GuideWell. Group private medical insurance using open referrals.
GuideWell. Health insurance for 250+ employees
GuideWell helps to make private medical insurance (PMI) more sustainable and affordable by utilising an open referral claims pathway, putting the needs of your clients’ businesses and their employees first. It’s available to companies with 250 employees or more – providing flexible PMI, at a sustainable and affordable price.
GuideWell, available to large corporates.
It’s important to fully understand this product’s details, as this will help you conduct a compliant sale. Examples of the flexible cover we could create, options and exclusions are listed in the product’s brochure (PDF 2,421KB). Non-standard terms may apply to your client's policy.
Getting the right treatment at the right place and at the right time for the client's employees is our priority. In a GuideWell scheme, Aviva will select an appropriate specialist and hospital for each employee's clinical needs based on location as well as specialism. Employees can choose to make their claim using either their work or home postcode, whichever is more convenient.
More flexibility, happier clients
GuideWell promises that there’ll never be a shortfall for employees when the open referral claims pathway is followed. This makes for an easier overall claims experience as we take care of finding the right specialist hospital on the employees behalf, and in most cases, an appointment can be booked in the same call reducing the stress and increasing the efficiency of the handover.
GuideWell can be sold as a lower priced alternative to our Optimum PMI. If your clients would prefer to keep some of their employees on Optimum and the rest on GuideWell, they can. It’s that flexible.
We’re here to help you understand GuideWell, explain how it works to your clients, and help you propose a PMI policy that can match their needs as closely as possible. We believe our policies are flexible enough to match cover from a current provider.
We know that companies want some ‘must have’ benefits – so we’ve included an example of core cover here, with a description of our underwriting options available.
- Example cover and options
These are example benefits of what is available for GuideWell clients:
- Access to full in-patient and out-patient care by the specialist and hospital confirmed by us
- All hospital charges, specialists’ fees and diagnostic tests (such as MRI scans, blood tests and X-rays)
- Cancer cover, at a level chosen by the business, as explained in full in our Cancer brochure (PDF 836KB)
There are many other benefits included in the cover, such as payment for minor surgery carried out by a GP. Examples of the benefits available can be found in the GuideWell brochure (PDF 2,421KB).
Ways to enhance cover
There is no limitation on levels of cover with GuideWell. However, selecting enhanced cover options will increase your client's premium. All the benefits available are described in greater detail in the GuideWell brochure (PDF 2,421KB)
- Psychiatric in-patient, out-patient and day-patient cover
- GP referred services, such GP referred radiology
- Complementary and alternative medicine such as GP referred homeopathy, chiropody and podiatry
- Dental and optical benefits, which can help with the cost of routine dental expenses, accidental dental injuries and optical expenses
Ways to reduce cover
Cost savings are important. That’s why GuideWell is so attractive to many large companies – it offers a more affordable and sustainable private healthcare product, without compromising the quality of the care. But clients can further reduce the cost of this policy by choosing:
- An employee excess option
- Reduced out-patient cover
- Six week option – employees will be covered for in-patient or day-patient treatment if the wait for that treatment is longer than six weeks on the NHS. Eligible out-patient consultations and treatment are not subject to the six week rule.
Your client can still specify that senior management have access to one group of benefits while the rest of the workforce has another. All staff in a category must have the same benefits. If preferred, your clients can choose to keep some employees on Optimum and the remainder on GuideWell.
- Benefits of GuideWell for employers and employees
Sustainability is a key factor in the choice of a healthcare policy. Larger companies want to not only provide the right mix of benefits to their employees, but to also be in a position that affords reassurance over the long term.
Benefits of GuideWell for employers
- Flexible benefits available
- Different levels of cover to include different categories of staff if required
- By carefully managing our claims costs, you benefit from more sustainable pricing
- Access to BacktoBetter and other policy benefits that could help employees return to work faster
- No shortfalls if the GuideWell claims process is followed
- A choice of levels of cover for cancer, as explained in our Cancer brochure (PDF 836KB)
Benefits of GuideWell for employees
- Prompt access to private medical diagnosis and treatment
- No shortfalls on hospital charges, or specialist fees for treatment that is covered by the policy, if the GuideWell claims process is followed
- Appointments close to home or work
- Simple claims process
- Easy appointment booking
We want to offer services that can help reduce the costs of absenteeism and promote wellbeing among the workforce. We encourage clients to consider services that could help employees overcome challenges affecting morale, working relationships and productivity:
Support for employees when they need it most
GPs commonly cite musculoskeletal conditions, those affecting the back, neck, muscles and joints, as one of the most prevalent reasons for employees not being fit for work. Traditionally, PMI providers only pay for a defined number of physiotherapy sessions – but we thought there was a better way to provide help and support.
