Private medical insurance for business
Solutions. Health insurance for 2-249 employees
Solutions is our flexible business Private Medical Insurance (PMI) policy covering between 2-249 lives. When employees get treatment promptly, they can return to work faster – helping reduce absenteeism costs.
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It’s important to fully understand this product’s details as this will help you conduct a compliant sale. Non-standard terms may apply to your client’s policy. Details of full cover, options and exclusions are listed in the product’s brochure (PDF 9225KB) and in the general terms and conditions for schemes covering 2 to 49 employees (PDF 923KB), and the general terms and conditions for schemes covering 50 to 249 employees (PDF 954KB).
Solutions is a flexible PMI policy for businesses, which can cover up to 249 employees. It helps members get prompt, private medical treatment at a nationwide network of hospitals and clinics, and its added value benefits can also help employers address health and risk factors in the workplace.
- A flexible PMI policy that fits around the needs of your business clients and their employees
- Our group PMI gives employees access to prompt care and treatment that helps them stay healthy
- Having our PMI in place can help your clients attract and retain the best staff, enhancing the business’s profile
- Our group PMI can help to keep absenteeism costs down, as health among the workforce improves
A flexible, modular policy
Did you know that your client can get flexible cover with a Solutions policy, so that different benefit levels can be provided for up to three different categories of staff?
Solutions offers every business an opportunity to provide health-centric benefits that could help their employees get prompt care, return to work faster after illness, and save money on the bottom line.
Whenever you present a Solutions policy, you’ll need to find out which modules suit your clients’ needs best. To help you understand how flexible Solutions can be, we’ve broken it down into four overview areas: core cover; options available, differences for policies covering 50 to 249 employees and the additional value that’s included with every policy irrespective of how many employees are covered.
- Core cover
When your clients start with our Core Cover, they can easily increase or reduce the cover level according to budget and needs. With our core level of cover, employees receive the following benefits as standard:
- Payment of all hospital charges and specialists’ fees up to the limits in our specialist fee schedule
- Diagnostics tests (such as MRI scans, blood tests and X-rays) are covered in full
- Cancer treatment, as explained in full on our Cancer Pledge page
- Specialist referred physiotherapy, osteopathy and chiropractic treatment as an out-patient
- Psychiatric treatment as an out-patient, up to £1,000 per person per policy year; on GP referral to a psychiatric therapist or specialist
- NHS cash benefit of up to £100 per night, for a maximum of 25 nights per person 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
- Investigations into the causes of infertility
- Treatment for pregnancy and childbirth complications
- £100 for each baby born to or adopted by a member
- Limited emergency overseas cover when temporarily abroad for a period of up to 90 days
- Surgical procedures on teeth performed in a hospital
- Hospice donations of up to £70 per day for a maximum of 10 days
- A private ambulance for transportation to hospital if medically necessary
- Out-patient treatment of acute conditions
Clients need to be made aware that a qualifying period applies, which means that in most cases they won’t be able to claim for treatment received during the first month of their policy.
Options that upgrade levels of cover and increase premiums
Your business clients may want to upgrade their Solutions policy to provide additional levels of cover. If they add an upgrade option, then their premiums will be higher. A summary is included in the Solutions brochure (PDF 9225KB). Upgrade options include:
- Psychiatric treatment. Employees could claim for in-patient and day-patient treatment if diagnosed with a psychiatric condition, such as clinical depression, for a maximum of either 28 or 45 days’ combined in-patient and day-patient treatment per person per policy year.
- GP referred services. This benefit is limited to claims of £1,000 per person per policy year. Employees can claim up to 10 sessions of physiotherapy, chiropractic treatments, osteopathy and acupuncture in combined total. Minor surgery by a GP is covered up to £70 per procedure, as is GP-referred chiropody, podiatry, homeopathy, radiology and pathology. Specialists’ fees for consultations and tests for non-acute conditions would be covered, and employees also have access to our award-winning Back-Up service (PDF 1127KB).
- Extended hospital list. If treatment in the Greater London area would be convenient for employees, it’s possible to upgrade their hospital list to include a choice of additional private hospitals and clinics.
