What can this product cover?
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With Solutions, your employees can avoid NHS waiting lists, and get prompt, private medical care. Our team is happy to answer any questions you have about Solutions, and full details of cover options are included in our Solutions brochure (PDF 1,678KB). All employees on the policy will have peace of mind knowing the costs of hospital accommodation, meals, nursing care and drugs are covered.
Treatment and care included in Solutions core cover…
If your employees need to make a claim for the benefits below, we'll be happy to help. They can also access our GP helpline and our Stress Counselling Helpline, free of charge, 24 hours a day. The stress counselling helpline is available to members aged 16 and over.
- In-patient, day-patient and out-patient treatment of acute conditions
- Hospital fees at a hospital on your hospital list
- Radiotherapy/chemotherapy treatment
- Specialists' fees - up to the limits in our specialist fee schedule
- Diagnostic tests - including X-rays, scans, blood tests and ECGs
- Out-patient CT, MRI and PET scans at a diagnostic centre that we recognise
- BacktoBetter - our innovative case management service for musculoskeletal (MSK) conditions helping get employees back to work faster. For more information on BacktoBetter read our Solutions brochure (PDF 4,425KB) or have a look at our BacktoBetter FAQs page
- Specialist referred physiotherapy, osteopathy and chiropractic treatment as an out-patient for non-musculokeletal conditions
- Psychiatric treatment as an out-patient, up to £2,000 per member per policy year; on GP referral to a psychiatric therapist or psychiatric specialist
- Extensive cancer cover through our cancer pledge
- NHS cash benefit of up to £100 per night, for a maximum of 25 nights per member per policy year
- Accommodation for one parent staying with a child of 11 or under receiving eligible treatment
- Home nursing on specialist recommendation following treatment as an in-patient or day-patient
- Treatment for pregnancy and childbirth complications
- £100 for each baby born to or adopted by a member
- Limited overseas cover for emergency treatment when temporarily abroad for a period of up to 90 days
- Surgical procedures on the teeth performed in a hospital
- Hospice donations of up to £70 per day up to 10 days
- A private ambulance when medically necessary
Treatment, care and options you can add to Solutions core cover…
Private health insurance is a very personal matter, but when it comes to cover for larger companies, some features can be of tangible benefit to your business. It's important to know that by choosing these benefits, your premiums will increase, but your financial adviser or our helpful team can tell you more - and we're always happy to talk about ways to make Solutions fit your particular business needs.
- Mental health cover. Choosing this option means that your employees could claim for in-patient and day-patient treatment if diagnosed with a psychiatric condition, such as clinical depression. Your plan can provide a maximum of either 28 or 45 days' combined in-patient and day-patient treatment per member per policy year, as well as specialist's fees of up to £210 per week for in-patient treatment.
- Routine & GP referred services. This option has an overall benefit limit of £1,000 per member per policy year and includes the following benefits:
- Specialists’ fees for consultations and diagnostic tests for a chronic condition - chronic conditions are usually excluded by all private medical insurance policies so this gives extra reassurance for your employees
- Follow-up consultations with a specialist to monitor a member when they have finished treatment for an acute condition
- GP referred radiology/pathology for non-musculoskeletal conditions
- GP referred physiotherapy, chiropractic, osteopathy and acupuncture treatment for non-musculoskeletal conditions – up to 10 sessions in combined total per condition per member per policy year
- GP referred chiropody, podiatry and homeopathy for non-musculoskeletal conditions
- GP minor surgery – up to £100 per procedure (payable to the GP).
- Extended hospital list. If treatment in the Greater London area would be convenient for your employees, it's possible to upgrade your hospital list to include a choice of additional private hospitals in the London area.
- Dental and optical cover. Eligible surgical procedures would be covered by your core cover, but by choosing this option you could claim for routine dental treatment up to £500, accidental dental injury up to £600 and routine optical expenses up to £300. We apply a separate £50 excess to both the optical benefit and routine dental treatment, per member per policy year. Meaning we'll pay a maximum of £450 for routine dental and £250 for routine optical costs per member per policy year.
