Private medical insurance for business
Solutions. Health insurance for 2-249 employees
Solutions is our flexible group Private Medical Insurance (PMI) product covering between 2-249 lives. When employees get treatment promptly, they can return to work faster – helping reduce absenteeism costs.
To help you advise if this product is suitable for your client, we have created target market information which is included in the additional information on our Helping you sell page.
It’s important you understand the product's details to 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 terms and conditions. Please see the general terms and conditions for schemes covering 2 to 99 employees (post 1 October 2018) (PDF 613KB), and the general terms and conditions for schemes covering 100 to 249 employees (Post 1 October 2018) (PDF 573KB).
For 2-99 employees please also read the Insurance product information document (Post 1 October 2018)(PDF 93KB) and the pre-sales brochure (Post 1 October 2018) (PDF 5.05MB)
For employees 100-249, there is no insurance product information document but similar information will be provided within the illustration, when a quote is requested.
Solutions is a flexible PMI product for businesses, which can cover up to 249 employees. It gets members access to 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 product that's been designed to meet the needs of your SME business clients and their employees
- 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
- Solutions includes BacktoBetter, a clinical case management service for musculoskeletal (MSK) conditions, helping get employees back to work faster.
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 the right care, return to work faster after illness, and save money.
Whenever you present Solutions, you’ll need to find out which options suit your clients’ needs best. So you can see how flexible Solutions can be, we’ve broken it down into five overview areas: core cover; BacktoBetter, options available, differences for policies covering 100 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:
- hospital charges at a network facility or a hospital on your clients' chosen hospital list
- 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
- BacktoBetter - the independent case management service for musculoskeletal (MSK) conditions helping get employees back to work faster
- specialist referred physiotherapy, osteopathy and chiropractic treatment for non-musculoskeletal conditions
- Psychiatric treatment as an out-patient, up to £2,000 each member every policy year; on GP referral to a psychiatric therapist or psychiatric specialist
- NHS cash benefit of up to £100 each night, for a maximum of 25 nights each member every policy year
- accommodation for one parent staying with a child of 15 or under receiving eligible treatment
- home nursing on specialist recommendation following eligible treatment as an in-patient or day-patient
- investigations into the cause of infertility
- treatment for complications of pregnancy and childbirth (as specified within the policy wording)
- £100 for each baby born to or adopted by a member, within a year of birth
- limited emergency overseas cover when temporarily abroad for a period of up to 90 days in total each policy year
- surgical procedures on teeth performed in a hospital
- hospice donation of up to £70 per day for up to 10 days
- private ambulance if medically necessary.
BacktoBetter is an independent musculoskeletal (MSK) service for SMEs.
BacktoBetter provides end-to-end case management for employees, regardless of the treatment path – independent BacktoBetter clinical case managers will assess the employee and coordinate the appropriate clinical pathway that their condition requires.
BacktoBetter is included as standard on all Solutions policies as part of core cover. We believe it is the most appropriate way to manage MSK claims.
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 pre-sale brochure (Post 1 October 2018) (PDF 5.05MB). Upgrade options include:
- mental health treatment. Employees could claim for in-patient and day-patient treatment if diagnosed with an acute mental health condition, such as clinical depression, for a maximum of either 28 or 45 days’ combined in-patient and day-patient treatment each member every policy year. Specialists' fees for in-patient treatment are covered up to £210 each week with this option.
- routine & GP referred services. This option has an overall benefit limit of £1,000 each member every policy year. As with most health insurance policies, our core cover excludes long-term treatment for chronic conditions. However, by adding routine and GP referred services there is cover within the overall benefit limit for some treatment of chronic conditions (see below).
In addition, we recognise that more and more people want to use complementary or alternative treatments and want to be able to access diagnostic tests following a visit to their GP. So by including this option your clients' employees can access various therapies without the need for a specialist's referral (as shown below).
