Group private health insurance

What can this policy cover?

Extensive, effective, flexible care and support for your employees: that’s the essence of Optimum. We realise that you’re looking for a set of options that can be adapted to fit your needs, and that’s why Optimum could be ideal for your business. It’s completely flexible – it’s up to you what’s included, right down to choosing individual benefits and setting individual limits.

However, in our experience there are some ‘must have’ benefits and support systems that you’ll want as a basic level of cover. Things like diagnostic tests, specialists’ fees, the costs of cancer care and physiotherapy – these are all part of Optimum’s basic cover levels, along with access to full in-patient and out-patient care at a wide range of private hospitals across the UK.

As a basic level of cover, we propose…

In-patient or day-patient treatment of acute conditions at a hospital on the extended hospital list, facility recognised by us as part of a network or an NHS hospital recognised by us:

  • Consultations with a fee approved specialist
  • Out-patient procedures – specialist fees up to the limits in our fee guidelines
  • Specialists’ fees – up to the limits in our specialist fee guidelines
  • Treatments for cancer – there are different levels of targeted cancer therapy cover to choose from, including our 'Extensive Cancer Cover' option and everyone will benefit from the support of our specialist oncology team
  • Diagnostic tests – including X-rays, scans, blood tests and ECGs; CT, MRI and PET scans
  • Radiotherapy / chemotherapy treatment
  • Treatment for pain in your back, neck, muscles or joints – musculoskeletal conditions

Out-patient costs for acute conditions, helping your staff to minimise time spent away from work:

  • Consultations with a fee approved specialist
  • Out-patient procedures - specialist fees up to the limits in our fee guidelines
  • Treatment by a physiotherapist (for any condition other than pain in your back, neck, muscles or joints – musculoskeletal conditions) – up to 10 sessions, per condition, per policy year, on a GP’s referral
  • Diagnostic tests – including X-rays, scans, blood tests and ECGs. Out-patient CT, MRI or PET scans will only be covered at a diagnostic centre recognised by us
  • Radiotherapy / chemotherapy treatment received as an out-patient
  • Treatment for pain in your back, neck, muscles or joints – musculoskeletal conditions

Whichever options you add to the above levels of cover, you’ll want your policy to work hard while your employees are healthy, too. So we offer additional benefits free of charge. Things like generous gym discounts, our 24 hour GP helpline, and our 24 hour stress counselling helpline (this benefit is available to members aged 16 and over). These can help employees to focus on looking after themselves, which in turn may help reduce absenteeism in your business.

We’ll also help you promote awareness of our partnership in a way that can enhance your employees’ perceptions of your commitment to their wellbeing. When you choose Aviva for your company’s private medical insurance, they’ll also receive discounts on motor insurance and travel insurance. Full details of cover are in our terms and conditions booklet, which you can ask for at any time. You’ll need to complete an application form for us to work out the final terms of your policy if we accept your application and, depending on your circumstances, non-standard terms may apply.

Treatment, care and options to suit your needs…

When it comes to buying private health insurance for a large number of employees, some features are also of tangible benefit to your business. Cover for treatment for pain in the back, neck, muscles or joints – musculoskeletal conditions, for example, could help employees make a more rapid recovery after illness. With Optimum, you have the flexibility to include a number of additional benefits. It’s important to know that, by choosing them, your premiums will increase, but your adviser can tell you more. With experience, we’ve found that companies usually choose a combination of the following optional additional benefits:

  • Home nursing costs on a specialist’s recommendation after eligible in-patient or day-patient treatment, and parent accommodation for one parent accompanying a child under nine who is receiving eligible treatment under the policy.
  • If an eligible individual needs hospice care, we can make a donation to the hospice of £70 per day, for up to 10 days’ care. We can also pay NHS cash benefits – up to £100 per night for eligible NHS treatment, for a maximum of 25 days per policy year.
  • You can include cover for GP-based minor surgery, for which we’ll pay up to £70 per procedure directly to the GP. Oral surgical procedures can also be covered, subject to our fee guidelines.
  • Routine dental cover, for things like fillings, crowns and tooth cleaning. If you choose optical benefits, we’ll provide a contribution towards the cost of contact lenses and glasses following a change in prescription. These benefits may be subject to an excess.
  • Limited emergency overseas cover is also available – another example of the flexibility that Optimum provides for your employees.
  • Mental health treatment can also be added to your scheme as in-patient, day-patient and out-patient treatment.
  • Complementary and alternative medicines are becoming more popular. You can choose GP referred homeopathy, chiropody and podiatry as additional benefits.