- Dental and optical cover. Eligible surgical procedures would be covered by core cover, but employees can claim for routine dental treatment up to £500, accidental dental injury up to £600 and routine optical expenses up to £300 under this option. A separate £50 excess is applied to both the optical benefit and routine dental treatment, per person per policy year.
Options that reduce levels of cover and decrease premiums
By choosing a reduction in the levels of cover provided, a business would pay lower premiums without compromising on the quality of the prompt, private care their employees receive:
- Six week option. Employees on the policy can’t claim for in-patient or day-patient treatment, or NHS cash benefit, if the NHS can treat them within six weeks.
- Policy excess. A member excess of £50, £100, £150, or £200 can be added to the policy, which we’ll apply once per person, per policy year, irrespective of the number of claims each person makes.
- Selected benefit reduction. This removes the following benefits from cover: costs associated with infertility, complications of pregnancy, oral surgical procedures and limited emergency overseas cover.
- An alternative hospital list. Your client could choose our Trust hospital list, which includes private patient units of NHS Trust and Partnership hospitals only. To choose this list, the company head office must be within 30 miles of a Trust hospital and there must be fewer than 50 employees covered by the scheme. Clients can also choose our Signature hospital list if their head office is in Scotland or Northern Ireland.
- Reduced out-patient cover. Employees would still have full cover for CT, MRI and PET scans at a recognised diagnostic centre, and out-patient radiotherapy and chemotherapy treatment, but all other out-patient treatment would be limited to £1,000 per person per policy year. If your clients choose this option, the monetory limit for out-patient treatment will not apply to cancer treatment received after diagnosis.
- Differences for businesses with 50 to 249 employees
When your client employs a slightly larger workforce, we make some changes to the policy. These are the key differences that will be seen by businesses with 50 to 249 employees:
- The Trust hospital list is not available as part of the reduced benefit options.
- Payments must be made by monthly or quarterly Direct Debit through a business account – annual payment (which attracts a 5% discount for businesses with 2 to 49 employees), is not available.
- The qualifying periods for treatment regarding complications in pregnancy, the maternity cash benefit, and investigations into infertility no longer apply.
- Experienced rated premiums – more closely linked to the prior claims experience on the policy.
- We’ll need to know how many employees are aged over 65.
- Added value benefits included as standard
Using our clinical expertise, we’ve created products that can help make a tangible difference to a company’s bottom line. By offering Solutions to its employees – promoting services that improve health and facilitate rehabilitation and recovery – a business should see a reduction in the costs of absenteeism over time.
While that outcome clearly benefits a business, we think it’s also important to give employees direct access to services that can make a positive difference to their lives. These points can help you demonstrate the value of putting Aviva’s Solutions policy into place:
- 24-hour GP helpline and a 24-hour stress counselling helpline
- Up to 25% off membership at a range of UK gyms and health clubs
- Home of Health – online health information and advice
Presenting Solutions to your clients this way – explaining the cover, the options, and the added value that Aviva provides – helps them understand the benefits of offering a PMI policy to their employees. You’ll find a useful range of Solutions documents under the Documents tab on this page.
Renewal dates are an opportunity to re-engage with your client: talk about their business, the impact of health issues on productivity, and ways in which our products could help them improve attendance.
Solutions renews annually on the date the policy started. Renewal documents will be sent out to the business directly, about 50 days prior to renewal. You can ask us to copy you in on that notification. The renewal packs include information about any changes in premium; a copy of the policy; a new policy schedule and details of any changes that apply to the cover.
This year, for example, we’ll be raising awareness of our Cancer enhancements , which should help to emphasise the value of the policy and encourage renewal.
- Plan your meeting, re-engage with your clients
- Use policy enhancements to help encourage renewals
- Encourage businesses to take advantage of services
We’re proud to have been recognised for our work in developing products that can make a difference to companies and individuals alike. Instil confidence in your clients: let them know that for the second year running, Aviva UK Health won Best Group PMI Health Provider and Health Insurance Company of the Year at the 2011 Health Insurance Awards. We were also voted Best Individual PMI Health Provider in 2011.
PMI for business. Which documents should you use?
Our documents help business owners understand how our policies can support them and help their employees. They’re also designed to help you introduce the benefits of each product to the client.
