What can this product cover?
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Our Defaqto 5 Star rated Solutions product helps your employees gain access to prompt, private medical care at a national network of hospitals. Our team is happy to take you through all the benefits, along with what options are available to help increase cover or reduce costs. We'll also talk to you about the types of underwriting available.
Full details of cover are in our policy wording booklet(PDF 1,572KB). 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.
Treatment and care included in Solutions core cover…
All policies will include the following cover plus access to 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
- Extensive cancer cover, see Our cancer pledge for further details and full terms and conditions
- 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 clinical 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-musculoskeletal 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
- 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 subject to a 10 month qualifying period
- £100 for each baby born to or adopted by a member, subject to a 10 month qualifying period
- Limited emergency overseas cover for treatment when temporarily abroad for a period of up to 90 days per policy year
- Surgical procedures on the teeth performed in a hospital
- Hospice donation of £70 per day, up to 10 days maximum
- A private ambulance for transportation to hospital if medically necessary.
Treatment, care and options you can add to or remove from your Solutions cover…
You may want to offer these options to your employees. If you choose these extra benefits, your premiums will increase.
- Mental health cover. Choosing this option means that your employees could claim for in-patient and day-patient psychiatric treatment if diagnosed with a 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. This also includes specialist 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 having treatment in the Greater London area would be convenient for you, your employees and your business, it's possible to upgrade your hospital list to include a choice of additional private hospitals and clinics in this area.
- Dental and optical cover. Eligible surgical procedures would be covered by your core cover, but by choosing this option your employees 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 reduce your costs…
Choosing 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 on the policy 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 after the date on which the specialist recommends that treatment.
- 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 less essential extras. By taking this option, you would exclude cover for costs associated with investigations into the causes of infertility, complications of pregnancy and childbirth, surgical procedures on the teeth performed in a hospital and limited emergency 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. Or you could choose our Trust hospital list, which includes private patient units of NHS Trust and Partnership hospitals. You can only choose the Trust hospital list if you have less than 100 employees covered by the scheme, and you need to make sure there is a Trust hospital in your area that all your employees can use.
- Reducing out-patient cover. By choosing this option, your employees would still have full cover for CT, MRI and PET scans at a diagnostic centre that we recognise, out-patient radiotherapy and chemotherapy 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 admission to enable you or your employees to proceed into hospital for eligible in-patient or day-patient treatment. All other out-patient treatment would be limited to £0, £1,000 or £1,500 per member per policy year - you can choose any of these limits to apply to your Solutions policy.
What’s not included in Solutions?
Like most private health insurance policies, Solutions won’t cover any pre-existing conditions unless we have expressly included treatment relating to them during full medical underwriting or under continued medical exclusions. Or if you choose medical history disregarded underwriting (available to policies covering 15 members or more) pre-existing conditions are covered providing they fall within the terms and conditions of the policy. Some occupations, and some specific 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 on 0800 158 5182. Calls to and from Aviva may be monitored and/or recorded.
Solutions won’t provide cover for these treatments…
- Long term or chronic conditions (except specialists' fees 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
- Experimental treatment (limited benefit may be available - you or your employees should contact us)
- Treatment for pregnancy or childbirth, although some complications are covered provided the mother has been on the policy for at least ten months (unless the selected benefit reduction option has been chosen)
- 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 is not 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
- 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
- Varicose veins of the leg, unless they meet the criteria detailed in the policy wording
- Weight loss surgery.
Solutions; Value-for-money, flexible and effective
We know how important it is to find value-for-money for your business. Solutions is an affordable policy that can help keep your employees healthy, which also helps keeps the costs of absenteeism down. Find out more about Solutions by calling us on 0800 158 5182 or ask us to call you back. Calls to and from Aviva may be monitored and/or recorded.