Options you could choose to reduce cover and help contain your costs…

We understand that the right private health insurance policy is likely to be one that offers excellent value for money. So we’ve found ways to help you meet your budgets and provide valuable benefits for your employees.

You can select options that will reduce your cover levels, and reduce your premiums. What follows is an overview of these cost-containing options:

  • Excluding some specific benefits. One of Optimum’s greatest features is its flexibility. For example, you could choose to exclude cover for oral surgical procedures, or not offer emergency overseas cover to your staff.
  • Flexible care levels. As long as all staff within a defined category have the same benefits, we can set Optimum up with different levels of cover. For example, senior staff may benefit from more extensive cover than the majority of employees.
  • Six week option. Choosing this option means that your employees won’t be able to claim for in-patient or day-patient treatment, or NHS cash benefit, if the NHS can treat them within six weeks.
  • Policy excesses. We can set up different levels of excess on your policy. In each case, we’ll apply an excess once per person, per policy year, irrespective of the number of claims made.
  • Choosing an alternative hospital list. As an alternative to the extended list you could choose our key hospital list, which reduces the number of hospitals available. If your employees live in Scotland or Northern Ireland you could choose our signature list.

Remember if we have a network for your condition or suspected condition you’ll still need to use our network facility for your treatment rather than a hospital on your list.

Because Optimum is so flexible and there are so many variations open to you, it’s a good idea to discuss these in more detail with our National Accounts team. We’re happy to propose a combination of benefits that would suit your budget and your business needs. For example, you could consider Optimum Access, which is a lower cost alternative policy with reduced benefits.

What’s not included in Optimum?

Like most private health insurance policies, Optimum has exclusions. This is an overview of those conditions, but full details will be in your policy documents. We can supply specimen documents on request, but non-standard terms may apply:

  • Treatment for chronic conditions. Optimum covers treatment for curable, short-term illness or injury (acute conditions), not long term illnesses which can’t be cured (chronic conditions)
  • Any follow-up consultations or tests when illness or injury is no longer considered to be acute
  • Drug abuse, alcohol abuse, solvent abuse and other addictive conditions
  • Treatment undertaken without a GP’s referral
  • Normal pregnancy and childbirth
  • Certain occupations
  • Cosmetic treatment
  • HIV and AIDS

This is a summary and highlights how flexible Optimum can be to meet your needs. Full terms and conditions are available on request.

The default underwriting on Optimum is Medical History Disregarded which means pre-existing conditions are covered. Should you wish to contain your premium, you can choose to underwrite your policy. Some occupations, and some specific treatments and conditions aren’t covered by our medical insurance. But if you have any questions, we’ll do our best to answer them. Call our National Accounts team for more details on 0800 001 4272.

What is a network?

We’re developing a number of networks of facilities, specialists or other practitioners that we recognise to provide the treatment required for a specific condition or suspected condition.

By creating networks, Aviva has more control over the treatment pathway. This means we can drive better commercial deals, which helps us maintain affordable prices. What’s more, by controlling the treatment pathway we can give our customers greater assurance when it comes to clinical quality and treatment, and ensure that more treatment can be covered before benefits limits are reached.

Our networks are updated frequently as we work to ensure we get the best possible service for our customers. We regularly add or evolve networks, or in the event that a facility/specialist is no longer suitable for a network we may remove them. Please contact our claims team before arranging any treatment.

Contact our claims team on 0800 158 3344. Our lines are open from 8am-8pm Monday to Friday and 8am-1pm on Saturdays.


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