This option includes the following benefits (covered within the overall benefit limit of £1,000 each member every policy year):
- consultations with a fee approved specialist and diagnostic tests for a chronic condition
- follow up consultations with a fee approved specialist to monitor a member when they have finished treatment for an acute condition
- GP referred radiology/pathology for non-musculoskeletal conditions
- GP referred physiotherapy, osteopathy, acupuncture and chiropractic treatment for non-musculoskeletal conditions – up to 10 sessions in combined total each condition each member every policy year
- GP referred chiropody, podiatry and homeopathy for non-musculoskeletal conditions
- GP minor surgery – up to £100 per procedure (payable to the GP).
- extended hospital list.Your clients' employees' will have access to the Key hospital list as standard. If they wish to increase the choice available to them, it's possible to upgrade their hospital list to include a choice of additional private hospitals, predominantly in the Greater London area.
- 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, each member every 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. Reduction options include:
- six week option. Employees on the policy can’t claim for in-patient or day-patient treatment, NHS cash benefit, NHS cancer cash benefit or for the cost of an amenity bed, if the NHS can treat them within six weeks.
- policy excess. A member excess of £50, £100, £150, £200, £250 or £500 can be added to the policy, which will apply once for each member, every policy year, irrespective of the number of claims each person makes.
- selected benefit reduction. This removes the following benefits from cover: investigations into the cause of infertility, treatment for complications of pregnancy and childbirth, surgical procedures performed on the teeth in a hospital 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 must have fewer than 100 employees covered by the scheme. Clients can also choose our Signature hospital list if employees are solely based 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, out-patient radiotherapy and chemotherapy treatment, and pre-admission tests within 14 days before in-patient or day-patient treatment to check the member is fit to undergo surgery and anaesthesia. However, all other out-patient treatment would be limited to either £0, £1,000 or £1,500 each member every policy year. If your clients choose one of these options, the monetary limit for out-patient treatment will not apply to cancer treatment received after diagnosis.
- Differences for businesses with 100 to 249 employees
When your client employs a larger workforce, we make some changes to the policy. These are the key differences that will be seen by businesses covering 100 to 249 employees:
- the Trust hospital list is not available.
- payments can be made annually or by monthly or quarterly Direct Debit through a business account.
- depending on underwriting type selected, the qualifying periods for treatment regarding complications in pregnancy and childbirth, the maternity cash benefit, and investigations into the cause of infertility may no longer apply.
- experience 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 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 product into place:
- Access to Aviva Digital GP (from 1 October 2018 for new and renewing clients). Benefits include unlimited video GP consultations per policy year. See our flyer for more information (PDF 173KB).
- 24-hour stress counselling helpline (available to members aged 16 and over)
- up to 25% off membership at a range of UK gyms and health clubs. Terms and conditions apply.
- MyAviva - our online platform will help employees manage their Aviva policies in one secure, easy-to-use place at a time that suits them.
Presenting Solutions to your clients this way – explaining the cover (including BacktoBetter), the options, and the added value that Aviva provides – gives them a better understanding of 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; the insurance product information document; a copy of the policy wording; a new policy schedule and details of any changes that apply to the cover.
- 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. Instill confidence in your clients: by letting them know that, for the ninth year running, Aviva UK Health won Health Insurance Company of the Year at the Health Insurance Awards 2018, along with Best Customer Service, Best Individual PMI provider and Best Use of Marketing to Intermediaries.
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 product’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. Please read the following documents together; the Solutions brochure, policy wording document and the insurance product information document.
These documents explain how the product works
Solutions brochure - post 1 October 2018 (PDF 4470KB) – client-facing pre-sale brochure
Hospital Lists (PDF 1890KB) – options for your clients
At a glance guide - post 1 October(PDF 620KB) – leaflet showing the benefits of Solutions at a glance
Policy wording - post 1 October 2018(PDF 543KB) – contains the terms and conditions for policies with 2-99 members
Policy wording - post 1 October 2018 (PDF 574KB) – contains the terms and conditions for policies with 100-249 members
Insurance product information document - post 1 October 2018 - 2-99 members showing a summary of the cover provided by Solutions.
Solutions for 100-249 members- there is no insurance product information document but similar information will be provided within the illustration, when a quote is requested.
