CS Healthcare has been providing private healthcare for over 85 years and during that time, we’ve discovered there are some medical phrases and terms that can cause confusion. We’ve put together a handy jargon buster to cover medical terminology used on the website. You can also check the policy document for further clarification about any of the definitions used and how they relate to the individual policy.

A

Acute Flare-Up

This refers to an acute worsening or sudden deterioration of a previously diagnosed long-term chronic condition likely to respond to treatment in the short term. This does not include the care for recurrent, relapsing and poorly controlled conditions and or symptoms or the monitoring of your state of health or review of your medications.

Acute Medical Condition

This covers a disease, illness or injury which responds to short term treatment designed 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.

C

Cancer

A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue; and for the purpose of claiming under the your choice Heart & Cancer option any brain tumour requiring surgery or chemo or radiotherapy.

Chronic Medical Condition (long-term)/Chronic

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

  • It requires 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 cure
  • It comes back or is likely to come back

Claim

When the policyholder asks us to pay or reimburse them for treatment or procedures for an eligible condition.

ContinuedMoratorium(CM)

A method of underwriting designed to continue the date of the original Moratorium period from your previous insurer.

Continued Personal Medical Exclusions (CPME)

CPME is a method of underwriting which may allow individuals who are currently insured with another provider to switch cover and carry any current personal medical exclusions which apply to the existing policy across to a new policy. Eligibility for CPME terms will depend on the answers provided to some medical questions at application stage. A copy of your previous provider’s medical insurance certificate is usually required as part of the application process.

Co-payment

This is the percentage of medical expenses which you have agreed to pay towards the cost of all eligible treatment, per person per policy year.

Critical Care

Treatment carried out in a resuscitation room, intensive care or high dependency unit, which requires the specialist care, supervision and support of intensive care specialists.

Customary and reasonable

By this we mean that all costs must be necessary, customary and reasonably incurred at a hospital or medical services provider as previously agreed by us, and that all Surgeon and Anaesthetist fees will be paid in full according to the rates of the CS Healthcare fee schedule. All other costs incurred must be within average and acceptable levels appropriate for the services provided.

D

Day-Patient Treatment

A patient who is admitted to a hospital or day-patient unit because he or she needs a period of medically supervised recovery but does not occupy a bed overnight.

Dependant

This describes the individuals who are closely related or tied to the policyholder. They are normally financially dependent and tend to be legal or civil partners including married and separated couples, and your natural children, legally adopted children, partner's children or stepchildren or children where you are the legal guardian. All children must be under the age of 25. This does not include a person living with you or any other members of your family, for no matter how long the period.

Diagnostic Tests

This covers investigations such as X-rays, blood tests and ECG tests to help find the cause of the policyholder’s symptoms.

E

Emergency Treatment

An admission to:

  • a hospital directly following an accident, or
  • a hospital ward directly from the emergency department for urgent or unplanned treatment, or
  • a hospital ward on the same day as a referral for treatment is made either by a GP or specialist, when immediate treatment or diagnostic tests are necessary, or
  • a hospital to receive immediate lifesaving surgery

Please note, emergency treatment is not covered under a CS Healthcare policy

F

Full Medical Underwriting (FMU)

A method of underwriting where you are asked to give details of your medical history.

G

Guided Healthcare

This is the term applied to the hospitals that you will have access to under a HealthBridge policy. When contacting our Claims Advisers you will be given a choice of three private hospitals or NHS Private Patient Units at which you will be covered to receive treatment, subject to benefit limit.

I

In-Patient Treatment

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

M

Managed Care Team

Our Managed Care Team assist with all cancer claims and other potentially complex claims such as some heart procedures and joint replacement surgeries. They also manage urgent hospital admissions and complications of planned treatment. The aim of the team is to ensure treatment is pre- authorised in a timely manner, that policy terms and conditions are followed, and where there is a benefit limit, to notify the member should that limit be reached.

Medical Exclusion

When you take out a policy with CS Healthcare under Full Medical Underwriting (FMU), we will notify you of any personal or medical exclusion that will be applied to your policy at the point of application. As with most health insurers, this will include any pre-existing or chronic conditions.

Medical history disregarded (MHD)

This is a form of underwriting where your medical history is not taken into account and cover is provided for pre-existing medical conditions. CS Healthcare does not offer this type of underwriting.

Medical Necessity

Diagnostic investigations and treatment including surgery that is required to cure, correct and stabilise an acute medical condition.

Member

We refer to the policyholder as a member of CS Healthcare. This individual is also responsible for paying the premiums for a CS Healthcare policy.

