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Healthy mature woman sitting on exercise mat in lotus position and doing yoga in the class


Health insurance terms explained

Health insurance uses words and phrases that most of us never normally use or have to understand. This list explains what some of them mean.

For a comprehensive list of health insurance terms with detailed explanations, see our policy book.

Chronic condition

A disease, illness or injury which has one or more of these features:

  • it needs to be checked regularly for a long time or for the rest of your life by a doctor, specialist, nurse or clinic
  • it needs to be treated or controlled regularly for a long time
  • it needs you to adapt to live with it 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.

Someone who goes into hospital or a day-patient unit for treatment but doesn't need to stay in overnight.


The amount of money you've agreed to pay towards your claim. Excesses are payable only once per person, per policy year, no matter how many times you claim. Learn about your excess options with Saga.


Someone who goes into hospital for treatment and needs to stay overnight or longer.

No Claim Discount

This is a discount you get on your premium when you renew if you have not made a claim in the previous year.

No Claim Discount Protection

You can pay extra to keep your No Claim Discount after one claim. Find out more about No Claim Discount Protection.

Open referral

To see a specialist or consultant, you need a referral letter from your GP. These letters often name the specialist the GP wants you to see. An open referral is when a GP says what type of specialist you need instead, such as skin or eye specialist.


Someone who goes to a hospital or out-patient clinic for an appointment with a doctor or specialist. Not a day- or in-patient.


A practising member of certain professions allied to medicine who, in all cases, meets our recognition criteria for benefit purposes in their field of practice and who we have told in writing that we currently recognise as a practitioner for benefit purposes.

When such persons provide such services to you as part of your in-patient or day-patient treatment those services will form part of the private hospital charges. The professions concerned are dieticians, nurses, orthoptists, speech therapists, audiologists, psychologists and psychotherapists.


A medical practitioner with particular training in an area of medicine (such as consultant surgeons, consultant anaesthetists and consultant physicians) with full registration under the Medical Acts, who meets our criteria for specialist recognition and benefit purposes, and who we have told in writing that we currently recognise as a specialist or benefit purposes in their field of practice.


Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.

Underwriting methods

When you take out a Saga HealthPlan, you can choose from three different underwriting methods. Read more about underwriting methods.