Private medical insurance for business
Solutions. Health insurance for 2-249 employees
Solutions is our flexible business 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.
It’s important to fully understand this product’s details as this will 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 pre-sale brochure (PDF 4,425KB). For anyone on a policy starting after 1 December 2016 please see the general terms and conditions for schemes covering 2 to 99 employees (PDF 544KB), and the general terms and conditions for schemes covering 100 to 249 employees (PDF 534KB).
Solutions is a flexible PMI product for businesses, which can cover up to 249 employees. It helps members get prompt, 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
- Our group PMI gives employees access to prompt care and treatment that helps them stay healthy
- 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, our 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 prompt care, return to work faster after illness, and save money on the bottom line.
Whenever you present Solutions, you’ll need to find out which modules suit your clients’ needs best. To help you understand 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:
- payment of hospital charges and 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 - our 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 as an out-patient
- Mental Health 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 11 or under receiving eligible treatment
- home nursing on specialist recommendation following eligible treatment as an in-patient or day-patient
- investigations into the causes of infertility
- treatment for pregnancy and childbirth complications
- £100 for each baby born to or adopted by a member
- limited emergency overseas cover when temporarily abroad for a period of up to 90 days
- surgical procedures on teeth performed in a hospital
- hospice donations of up to £70 per day for up to 10 days
- private ambulance for transportation to hospital if medically necessary
BacktoBetter is our independent musculoskeletal (MSK) service for SMEs.
BacktoBetter provides end-to-end case management for employees, regardless of the treatment path – independent BacktoBetter clinicians 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, as we believe it is the most appropriate way to manage MSK claims and it also supports your clients’ business by managing claims spend responsibly.
Please go to the BacktoBetter tab for more detailed information on BacktoBetter and to see how it benefits your clients and their employees. Or watch our BacktoBetter video or read this handy sales aid (PDF 3,056KB) to find out more.
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 (PDF 4,470KB). Upgrade options include:
- Mental health cover. Employees could claim for in-patient and day-patient treatment if diagnosed with a 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 option 2 - routine and GP referred services there is cover within the overall benefit limit for some chronic condition treatment (see below).
In addition, we recognise that more and more people want to use complementary and alternative treatments and want to be able to access diagnostic services following a visit to their GP. So by including this option your clients' employees can access various therapies without the need for a specialist 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 chronic conditions
- 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, chiropractic, osteopathy and acupuncture 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. If treatment in the Greater London area would be convenient for employees, it’s possible to upgrade their hospital list to include a choice of additional private hospitals and clinics.
- 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 without compromising on the quality of the prompt, private care their employees receive:
- 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 we’ll apply once each member, every policy year, irrespective of the number of claims each person makes.
- selected benefit reduction. This removes the following benefits from cover: investigation into the causes of infertility, treatment for complications of pregnancy and childbirth, surgical procedures performed on the teeth 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 their head office is 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 must be made by monthly or quarterly Direct Debit through a business account – annual payment is not available.
- the qualifying periods for treatment regarding complications in pregnancy and childbirth, the maternity cash benefit, and investigations into infertility 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:
- 24-hour GP helpline and a 24-hour stress counselling helpline (the stress counselling helpline is available to members aged 16 and over)
- up to 25% off membership at a range of UK gyms and health clubs
- Aviva News & Guides - an online portal of tips and tools that can help your clients' employees with various topics including health and fitness advice
- Aviva Advantages - employees get access to lots of rewards and money saving offers - not just on personal Aviva insurance products (such as car or home insurance) but with 100s of our partners too
MyAviva - our online platform will help you manage your Aviva policies in one secure, easy-to-use place at a time that suits you.
Presenting Solutions to your clients this way – explaining the cover (including BacktoBetter), the options, and the added value that Aviva provides – helps them understand 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; a copy of the policy wording; a new policy schedule and details of any changes that apply to the cover.
- Plan your meeting, re-engage with your clients
- 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: let them know that for the eighth year running, Aviva UK Health won Health Insurance Company of the Year, Best Group PMI provider, Best Customer Service and Best use of Marketing to Intermediaries at the Health Insurance Awards 2016.
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 policy’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.
These documents explain how the product works
Solutions brochure (PDF 4470KB) – client-facing pre-sale brochure
Hospital Lists (PDF 1890KB) – options for your clients
At a glance guide (PDF 620KB) – leaflet showing the benefits of Solutions at a glance
Policy wording (PDF 543KB) – contains the terms and conditions for policies with 2-99 members
Policy wording (PDF 533KB) – contains the terms and conditions for policies with 100-249 members
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.
- Finding the right clients
Who do you know, and where do you work? In theory, most businesses close to your own 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, 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 Healthcare Sales Bureau 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 20 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 wellbeing features and services that are included free of charge – which represent a tangible, more easily rationalised ‘value for money purchase’ if they’re helping to improve their employees’ wellbeing and attendance at work.
- “I want a policy that uses a standard claims process for musculoskeletal (MSK) conditions...”