Client-facing Solutions literature describes the policy’s cover, the options and the general exclusions in full. It’s a useful guide for you when you’re talking through the upgrades and downgrades available. It’s important that you get to know these documents well, as this will help you conduct a compliant sale.
These documents explain how the product works
Solutions (PDF 9225KB) – client-facing pre-sale brochure
Hospital Lists (PDF 1780KB) – options for your clients
At a glance leaflet (PDF 120KB) – leaflet showing the benefits of Solutions at a glance
Terms and conditions (PDF 923KB) – for policies with 2-49 members
Terms and conditions (PDF 954KB) – for policies with 50-249 members
Use our online Hospital List Checker to show clients some of the private facilities their employees could access in their area under a Solutions policy.
These documents help you make applications
Solutions for 2-49 members – small group application form (PDF 232KB)
Solutions for 50-249 members – Solutions application form (PDF 239KB)
Solutions – FMU application form (PDF 161KB)
Remember, you can always get a quote by speaking to your Healthcare Bureau Consultant. You’ll also find a full range of Solutions literature in our searchable Document Library. Other items that may be useful include:
Private healthcare for businesses (PDF 4355KB) – a handy guide explaining the business case for PMI, which you can use as a leave-behind or use to attract new clients.
Helping you sell Solutions
There’s no limit to the number of business clients you can approach about Group PMI. We’re here to help you, whether you’re talking to a company that wants to cover all of its employees, or concentrating on a policy for just a few members of staff.
The costs incurred if staff have to wait for treatment on the NHS can be significant, so most businesses will be open to talking about ways they could save money. These ideas could help you identify prospective clients, overcome objections, and help you make an attractive Solutions recommendation that fits the business’s specific needs.
- Finding the right clients
Who do you know, and where do you work? In theory, most businesses close to your own could benefit from offering its employees a Group PMI policy – whether they’re a large manufacturing enterprise or a small family-run business employing only a handful of staff.
Thinking about your current client base may help you identify potential clients. Where two or three individuals working for the same company have put a personal PMI policy into place, there’s a case for approaching their employer to highlight this as an appreciated benefit. If you have senior staff, directors, managers or specialist/technically capable individuals using your services, it is always worth asking them if their company would welcome an opportunity to potentially save costs.
Networking will be natural to you as an adviser. Have you thought about how many potential clients you engage with in your social life? Think about local shop owners; plumbers; electricians; cleaning companies; your solicitor and accountant. If employees in a small business have to spend time off work, those companies may suffer a serious downturn in productivity. Introducing the concept of beating waiting lists may be very attractive to them.
Estate agents, care homes, private schools: these are businesses that may have a chain or group of companies operating under one name. Make a professional approach to them, and demonstrate how a Group PMI policy could save their business money by cutting absenteeism among employees and reducing the costs associated with covering absence.
The larger the business, the more potential there is for a Group PMI policy to have a significant impact on helping them save money. Benefits can help attract and retain key staff; health-awareness programmes can improve employee wellbeing; businesses can also benefit by enhancing their perceived commitment to employees. If there’s a business with a significant number of employees that you’d like to talk to, we’re happy to give you help making a presentation – whether it’s a business without PMI in place, or a business that you feel may be prepared to switch providers, if we can demonstrate appropriate benefits. If you would like support, call our Healthcare Bureau today.
TIP: At every individual review, ask “Does your business provide a PMI policy?” If the answer is ‘no’, you can move on to promote individual PMI – but you should also be making a note to contact that business.
- Overcoming objections
We’re still dealing with challenging economic times. But most business owners will appreciate an opportunity to save money, protect their competitive edge in a market, and safeguard a productive workforce irrespective of the company’s financial position. These are some of the most common objections you’ll hear if you make an approach about Group PMI – and some ideas for overcoming them.
- “My company already has a policy.”
“When was it last reviewed? Would there be an opportunity at least to quote against the same level of cover and – if it were possible to make savings, by switching provider – would you be interested in spending half an hour with me…?” In most cases we can help you prepare an outline illustration against other providers’ policies in advance, which helps you promote efficiency to the client.
- “We just can’t afford it.”