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 2-249 members – Solutions application form (PDF 330KB)
Solutions – FMU application form (PDF 523KB)
Remember, you can always get a quote by speaking to your Health Trading Centre consultants. You’ll also find a full range of Solutions literature in our searchable Document Library and you can order printed copies from here as well. 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.
- Target Market Statement
What customer need is met by this product?
This product is designed for companies who wish to protect either their whole work force or a subsection of their work force by providing fast access to private diagnostics, specialists and treatment for acute conditions - it has a number of upgrade and down grade options to enable it to be tailored for all staff or to offer different options for different sectors of their work force. It offers support to manage absence costs and attract and retain staff.
Who is Solutions designed for?
This product is designed for companies who wish to cover 2 – 249 employees and their dependents for Private Healthcare. They may choose not to cover all sections of their work force and as such this product could cover not only SME business, but also large companies should they only wish to cover a section of their employees.
Who is Solutions not designed to support, or are there any features that you should be aware of when considering this product for your customer?
This product is suitable for employees and their families who are resident in the UK. It is not suitable for sole traders, or companies who only wish to select cover for only one key individual. Should this be the case the customer should be directed to Healthier Solutions. This product is also not suitable for larger companies who wish to insure more than 249 members of staff; in this case they should consider Optimum. The customer should also consider the availability of local hospitals to their staff, for example both the Signature hospital list (which only allows access to hospitals in Northern Ireland and Scotland), and the Trust hospital list which accesses local NHS trusts may not be suitable based on client geography.
For all products you should take further care in whether the product and underwriting approach is suitable for customers you identify as vulnerable. For guidance please see Aviva’s guide to vulnerable customers(PDF 169KB).
Can Solutions be sold without advice?
How can I sell Solutions?
We would suggest that Solutions can be sold face to face or via telephone, we cannot support digital or postal sales.
- Finding the right clients
Who do you know, and where do you work? In theory, many businesses 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 due to ill health, 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 Health Trading Centre 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.
- “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 15 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 cost of workplace absence for long and short term ill-health. Solutions helps get employees back to work and our added value benefits can help to prevent the causes of workplace absence.
- “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:
- Access to Aviva Digital GP – (from 1 October 2018 for new and renewing clients). Benefits include unlimited video GP consultations per policy year. See our flyer (PDF 174KB) for more information.
- 24-hour stress counselling helpline – whatever the concern, be it work-related, money or relationship – employees have someone they can turn to in confidence, which could help reduce any downturn in productivity due to stress. This benefit is available to members aged 16 and over.
- MyAviva – our online platform wilt help you manage your Aviva policies in one secure, easy-to-use place at a time that suits you.
- Group PMI makes sense
There are three 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 BacktoBetter services means no more waiting for a GP appointment for MSK conditions.
- 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.
- 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:
For schemes with 2 to 99 employees, call the Healthcare Trading Centre: 0800 158 3348
Monday to Friday
9.00am - 5.00pm
For policy quotes, please email: email@example.com
For schemes with 100 to 249 employees call Sales Support: 0800 0014 272
Monday to Friday
9.00am - 5.00pm
For policy quotes, please email: firstname.lastname@example.org
Calls to and from Aviva may be monitored and/or recorded
Our health trading centre consultants 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 100 employees, our account managers will also be happy to accompany you on visits and assist with the sale.
What makes our product different?
For the ninth year running, we have been voted Health Insurance Company of the Year at the 2018 Health Insurance Awards. We believe it’s our products flexibility and the way we help employees benefit from our clinical expertise that makes us the provider of choice.
Our claims expertise and BacktoBetter service 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 an Aviva Solutions policy?
- Solutions is flexible, affordable, and fits around your clients’ needs. Every business should have the option to choose the level of cover they provide for employees, in a way that benefits your clients as well as their staff. Solutions provides that opportunity.
- Specialist claims management teams. We understand that certain conditions, such as cancer, heart conditions or mental health problems have complex clinical needs. We have highly dedicated claims teams, with highly trained claims consultants, who can offer your clients' employees' guidance and support throughout their claim. This gives extra reassurance through a very worrying time and can support in getting them back to work as soon as possible.