BacktoBetter is now provided as standard with our GuideWell policies. It’s an expert-led support and case management service that uses evidence-based medical guidelines to help manage musculoskeletal symptoms. Through BacktoBetter, we can deliver personal treatment plans without the need to see a GP, no matter how large or small the problem.
By intervening promptly, we can help employees return to work faster and ensure access to the most clinically appropriate treatments before the condition deteriorates. A clinical case manager will call the employee at a convenient time which means they don’t need to wait for a GP appointment and if clinically appropriate, they will be referred to a BacktoBetter approved physiotherapist for treatment within two working days. This not only saves time for the employee, but also potentially maintains productivity for employers. Full details can be found in our BacktoBetter brochure (PDF 2,992KB).
- Wide range of underwriting choices
GuideWell provides clients with a choice of underwriting options. The standard underwriting option is medical history disregarded, however other options are offered to help reduce costs or to allow underwriting to continue from a previous insurer.
- Medical history disregarded: available for companies taking their first policy with us, or switching to Aviva from another insurer. This is the type of underwriting that we’ll offer as standard to your clients. Any pre-existing conditions will be covered providing they fall within the terms and conditions of the policy.
- New moratorium: your client could choose a new moratorium based policy. Here, employees cannot claim for any disease, illness or injury (whether or not diagnosed) or any related condition that existed within the five years preceding the policy’s start date (or the date that employee joined the policy, if later) unless two clear years have passed since they joined the policy during which the employee has been free of medication for, treatment for, diagnostic tests and advice about such a disease, illness or related condition.
- Continued moratorium: available for clients transferring from an existing medical insurance plan that’s underwritten on a moratorium basis (we’ll need to see proof of previous terms). Our moratorium wording will apply with effect from each employees original moratorium start date.
- Continued medical exclusions: these can be chosen if the client is transferring from an existing plan that was fully medically underwritten. We would accept the employees existing terms (we’ll need to see proof) and apply the personal medical exclusions (if any) their previous insurer imposed. If loadings were applied however, instead of exclusions, those members will have to complete an application form and be fully underwritten.
- Full medical underwriting: in this instance, we ask questions about every member’s past health, and their pre-existing medical conditions will be excluded unless we agree to accept them.
- The open referral claims process
Employees’ welfare is our top priority. We want to make the claims journey as easy as possible, which is why we developed a specialist finder database: combining our own claims experience with external data to offer employees an appropriate, convenient specialist and hospital in their area. The employees can choose whether they’d like to be treated closer to work or closer to home.
- We aim to offer a specialist working within a 25 mile radius of that location (10 miles within London) in most cases
- Treatment is provided at one of over 302 hospitals. All of the specialists we nominate are registered with the General Medical Council and are recognised on their professional register as a specialist in their area of expertise. For certain sub-specialties where it has not been possible to use historical claims data, specialists have been selected using independently verified information.
In most cases, we connect the employee with the hospital appointment booking line there and then. Generally, there’ll be no need for a second phone call to book an appointment.
For more information about our claims process, please see the claims tab at the top of the page.
If the employee is claiming for a musculoskeletal condition then they don’t need to see their GP. They just need to call us and follow the BacktoBetter claims process (PDF 263KB).
- Added value benefits included as standard
We want to help your clients employees’ lead healthier lives and promote a feeling of appreciation towards employers. These features are included at no extra charge with every GuideWell policy:
- Discounts for all members on home, motor and travel insurance - up to 15%
- Up to 25% off membership at a range of UK gyms and health clubs
- Access to a 24 hour GP helpline
- Access to a 24 hour stress counselling helpline. Available to members aged 16 and over.
Which documents should you use?
Our documents help clients understand what policies are designed to do. They can also help you introduce the benefits of each product to your clients.
GuideWell literature is a useful guide for you when you’re talking through the options available to your clients. It’s important that you get to know the brochure well, as it can help you conduct a compliant sale.
These documents explain how the product works
- GuideWell brochure (PDF 2,421KB) – employer-facing pre-sale brochure
- BacktoBetter brochure (PDF 2,992KB) – pre sale corporate information
- Cancer brochure (PDF 836KB) – employer facing
We can help you sell GuideWell
When you’re talking to a large company, we can offer dedicated support to help you explain the benefits of our GuideWell product. Our account managers will make themselves available to accompany you on visits to your clients.
