Bespoke Group Private Medical Insurance for 250 or more employees
Optimum. Health insurance for 250 or more employees
Optimum is our bespoke private medical insurance (PMI) policy for schemes with 250 employees or more. This is a highly flexible PMI policy. It’s up to your clients what’s included – and what’s not.
It’s important to fully understand this product’s details as this will help you conduct a compliant sale. Examples of the bespoke cover we could create, the options and exclusions are listed in the product’s brochure (PDF 4,361KB). Non-standard terms may apply to your client's policy.
Optimum is a bespoke PMI policy. With it, we’ll help your clients choose a unique set of benefits for their employees – helping them get access to prompt, private medical treatment:
- Dedicated account management for you and your clients
- Flexibility regarding the benefits offered to the employer
- Different levels of cover to include different categories of staff if required
- Added value benefits that could help improve the health and wellbeing of the workforce
- Access to medical treatment that could help employees return to work faster
- A choice of cover levels for cancer, explained in our Optimum Cancer cover (PDF 963KB) leaflet
More flexibility, happier clients
Optimum is a bespoke PMI policy. It lets your clients have flexibility, when it comes to choosing a suite of benefits they want to offer their employees.
Larger businesses want PMI that can help them raise morale and productivity; reduce absenteeism; show a commitment to employees by promoting a caring attitude. Optimum is a policy that can help your clients achieve those goals.
We’re here to help you understand Optimum, explain the many combinations of benefits to your clients, and create a bespoke PMI policy to match their needs as closely as possible. We would also try to match your clients cover from their current provider as closely as possible, if they’re considering a switch to us.
We know that companies want some ‘must have’ benefits – so we’ve included an example of cover here, along with a description of our many underwriting options for companies of this size.
- Example cover and options
These items have been among the benefits most commonly chosen by Optimum clients.
- Access to full in-patient and out-patient care at a wide range of private hospitals across the UK
- All hospital charges, specialists’ fees (up to our fee limits), 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 on our Optimum Cancer cover (PDF 963KB) leaflet
There are many other benefits that we could include in the cover, such as payment for minor surgery carried out by a GP. Examples of the benefits available can be found in the Optimum brochure (PDF 4,361KB).
Ways to enhance cover
There are a number of ways that your client can enhance the levels of cover provided, as shown below and in the Optimum brochure (PDF 4,361KB), which will increase premiums.
- Mental Health - psychiatric in-patient, out-patient and day-patient cover
- GP referred services, such as physiotherapy or 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
- Extended hospital list, which would increase the number of hospitals available.
Ways to reduce cover
Cost savings are always important and Optimum can help reduce the costs of a policy, without compromising on the quality of prompt, private care
- Hospital coverage – your clients can limit the hospitals that their employees can use
- A member excess option
- Reduced out-patient cover
- Six week option – a member can’t claim for private treatment as an in-patient or day-patient, NHS cash benefit, NHS cancer cash benefit or for the cost of an NHS amenity bed if their treatment is available on the NHS within six weeks from the date their specialist recommends it
We recognise the need for flexibility not only in the cover your client chooses, but also the members to whom that cover applies. With Optimum, your client can specify that senior management have one set of benefits and the rest of the workforce another. Our only stipulation is that all staff within a defined category have the same benefits.
- A choice of additional services
We want to offer your clients services that can help reduce the costs of absenteeism, and help promote wellbeing among the workforce. We encourage clients with more than 250 employees to consider services that could help employees overcome challenges that could be affecting morale, working relationships and productivity:
BacktoBetter - support for employees when they need it most
GPs commonly cite musculoskeletal conditions - back, neck, muscle or joint pain - as one of the most prevalent reasons for writing sick notes. 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 provided as standard with our Optimum policies, unless your client chooses not to take it up. It’s our independent clinical 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 case manager, from one of the clinical case management providers, will call the employee back at a convenient time which means they don’t need to wait for a GP’s appointment. This not only saves time for the employee, but also potentially maintains productivity for employers.
- Wide range of underwriting choices
We can offer a number of underwriting options to clients with schemes of 250 employees or more. Some may be more appropriate than others; we’re happy to answer any questions you or your clients may have about the processes involved.
- 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, members cannot claim for conditions that existed within the five years preceding the policy’s start date unless two clear years have passed since the member joined the policy during which the member has been free of medication for, treatment for, diagnostic tests for and advice about that particular condition and any other illness or injury related to it.
- 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 member’s original moratorium start date.
- 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.
- Continued Medical Exclusions: can be chosen if the client is transferring from an existing plan that was fully medically underwritten. We would accept the members’ 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.
