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Optimum Referral – quality healthcare for companies

Optimum Referral. Easily accessible, appropriate healthcare for 250+ employees

Optimum Referral is an option on our Optimum product. It is designed to deliver a high standard of medical care for your clients’ employees on an open referral basis.

Guaranteed bill payment

Optimum Referral promises that, where the open referral process is followed, there will never be a shortfall when payment is due. Eligible bills are settled in full, directly, ensuring peace of mind to members and reassurance to employers that their benefits budgets will be spent wisely.

Our facility choices are underpinned by industry quality standards with the majority of hospitals having been hand picked based on Care Quality Commission and Health Improvement Scotland ratings. Patient safety is our key concern.

We’ll also only recommend specialists who meet the professional standards of the relevant governing bodies, including, but not limited to, the General Medical Council. Rest assured, we’ll only work with specialists who are trusted from a clinical perspective, and whose charges we believe are fair and reasonable.

Once the employee has obtained an open referral from a GP; care is tailored to their needs, depending on their symptoms or condition, and the type of clinical referral that they've been given. On this basis, our claims consultants will discuss a choice of specialists and hospitals with the employee - all of whom meet our quality criteria.

How Optimum Referral benefits employers and employees alike

A great choice for employees

  • Employees can manage their claims, their way – they can choose to start their claim online via MyAviva or over the telephone.
  • Extensive choice – our claims team will discuss options and provide information so they can make an informed decision about who they want to see and where.
  • Simplicity – there's no need for employees to chase around making contact with a specialist whom they've never met; our claims consultant can transfer an employee to the right person from the outset.
  • Quality treatment guided by needs – members receive the most appropriate treatment, undertaken in quality facilities.
  • Flexibility – we won’t interrupt the flow of a claim where the member is already following a treatment plan. Equally, we’ll look to provide alternative treatment providers where required.
  • Bills settled directly – no need to worry, eligible bills will be paid in full.

Benefits for their employers

  • Cost control & Management – our pricing approach reflects the value of long-term relationships. And, we challenge doctors, evaluate fees and embrace medical advances to maintain quality and value.
  • Tackling the key reasons for escalating costs – Dedicated case management of conditions such as mental health, musculoskeletal and cancer, to aid employee recovery and return to work.
  • Regular reviews and reports – to demonstrate how the scheme is running, in terms of both cost and performance.
Helping employees to get back to work sooner

A key objective of the healthcare provided under Optimum Referral is reducing the costs of absenteeism and promoting wellbeing in the workforce.

  • Musculoskeletal (MSK) conditions are one of the biggest causes of long-term absence. The BacktoBetter (PDF 1.73MB) service offers prompt access to clinical support for members who have MSK symptoms.
  • Members get the right treatment at the right time, with access to conveniently located physiotherapists where appropriate, without waiting for GP appointments.
  • BacktoBetter is included as standard within Optimum Referral.

Managing Mental Health in the Workplace

We can offer dedicated support for mental health. Available as an optional extra, our Mental Health Pathway gives your clients’ employees access to dedicated case managers, expert in managing mental health conditions.

Find out about Aviva’s Mental health pathway (PDF 3.98MB).

The open referral claim process: 5 simple steps
  1. Members obtain an open referral from their own GP, or via Aviva Digital GP if this service has been selected.
  2. Members can contact us over the phone or via MyAviva. Where the claim is started online they can arrange a call back at a time to suit them. They can also live chat directly with one of our claims experts.
  3. We’ll chat to members about the choice of hospitals and specialists available and get an understanding of their exact needs. These could be anything from understanding their medical requirements – through to where they’d like to have their treatment. When requested we’ll send them through a notification of their options.
  4. Members choose their hospital and specialist. If they’d like, we’ll transfer their call directly to the hospital, so they can book an appointment there and then.

For details of all the benefit options available on Optimum, visit our Optimum section for further information.

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Which documents should you use?

Optimum Referral 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 option 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.

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