With Solutions, your clients can hand-pick the cover that fits their needs, so they don’t have to buy benefits they don’t want or feel their employees don’t need. In addition, there’s the option to vary the level of cover for different groups of employees: Directors could have a higher level of cover, for example, with reduced benefits for other members of staff. All we ask is that all staff within each group have the same benefits and there are at least two members per group – unless there’s a significantly clear distinction between the levels of staff, in which case we’ll accept one member per group.
- “It would cost us too much to change – we’ve made a claim.”
This isn’t necessarily the case. It’s often possible to take out a new policy and still have a similar level of cover. In some cases, a previous claim may not affect the premium’s we’d propose at all.
- “We’ve got a Critical Illness policy – that’s all we need.”
It’s important that your clients understand the benefits of each healthcare or protection product clearly. Critical illness policies make a one-off payment and only cover employees for specific conditions. Our Solutions policy is a PMI product: it provides employees with access to the best possible treatment to ensure their prompt return to work; and it helps employers attract and retain staff.
- “It would be too much hassle to change policies…”
We’ll do everything we can to help your clients make the switch. We realise that there’ll be some admin involved, but our switch-over process is designed to make things go as smoothly as possible. In addition, much depends on the type of underwriting your client chooses – which is why we offer a continued medical exclusions option; a continued moratorium; and – if there are 20 or more employees on the scheme – a medical history disregarded option. With a continued medical exclusions policy, for example, the exclusions for each member will be matched from the previous provider reducing the need for employees to re-submit health questionnaires. Full Medical Underwriting involves more paperwork as the scheme would need to be re-underwritten, but this is something that we can help your client (and their employees) manage so that it causes minimum disruption to the business.
- “No, I still can’t see the point.”
A PMI policy is an expense that some businesses clients may find hard to value while their employees are all fit and healthy. With Solutions, it’s important to highlight the wellbeing features and services that are included free of charge – which represent a tangible, more easily rationalised ‘value for money purchase’ if they’re helping to improve their employees’ wellbeing and attendance at work.
- “My company already has a policy.”
- Promoting attendance at work
Every employer runs the risk of their greatest asset – their workforce – not turning up for work due to ill health or injury. With Solutions in place, employees can have access to:
- 24-hour GP support via our free helpline - there may still be a need to make an appointment for some conditions, but reassurance can be found straight away for minor concerns.
- 24-hour Stress Counselling helpline – whatever the concern, be it work-related, money worries, relationships or general ‘blues’ – employees have someone they can turn to in confidence, which could help reduce any downturn in productivity due to stress.
- Back-Up - this award winning service is available when employers add the GP referred services option to their core cover. With it, employees have access to a service that reacts quickly – with no need for a GP appointment. Help, advice and support is available for all back and neck disorders, which means back pain doesn’t necessarily have to lead to time off work.
- Home of Health – our online portal, holding useful information about a range of health matters. We believe that, by becoming more aware of health issues, employees can take more care of their own wellbeing.
- Group PMI makes sense
There are four key points that are useful to communicate, when you’re first engaging a business about Group PMI, as they illustrate the main reasons for putting a policy into place:
- Improved health among the workforce – for any business that’s suffered from many ‘sick notes’, or high levels of absenteeism, the services we offer via Solutions should be attractive. Our helplines are provided free of charge to all members on the policy, and the rehabilitation services offered through our optional Back-Up service could make a tangible difference in helping employees return to work after musculoskeletal injury.
- Commitment and loyalty – employees see benefits as an attraction during recruitment, and an incentive once employed. A Group PMI policy is a demonstration of commitment to the employees’ welfare, as well as being a practical medium to ensure a prompt return to work after illness.
- Reduced absence costs – The Charted Institute of Personnel and Development carries out in-depth research into the cost of absence for businesses. In October 2011, the median annual cost per employee in the public sector was stated to be £800; in the non-profit sector it was £743; £446 in private services and £444 in the production and manufacturing sector. Group PMI won’t eradicate sickness absence, but it can help get employees back to work more quickly, because they don’t have to join NHS waiting lists.
- Commercial and financial advantages – a private medical insurance policy is also a tax-deductible business expense under current tax rules (this may change in the future). And if any members of staff currently have individual policies in place, they could cut the cost significantly if their employer offers a scheme that they then join.