If you’d like to find out more about selling PMI in general, what it is, and why you should promote it to large business clients – take a look at our Growing Your Business section. But if you’d like to find out more about GuideWell in particular, please call our account managers:
National Accounts, call: 0800 0014 272 Monday to Friday 9.00am – 5.00pm Or email email@example.com
Calls to and from Aviva may be monitored and/or recorded
We’re here to offer you support with your clients, deal with any queries, and give you information that will help companies with 250 employees or more proceed with confidence as they buy a GuideWell policy.
- Finding the right clients
When a business wants a policy to cover 250 employees or more, affordability plays a key role in narrowing down the products on the table. GuideWell offers significant benefits in terms of sustainability.
We’ve seen a steady increase in the number of people receiving open referrals from their GPs. The open referral process enables us to carefully manage our claims costs so that we can offer more sustainable pricing.
Group PMI products are a common purchase in the manufacturing, professional services, motor vehicle trade and engineering sectors. One reason for this is that the impact of sickness absence can be felt much more in industries requiring professionals with specific skill sets.
- Are your offices located close to local businesses like these?
- Are you networking with key decision makers in those industries?
- Do you have clients who are interested in ways of better managing their employee benefits or PMI costs without impacting their level of PMI cover?
- Overcoming objections
Clients with 250 employees or more are likely to have a first-hand understanding of the dramatic impact that illness or injury can have to a workforce. But these are some of the most common objections we hear:
- “It’s too expensive.” GuideWell is a sustainable and affordable product that keeps the claims journey easy for your employees. It offers the same flexibility in benefits that are usually associated with much more expensive cover but by utilising the open referral claims pathway, we can offer this at a competitive price. Our account managers will work with you to help shape a product that meets your clients’ needs as closely as possible. With GuideWell, objections to cost could be a sign that your client hasn’t understood the benefits of the open referral process. And, ultimately, without PMI in place, employees may have to wait for NHS treatment, which can affect the overall productivity of a business.
- “We don’t need a PMI policy.” A group PMI policy can help employers recruit and retain valuable employees, and reduce the costs of ill health in the workplace. Our clinical expertise not only helps staff get prompt access to private medical care, it also means that individuals can be offered appropriate treatments that could enable a more prompt return to work. Rehabilitation and rapid intervention are two key areas in which we’re able to offer our expertise – and help employers use their PMI policy’s benefits to maximum advantage.
- “I’ve got other priorities.” If you understand your client’s business, you’ll have an insight to their plans – for expansion, perhaps, or specialisation in a particular market. Good employee health levels and ways to keep absence-related costs to a minimum can play an important role in a business’ economic future.
- “Employees won’t appreciate the policy.” We can work with your client to help promote the benefits in the workplace; building their profile and enhancing their perception as an employer who cares.
- “We already have a policy in place…” That’s excellent news. Your clients already understand the value of providing PMI for their employees. We’re happy to offer a consultation process that could show not only cost savings, but also enhanced benefits to the business by switching to GuideWell. Also if your client chooses to transfer to us we can try to match their current benefits to make the transition as smooth as possible.
- Answering clients’ technical questions
Our account managers are here to help you – but we recognise that it’s also important to show your own detailed insights. Here are a few of the questions we’re asked regularly:
- “What’s the difference between acute conditions and chronic conditions?” An acute condition is a disease, illness or injury that’s likely to respond quickly to treatment so that you can return to your previous level of health. Chronic conditions are those illnesses, diseases or injuries that either continue indefinitely, have no known cure, come back (or are likely to come back), need long term monitoring or need on-going control or relief of symptoms, such as diabetes or Crohn’s disease. Chronic conditions aren’t usually covered by GuideWell, but acute conditions are – and as it’s a flexible product, we’ll work with your clients if they’d like to include cover for routine monitoring of chronic conditions in their policy.
- “How does open referral work?” An open referral is a recommendation by a GP for further investigation or treatment, without actually naming a specialist or hospital. We’ve developed a specialist finder database – combining our own claims experience with external data to select an appropriate specialist and hospital in the member’s chosen area. One advantage of using an open referral claims pathway, is that there’s no need for hospital lists. We take care of the onward journey on the member’s behalf, reducing the stress involved and increasing the efficiency of the handover.
We aim to offer a specialist working within a 25 mile radius of that location (10 miles within London) in most cases.
