Money, money, money
The amount paid by Members/employers to maintain an active insurance policy
What is a Premium?
A primary care doctor providing non-specialized medical services
What is a General Practitioner (GP?)
A request made by a policyholder or provider asking the health insurer to pay for a covered service
What is a Claim?
The date of the claiming year when annual benefits refresh on the Member's policy
What is a Claims Anniversary?
The portion/amount the Member must pay before insurance provider contributes to the cost
What is an Excess?
Admission to a hospital for treatment that cannot be handled in non-hospital settings
What is Hospitalisation?
The contract between the health insurance provider and the Member, that determines their personal cover
What is a Policy?
Any Member who is not part of a group insurance scheme
What is a Retail Customer?
The maximum amount an insurer will pay for covered services within a policy year
What is an Annual Limit (or Annual Maximum)?
A medical doctor who has completed advanced surgical training and is qualified to perform operations in a particular area of medicine
What is a Specialist?
The process of assessing Member health information on application to decide policy terms and mitigate risk
What is Underwriting?
Special terms that allow easier entry into a workplace health insurance plan, often providing immediate cover for pre-existing conditions when joining within the eligible period
What is a Special Joining Concession (SJC)?
A fixed amount the Member pays towards a service, with the insurer covering the remainder
What is Co-Payment/Co-Pay?
Treatment that does not require overnight hospital admission
What is Outpatient?
The period after joining or upgrading a policy before benefits become available
What is a No Claiming Period?
An expert who uses statistics to calculate risk and ser premiums in a sustainable way for insurers
What is an Actuary?
How much a health insurer pays out in claims compared with how much it collects in premiums
What is loss ratio?
A senior medical doctor who specializes in diagnosing and managing complex medical conditions through non-surgical treatments
What is a Consultant physician (CP)?
Medical conditions that are not covered on a Member's policy
What is Exclusions?
An approved list of prescription medications
What is Formulary?