- We’re here to help you
When you’re talking to a business, you’re proposing a policy that can affect – and help – many individuals. We’re here to give guidance on Solutions, and help you make a recommendation that’s right for both the employer and the employees. If you’d like our support, or would like to talk about a potential client:
Call the Healthcare Bureau: 0845 3000 649
Monday to Friday
9.00am – 5.00pm
For policy quotes, please email: email@example.com
Calls to and from Aviva may be monitored and/or recorded
Our specialist healthcare advisers can offer advice, help you submit the application, deal with underwriting queries, and give you information that will help your clients proceed with confidence as they buy a Solutions policy for their business. If you have clients with over 50 employees, our account managers will also be happy to accompany you on visits and assist with the sale.
What makes our policy different?
For the second year running, we were voted the Best Group PMI Health provider and Healthcare Insurance Company of the Year at the 2011 Health Insurance Awards. We believe it’s our policies’ flexibility and the way we help employees benefit from our clinical expertise that makes us the provider of choice.
Our claims expertise and rehabilitation experience means that we can help employees return to work promptly, focus on their health and keep productivity levels up.
We develop products that can help businesses reduce the costs of health-related absenteeism. Our focus on delivering value is matched by a commitment to offering flexibility, and ensuring that companies have the option to make the benefit choice they believe will be most beneficial to their business.
Why choose Aviva’s Solutions policy?
- Solutions is flexible, affordable, and fits around your clients’ needs. Every business should have the option to choose the level of benefits it provides for employees, in a way that’s advantageous for them as well as their staff. Solutions provides that opportunity.
- It’s a policy with options that can make a difference. Our award winning Back-Up service, available under the GP Referred Services option, helps individuals with back and neck disorders get early intervention for their condition: enabling a prompt return to work.
- We lead the way with improvements and enhancements that reflect clients’ needs. Our Cancer Pledge, shows that we’ve looked closely at our proposition – and improved it, in light of medical advances and the needs of patients suffering from this condition.
- Our expertise means that we can triage conditions effectively. We’re clinical experts, so companies can rest assured that we’ll treat ‘routine’ clinical journeys efficiently, and take a case-by-case approach to ‘complex’ clinical conditions. All of our claims are dealt with by specialist teams that have access to clinical expertise that can help employees return to work as quickly as possible.
- We help remove the stresses associated with making an insurance claim. A business has other things to concentrate on – so we make sure that any claims are dealt with as efficiently as possible, with as little impact on their day-to-day resources as possible.
- We stay abreast of issues that can affect employers. This means that we can respond promptly with guidance on the impact of legislation changes affecting health and welfare in the workplace. It also means we’re in an excellent position to continuously make improvements to our products.
- Clients can be confident we’re able to meet their claims. Just a couple of claims statistics can help instil confidence in your clients:
- In 2010, we paid over £312million in claims to Solutions policy holders – of which over £47million and £114million were in lieu of oncology (cancer) and musculoskeletal conditions respectively. This is a keen reflection of the impact these illnesses can have on a company.
- To do that, we dealt with 178,387 claims.
As a result of our focus on delivering high levels of healthcare expertise, for the second year running, we won Health Insurance Company of the Year and Best Group PMI Health Provider at the 2011 Health Insurance Awards. When you tell clients about these awards, it helps build confidence in making a purchase.
Solutions claims – what happens next?
With a Solutions policy, employees should have all the information they need to make a claim in their policy documents. But it’s useful to understand the process so that you can field Group Administrators’ queries.
Your client will hold a group policy but we pride ourselves on treating people like individuals. Employees may not be feeling 100% when they call – which is why our claims teams will provide help every step of the way. We have a dedicated department looking after our Private Medical Insurance (PMI) claims, with staff who can familiarise themselves with the details of each claim they’re working on – and we believe that’s one of the reasons we were awarded the title Best Group PMI Health Provider at the 2010 and 2011 Health Insurance Awards.
Technical expertise, leading insights
Our technical experts are tasked to stay abreast of and analyse new technologies and medicines, so we can advise your clients of any new drugs or approaches available.
We make sure that our in-house clinicians are on hand to give staff detailed support, providing medical insights as necessary so that employees can get the best possible treatment and support. Patients will have a dedicated claims adviser looking after their details throughout the claim.