Treatment is provided at one of over 249 hospitals – and with GuideWell, we promise that if members follow the GuideWell claims process, they will not incur any shortfalls on hospital charges or specialist fees for treatment that is covered by the policy.
- “What’s the difference between an in-patient, out-patient and day-patient?” An in-patient is someone who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons. As a day-patient, employees would be admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but would not occupy a bed overnight. An out-patient is someone who attends a hospital, consulting room or out-patient clinic and is not admitted at all, either as a day-patient or in-patient.
- “Which type of underwriting would my client have to use?” We’ll work with you and your client to find the most efficient and effective way of underwriting cover – whether it’s a new policy, or a transfer from another provider. The majority of GuideWell policies will be written on medical history disregarded underwriting due to their size. For more details about our range of underwriting choices, look at the overview tab on this page.
What makes our Private Medical Insurance different?
It’s a competitive market – and open referral policies are becoming more popular. Your clients want to get the right PMI policy for their business: we’ll make time to understand their needs and work with them to build a scheme that meets their objectives.
Right time, right price, right treatment
Your clients can choose the benefits they believe to be most beneficial for their workforce. The open referral process can improve claims management costs whilst providing employees with an easy claims experience and still treat every claim on a case by case basis.
Why choose Aviva’s GuideWell policy?
- We excel in delivering private medical insurance products. At the Health Insurance Awards, we’ve been awarded the title ‘Best Group PMI provider’ and ‘Health Insurance Company of the Year’ for six years in a row – 2010, 2011, 2012, 2013, 2014 and 2015.
- We offer account support. We’ll provide dedicated account management to every adviser who would like to offer GuideWell policies to their clients. Our national accounts team can visit you to help create GuideWell policies that meet clients’ needs as closely as possible.
- Our claims process promotes prompt returns to health and to the workplace. We’ve set up dedicated claims teams to focus on specific medical conditions. Our in-house clinicians work closely with the teams to offer one-on-one support so that we can treat each claim on a case by case basis.
- We believe our Cancer Pledge sets a new standard for providers. The levels of cancer cover we provide are at your client’s discretion. But for such an emotive condition, we’ve taken a stance that should prompt better levels of care during treatment, and afterwards, right across the industry. Read more details about our Cancer Pledge. The Cancer Pledge applies if the ‘Extensive cancer cover’ option is selected.
- We help remove the stresses associated with making an insurance claim. When it comes to helping employees, we focus on what’s important – making a recovery and returning to work – rather than dealing with paperwork. Most claims are dealt with over the phone, and most employees are transferred straight through to the hospital or facility at which they’re going to be seen by a specialist. We make time to help your clients manage their claims costs, and we’re always exploring innovative ways to manage overall spend - without affecting the member experience.
- Clients can be confident we’re able to meet their claims.
- To help employers manage their claims spend, we’ll invest our resources and time in working closely with them – and you – as we set up and then deliver the policy.
- We stay up-to-date on industry issues and continually evolve our products. We’re committed to keeping up-to-date on healthcare, government, legislation and economic issues that could help employers use benefits to promote health and improve productivity and profitability.
As a result of our focus on delivering high levels of healthcare expertise, Aviva UK Health was awarded the title Best Group PMI Health Provider and Health Insurance Company of the Year for the sixth year running at the 2015 Health Insurance Awards. When you tell clients about these awards, it helps build confidence in making a purchase.
Understand our open referral claims process, so you can speak confidently about GuideWell.
Our focus is on the employees’ welfare. We never compromise on the levels of care being offered through our products – we want to help them return to health and get back to work as quickly as possible. To do that, we aim to make sure our claims process is as smooth and easy as possible.
- Simple claims process – where possible, we’ll offer the employee the opportunity to book their appointment on the same call by transferring them directly to the hospital’s appointment booking line
- We promise no shortfalls on hospital charges, or specialist fees for treatment that is covered by the policy as long as the GuideWell claims process is followed
- Employees can choose to make an appointment close to their work or home address - we aim to offer a specialist working within a 25 mile radius of that location (10 mile radius with within London)
- On average, Guidewell customers travel between 9-10 miles outside of London and 7-8 miles within the London region to their treatment location
- In most cases, employees won’t have to complete any claims paperwork
- Businesses and employers have case by case support for complex and lengthy claims
- Group administrators can monitor claim levels online.
- Our approach to claims
When employees need to make a claim, they may not be feeling 100% when they call, so our claims teams and in-house clinicians are always sympathetic to their needs.