- A claims process that helps employees and employers
We prioritise the welfare of your clients’ employees throughout the claims process. We draw on in-house clinical expertise to give insights and offer genuine empathy with each member’s situation. In addition we have dedicated expert claims teams focusing on areas such as cancer, heart conditions, mental health, and back, neck, muscle or joint pain to make sure these conditions are dealt with sensitively.
Our in-house clinicians also work closely with the advisers taking calls, listening in and offering advice if necessary – then speaking with relevant consultants to find the most appropriate clinical journey for the employee.
The net effect for your clients is a claims process that helps reduce the stress involved in making a claim, providing an efficient journey to help them with a return to health - getting them back to work quicker. For more information about our claims process, please see the claims tab at the top of the page.
- Healthpoint: efficient scheme management
When your clients choose Medical History Disregarded or New Moratorium underwriting, we’ll give them access to Healthpoint – our online portal for managing scheme membership. By using Healthpoint, group administrators can save time by managing membership details in real-time and producing reports on claims to date immediately.
- Added value benefits included as standard
We want to help your clients’ employees lead healthier lives and promote a feeling of appreciation towards employers. The following features are included at no extra charge with every Optimum policy:
- Discounts for all employees on home, motor and travel insurance.
- Up to 25% off membership at a range of UK gyms and health clubs.
- Access to a 24 hour GP helpline – through which employees can have an over-the-phone consultation without taking time off work. Trained nurses can also answer general queries, which means employees can seek reassurance day or night about any medical issues.
- Access to a 24 hour stress counselling helpline – providing access to counsellors who employees can talk to, in confidence, for as long as they want. The stress counselling helpline benefit is 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.
Optimum 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 these documents well, as they can help you propose options that will make up a bespoke policy and conduct a compliant sale.
These documents explain how the product works
- Optimum Brochure (PDF 976KB) – employer-facing pre-sale brochure
- BacktoBetter brochure (PDF 2920KB) – post sale employer information
Optimum policies include the Extended hospital list as standard. Use our online Hospital List Checker to show clients some of the private facilities their employees could access with an Optimum policy.
Alternatives to Optimum
You’ll find a full range of Optimum literature in our searchable Document Library, which will help you talk about this policy with prospective clients. However, working with companies of all sizes, we understand just how important it is to contain costs. As an alternative to Optimum, you can offer Optimum Access (PDF 92KB). With three levels of cover, this policy can give employees access to private consultations and diagnostics – it’s a starting point from which an employer can offer a new benefits scheme with a limited budget. It’s important that your clients get the right level of cover, so speak to our National Accounts team if you’d like to find out more about this product.
We can help you sell Optimum
If you’re approaching a large company, we can provide dedicated support to help you introduce the benefits of our Optimum policy. Our Account Managers will be happy to go with you to see your clients.
If you’d like to find out 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. If you have any questions about Optimum, or for support with any of your clients, call our National Accounts managers:
Call: 0800 0014 272 Monday to Friday 9.00am – 5.00pm Or email firstname.lastname@example.org
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 or more employees proceed with confidence as they buy an Optimum policy.
- Finding the right clients
Any business could realise benefits by offering a pro-active benefits package to promote wellbeing among its workforce. Optimum is designed for situations in which large economies of scale are possible, with services available for over 250 employees and the option to create a bespoke benefits package for each employer. Group PMI policies 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?
- Are you networking with key decision makers?
- Could you run a seminar that introduces PMI to potential clients?
- Overcoming objections
Clients with 250 or more employees are likely to have a first-hand understanding of the dramatic impact that illness or injury can have on a workforce. But these are some of the most common objections we hear:
- “It’s too expensive.” Optimum is a bespoke policy, which means that we can offer great flexibility in the benefits and costs associated with cover. You’ll have an opportunity to work with our Account Managers closely, and create a proposition that meets your clients’ budgets as closely as possible. In many ways, an objection to cost can be a sign that your client hasn’t understood the benefits of Optimum in detail: it’s certainly an opportunity to highlight the value this policy could add to absence management and employee wellbeing. 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 for our employees.” 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. For example, BacktoBetter offers employees rapid access to qualified clinician who can help deal with the pain of musculoskeletal injury.
- “I’ve got other priorities.” If you understand your client’s business in depth, you’ll have an insight to their plans for the future – expansion, perhaps, or specialisation in a particular market. Good health among employees, and ways to keep absence-related costs to a minimum, can play a key role in a business’s 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 because it demonstrates that your clients have understood the value of providing PMI for their employees. We’re happy to offer a consultation process which may show not only cost savings, but also enhanced benefits to the business by switching to Optimum. Also if your client chooses to transfer to us we can match their current benefits to make the transition as smooth as possible.
