Health insurance is an essential aspect of our lives, providing financial protection and access to vital healthcare services when we need them most. Yet, navigating the world of health insurance can often feel like deciphering a complex language filled with unfamiliar terms and acronyms. From premiums to benefits, pre-existing conditions to excess, the jargon in health insurance can be overwhelming.
Mo.health have put together a glossary of terms to help our members better understand the language used in the industry.
Benefit: The amount or services covered by a health insurance plan that a policyholder is entitled to receive when they use the plan to pay for medical expenses
Claims: Formal requests made by policyholders or healthcare providers to their health provider for payment or reimbursement of medical expenses covered by the policy.
Chronic: Refers to long-lasting or ongoing medical conditions that persist over an extended period and often require ongoing medical care.
Collective model: A type of health protection risk management where a group pool their resources and share the cost of health coverage. Mo.health is a collective model of health cover.
Consultant: A medical specialist or expert who provides advice, diagnosis, and treatment recommendations to patients or other healthcare professionals.
Diagnostic Imaging: The use of various medical imaging techniques, such as X-rays, MRI, or CT scans, to visualize and diagnose medical conditions.
Excess: The amount of money a policyholder must pay out of pocket before their health insurance coverage begins to cover the remaining expenses.
Exclusions: Specific medical conditions, treatments, or services that are not covered by a health insurance policy and for which the insurance company will not provide reimbursement.
Health insurance: A contract between an individual or organization and an insurance company that provides financial coverage for medical expenses, including doctor visits, hospital stays, and prescription drugs.
Health Trust: A financial arrangement where funds are set aside to provide healthcare benefits to employees or members, often managed by trustees. Mo.health runs on a collective health trust, and acts as trustee.
Itemised receipt: A detailed invoice provided by a healthcare provider that lists all the services rendered, their costs, and any payments made. Mo requires members to submit their itemised receipts after they have treatment, to confirm the service is covered by Mo.
Medical History: A record of a person’s past and current health conditions, treatments, surgeries, medications, and other relevant medical information.
Minimum Contracts: The terms and conditions that define the minimum requirements and obligations within a health insurance policy
Moratorium Period: A waiting period during which certain pre-existing conditions may not be covered by a health insurance policy.
Musculo-Skeletal: Relating to the muscles and skeleton of the body, often referring to medical conditions or treatments affecting these systems. Mo musculoskeletal benefit covers physiotherapy, chiropractor, and osteopath.
Policyholder: The person or entity that owns and is covered by a health insurance policy and is responsible for paying premiums.
Premium: The total cost of insurance coverage over a specified period, typically paid on a monthly or annual basis.
Practitioner/Clinician: A healthcare professional who provides medical services, diagnosis, and treatment to patients. This can include doctors, nurses, and other licensed healthcare providers.
Pre-existing condition: A medical condition that a person had before obtaining health insurance coverage. The coverage of pre-existing conditions varies among policies.
Psychotherapist: A mental health professional who specializes in providing therapy and treatment for emotional and psychological matters.
Referral: A recommendation from one healthcare provider to another for a patient to receive specialized care or treatment.
Renewal: The process of extending or continuing a health insurance policy beyond its initial term, often requiring the payment of new premiums.
Specialist: A healthcare provider with advanced training and expertise in a specific area of medicine or healthcare.
Trustee: A person or entity appointed to manage and oversee the assets and operations of a health trust or other financial arrangements.
Underwritten: The process by which an insurance company evaluates an applicant’s health and risk factors to determine eligibility and premium rates for coverage.
Loss ratio: A loss ratio in health insurance is a key financial indicator that represents the proportion of insurance premiums collected by an insurer that is paid out as claims for medical expenses and healthcare services.
Reimbursement: Reimbursement in health insurance is the act of receiving financial compensation from the insurance company for eligible medical expenses incurred by the policyholder or their covered dependents.
Healthcare payments card: A healthcare payments card is a financial card, often linked to a specific healthcare provider or plan, that allows individuals to pay for eligible medical expenses directly at healthcare providers’ offices, pharmacies, or other healthcare-related establishments.