We’ll help as much as possible. Our staff work in an environment where they can familiarise themselves with the details of each claim they’re working on.
- Specialist expertise and support
Some conditions are more complex than others. We have teams of specialists who look after the more sensitive or complex claims such as:
Then, when employees’ call, they can talk to experienced staff who empathise with what they’re going through at a stressful time.
- GuideWell claims - Step 1
When employees feel ill, they should go and see their GP as usual. If they’re referred for further assessment or treatment, they’ll need to ask their GP for an open referral before contacting us.
- GuideWell claims - Step 2
When employees call, they’ll need to give us their personal details, including a policy number; a description of the symptoms, the type of specialist that they need to see and the sub-specialty and also what the GP has said.
We aim to offer a specialist working within a 25 mile radius of that location (10 mile radius within London) and appropriate for their medical needs. Most of the time, we’ll connect the employee with the hospital there and then. A warm handover makes the process as stress free as possible.
- GuideWell claims - Step 3
If the specialist decides that an employee needs treatment for a diagnosed condition, then we need to be updated with the details.
Your specialist may recommend another specialist for treatment but the employee must always ask for the specialism and sub-specialism required for treatment so that we can identify a specialist if necessary.
Finally, the employee must ensure that they ask for the procedure code (called the CCSD code) from their specialist.
- Payment of bills
We will settle most bills directly with the hospital. Most specialists send their bills straight to us. If employees do get a bill at home, they – or their Group Administrator –can forward it on to us at:
Bill Payment Team,
Aviva Health UK,
- Cancer claims
If an employee needs to make a claim for cancer, they’ll find that our approach takes the sensitive nature of this condition into consideration. We have a specialist oncology team who are trained to help patients deal with different types of cancer.
We’ve created a choice of targeted therapy cover levels to suit your client’s requirements. They can choose to upgrade or downgrade from the standard cover, and their employees will still benefit from other cancer treatments included within their policy, even if they remove targeted therapy cover entirely.
If the ‘extensive cancer cover’ option is selected, we’ll cover the cost of proven breakthrough cancer therapies for your client's employees in full, for as long as their specialist says they need them. This means that they will never need to worry about cover ‘running out’ for targeted therapies – drugs like Herceptin and Avastin. With this level we’ll also pay for bone strengthening drugs ( such as bisphosphonates,) in full when they are being used to treat metastatic bone disease.
No matter what level of cancer cover is selected, everybody who makes a claim will benefit from the one to one advice from a member of the oncology team, who will be there to help and support your client's employees from diagnosis through to treatment and aftercare. We ensure that a named case manager is on hand to talk to, who can get to know them and stay up to date with their progress during treatment.
Please see our Cancer brochure (PDF 836KB).
- BacktoBetter claims
We include the BacktoBetter service as standard. BacktoBetter addresses all musculoskeletal issues - please see the BacktoBetter brochure (PDF 2,992KB) for full details of this service, which you’re welcome to share with prospective GuideWell clients.
No need to see a GP
If scheme members find themselves suffering from musculoskeletal pain, we ask them to call us – there’s no need to wait for a GP’s appointment.
The BacktoBetter team will use proven evidence-based guidelines to assess the employee's situation over the phone, with no need to see a GP. They’ll work out what the most appropriate course of action is – that’s everything from advice for all issues that can help relieve the pain, to an appointment with a physiotherapist, or a recommendation to seek immediate help.
No matter how large or small the problem, we’ll make sure that your client's employees are looked after by a dedicated case manager. This is a very personal treatment plan. By intervening promptly, we can help individuals return to work faster and ensure access to the most clinically appropriate treatments before the condition deteriorates.
Helping your clients make a claim
In theory, employees should find all the information they need in their policy documents. However, you may receive a call from a group administrator with queries about the process. If that happens, we can help you guide them through the three simple steps they’ll need to share with employees who want to make a claim.
- Systems that support administrators’ needs
Using Healthpoint, group administrators can log in to generate reports on claims to date. We can help your clients use this information to pinpoint areas of concern such as high levels of musculoskeletal injury in a physical working environment, for example.
This helps your clients meet their Health and Safety responsibilities, and encourages employers to take a pro-active role in promoting wellbeing among employees. In turn, this could lead to reduced costs of absence due to sickness or injury.
Can we help you?
Think of us as part of your team. For help or queries, call us on:
0800 0014 272
9.00am – 5.00pm, Monday – Friday
For policy quotes, please email:
Calls to and from Aviva may be recorded and/or monitored.