The business case for private health cover Aviva s guide to protecting your company and your employees

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1 The business case for private health cover Aviva s guide to protecting your company and your employees

2 We are one of the UK s leading providers of health and protection solutions, and experts in providing healthcare to businesses just like yours. We understand that private health cover can be a confusing product if you ve not had experience it before. That is why we ve written this guide, helping you and your company find out more about the product and why it might be good for your company and your employees. If you choose to buy private health cover we re sure we have a solution to suit your company, whether you have 2 or 249 employees that you want to provide cover for. Contents 3 Why private health cover? 6 Some common misconceptions 7 Choosing the right insurer frst time buyers 8 Switching insurers what to look out for 10 Aviva in the workplace 17 Why Aviva? 19 Further information

3 Why private health cover? Why private health cover? As with all business decisions it s a good idea to have all the facts before you part with your money. That s why we ve written this guide, to help you understand about private health cover, how it works and how it can benefit your business. So what is it? Private health cover (also known as private medical insurance) is designed to cover the costs of private medical treatment for curable, short-term illnesses or injuries (commonly known as acute conditions). Having key staff absent from work can have a huge impact on small businesses. So most small companies buy private health cover to avoid lengthy absences and high business costs caused by staff having to wait for treatment on the NHS. Your staff may also benefit from choosing when to have treatment and at which hospital. Usually there s also the privacy of an en-suite room with TV and other home comforts. It is also a staff benefit that will show you as a caring employer so your staff will really feel valued. Most insurers offer products that provide cover for in-patient (where stays in hospital are overnight or longer) and day-patient (where some time is spent recovering, but not overnight) treatment. Some will also cover for out-patient treatment (including pre and post-treatment appointments relating to the condition). 3

4 Why private health cover? Private health cover; why is it good for business? Company cars and expense accounts are benefits you can use to attract (and keep) staff. However, private health cover is one benefit that can help give your employees peace of mind, whilst also enabling you to help them return to work as soon as possible. In fact, its perceived worth can be far greater than the amount you actually pay for it. There s also the added benefit that, when you take out company private health cover for your employees, they ll feel more valued and as such, could help you improve your staff retention. Then there s the commercial side to private health cover. On average, across all major business sectors, employees are absent for 7 working days per year, at a cost of 595 for each employee and this doesn t include time off to see their GP. So this means if you have a workforce of 50 employees, absence will cost you around 29,750 a year (Absence statistics are taken from the CIPD Absence Management Report 2013). Although private health cover can t eradicate sickness absence, it can help get employees back to work more quickly, because they won t have to join a NHS waiting lists. There are other benefits too. Private health cover is a tax-deductible business expense (under current tax rules). Also, if you and any of your employees already have individual private health cover, you could cut the cost significantly by taking out a company paid policy. After all, why shouldn t you benefit as well as your employees? 4

5 Why private health cover? 5

6 Some common misconceptions Some common misconceptions Private health cover is for larger companies not smaller ones. Not at all. The market offers private health cover for companies of all sizes. We offer our Solutions product for companies covering between 2 & 249 employees and we offer our Optimum product for companies covering 250 or more employees (with no upper limit). And remember, the smaller the company, potentially the greater the impact of sickness absence. We can t change cover, as we ve made a claim with our current insurers. This may not necessarily be so. It s often possible to transfer your health cover to an alternative provider and still have a similar level of cover. However, it s best to ask your new provider if this is the case before you sign on the dotted line. We ve already got a Cash Plan or Income Protection cover. These are different to private medical insurance as neither of these will cover you for private medical treatment. Whereas a health cash plan just covers the cost of everyday health costs, and income protection covers the financial aspect, having PMI in place helps get employees back to work quicker, reducing the strain on your business. We re covered for all critical illnesses and that s all the cover we need. Critical illness policies will only cover your employees for specific conditions and will then only make a one-off payment. Private health insurance covers treatment for a wide range of conditions and treatments. Furthermore, we don t limit the number of claims you make per year. My company can t afford private health cover. Whilst we can t speak for other insurers, we offer flexible private health cover to suit all budgets. And don t forget, getting private health cover through the company could provide you with significant savings compared to rates for individual health cover. There s loads of admin involved in making a claim. All claims are the responsibility of the individual staff member and we try to assess as many claims as possible over the phone. So valuable work time isn t wasted on unnecessary paperwork. Our claims process has been designed to be as simple as possible for your employees meaning they can focus on getting better. 6

7 Choosing the right insurer Choosing the right insurer first time buyers As an employer, your decision is going to be driven largely by cost but don t be fooled into simply comparing premiums. The cheapest private health cover will probably have the fewest benefits for you and your company so it s best to see just how much (or how little) you get for your money. After all, you want a good level of cover for yourself as well as your employees. To help you narrow down your choice of insurer and cover, there are all sorts of questions to ask yourself. Below, we suggest a few key issues to consider. How many employees do you want to cover? Obviously, the greater the number, the larger your premiums will be (although it will normally work out cheaper per employee). Do you want health cover that offers reduced premiums in return for reduced cover? Do you want different levels of cover for different types of employee or levels of management? Are your employees prepared to use the NHS if treatment is available within a reasonable period? This could help reduce your premiums. Do you want your cover to include out-patient treatment? Do you want an insurer that offers preventative health advice and value added services such as GP and stress counselling helplines or health and fitness club membership discounts for all employees, as well as cover for treatment? Are there any specific hospitals you d like to be included in your employees cover? Do you want to cover monitoring for chronic conditions? 7