- Solutions comes with the BacktoBetter service as standard. BacktoBetter is an independent clinical case management service for back, neck, muscle or joint pain (musculoskeletal conditions). It gives your clients' employees' quick and easy access to a clinical case manager to help them get better as soon as possible - they don't even need to take time off work to see their GP.
- Our cancer pledge. Solutions includes our extensive cancer cover via our cancer pledge. We understand the importance of providing extensive cover and support at every stage of cancer treatment. Our cancer pledge means we’ll cover the treatment and palliative care your clients' employees need as recommended by their specialists.
- 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, to minimise the impact of their day-to-day resources.
- 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 2017 we paid £430m in health claims and looked after the health of over 900k people.
As a result of our focus on delivering high levels of healthcare expertise, for the ninth year running, we've won Health Insurance Company of the Year at the 2018 Health Insurance Awards. When you tell clients about these awards, it helps build confidence in making a purchase.
Solutions claims – what happens next?
With Solutions, employees will have all the information they need to make a claim within their policy documents. But it’s useful to understand the process so that you can field group administrator queries.
Your client will hold a group policy but we pride ourselves on treating people as individuals. Employees may not be feeling 100% when they call – which is why our claims teams provide help every step of the way. We have a dedicated department looking after our private medical insurance (PMI) claims, with staff who familiarise themselves with the details of each claim they’re working on – and we believe that’s one of the reasons we were awarded Health Insurance Company of the Year for the ninth year running at the 2018 Health Insurance Awards.
We make sure that our in-house clinicians are on hand to give claims advisers detailed support. Employees will have experienced claims advisers looking after their claim.
All Solutions policies include the BacktoBetter musculoskeletal clinical case management service, to help your client's employees get back to work faster.
- How does our expertise help your clients?
Our in-house clinicians work closely with our claims teams to understand your members’ clinical needs. Together, they use a triage process that identifies routine pathways (treatment for things like hernias and cataracts) and separates them from the more complex conditions such as heart and mental health conditions, as well as cancer. And if it’s a more complex case, one of our specialist claims teams will provide dedicated case management.
Employees can rest assured, knowing that they’ll be talking to experienced staff who can empathise and understand what they're going through.
To claim for musculoskeletal conditions (such as pain in the back, neck, muscles or joints) employees will use the BacktoBetter service. This gives them rapid access to a clinical case manager from one of the independent case management providers. There’s no need to see their GP, they just call us and we arrange for them to be contacted for a telephone clinical assessment, so treatment can be started as soon as possible.
With musculoskeletal conditions it's really important that employees are assessed quickly. We know from experience that the sooner the employee receives the right support, the better their prognosis.
- BacktoBetter - making a musculoskeletal claim
Making a claim through the BacktoBetter service couldn't be simpler.
If your clients ask you to explain how to make a claim on the BacktoBetter service, it's just three steps:
No need to see their GP
Employees can contact our customer service helpline and describe their symptoms.
Telephone clinical assessment
Providing it's a valid claim, we’ll arrange for a clinical case manager, from one of our recognised providers to contact the employee at a convenient time to assess their symptoms.
If treatment is necessary, the clinical provider will refer the employee to an approved physiotherapist for treatment and/or onward referral to a specialist. But if it isn’t necessary, the clinical provider will teach the employee how to manage their condition.
If an employee has already received medical advice and/or a referral to treatment they do not need to be re-assessed by a clinical case manager. Our in-house claims team will support their referral, this could include referring for physiotherapy via our provider's approved network or, using our Specialist Finder tool, guide them to an appropriate specialist.
- Making a claim for non-musculoskeletal conditions
Our documents are designed to help employees make a claim easily and the majority of cases can be approved over the phone. There is a 4 step claims process.
If an employee is unwell they'll need to see a GP, where they may be referred for further assessment or treatment. This could be an open referral or a named referral.
It’s really important that employees get in touch with us before attending any appointments so we can make sure their claim is covered under the terms and conditions of the policy before they incur any costs.
When an employee has been given a referral by their GP, they need to call us to set up their claim.
