Health insurance terms explained in plain English

Health insurance has a language of its own. This page explains the words that come up most often in policy documents, claim forms and renewal letters, in plain English. It is for anyone we look after: individuals, families, and employees on a company plan. Terms that mainly matter to people running a company plan are grouped at the end, so you can skip them if they don't apply to you.

Example figures are illustrative only. They are not taken from any real plan.

Jump to (A–Z): Annual overall limit · Area of cover · Cashless · Census · Co-insurance · Co-payment · Continuation of cover · Day-case · Deductible / excess · Dependants · Direct billing · Evacuation and repatriation · Exclusions · Full medical underwriting · Guarantee of payment · Inpatient · Medical history disregarded · Member movements · Moratorium underwriting · Network / panel · Out-of-pocket maximum · Outpatient · Policy wording · Policy year · Pre-authorisation · Pre-existing condition · Premium · Pro-rata premium · Reimbursement claim · Renewal · Sub-limit · Table of benefits · Waiting period

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Costs: what you pay and what the plan pays

Premium

The amount paid to keep the policy in force, usually yearly, quarterly or monthly. On a company plan, your employer usually pays some or all of it.

Deductible (also called excess)

The amount you pay yourself before the plan starts paying. It may apply per policy year, per claim or per condition, depending on your plan. Illustrative only: with a 500 deductible and a 2,000 eligible bill, you pay the first 500 and the plan considers the remaining 1,500. Why it matters: a higher deductible usually means a lower premium, but more to pay when you claim.

Co-insurance

A percentage of each eligible bill that you share with the insurer, usually after any deductible. Illustrative only: with 10% co-insurance on a 1,500 eligible amount, you pay 150 and the plan pays 1,350.

Co-payment

A fixed amount you pay each time you use a service, such as a GP visit, whatever the bill. People often mix it up with co-insurance: co-payment is a set sum, co-insurance is a percentage. Illustrative only: a 20 co-payment per consultation.

Out-of-pocket maximum

A cap on the total deductible, co-insurance and co-payments you pay in a policy year. Once you reach it, the plan usually pays eligible costs in full for the rest of that year, up to its limits. Not every plan has one.

Annual overall limit

The most the plan will pay for one person in a policy year, across all benefits. Some plans also have a lifetime limit.

Sub-limit

A smaller cap within the overall limit for a specific benefit, such as physiotherapy, dental or maternity. You can hit a sub-limit long before the overall limit. Why it matters: check the sub-limit for treatment you use often, not just the headline limit.

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Where and how you are covered

Area of cover

The countries or regions where you can get treatment under the plan, for example Asia only, worldwide excluding the USA, or worldwide. Why it matters: treatment outside your area of cover is usually not paid, except perhaps in emergencies, if your plan says so. See leaving Singapore.

Network (also called panel)

The hospitals, clinics and doctors that have an agreement with the insurer or plan administrator. Using them often means direct billing and, on some plans, lower out-of-pocket costs. See using your cover.

Inpatient

Treatment where you are admitted to hospital and occupy a bed, usually overnight or longer, such as surgery with an overnight stay. Exactly how a plan defines an inpatient admission depends on its terms. It is usually the core of any health plan.

Day-case

Treatment where you are admitted to a hospital bed for a planned procedure but go home the same day, for example some scopes or minor surgery. Many plans treat it like inpatient care rather than outpatient, but this varies, so check how your table of benefits lists day-case treatment.

Outpatient

Care where you are not admitted, such as GP and specialist visits, tests, scans and physiotherapy. It is often an optional extra, with its own sub-limits.

Evacuation and repatriation

Evacuation means moving you to the nearest place that can give suitable treatment when it isn't available locally. Repatriation means bringing you back to your home country, either for treatment or after it. Both usually need the insurer's assistance team to arrange or approve them in advance.

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Claims and approvals

Pre-authorisation (also called guarantee of payment)

Asking the insurer to confirm, before treatment, that it is eligible and that they will pay. When the insurer sends this confirmation to the hospital it is often called a guarantee of payment (GOP). Many plans require it for inpatient, day-case and costly tests. Why it matters: skipping a required pre-authorisation can reduce or delay a claim. See pre-authorisation and direct billing.