Alternatives to Optimum
We know how important it is to contain costs. As an alternative to Optimum, you can offer Optimum Access (PDF 92KB). This policy offers three levels of cover, which will give employees access to private consultations and diagnostics – it’s a starting point from which an employer can offer a new benefits scheme with a limited budget. It’s important that your clients get the right level of cover, so speak to our National Accounts teams if you’d like to find out more about this product.
- Answering clients’ technical questions
Our National Accounts managers are on hand to answer questions in person for Optimum clients. This gives you an exceptional level of support from a provider – 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 Optimum, but acute conditions are – but as it’s a bespoke policy, we’ll work with your clients if they’d like to include cover for routine monitoring of chronic conditions in their policy.
- “What are hospital lists?” Your clients can choose a selection of hospitals where they’d like employees to receive treatment. They do this by selecting one of the following ‘lists’ of facilities.
- Key hospital list – this provides access to a nationwide network of over 350 private hospitals
- Extended hospital list – most Optimum customers choose to have this list as standard – it is the same as the key list but contains more hospitals around the central London area
- Trust hospital list – this incorporates dedicated private patient units within NHS hospitals
- Signature hospital list – this is an option for clients living in Scotland and Northern Ireland and excludes use of hospitals in England.
Use our online Hospital List Checker to show clients the facilities available in their area.
- “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, 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 Optimum policies are written on Medical History Disregarded underwriting due to their size. For more details about our wide range of underwriting choices, look at the overview tab on this page
What makes our Group Private Medical Insurance different?
It’s a competitive market. Your clients want to be sure they’re getting the right Group 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.
Your clients can choose the benefits they believe to be most beneficial for their workforce; we’ll treat every claim on a case by case basis.
We draw on extensive clinical expertise to create policies that can help your clients reduce the costs associated with sickness in the workplace and promote wellbeing among their workforce.
Why choose Aviva’s Optimum 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’ in 2010, 2011, 2012, 2013, 2014 and 2015.
- We’ll match your clients’ existing cover. If your clients want to transfer from another provider, we’ll match their current benefits. Optimum is a completely bespoke policy.
- We offer exceptional levels of account support. We offer a dedicated level of account management to every adviser who would like to offer Optimum policies to his or her clients. Our National Accounts team can visit you to help create Optimum policies that meet clients’ needs as closely as possible.
- Our claims process promotes prompt returns to health (and the workplace). We’ve set up dedicated teams to focus on specific medical conditions; our in-house clinicians work closely with claims advisers 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 across the industry, throughout and after the treatment process. Read more details about our Cancer Pledge. As Optimum is a completely bespoke policy your clients can tailor their cancer benefits to their exact needs as shown in our Optimum Cancer Cover brochure (PDF 963KB).
- 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 every one is treated on a case by case basis. With their employers, we’ll make time to help them manage their claims costs, and explore innovative ways to manage overall spend without affecting the member experience.
- 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 2015, we paid over £441million to customers who needed us to help them deal with illness, injury, rehabilitation and recovery.
- 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 abreast of industry issues and continually evolve our products. We’re committed to staying abreast of healthcare developments, 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.
Get to know more about our claims process, so you can offer insights about Optimum to your clients.
When it comes to making a claim, our focus is very much on the individual employee concerned: helping them return to health and get back to work as quickly as possible. To do that, we commit heavily to ensuring our claims process is as smooth and stress-free as possible.
- Employees have case-by-case support for complex and lengthy claims
- We’ll use our experience and clinical insights to guide them, individually, to the right treatment
- Most of our claim outcomes are decided over the phone, without any need for the employee to complete any paperwork
- Associated stress levels are reduced for employees
- Group administrators can monitor claim levels online
- Our approach to claims
When employees need to make a claim, they’ve become patients: people whose needs differ from case to case. They may not be feeling 100% when they call, so our claims teams and in-house clinicians are sympathetic to their needs.
We’ll help as much as possible, often eliminating the need for employees to complete paperwork. 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, so we operate a proven process. We separate out ‘routine’ clinical journeys, for conditions such as hernias 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.
In addition to general claims, our advisers are divided into dedicated specialist condition management teams which means that we have dedicated banks of expertise, focusing on areas such as cardiothoracic, oncology and mental health.
Each of these teams offer guidance from highly trained experts, 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.