They should call the claims team on:
0800 068 5821
Monday to Friday
8.00am – 8.00pm
8.00am – 1.00pm
Calls to and from Aviva may be monitored and/or recorded
If we have a network in place for their condition or suspected condition, we’ll let them know where they can have their treatment. Our network facilities may be different to the hospitals on your client’s chosen hospital list. If your client has selected the extended hospital list then they don't have to use our networks.
If we don't have a network for the employee’s condition or suspected condition:
- if the employee has been given a named referral, we’ll check to make sure the specialist is recognised by us.
- if it’s an open referral, we’ll use our specialist finder database to select an appropriate specialist and/or hospital.
After the employee attends an appointment, their specialist may recommend hospital treatment – this is when they need to ask for a procedure code (CCSD code).
Once they’ve called us with these details, we can confirm whether their treatment can be covered. If it can, we will provide further information about where they can have their treatment, which may be through one of our networks, at a hospital on their hospital list, or at other facilities recognised by us.
Most eligible bills can be settled directly with the provider of treatment. 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 to us at:
Bill Payment Team
Aviva Health UK
We’ll do everything we can to make sure your client, 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.
BacktoBetter is a clinically case managed musculoskeletal (MSK) service which is standard within core cover.
A clinical case manager from our independent provider can assess your employees' MSK symptoms to determine the most appropriate treatment pathway to improve their condition.
Please read on for more information.
- How does BacktoBetter work?
BacktoBetter introduces quality clinical decision-making throughout an employee's claim. Using BacktoBetter means that employees don’t need to see their GP, they just need to call us and we’ll arrange for them to receive a telephone clinical assessment from one of our case management providers. This makes sure that only appropriate and effective interventions are approved, which means a better outcome for your clients’ employees and a positive impact on absence levels.
So, if an employee experiences back, neck, muscle or joint pain, the BacktoBetter service is their first point of contact, there's no need for them to see a GP first.
Following their telephone clinical assessment, the employee will begin the most appropriate course of treatment for their condition - this could be self-managed exercises (given to them over the telephone and backed up by online support), physiotherapy or referral to a specialist for diagnostic tests or treatment.
All of the clinical case managers have a wealth of experience - meaning employees are being supported by someone who really understands their condition.
- What are the benefits of BacktoBetter for employees?
BacktoBetter is a service that ensures employees receive the right treatment for their MSK symptoms or conditions. No matter how complex the problem is, the individual will receive clinical support to help meet treatment goals and get better quicker. Early intervention is key in treating MSK conditions which is why BacktoBetter is a fluid system enabling them to get treatment as quickly as possible.
- No need to see a GP which means employees can receive help quickly
- If reduced out-patient cover has been selected the limit will not apply to physiotherapy treatment through BacktoBetter
- Choice of over 1,800 clinics throughout the UK
- A shorter claims journey for employees
- Provides easy access to clinical expertise and a tailored treatment plan specific to their individual condition.
- What are the benefits of BacktoBetter for employers?
BacktoBetter offers access to a clinical case manager who can help employees deal with the pain of a musculoskeletal condition
- A service that complements your clients’ wellbeing strategies offering preventative advice early on as well as treatment
- There’s no need to see a GP. Making it quicker and easier for employees to access treatment
- Employees get the right treatment at the right time which can help lead to a faster recovery, reducing workplace absence
- Getting employees back to work quickly is especially important in the SME space as having key staff off work for any period of time can have a significant effect on the business.
- What if a member has already seen their GP?
If a member has already received medical advice and/or a referral to treatment they do not need to be re-assessed by a clinical case manager. Our in-house claims team will support their referral, this could include referring for physiotherapy via our provider's approved network or, using our Specialist Finder tool, guide them to an appropriate specialist.
Treatment related to musculoskeletal conditions will not be eligible under any other benefit on this policy, except for NHS cash benefit.
Can we help you?
Think of us as part of your team. For help or queries:
For schemes with 2 – 99 employees, call us on:
0800 158 3348*
For policy quotes, please email: email@example.com
For schemes with 100 – 249 employees, call us on:
0800 0014 272*
For policy quotes, please email:
*Calls to and from Aviva may be recorded and/or monitored
9.00am – 5.00pm, Monday – Friday