Group private health insurance

General FAQs

If you’re thinking about buying Optimum, you may have questions you’d like to ask. Your adviser may have the answers, or if there’s something more specific you’d like to ask – perhaps in connection with your industry or business needs – we’re always happy to help. Some of the questions we’re asked most often are answered here…

Is there a difference between ‘private health insurance’ and ‘private medical insurance’?

In our industry, both terms refer to the same type of cover. Optimum is a policy that helps employees get private treatment – we call it private health insurance, but you may hear other providers refer to policies as private medical insurance.

With Optimum, can I pick and choose any benefits I want for the business?

Flexibility is key, we understand that. From our experience working with large companies, we’re confident that Optimum can offer an appropriate level of benefits and services for your business. However, if there's something specific you'd like to include such as a particular combination of benefits for certain employees - then we're happy to discuss how we can adapt Optimum to create a benefits package specifically for your business.

What happens if an employee leaves the company?

We’ll offer them an individual UK policy. Details will be given to your group administrator when you start an Optimum policy.

Could the terms and conditions change?

The terms and conditions may change annually at renewal. This may include the removal of some benefits and services, or the improvements or benefits and services. Optimum is an annual contract, so we’ll tell you about any changes prior to renewal.

Will our premiums increase over time?

We’ll take your scheme’s membership profile, claims experience and any changes to the benefits chosen into account when we calculate your premiums. With new treatments and technologies also appearing, we’ll also take into account general changes in the cost of claims to reflect medical inflation.

How long does Optimum last?

It’s a one year contract.

If things go wrong, what do I do?

Aviva is covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the FSCS if we can’t meet our obligations, depending on the type of product and the circumstances of the claim. Of course, we’ll make sure you have all the necessary details when we give you the paperwork accompanying your Optimum policy. More information about compensation scheme arrangements is available from:

Financial Services Compensation Scheme
10th Floor
Beaufort House
15, St Botolph Street
London EC3A 7QU

Website: www.fscs.org.uk

Who deals with our claims – is it Aviva, or is it an outsourced company?

You and your employees will be speaking to a team of experts at Aviva, here in the UK, via our customer services helpline. They’ll answer any questions you have and offer guidance to your staff. If you choose Recorded Membership, then employees can make use of our telephone assessment service and speed up the claims process. When a claim is confirmed as being eligible, we’ll deal with the paperwork and, if necessary, send any claim forms directly to the member.

For musculoskeletal (MSK) claims, Aviva carefully selects case management providers, such as Nuffield Health and HMCL, to ensure these claims are managed to the highest clinical quality. These strategic case management providers are quality assured and their performance is regularly monitored against a strict contractual arrangement.

What information will I have access to?

We’ll send you a group administrator’s report once a month, showing claims made during the previous period. This will help you keep track of the claims spend on your policy. Before renewal, we’ll also give you a detailed management report showing the annual spend, frequency of claims and membership information. This annual report will have analysis and commentary on the scheme’s performance, which we’ll take into account for your renewal terms.

What types of underwriting do you use?

When it comes to underwriting, different insurers offer different options. We offer the following types:

Our employees have a lot of back problems, can you help?

With Optimum, you have access to a service called BacktoBetter. BacktoBetter is an end-to-end clinical case management service that coordinates appropriate clinical pathways for members with musculoskeletal (MSK) claims. We’ve designed it to help your employees recover as quickly as possible, helping them and helping your business as they return to work. As soon as your employees suffer back, neck, muscle or joint pain, they can call us straight away and we’ll deal with the claim – there's no need to see a GP.

Why don’t you list your specialists and hospitals on the internet?

Specialists may change the hospitals they work from. It would be almost impossible to keep a list of specialists up to date. Rather than give you incorrect information, we would rather let you know that we’ll do our best to help you find a specialist or hospital covered under your policy, if your employees need to make a claim.

If your employee has an open referral from their GP (a recommendation for a medical investigation or treatment that doesn't name a specialist or hospital) we can use our specialist finder tool to find an appropriate consultant and treatment unit in their chosen area. We have over 16,000 specialists on our specialist finder tool who operate out of hospitals across the UK.

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