Group private health insurance

Making a claim

The more employees you have working for you, the more likely it is that one of them will need to make a claim. We’ll do everything we can to make things go smoothly, because we know how important a professional and efficient service can be.

First and foremost, we want your employees to receive the exemplary levels of service they’ll expect from a company like Aviva. We also know that your staff may not be feeling 100% when they call, so we’ll take great care to make sure they receive a sensitive, personal service – every step of the way.

Step-by-step help from experts

From their initial GP’s recommendations through to specialist referrals, we’ll help individuals through their claim, explaining what needs to happen next at every stage. Claims can usually be assessed over the phone, and often authorised immediately. If we need to send out a claim form, your employees will be given help to fill it in accurately – and of course, we’ll settle invoices with the hospital on your behalf, once treatment is complete.

But an efficient claims service does more than help your employees – it also helps us identify and manage high-cost cases: things like cardiac or orthopaedic treatments or specific, more complex conditions such as cancer, stroke or psychiatric care. This vigilance helps us to manage our premium levels for the long term, which is good news for everyone.

Dedicated Teams

With our specialist claims teams, we can provide appropriate support to employees – and effectively manage costs.

Cancer Care…

No one expects this diagnosis. It’s a life-changing moment, so we have a dedicated team that’s trained to help claimants for cancer, 24-hours a day. We’re determined to provide a consistently high level of cover and support.

Patients will be put in touch with a dedicated case handler straight away – so while we get to know their needs and history in depth, they can focus their full attention on treatment. And everyone’s treated individually – like a patient. We think that’s vital, and a positive, contributing factor to easing the transition between stages of treatment.

Where possible, we’ll also suggest options to make things easier for everyone involved. For example, if the journey to and from hospital is tiring or impractical, we may be able to cover treatment at home, providing the specialist is in agreement.

If a specialist recommends that chemotherapy, intravenous antibiotics, blood transfusions or other treatments are given from the comfort of patients’ own surroundings, we may be able to cover those circumstances, as well. This cover extends to give patients treatment at work or even cover treatment that’s necessary on a holiday that’s taken in the UK.

Psychiatric Care…

Over 33% of employers reported an increase in stress-related absence in 2010, according to the Chartered Institute of Professional Development. Whatever the causes, dealing with symptoms of stress in the workplace requires sensitivity and professional care. Your employees’ health and wellbeing, and the welfare of their immediate family, may depend on it.

Our psychiatric team understands that dealing with the processes involved in making an insurance claim may be difficult. All cases are referred to an experienced psychiatric nurse, and all the facilities we work with know that admissions need to be pre-authorised.

We’ll carefully manage psychiatric claims, monitoring and controlling the costs involved from the outset. A range of the in, day and out-patient bills we receive are audited to make sure that charges are reasonable. And we can always offer an independent evaluation and management service offered by highly experienced external psychiatric consultants.

Back-Up and Back-Up Plus

Back-Up is an expert-led support and rehabilitation service from Aviva which is available on all our large corporate PMI schemes with 250+ employees.

Aimed at helping employers manage their sickness absence costs, it utilises evidence-based medical guidelines for managing back and neck pain and delivers personal treatment plans for patients.

In fact, Back-Up has been such a success that Back-Up Plus has now been introduced benefiting employers and employees alike. This new service applies the same process of Back-Up to other musculoskeletal conditions that can affect a significant number of employees.

Early intervention - no need to see a GP first

By accessing Back-Up and Back-Up Plus as soon as a back, neck or musculoskeletal problem develops, and with no need to wait for a GP appointment first, employees quickly gain access to help, advice and support which means the problem doesn't necessarily have to lead to time off work - in fact 97% of claimants speak to a qualified case manager within two hours.²

Rehabilitation support

Employees will be provided with practical and clinical information, advice and support to enable them to manage their back, neck and musculoskeletal pain and where appropriate, be referred for further treatment such as physiotherapy to help them return to full health as soon as possible.

Dedicated case management

A dedicated clinical case manager will keep in contact with the employee throughout to monitor progress and assess if further treatment is required or the employee is ready to be discharged.

To find out more view our Back-Up and Back-Up Plus literature (PDF 1,127KB).

²HCML – December 2011