DEFINITIONS OF TERMINOLOGY USED BY TRICARE
Wherever the following expressions appear, they shall have the meanings set out below.
Acupuncturist: A practising acupuncturist who is a current member of the British Acupuncture Association and Register.
Acute Illness: A disease or illness of rapid onset, severe symptoms and brief duration.
Chiropractor: A practising chiropractor who is a current member of the British Chiropractors’ Association.
Chronic Illness: A disease or illness of long duration involving very slow changes and often of gradual onset. The term does not imply anything about the severity of an illness or condition.
Claim: a course of treatment undergone in relation to a specific medical condition which has been authorised by the Fund Manager, but excluding ongoing and routine treatment to monitor such a condition.
Commencement Date: the date upon which members who have applied for membership are accepted by the Management Committee and from which benefit may be payable.
Complementary & Alternative Therapies: shall mean acupuncture, homeopathy, chiropractic treatment, osteopathy and other complementary medicine treatments as approved by the Fund Manager.
Consultant/Specialist: A Medical or Dental practitioner who is currently registered under the Medical Acts and holds a Consultant’s appointment in an NHS hospital and holds a Specialist Accreditation issued by the General Medical Council in accordance with EC Medical Directives, or for the provision of Complementary Medicine, a registered practitioner as defined in the rules of the Fund.
Claims Helpline: available on 01905 796682 Monday-Friday before 3pm
Day Case: Hospital treatment which requires some form of preparation or period of recovery, or both, involving the provision of accommodation and other services but not involving an overnight stay and where the patient is admitted to the care of the hospital.
Day Patient: A patient who receives day case treatment in a hospital.
Dental Condition: Any dental condition or dentistry, including gum conditions (periodontal treatment) and malocclusion (orthodontic treatment).
Dental Practitioner: A registered Dental Practitioner in general practice in the UK
Emergency: Immediate or early treatment for a medical condition requiring urgent attention.
Fund Manager: A person or persons appointed by the Management Committee to administer the membership records and claims of the Fund.
General Practitioner: A registered Medical or Dental Practitioner in general practice.
‘Hi-Tech’ Investigation: Specialist investigation used as an alternative or in addition to routine diagnostic procedures only when ordered by a consultant physician/surgeon.
Homeopath: A practising homeopath who is a current member of the British Homeopathic Association.
Hospital Charges: Charges directly related to the treatment received as an In-patient or Day patient, including Accommodation, Theatre Fees, Nursing, Pathology, Radiology, Physiotherapy, Drugs and Dressings, or any additional items which form part of an integral pre-agreed procedural price.
In-patient: A patient who occupies a bed overnight in a hospital for the sole purpose of receiving treatment.
Management Committee: A committee appointed by the Federation to administer all matters relating to the operation of the Fund. The Management Committee may retain the services of such preferred bodies or individuals to assist in the operation of the Fund as they may decide from time to time.
Medical Condition: Any disease, illness or injury other than a Dental Condition as defined.
Member: A person who has applied for membership of the Fund and who has been accepted for membership by the Management Committee and whose contributions are fully paid up to date.
Nursing at Home: The attendance of a Registered Nurse in the patient’s home to provide nursing services for treatment covered under the Rules of the Fund immediately following treatment in a hospital if such services are necessary and recommended by the Consultant/Specialist who treated the patient. Such services must be for medical and not domestic reasons.
Osteopath: A practising osteopath who is a current member of the Register of Osteopaths (MRO) or College of Osteopaths.
Out-Patient: A patient who receives treatment other than as an In-patient or Day patient at a hospital or Consultant/Specialist’s consulting rooms or other facility where the patient does not remain overnight and is not required to sign an admission form.
Physiotherapist: A State Registered Physiotherapist who, for the purposes of Outpatient cases, is deemed to be a Specialist. Physiotherapy must be given under the direction of a specialist.
Pre-Claim Authorisation: The process required under fund rules to validate a claim before treatment is undergone.
Pre-Existing Condition: Any Injury, Illness or Condition or related injury, illness or condition:
- For which medical advice or treatment has been received, or
- of which the Member, or Dependant, was aware or ought reasonably to have been aware, and for which medical advice or treatment was not sought, before the confirmed date of joining. Benefit will not be paid for the first 24 months of membership for a Member or a Dependant and then only after 24 continuous months have elapsed without further medical advice or treatment, including drugs and/or medication.
Preferred Provider: A hospital or group of hospitals or other providers of private medical care, who have agreed special pricing arrangements with the Fund Managers.
Private Hospital: A Nursing Home or Independent Hospital registered in accordance with the Nursing Homes Act or NHS pay bed, and those hospitals opting out of Regional Health Funding control.
Registered Nurse: A nurse included in the professional register of nursing maintained by the Nursing and Midwifery Council.
Second Opinion: An alternative view of a Medical condition from a second Specialist. Second Opinions may only be sought following diagnosis by a first Specialist and after authorisation by the Fund Managers.
Surgical Appliance: Any external device prescribed by the consulting specialist.
Treatment: The diagnosis and /or treatment of any surgical or medical condition including Complementary Treatment defined as such in the Fund Rules, for the sole purpose of curing or permanently relieving a medical condition under the direction of a Specialist. Treatment does not extend to include alteration or relief of chronic or long-term disease, illness or injury.
United Kingdom: Great Britain and Northern Ireland including the Channel Islands and the Isle of Man.
PREFERRED PROVIDER HOSPITALS
Your Federation Health Scheme has a Preferred Provider Hospital which provides services at a preferential rate. As these may vary from time to time it is essential that you check with the Tricare Office for your nearest Preferred Provider Hospital at the time of starting your claim.