- How does our specialist expertise help your clients?
Some conditions are more complex than others, so we operate a proven triage system. We separate out ‘routine’ clinical journeys, for conditions such as hernias or cataracts where a narrow range of proven treatments are well established. Then we can take a case-by-case approach to ‘complex’ clinical conditions – such as musculoskeletal conditions or immune system disorders – which could benefit from various different clinical pathways to recovery, depending on the individual’s medical history.
Our advisers are divided into dedicated specialist Condition Management Teams. In addition to general claims, this means that we have dedicated banks of expertise, focusing on areas such as cardiothoracic, oncology, psychiatric, women’s health and gastro-intestinal conditions.
Each of these teams offer guidance from highly trained experts, many of them clinical practitioners, who understand the condition and the treatment required. They are able to provide dedicated one-to-one support and remain with your clients throughout the course of their treatment. This ensures they have consistency of care and can progress from one stage of treatment to the next as seamlessly as possible.
Employees can rest assured, knowing that they’ll be talking to experienced staff who can empathise and understand what they are going through.
- Helping your clients make a claim
Our documents are designed to help employees make a claim easily: the majority of cases can be approved over the phone. But when treatment is a priority, not paperwork, there’s a possibility that Group Administrators may call you for advice. If that happens, you can guide them through the 4 simple steps that employees will need to take, to make their claim.
Employees will need to see their GP and let him or her know they’re covered by a Solutions policy. If they’re asked to have tests or treatment, or see a specialist, they’ll need to check with us to make sure that facility or specialist is included in their cover. They should:
Call the claims team: 0800 068 5821
Monday to Friday
8.00am – 6.00pm
8.00am – 1.00pm
Calls to and from Aviva may be monitored and/or recorded
We'll ask for the employee’s personal details, including a policy number, a description of the symptoms and condition, what the GP has said, and the name of their specialist and where they practice. If we can, we’ll authorise the treatment or consultation straight away.
If employees are given an open referral, they won’t have the specialist’s name. If that's the case, then we'll just need to know which kind of specialist they need to see. If we need more information from a GP then we'll do our best to make this happen quickly – filling in as much paperwork as we can, on the employee’s behalf.
If we can’t approve the employee's claim because it's not covered by the policy, your client may contact you for further information. We’re happy to talk to you, and help you explain this to the Group Administrator, but we can’t divulge any confidential medical details.
If your clients’ employees need treatment for a diagnosed condition, they’ll need to update us with the details. We'll need to know where they’d like to be treated, when, and which procedure code (CCSD code) applies to their treatment. The specialist will have these details. It’s really important that clients call us first for approval before going ahead with any treatment.
Most bills can be settled directly with the hospital. Specialists usually send their bills straight to us, but if the Group Administrator – or the employee – receives the paperwork, it will need to be forwarded on to us at:
Bill Payment Team,
Aviva Health UK,
We’ll do everything we can to make sure your clients, and their employees, get the support they need if they’re injured or ill. That includes being empathetic with their situation, when they call to make a claim. Our teams are trained to understand that people may not be feeling well – and do their best to make it a stress-free process.
- Claims using our Back-Up service
If your client has selected the GP Referred Services option and an employee is experiencing back or neck pain, there’s no need for them to see their GP first. They need to call our claims helpline: we’ll then let them know if it’s appropriate for them to be referred to our award winning Back-Up service.
Once referred, we’ll arrange for a clinical case manager to give them an assessment over the phone within two hours. Using evidence-based medical guidelines, the case manager will recommend the most effective course of treatment and advise on immediate relief of the symptoms. If appropriate, their case manager will refer them to a local physiotherapist, who’ll contact them within 24-hours to book a course of treatment within 2 working days. The Back-Up case manager will stay in touch to monitor progress and assess any further treatment.
Can we help you?
Think of us as part of your team. For help or queries:
For schemes with 2 – 49 employees, call us on:
0845 3000 649*
For policy quotes, please email: firstname.lastname@example.org
For schemes with 50 – 249 employees, call us on:
National Accounts - North
0845 300 1530*
National Accounts - South
0845 300 4451*
*Calls to and from Aviva may be recorded and/or monitored
9.00am – 5.00pm, Monday – Friday