Moratorium Underwriting (MOR)

A method of underwriting offered at the time of joining where you do not declare any medical history. However, all pre-existing conditions or symptoms (whether diagnosed or not) which have been in existence during the five years immediately before your policy start date will not be covered until a two-year period has passed where no symptoms, treatment or medical supervision of any kind has been confirmed.

N

Necessary Aftercare

During the period directly after you have been discharged from hospital you will be covered for a 90-day period of necessary aftercare. This covers the post-operative or follow-up consultations related directly to your surgery or medical admission to check your progress or treat any complications subject to any limits that may apply. Please refer to the policy document for full details as to what is covered under your policy.

Wound care, dressings and small procedures will also be covered where they are a direct consequence of your surgery or medical admission. If you have chosen the Heart & Cancer option the period of necessary aftercare will continue subject to pre-authorisation for one year for cardiac conditions and five years for cancer conditions.

No Claims Discount (NCD)

No Claims Discounts are applied by some insurers as a way to reduce the premiums for those people who do not make a claim or who only make claims of a small value. However, the no claims discount may reduce or be removed completely in the event of a claim resulting in an increase in premium at policy renewal. CS Healthcare do not currently offer a no claims discount on any of our schemes.

O

Out-patient

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

P

Planned Treatment

Admission to hospital by means of a waiting list or direct Consultant referral - not from the hospital Accident and Emergency unit or following a request for immediate admission on the advice of a GP or Consultant.

Policy

The insurance contract set out and agreed between you (the policyholder) and us (the health insurance provider). This includes the following documents, which are sent to you from time to time:

  • Any application form the Society ask you to complete
  • Policy Document and Benefit Schedules
  • Registration Certificate and letter of acceptance
  • Directory of Hospitals
  • Memorandum of Association and Rules
  • Contribution rates
  • Any other document setting out information affecting the rights and obligations of the Society and you concerning membership

Pre-Authorisation

Approval given either orally or in writing by the Society prior to any treatment taking place, as a guarantee that we will meet your treatment costs as part of an eligible claim – providing you are still paying premiums at the time of treatment.

Pre-Existing Conditions

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 in the five years preceding the start date of your cover

Prosthesis

An artificial device such as a joint replacement and bone fixation, heart valve, pacemaker, stents, grafts and meshes, which are implanted by a Consultant specialist during a surgical procedure.

R

Related Condition

Any symptom or condition, disease, illness or injury which is considered to be associated with, caused by or the source of another condition.

Routine Monitoring

Regular consultations, check-ups, examinations or tests designed to assess your ongoing state of health.

S

Specialist/Consultant

A registered medical or dental practitioner who holds or has held a substantive NHS Consultant's post, or has a certificate of Higher Specialists Training in the relevant speciality issued by the appropriate Royal College or General Medical Council in accordance with the EU medical directives.

Specialised Scans

This term describes high cost scans such as:

  • MRI and CT Scans
  • PET Scans
  • Myelogram
  • Thallium Scans
  • DAT and MIBG Scans
  • Perfusion/Ventilation Scans

Switch

The terms under which we will transfer your cover from another health insurer to CS Healthcare provided you have been insured within the last 60 days prior to joining and transfer your current underwriting terms. The two methods by which you can do this are Continued Personal Medical Exclusions (CPME) or Continued Moratorium (CM).

V

Voluntary Excess

The excess is the amount you agree to pay at the time of taking out your policy towards the costs of eligible treatment for each person covered on the policy, per policy year. Essentially, the bigger the excess, the bigger the discount on your premium.

Y

Your Care Package

A tailor-made, discretionary package of care agreed, in advance of treatment, for those members electing to receive all, or part, of their treatment on the NHS. Benefits may include assistance with travel costs, childcare, pet care and a cash allowance.

Our Service

CS Healthcare provides specialist health insurance policies to civil and public servants as well as their dependants. For over 85 years, we’ve been dedicated to protecting the health of our members and during that time we’ve built up partnerships with more than 300 hospitals, ensuring our members have access to the best care and treatment.

Proud to be Mutual

We think our Mutual status makes us a little different from many other insurers. We’re not answerable to shareholders which means our members remain at the heart of everything we do. As a result, our members continually benefit from the highest standards of service.

CS Healthcare News

Keep up-to-date with all the latest healthcare news and updates from CS Healthcare. We know that looking after your health should be a number one priority, which is why we aim to keep you informed of any breakthroughs in medical care as well as the latest health and wellbeing tips.