It should be easy to sell the benefits of our market leading BacktoBetter rehabilitation service to your clients. BacktoBetter introduces high quality clinical decision-making throughout your clients’ employees' claims. Using BacktoBetter means that employees don’t need to see their GP, they just need to call us and they’ll be connected with one of our BacktoBetter expert clinicians. This makes sure that only appropriate and effective interventions are approved, which means a better outcome for your clients' employees, a well-managed claims spend and a positive impact on absence levels.
Watch our BacktoBetter video for more information on the service, including the benefits to both employers and employees.
- “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:
- 24-hour GP support via our free helpline - there may still be a need to make an appointment for some conditions, but reassurance can be found straight away for minor concerns.
- 24-hour stress counselling helpline – whatever the concern, be it work-related, money worries, relationships or general ‘blues’ – 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.
- Aviva News & Guides - our online portal of tips and tools to help improve health and fitness. We believe that, by becoming more aware of health issues, employees can take more care of their own wellbeing.
- Group PMI makes sense
There are four 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 our 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.
- Reduced absence costs – The Charted Institute of Personnel and Development carries out in-depth research into the cost of absence for businesses. In 2015, the median annual cost per employee in the public sector was stated to be £789; in the non-profit sector it was £639; £400 in private services and £557 in the production and manufacturing sector. Group PMI won’t eradicate sickness absence, but it can help get employees back to work more quickly, because they don’t have to join NHS waiting lists.
- 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:
Call the Healthcare Trading Centre: 0800 158 3348
Monday to Friday
9.00am - 5.00pm
For policy quotes, please email: email@example.com
For 100 to 249 call Sales Support: 0800 0014 272
Monday to Friday
9.00am - 5.00pm
Calls to and from Aviva may be monitored and/or recorded
Our specialist 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 policy different?
For the seventh year running, we have been voted the Best Group PMI Health provider and Healthcare Insurance Company of the Year at the 2016 Health Insurance Awards. We believe it’s our policies’ flexibility and the way we help employees benefit from our clinical expertise that makes us the provider of choice.
Our claims expertise and rehabilitation experience 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 Aviva’s Solutions policy?
- Solutions is flexible, affordable, and fits around your clients’ needs. Every business should have the option to choose the level of benefits they provide for employees, in a way that’s advantageous for your clients as well as their staff. Solutions provides that opportunity.
- Our expertise means that we can route conditions effectively. We’re clinical experts, so companies can rest assured that we’ll treat ‘routine’ clinical journeys efficiently, and take a case-by-case approach to ‘complex’ clinical conditions. All complex claims are dealt with by specialist teams that have access to clinical expertise that can help employees return to work as quickly as possible.
- Solutions comes with BacktoBetter as standard on all policies. BacktoBetter is our market leading musculoskeletal rehabilitation service and introduces high quality clinical decision-making throughout your clients’ employees' claims. Using BacktoBetter means that employees don’t need to see their GP, they just need to call us and they’ll be connected with one of our BacktoBetter expert clinicians. This makes sure that only appropriate and effective interventions are approved, which means a better outcome for your clients' employees, a well-managed claims spend and a positive impact on absence levels.
- Our cancer pledge. All Solutions policies include our extensive cancer cover through 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, with as little impact on their day-to-day resources as possible.
- 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 2015, we paid over £132million in claims to Solutions policy holders – of which over £25million and £44million were in lieu of oncology (cancer) and musculoskeletal conditions respectively. This is a keen reflection of the impact these illnesses can have on a company.
- To do that, we dealt with 108,382 claims.
As a result of our focus on delivering high levels of healthcare expertise, for the eighth year running, we've won Health Insurance Company of the Year and Best Group PMI Health Provider at the 2017 Health Insurance Awards. When you tell clients about these awards, it helps build confidence in making a purchase.
Solutions claims – what happens next?
With a Solutions policy, employees should have all the information they need to make a claim in their policy documents. But it’s useful to understand the process so that you can field group administrators’ queries.
Your client will hold a group policy but we pride ourselves on treating people like individuals. Employees may not be feeling 100% when they call – which is why our claims teams will provide help every step of the way. We have a dedicated department looking after our private medical insurance (PMI) claims, with staff who can familiarise themselves with the details of each claim they’re working on – and we believe that’s one of the reasons we were awarded the title Best Group PMI Health Provider for the eighth year running at the 2017 Health Insurance Awards.
Technical expertise, leading insights
Our technical experts are tasked to stay abreast of and analyse new technologies and medicines, so we can advise your clients of any new drugs or approaches available.
We make sure that our in-house clinicians are on hand to give staff detailed support, providing medical insights as necessary so that employees can get the best possible treatment and support. Patients will have dedicated claims advisors looking after their details throughout the claim.
Plus all our Solutions policies include our innovative BacktoBetter musculoskeletal clinical case management service helping your clients' employees get back to work faster.
- How does our specialist expertise help your clients?
Some conditions are more complex than others, so we operate a proven system. We separate out ‘routine’ clinical journeys, for conditions such as hernias or cataracts, 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. This is why we have our BacktoBetter clinical case management service for musculoskeletal conditions on all Solutions policies. It means that each member's claim will follow a unique journey depending on their individual clinical needs, which leads to a better, and faster, outcome for the member.
