How to read a health insurance policy: four documents, five words

The benefit table (or plan summary) answers what does this level cover, and up to how much? — one column per plan, one row per benefit, limits in each cell. It is the document the compare page is built from. It is also, in the brochure's own words, a summary only: the insurer's disclaimer says to read the full policy wording, and that applications are subject to acceptance.

The Certificate of Insurance (some insurers say policy schedule) answers what applies to me? — the names on the policy, the plan level, the excess and coinsurance rate, the geographical area of cover, the start and renewal dates. On the plans we arrange this is where your cost-sharing figures live; the brochure has no menu. The policy wording is the contract: definitions, general conditions, the claims procedure, and the exclusions — 73 of them on the international health plans we arrange. Endorsements add or alter benefits: the evacuation-and-repatriation add-on, for example, is governed by a separate endorsement rather than the main wording.

Policyholder — the person who holds the contract; where a minor is insured, the parent or guardian who applied is treated as the policyholder. Period of cover or policy year — the twelve months from commencement; annual limits are per policy year, meaning per that twelve-month period, not per calendar year. Date of entry — the day your cover began, which is the date the pre-existing-condition test is measured against; on the plans we arrange a break in cover, including a missed premium, resets the date of entry and reapplies the exclusions.

Pre-authorisation — the insurer's advance approval, mandatory for all planned inpatient and outpatient-surgical treatment, after which bills are settled directly; not needed for outpatient consultations. Dependant — one spouse or adult partner, and unmarried children up to 18, or up to 26 in full-time education, all named on the certificate. Our exclusions guide and limits guide take the two densest sections of the wording one at a time.

Read the exclusions before the benefits; a benefit you were counting on is only as real as the exclusion that does not remove it. Then the claims section: the deadline (two months after the event on the plans we arrange), the language (English), the settlement route (direct settlement for pre-authorised care, reimbursement otherwise). Then the geographical area — costs outside it are excluded, including conditions that began there. Then, and only then, the benefit table.

What you will not find in any of the four documents is a rate table; premiums are quoted, and on this site they come only from the insurer's rate card via the pricing page. If a line in the wording does not match what you were told, that is the question to bring to the quote call.

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