Direct billing

The hospital or clinic sends the bill straight to the insurer, so you don't pay the covered part up front. You may still pay any deductible, co-insurance or non-covered items.

Cashless

A term often used to mean the same as direct billing: you leave without paying for the covered part of the bill. Insurers and hospitals don't all use it in the same way, so check what your plan means by it. It usually depends on using a network provider and, for bigger treatment, pre-authorisation.

Reimbursement claim

You pay the provider yourself, then send the bill, receipts and any medical report to the insurer to be paid back. See making a claim. Why it matters: keep itemised bills and receipts; incomplete paperwork is a common cause of delays.

Exclusions

Things the plan does not cover at all, listed in the policy wording. Common examples across the industry include cosmetic treatment and some experimental treatments, but every plan has its own list.

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Underwriting and your health history

Underwriting (in brief)

Underwriting is how an insurer decides whether, and on what terms, to cover someone, based on their health history. The main approaches are below.

Pre-existing condition

A medical condition you had symptoms of, or received advice or treatment for, before your cover started. Exactly how far back a plan looks depends on its terms. See pre-existing conditions.

Full medical underwriting

You complete a detailed health questionnaire when you apply. The insurer then tells you up front what is covered, and may exclude certain conditions or add terms. Why it matters: more paperwork at the start, but more clarity about what you're covered for.

Moratorium underwriting

You don't give a full medical history when you join. Instead, pre-existing conditions from a set period before you joined are not covered at first. If you then go a continuous stretch without symptoms, treatment or advice for that condition, it may become eligible. Some conditions may stay excluded. The length of both periods varies by insurer and plan, so check your policy wording. Why it matters: quicker to start, but less certainty about what will be paid until you claim.

Medical history disregarded (MHD)

Pre-existing conditions are covered as if they were new, subject to the plan's normal terms and limits. It is mainly offered on company plans. Insurers usually set a minimum number of employees, which can be fairly small, and may charge more for MHD terms.

Waiting period

A set time after cover starts before certain benefits can be used, such as maternity. Claims for those benefits during the waiting period are usually not paid. See maternity insurance.

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Your policy

Policy wording

The full legal document that sets out what is covered, what isn't, and the conditions. If the wording and a summary disagree, the wording normally applies.

Table of benefits

The summary of what your plan pays for each benefit: limits, sub-limits, deductibles and co-insurance. It is the quickest way to check your cover, alongside the policy wording.

Policy year

The 12-month period your cover runs for, starting on the policy start or renewal date. It may not match the calendar year. Annual limits and deductibles usually reset at the start of each policy year.

Renewal

When the policy comes to the end of its period and continues for another, often with updated premiums or terms. See renewals and premiums and why premiums can rise at renewal.

Dependants

Family members covered under your plan, usually a spouse or partner and children up to an age set by the plan. Adding newborns or new spouses usually has a time window. See adding or removing people.

Continuation of cover

An option, on some plans, to move from a company plan to an individual plan when you leave your employer, sometimes without new medical underwriting. Whether it's available, and on what terms, depends on the plan and the insurer. It may depend on how long you were on the company plan or why you left, and there is usually a deadline to apply. Why it matters: if you have ongoing health conditions, ask about this before your last day. See cover beyond your employer's plan.

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Company plans

Mainly for employers and HR teams. Individual members can skip this section. See also employee benefits and setting up a first company scheme.

Census

The list of people to be covered on a company plan, typically with dates of birth, gender, nationality, plan level and dependants. Insurers use it to price and set up the plan. Why it matters: an accurate census avoids pricing surprises and cover gaps later.

Member movements (joiners and leavers)

Changes to who is covered during the policy year: new joiners, leavers, new dependants or changes in plan level. These are usually reported to the insurer as they happen or at regular intervals. Why it matters: late notifications can leave a new employee without cover, or keep paying for someone who has left.

Pro-rata premium

A premium charged (or refunded) only for the part of the policy year someone is covered. Illustrative only: someone joining halfway through the year might be charged around half the annual premium.

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Still unsure what a term means for your own plan? Ask us, and we'll check it against your policy documents.