutritionist and Psychologist or Psychotherapist.

Tomography

An x-ray type of scanning technique which helps healthcare providers detect diseases and injuries. Uses a series of x-ray beams which rotate around the area within the scanner and with a computer, create detailed images of bones and soft tissue.

Treatment

Surgical or medical services (including diagnostic tests) that are provided to investigate, relieve and/or cure a symptom, disease, illness or injury. This includes any form of medical care or prescribed medication.

Treatment Provider

A licensed or certified health professional who assists in providing a diagnosis, treatment plan and treatment services. Can also be referred to as a Healthcare Provider.

U


Ultrasound Scan

Uses high frequency sound waves to capture live images from inside of the body. Non invasive ability to see into the body without surgery.

Underwriting

When a customer applies for a Policy or joins a Scheme with us, we assess the risk being presented to WPA at the point of joining or sometimes on transfer between products. Depending on the type of Underwriting, this may result in personal exclusions being applied to their cover. The Underwriting types are Full Medical Underwriting, Moratorium, Continued Moratorium, Continued Personal Medical Exclusions (Switch) and Medical History Disregarded. Not all underwriting types are available on all Policies or Schemes. For more information please visit: What is underwriting?

Undiagnosed Conditions

A person may experience symptoms or may be undergoing tests but has not yet been diagnosed. Such symptoms may include but are not limited to: weight loss, abdominal pain, change in bowel habit, rectal bleeding, chest pain, shortness of breath etc. If applying for cover, these symptoms should be disclosed to us even if a medical opinion has not yet been sought or a diagnosis has not yet been confirmed.

Unilateral

When we refer to 'unilateral' we mean 'one side'. For example, unilateral left shoulder pain means pain that is only affecting the left shoulder and isn't apparent in affecting the right shoulder.

Urologist - Urology

A physician who is an expert in the care of conditions which affect the male and female urinary system and the male reproductive and genital system.

Urology looks at conditions associated with but not limited to the bladder, urinary tract infections, overactive bladder, erectile dysfunction and the prostate.

V


Vascular Disease

Abnormal condition of the blood vessels, veins or arteries not within the brain which can lead to conditions such as but not limited to blood clots, heart attacks and strokes.

W


Worldwide Coordination Centre for WPA

If the benefit for Overseas Emergency Treatment applies to a customer's cover, this is the 24-hour service which a person must contact to make an Overseas Emergency Treatment claim.

WPA

Western Provident Association Limited, a company registered in England and Wales under company number 00475557. Our registered office is at Rivergate House, Blackbrook Park, Taunton, Somerset, TA1 2PE. We are a company limited by guarantee with no shareholders.

We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. We are authorised to arrange and underwrite general insurance contracts and have provided access to healthcare for individuals, families and companies of all sizes for over 120 years.

WPA Charitable Foundation

A charity registered with the Charity Commission. Supports and assists families in the South West who are in financial distress and who have profoundly ill children. For more information please visit: Good causes

WPA Foundation

Supports projects throughout the UK promoting good health. Some projects WPA have supported in the past include the purchase and donation of musical instruments to bicycles, rugby equipment to edible playgrounds and vegetable patches. For more information please visit: Good causes

WPA Health (app)

An exclusive app for WPA customers providing a 24/7 secure online portal containing their Policy or Scheme details. This provides the ability to make claims, view claims, find a medical professional or treatment centre, send and receive secure messages, view documents, see member offers and more. For more information please visit: The WPA health app

WPA Healthcare Practice Plc

A wholly owned subsidiary of WPA, authorised and regulated by the Financial Conduct Authority. The WPA Healthcare Practice Plc has Healthcare Partners throughout the UK all of whom can advise on WPA's products and services.

For more information please visit: www.healthcarepractice.co.uk. See also Healthcare Partners.

WPA Protocol Plc

A wholly owned subsidiary of WPA which specialises in bespoke healthcare solutions for large companies that self-insure through a Corporate Healthcare Trust. An alternative arrangement to private medical insurance for 400 or more members.

X


X-ray

Quick and painless process commonly used to produce photographic or digital images of something such as bone, produced by x-rays being passed through it and being absorbed to different degrees.



Last reviewed: February 2024

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