Our advisers are divided into dedicated specialist condition management teams. In addition to general claims, this means that we have dedicated banks of expertise, focusing on areas such as cardiothoracic, oncology, psychiatric, and musculoskeletal conditions.
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.
To claim for musculoskeletal conditions (such as pain in the back, neck, muscles or joints) employees will use our BacktoBetter service. This gives them rapid access to a clinical case manager from our independent case management providers. There’s no need to see their GP, they just call us and we’ll 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 and the sooner they'll get better.
- BacktoBetter - helping your clients claim for a musculoskeletal condition
Making a claim through our BacktoBetter service couldn't be simpler for your clients, in fact it's even easier than the standard process as they don't need to see their GP.
If your clients ask you to explain how a claim for BacktoBetter works, it's just three simple steps:
The employee just needs to call our customer service helpline and describe their symptoms - remember they don't need to see their GP before calling us.
If an employee has already seen their GP, they can move to step 2 of the standard claim process if:
- the employee’s GP has recommended osteopathy or chiropractic treatment, or
- the employee’s condition does not relate to their back or neck, and
- the employee’s GP has recommended radiology, pathology, or referral to a specialist.
Otherwise the employee can continue to follow the BacktoBetter pathway.
Providing it's a valid claim, our advisers will arrange for a clinical case manager to contact them at a convenient time, to assess their symptoms
The clinical case manager will determine whether a referral for treatment is necessary. If treatment is not necessary, the employee will be taught how to self manage their condition.
If treatment is recommended they’ll be referred to an approved physiotherapist from the case management providers’ networks (to be seen within 2 working days), or they’ll be referred to a specialist for diagnostics and/or treatment.
- Helping your clients make a claim for non-musculoskeletal conditions
Our documents are designed to help employees make a claim easily: the majority of cases can be approved over the phone. But when treatment not paperwork, is a priority, there’s a possibility that group administrators may call you for advice. If that happens, you can guide them through the 4 simple steps that employees will need to take, to make their claim.
If an employee is unwell they will 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. They should:
Call the claims team: 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
When an employee has been referred by their GP they’ll need to call us to set up their claim.
If we have a network for the treatment the employee needs, 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 we do not 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 where they need to ask for a procedure code (CCSD code).
Once they’ve called us with these details, we can confirm whether or not their treatment is covered and provide information about where they can receive treatment whether this is through our networks, at a hospital on your client’s list or at other facilities recognised by us.
Most bills can be settled directly with the hospital. 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 on to us at:
Bill Payment Team,
Aviva Health UK,
We’ll do everything we can to make sure your clients, 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.
Our independent musculoskeletal (MSK) service BacktoBetter is standard within core cover.
BacktoBetter provides end-to-end case management for employees. A clinical case manager will assess the employee's symptoms and coordinate the appropriate clinical pathway that their condition requires.
BacktoBetter is included as standard on all Solutions policies as part of core cover as we believe it is the most appropriate way to manage MSK claims and it also supports your clients’ business by managing claims spend responsibly.
Please read on for more information.
- How does BacktoBetter work?
BacktoBetter introduces high quality clinical decision-making throughout your clients' employees' claims. 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, a well-managed claims spend 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 - 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 treatment, referral for diagnostic tests, or referral to a specialist.
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 your clients’ employees receive the right treatment for their MSK symptoms or conditions. No matter how complex the problem the individual will receive on-going 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.
- If reduced out-patient cover has been selected the limit will not apply to physiotherapy treatment.
- Choice of over 2,000 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.
- Delivers end-to-end case management, whatever the course of the treatment.
- What are the benefits of BacktoBetter for employers?
BacktoBetter offers rapid 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 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.
- It’s an end-to-end service that delivers clinical best practice no matter how complicated the problem is.
- It can help lower future insurance costs as the cost per MSK claim is reduced on average by 15% when managed through BacktoBetter and can be as much as 30% compared to unmanaged MSK claims. This is partly down to the fact that approximately 25% of MSK claims require further investigations by a specialist through BacktoBetter compared with 60% of unmanaged MSK claims.
- It encourages happier healthier employees.
- Terms and conditions update to BacktoBetter for new policies from 1 December 2016
Members do not need to see a GP before making a claim for a musculoskeletal condition. Members should call us before treatment begins and our external case management providers will arrange the most appropriate treatment for the member’s condition. Treatment may include, for example:
- telephone and/or online support
- physiotherapy via the providers’ approved networks
- referral to a specialist in our approved networks.
If a member has consulted their GP before contacting us, the member’s condition must still be assessed by our clinical case management providers and we will only cover treatment if it is managed by them unless:
- the member’s GP has recommended osteopathy or chiropractic treatment or
- the member’s condition does not relates to their back or neck, and
- the member’s GP has recommended radiology, pathology, or referral to a specialist.
Treatment related to musculoskeletal conditions will not be an eligible claim 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: firstname.lastname@example.org
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