Options you could choose to contain your costs…
Choosing some of these options won't impact on the quality of prompt private care your employees can receive, but it could help you reduce the costs of cover. Choosing these options will reduce some of the benefits covered on your policy.
- Six week option. Choosing this option means that your employees won't be able to claim for in-patient or day-patient treatment, NHS cash benefit, NHS cancer cash benefit or for the cost of an NHS amenity bed, if the NHS can treat them within six weeks.
- Policy excess. You can add a member excess of £50, £100, £150, £200, £250 or £500 to your policy. We'll apply it once per member, per policy year, irrespective of the number of claims made.
- Reducing selected benefits. This option lets your employees claim for in-patient, day-patient and out-patient costs - but doesn't cover some of the extras. By taking this option, you would exclude cover for investigation into the causes of infertility, complications of pregnancy and childbirth, surgical procedures on the teeth performed in a hospital and limited overseas cover.
- Choosing an alternative hospital list. As an alternative to the list of hospitals included in core cover, you could choose our Signature hospital list if you live in Scotland or Northern Ireland.
- Reducing out-patient cover. By choosing this option, your employees would still have cover in full for CT, MRI and PET scans at a diagnostic centre that we recognise, out-patient radiotherapy and chemotherapy treatment and physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions), claimed through BacktoBetter. Plus the monetary limit does not apply to out-patient cancer treatment received after your employees have been diagnosed with cancer. In addition we will also cover any costs for pre-admission tests required within 14 days of in-patient or day-patient treatment to check the employee is fit to undergo surgery and anaesthesia. You can choose to limit all other out-patient treatment to £0, £1,000 or £1,500 per member per policy year.
What's not included in Solutions?
Some treatments and conditions aren't covered by our medical insurance. But if you have any questions, we'll do our best to answer them. Call us to find out more.
- Long term or chronic conditions (except specialists' fees and diagnostic tests included under Option 2). This exclusion does not apply to treatment for cancer. Chronic conditions are explained in more detail on our general FAQs page
- HIV/AIDS and related conditions
- Alcoholism, alcohol abuse, drug abuse, solvent abuse and other addictive conditions
- Health hydros or similar facilities
- Treatment undertaken by a specialist without referral by your employee's GP (unless through BacktoBetter)
- Physiotherapy for a musculoskeletal claim that is not undertaken with a physiotherapist who is registered with our approved physiotherapy network
- Treatment for pregnancy or childbirth (other than the complications as detailed in the policy wording booklet)
- Surgical or medical appliances such as neurostimulators (eg cochlear implants) and crutches
- Charges made by a GP, medical practitioner or specialist for completing a claim form if the claim isn't covered by the policy
- In-patient and day-patient treatment for psychiatric and mental illness (unless the mental health cover option is taken)
- Kidney dialysis
- Cosmetic treatment (except following an accident or surgery for cancer)
- Take-home drugs and dressings
- Professional sports injuries
- Experimental treatment (limited benefit may be available - please contact us)
- Treatment required as a result of war, terrorism or contamination by radioactivity or chemicals
- Self inflicted injury
- Sleep disorders and sleep problems such as snoring or sleep apnoea
- Treatment for warts or verrucas
- Weight loss surgery
- Treatment for infertility
- Varicose veins of the leg unless they meet the criteria detailed in the policy wording booklet
Solutions; Value-for-money, flexible and effective
We know how important it is to find value for money. Whether you're covering the whole workforce, or putting a policy into place for just a few staff, Solutions is an affordable policy that can help keep your employees healthy. And as you know, that can also help keep the costs of absenteeism down. Find out more about Solutions. Talk to your financial adviser, call us or ask us to call you back.
Full details of cover are in our policy wording booklet (PDF 1,800KB). You’ll need to complete an application form for us to work out the final terms of your policy. If we accept your application and, depending on your circumstances, non-standard terms may apply.