8 Switching insurers Switching insurers what to look out for When changing your private health care provider there are a few areas you should consider. For instance, your new insurer may not cover any previous or existing conditions that are already covered by your current insurer. So before you cancel your current cover, it s best to check with your new insurer or your adviser. If you do decide to switch, different insurers will offer you different options. At Aviva, we offer the following types of personal medical underwriting (please note that policy terms and conditions will apply): 8

9 Switching insurers Full Medical Underwriting We ask your members questions about their past health, and their pre-existing medical conditions and related conditions will be excluded unless we agree to accept them. Moratorium Replaces filling out a health questionnaire; an automatic exclusion applies to any disease, illness or injury (whether or not diagnosed) or any related condition if: a member had symptoms for, diagnostic tests for, medication or treatment for, or advice about such a disease, illness or injury within five years before joining the scheme and there has not been a clear two-year period after joining during which the member has been free of medication for, diagnostic tests for, treatment for, and advice about such a disease, illness or related condition. Continued Medical Exclusions Can be chosen if your company is transferring from an existing fully medically underwritten medical insurance plan. With this option we apply the same personal medical exclusions that were applied to the previous plan. No new personal medical exclusions will be added. Continued Moratorium Your company can apply to transfer from an existing medical insurance plan which is underwritten on a moratorium basis. We apply our moratorium wording with effect from each member s original moratorium start date. Medical History Disregarded (schemes covering 15 or more employees) Means that we do not apply any personal medical exclusions to a member for pre-existing conditions. 9

10 Aviva in the workplace Aviva in the workplace Once you ve decided just what you want from your insurer, you re ready to choose the cover that s best for your company and your needs. And whilst we can t compare our products with those of our competitors, we suggest that you speak to your adviser before you make a decision. Options to enhance your cover Option 2 Routine & GP referred services Consultations or treatment with a specialist Out-patient treatment of acute conditions Option 3 Hospital lists Diagnostic tests Psychiatric treatment Option 4 Dental and optical Option 1 Mental health cover Radiotherapy/ chemotherapy Physiotherapy, osteopathy and chiropractic Option 8 Reduced out-patient cover Hospital charges In-patient/day-patient treatment of acute conditions (at a hospital on the key hospital list or in any NHS pay-bed) Diagnostic tests Specialist s fees Treatment for musculoskeletal (MSK) conditions Radiotherapy/ chemotherapy BacktoBetter Option 6 Member excess Option 5 Six week option Option 7 Selected benefit reduction Options to reduce your cover 10

11 Aviva in the workplace Solutions private health cover for employees Our Solutions product offers extensive in, day and out-patient cover at our approved hospitals. It also includes access to our innovative rehabilitation service BacktoBetter. Which means that if your employees need to claim for pain in the back, neck, muscles or joints (musculoskeletal conditions) they don t need to see their GP. They just need to call us and they will be referred for a telephone assessment with one of our expert BacktoBetter clinicians and if required, can start treatment straight away. However, the real difference lies in its flexibility. With Solutions, you can hand-pick the cover that fits your needs, so you don t have to buy benefits you don t want or feel you don t need. You can: Select extra options that allow you to increase or decrease the level of protection you want such as dental and optical cover, or reduced out-patient cover Vary the level of cover for different groups of employees for example a higher level of cover for Directors, and reduced benefits for other members of staff. Add extras or cut the cost We believe that Solutions is the most flexible product on the market. With Solutions, you can bolt on up to 4 extra cover options and/or select from 5 options to manage costs. Additional Options (will increase costs) In/day-patient psychiatric treatment Routine and GP referred services. As with most health insurance policies, our core cover excludes long-term treatment for chronic conditions. However, with Solutions you can cover routine specialist consultations and diagnostic tests for a chronic condition or follow up consultations with a specialist to monitor a member when they have finished treatment for an acute condition by adding this option. It also offers a number of GP referred services like acupuncture, homeopathy and radiology (for non-musculoskeletal conditions) Choose a more extensive hospital list Additional dental and optical benefits. Cost-cutting options (will reduce costs) 6 week option. If the NHS delay for in-patient or day-patient treatment is less than 6 weeks members will need to use NHS facilities or self fund any private treatment. However, if the waiting list is 6 weeks or more, we cover private treatment without delay Restrict your hospital lists, or decide to use private patient units within NHS hospitals (for schemes with less than 99 members) Member excess of 50, 100, 150, 200, 250 or 500 Selected benefit reduction cut back on less essential extras Reduced out-patient cover you can choose from 0, 1,000 or 1,500 limits for outpatient cover per member per policy year. 11