- Cancer claims
If your clients’ employees need to make a claim for cancer, they’ll find that our approach takes the sensitive nature of this condition very much into consideration. We have a specialist oncology team who are trained to help patients deal with different types of cancer, and this team have support from our clinicians.
As soon as an employee makes a claim we’ll be on hand to give them support. The case will be assigned to a dedicated member of the oncology team. This way, there’s one point of contact – a named individual who can get to know your clients' employees and ensure consistency of service.
The choice of cancer cover levels is entirely at your client’s discretion when they take out an Optimum policy. But our Cancer Pledge means that, across the board, we’ve enhanced the levels of cover that we are able to provide. For example, we place no limits on radiotherapy, chemotherapy or targeted therapies that use licensed and clinically proven drugs (like Herceptin or Avastin), and we’ll also pay for bone strengthening drugs in full when cancer cover is in place.
In addition, we’ve learned how important it is to make things as comfortable as possible for patients during treatment. To do this, we offer extensive aftercare that includes rehabilitation and consultations with a dietician, as well as money towards a prosthesis or a wig if necessary. Everyone who makes a claim will benefit from personal advice given by a member of our oncology team who will be there to help and support your clients’ employees from diagnosis through to treatment and aftercare. We make sure there’s a named contact, as a case manager, which means our teams can get to know the employees – and their needs – on an individual basis.
To help manage costs and drive consistent quality of care, we’re developing a number of networks of facilities, specialists and other practitioners for specific conditions. If we have a network for a condition or suspected condition, we’ll tell your clients' employees where they can have their treatment which may not be at a hospital on your clients' selected hospital list. We will only pay for that treatment if it is carried out within our networks.
A list of the conditions or suspected conditions for which we have networks in place can be found at www.aviva.co.uk/health-network/.
- BacktoBetter claims
We include our BacktoBetter service as standard, unless your clients choose not to offer this option to their employees. BacktoBetter addresses most musculoskeletal issues - please see our BacktoBetter brochure for full details of this service, which you’re welcome to share with prospective Optimum clients.
Telephone clinical assessment (TCA)
Our advisors arrange for a clinical case manager from one of our independent clinical case management providers to contact the member to assess their symptoms. We always aim to provide this assessment at a time that convenient for them.
For Musculoskeletal pain there's no need to wait to see a GP. Members just need to contact the customer service helpline and describe their symptoms.
If eligible, our advisors will arrange for a clinical case manager from one of our independent clinical case management providers to contact the member to assess their symptoms. We always aim to provide this assessment at a time that convenient for them.
The clinical case manager will work out what the most appropriate course of action is – that’s everything from advice to 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 the employee is looked after by a clinical 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 treatment before the condition deteriorates.
We understand that members may have already gone to see their GP, in these cases, they can move straight to the standard claims process if:
- their GP has recommended osteopathy or chiropractic treatment, or
- their condition doesn't relate to their back or neck (spine), and
- their GP has recommended radiology, pathology or referral to a specialist.
Otherwise members must continue to follow the Backtobetter pathway.
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 four simple steps they’ll need to share with employees who want to make a claim.
- Group PMI claims - Step 1
Employees need to visit their GP as normal, and let him or her know they have cover with Aviva. If they’re suffering from back, neck or any other muscle or joint pain, then they don’t need to see their GP: by calling us, we can arrange assessment and start treatment from there if required. For all other types of illness or injury, they’ll then need to check with us to make sure their policy covers any recommended tests, treatment or consultations. Over 88% of our claim outcomes are decided over the phone without the need for any paperwork. They should:
Call the claims team: 0800 158 3344 Monday to Friday 8.00am – 8.00pm Saturday 8.00am – 1.00pm Calls to and from Aviva may be monitored and/or recorded
- Group PMI claims - Step 2
Employees will need to give us their personal details, including:
- a policy number and company name
- a description of the symptoms and condition
- what the GP has said, and
- the name of the specialist and where they practice.
If employees are given an open referral, they may not know the specialist’s name in advance. If that's the case, then we'll just need to know which kind of specialist it is. If we need more information from a GP then we'll do our best to get this quickly.
If we have a network for a condition or suspected condition. we'll tell your clients' employees where they can have their treatment which may not be at a hospital on your clients' selected hospital list.
A list of the conditions or suspected conditions for which we have networks in place can be found at www.aviva.co.uk/health-network.
- Group PMI 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. We need to know where they’d like to be treated, when, and which procedure code (CCSD code) applies to the treatment. The specialist will have these details.
- Group PMI claims - Step 4
All eligible bills will be settled 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,
- 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 staff. 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.