Group private health insurance

General FAQs

If you’re thinking about buying Optimum, you may have questions you’d like to ask. You 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 – perhaps an element of Occupational Health services, or 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 my employees leave 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’d like you to contact us first and 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
7th floor, Lloyds Chambers
Portsoken Street
London E1 8BN

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.

What information do my staff get?

All of your employees will receive a membership pack, which explains their benefits in detail and what they should do if they need to make a claim. In the pack is a membership card that details their policy number, our Customer Service Helpline, the 24-hour GP Helpline and our Stress Counselling Helpline – and a brief summary of the claims’ process.

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 an analysis and commentary on the scheme’s performance, which we’ll take into account for your renewal terms.

Which kinds of underwriting do you use?

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

• Full Medical Underwriting. We ask your employees questions about their past health. Their pre-existing medical conditions and related conditions will be excluded unless we agree to accept them.
• Moratorium. This 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 of, medication or treatment for, or advice about such a disease, illness or injury within five years before joining and
  • There has not been a clear two-year period after joining during which the member has been free of medication for, treatment for, or advice about such a disease, illness or related condition.
• Continued Medical Exclusions. This option can be chosen if your company is transferring from an existing fully medically underwritten medical insurance plan. We’ll 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. This means that we do not apply any medical exclusions to your employees, but applies only to schemes covering 20 or more employees.

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

With Optimum, you have access to a service called Back-Up. Back-Up is a service that’s aimed at reducing absenteeism due to back or neck pain. 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 pain, they can call us straight away and we’ll deal with the claim – there’s no need for a GP’s referral, providing your policy has the alternative therapies and treatments option included.

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.

Does Optimum include cover for international travel?

Optimum includes a level of overseas cover for emergency treatment if your employees are temporarily abroad for a period of up to 90 days. But if you’d like to find peace of mind for a more extensive level of cover, then we can offer you a separate policy – talk to us, and we’ll find a solution that works for your business.

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