12 Aviva in the workplace Cancer cover with Solutions We understand the importance of providing extensive cover and support at every stage of your cancer treatment. Our cancer pledge means we ll cover the cancer treatment and palliative care you need, as recommended by your specialist. We also want to make things as comfortable as possible for you following your cancer treatment, so we ll provide extensive cover for your aftercare, including consultations with a dietician, as well as money towards prostheses and wigs. We know that cancer is a concern and when someone is diagnosed with it their whole world changes. With more than one in three people developing some form of cancer in their lifetime, we understand the importance of providing the cover and support they need should they be diagnosed with cancer. 12

13 Aviva in the workplace Added value benefits from Aviva It s widely accepted that, if employees lead healthier lives and feel more appreciated by employers, then a business could see a boost in workforce performance, morale and positivity. We include a range of helpful extra features at no extra charge with every Solutions policy. Access to a 24-hour GP helpline For over-the-phone consultations with a fully qualified GP when employees need reassurance about medical issues, day or night. A 24-hour stress counselling helpline When employees want to talk about a personal or professional issue that s causing them distress. This benefit is available to members aged 16 and over. Aviva News & Guides An online portal of tips and tools that can help your employees improve their health and fitness. Up to 25% off gym membership Solutions PMI also offers up to 25% off membership fees at some of the UK s leading health and fitness clubs. Access to Aviva Advantages All customers on our Solutions policies get given access to Aviva Advantages this gives your employees lots of rewards and money saving offers not just on personal Aviva insurance products (such as car or home insurance) but with 100s of our partners too. 13

14 Aviva in the workplace 14

15 Aviva in the workplace Other services from Aviva For Larger Companies... Companies with 250 or more employees will be offered our Optimum product. Optimum has been designed for larger schemes to ensure that they receive a product with benefits and services bespoked to their needs. For International Cover If your employees are living or working abroad on a long-term basis they may need private health cover. Our International Solutions policy is designed to cover your expatriate employees living or working abroad for six months or more. Living and working overseas can have many benefits, but access high quality medical treatment without costs may not be one of them. The cost of paying privately for even the most routine medical treatment can be prohibitively expensive, so it is important to have suitable cover. 15

16 Why Aviva? Why Aviva? No matter the solution chosen, there are several key benefits to working with us. Health Insurance Company of the Year 2014 for the ffth year running. And Best Group PMI Provider for the ffth year running too. We are a leading UK insurer with a 300 year heritage which gives us a great experience of understanding our customers needs 1. Flexible approach A highly fexible, pro-active and effcient approach to healthcare, specifcally tailored to business requirements. Our claims service We don t believe that a one size fts all method of assessing claims is the best way to go. So we ve created our own model to do this. For any claims for pain in the back, neck, muscles or joints (musculoskeletal conditions) your employees will have access to our innovative rehabilitation service BacktoBetter. This means that they don t have to see their GP they just call us and, providing it s an eligible claim, they will be referred to an expert BacktoBetter clinician who will call them back within 2 hours to take them through a telephone assessment. From this call they will receive advice about their condition and self management exercises, be referred to a physiotherapist or referred to a specialist for further diagnostics and/or treatment. This can lead to a faster recovery. The great thing about BacktoBetter is that it s an end-to-end service that delivers best practice rehabilitation no matter how complicated the problem is or what route your employee s treatment requires. 16

17 Why Aviva? For all other claims for non-musculoskeletal conditions your employees will follow the standard process. This is also as easy as possible for your employees. Once they ve been referred to a specialist by their GP they need to call us and can begin their claim from that call. What s great about our claims service is that instead of having claims assessors undertaking all types of claims we have expert advisers split into a number of condition management teams, including: Women s Health Unit Psychiatric Oncology This means that your employees will get the best help and advice from experienced claims assessors who will guide them through the whole process with ease. This is very important as we all know that becoming ill or being injured can be a stressful time, so we have made it as easy as possible with the vast majority of claims being approved on the telephone. We have also found that by having more knowledgeable claims assessors who are experts in their felds, we can help manage your company s future premiums. This is because we will case manage any complex or long-stay cases by liaising with your employee, their consultant and the hospital. 1 Source: Aviva.com, December

18 Why private health cover? 18

19 Further information Further information We hope you ve found this guide useful. However, if you need any more information the Association of British Insurers has published an independent guide called Are you buying private medical insurance? which you can order by visiting If you d like a copy of the policy wording detailing the full terms and conditions, just ask and we ll send them to you. If you d like to take out a policy, you ll need to complete an application. If we accept your application, the details you give us and the options you select will determine the final terms of your policy. To find out more about private health cover for your company please speak to your usual Aviva representative or speak to your financial adviser or insurance intermediary. 19

20 Aviva Health UK Limited. Registered in England Number Registered Offce 8 Surrey Street Norwich NR1 3NG. Authorised and regulated by the Financial Conduct Authority. Firm Reference Number This insurance is underwritten by Aviva Insurance Limited. Registered in Scotland, No Registered Offce: Pitheavlis, Perth, PH2 0NH. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number Aviva Health UK Limited, Head Offce: Chilworth House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY. aviva.co.uk/health GEN /2015 Aviva plc

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