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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.

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 (post 1 October 2018) (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 and hospital on the employee's 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

Example cover

These are example benefits of what is available for GuideWell clients:

  • Access to full in-patient, day-patient and out-patient care by the specialist and at the hospital confirmed by us
  • 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 our Cancer brochure (post 1 October 2018) (PDF 836KB)

There are many other benefits that can be included in the cover, such as payment for GP minor surgery. Examples of the benefits available can be found in the GuideWell brochure (post 1 October 2018) (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 (post 1 October 2018) (PDF 2,421KB)

  • Mental Health-psychiatric in-patient, day-patient and out-patient cover
  • GP referred services, such as GP referred radiology and pathology
  • 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:

  • A member excess option
  • Reduced out-patient cover
  • Six week option - if the member's specialist recommends in-patient or day-patient treatment that is available on the NHS (including accident or emergency admissions) within 6 weeks, it will not be covered by the policy; however out-patient treatment is still available regardless of NHS waiting times.

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 (post 1 October 2018) (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
BacktoBetter

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 common reasons for employees not being fit for work.

The BacktoBetter service is provided as standard with GuideWell. It’s an expert-led support and case management service that uses evidence-based medical guidelines to help manage musculoskeletal symptoms. Through the BacktoBetter service employees can have their own personal treatment plans without the need to see a GP, no matter how large or small the problem.

With quick intervention, we can help employees return to work faster and ensure access to the most clinically appropriate treatments before the condition deteriorates. This not only saves time for the employee, but also potentially maintains productivity for the employers. Full details can be found in our BacktoBetter brochure (post 1 October 2018) (PDF 2,992KB).

Wide range of underwriting options

GuideWell provides clients with options for underwriting. 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 out PMI for the first time, or switching to us from another insurer on MHD underwriting. This underwriting is offered as standard to new 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. Employees cannot claim for conditions or symptoms that existed within the five years prior to the policy’s start date 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 for and advice about that particular condition, or any 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 the previous certificate). Our moratorium wording will apply with effect from each employee's original moratorium start date.
  • Full medical underwriting: the past health of employees is considered, and any pre-existing medical conditions and related 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 employee's existing terms (we’ll need to see their current certificate) and apply personal medical exclusions (if any) from the previous insurer. However, if loadings were applied by the previous insurer, instead of exclusions, those members will need to complete an application form and be fully medically underwritten.
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 within a 25 mile radius of that location (10 miles within London) in most cases
  • Treatment is provided at one of around 248 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

We want to help your client's employees lead healthier lives and promote a feeling of appreciation towards employers. That’s why we offer a number of added value benefits with our GuideWell policies:

  • 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 (terms and conditions apply).
  • Aviva Digital GP - new interactive app available, that effectively puts a GP in a client’s pocket. For GuideWell clients, please contact your usual account manager to discuss Aviva Digital GP access. For more information see our flyer (PDF 174KB)
  • Access to a 24 hour stress counselling helpline. Available to members aged 16 and over.

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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

Company facing

Employee facing

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Can we help you?

Think of us as part of your team. For help or queries, call us on:

Sales Support:

0800 0014 272

9.00am – 5.00pm, Monday – Friday

For policy quotes, please email:
hcnd@aviva.com

Calls to and from Aviva may be recorded and/or monitored.

Health Insurance Company of the Year

Health Insurance Company of the Year (8 years running)

Best Customer Service provider
(2 years running)

Best Group PMI provider (8 years running)