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Bespoke Group Private Medical Insurance for 250 or more employees

Optimum. Health insurance for 250 or more employees

Optimum is our bespoke private medical insurance (PMI) product for schemes with 250 employees or more. This is a highly flexible PMI product. It’s up to your clients what’s included – and what’s not.

To help you decide 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 to fully understand this product’s details as this will help you conduct a compliant sale. Examples of the bespoke cover we could create, the options and exclusions are listed in the product’s brochure - post 1 October 2018 (PDF 4,361KB). Non-standard terms may apply to your client's policy.

Optimum is a bespoke PMI product. With it, we’ll help your client choose a unique set of benefits for their employees – helping them get access to prompt, private medical treatment:

  • Dedicated account management for you and your client
  • Flexibility regarding the benefits offered to the employer
  • Different levels of cover for different categories of staff if required
  • Added value benefits that could help improve the health and wellbeing of the workforce
  • Access to medical treatment that could help employees return to work faster
  • A choice of cover levels for cancer, explained in our Optimum Cancer cover (post 1 October 2018) (PDF 963KB) leaflet

Larger businesses want PMI that can help them raise morale and productivity, reduce absenteeism and show a commitment to employees by promoting a caring attitude. Optimum can help your client achieve these goals.

We're here to explain the many combinations that can be chosen with Optimum that can help create a PMI policy to match the needs of your client. It is a bespoke PMI product that gives your client the flexibility to choose the benefits they feel are most appropriate for their business and their staff.

If they're considering a switch to us, we can work with them to match their current level of cover.

We know that companies want some ‘must have’ benefits – so we’ve included an example of cover here, along with a description of our underwriting options for companies of this size.

Example cover and options

Example cover

These items have been among the benefits most commonly chosen by Optimum clients.

  • Access to full in-patient and out-patient care at a wide range of private hospitals across the UK on Aviva's Key hospital list
  • Hospital charges, specialists’ fees (up to our specialist fee limits), 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 Optimum Cancer cover (post 1 October 2018)(PDF 963KB) leaflet

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 Optimum brochure (post 1 October 2018)(PDF 4,361KB).

Ways to enhance cover

There are a number of ways that your client can enhance the level of cover provided, as shown below and in the Optimum brochure (post 1 October 2018)(PDF 4,361KB). Choosing one or more of these options will increase the premium.

  • 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, podiatry, acupuncture, osteopathy and chiropractics for non MSK conditions.
  • Dental and optical benefits, which can help with the cost of routine dental expenses, accidental dental injuries and optical expenses
  • Extended hospital list, which would increase the number of hospitals available.

Ways to reduce cover

Cost savings are always important and Optimum can help reduce the cost of a policy. Reduction options include:

  • Hospital coverage – your client can limit the choice of hospitals their employees can use
  • 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.

We recognise the need for flexibility not only in the cover your client chooses, but for the members to whom that cover applies. With Optimum, your client can, if they want to, specify that senior management have one set of benefits and the rest of the workforce another. Our only stipulation is that all staff within a defined category have the same benefits.

A choice of additional services

We want to offer your client benefits that can help reduce the cost of absenteeism, and help promote wellbeing among the workforce. We encourage clients with 250 employees or more, to consider services that could help their employees overcome challenges that could be affecting morale, working relationships and productivity.

BacktoBetter - support for employees when they need it most

The BacktoBetter service is provided as standard with Optimum unless your client decides they don't want it. BacktoBetter is an independent clinical 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 maybe able to help employees return to work faster and ensure access to the most clinically-appropriate treatments before the condition deteriorates. A case manager, from one of the clinical case management providers, will call the employee back at a convenient time which means they don’t need to wait for a GP’s appointment. This not only saves time for the employee, but also potentially maintains productivity for the employer.

Wide range of underwriting options

We offer a number of underwriting options to clients with schemes of 250 plus employees. We’re happy to answer any questions you or your clients may have about the the different types of underwriting and what's involved.

  • 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. Members 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 the member joined the policy during which the member 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 member’s original moratorium start date.
  • Full Medical Underwriting: the past health of members 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 member'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.
A claims process that helps employees and employers

We prioritise the welfare of your client's employees throughout the claims process. We draw on in-house clinical expertise to give insights and offer genuine empathy with each member’s situation. In addition we have dedicated expert claims teams focusing on areas such as cancer, heart conditions and mental health, to ensure these conditions are dealt with sensitively.

For more information about our claims process, please see the claims tab at the top of the page.

Networks

We’re continually developing our networks of specialists, other practitioners and facilities to help manage costs and drive a consistent quality of care. If we have an appropriate network, we’ll tell members where they can have treatment. We’ll only pay for that treatment if it is carried out within our networks. Our networks may include hospitals or other facilities that aren’t on your chosen list.If the extended hospital list option is chosen members do not need to use a network.

Healthpoint: efficient scheme management

When your client chooses Medical History Disregarded or New Moratorium underwriting, we’ll give them access to Healthpoint – our online portal for managing scheme membership. By using Healthpoint, group administrators can save time by managing membership details in real-time and producing reports on claims to date immediately.

Added value benefits

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

  • Discounts for all employees on home, motor and travel insurance.
  • 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 Optimum 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 – providing telephone access to counsellors who employees can talk to, in confidence, for as long as they want. The stress counselling helpline benefit is 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.

Optimum 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 these documents well, as they can help you propose options that will make up a bespoke policy and conduct a compliant sale.

These documents explain how the product works

Company facing

Employee facing

Optimum policies include the Extended hospital list as standard. Use our online Hospital List Checker to show clients some of the private facilities their employees could access with an Optimum policy.

Alternatives to Optimum

You’ll find a full range of Optimum literature in our searchable Document Library, which will help you talk about this policy with prospective clients. However, working with companies of all sizes, we understand just how important it is to contain costs. As an alternative to Optimum, you can offer Optimum Access (PDF 92KB). With three levels of cover, this policy can give employees access to private consultations and diagnostics – it’s a starting point from which an employer can offer a new benefits scheme with a limited budget. It’s important that your clients get the right level of cover, so speak to our National Accounts team if you’d like to find out more about this product.

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We can help you sell Optimum

If you’re approaching a large company, we can provide dedicated support to help you introduce the benefits of our Optimum product. Our Account Managers will be happy to go with you to see your clients.

Call: 0800 0014 272 Monday to Friday 9.00am – 5.00pm Or email hcnd@aviva.com

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

We’re here to offer you support with your clients, deal with any queries, and give you information that will help companies with 250 or more employees proceed with confidence as they buy an Optimum policy.

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. Designed for large corporations, it can be readily adapted to suit each corporation’s individual needs and requirements. It is also a useful tool to manage costs of absence and retain employees. The scheme can also be managed as a trust where Aviva will simply act as an administrator for the scheme.

Who is Optimum designed for?

This product is designed for larger companies and corporations who wish to cover more than 250 employees and eligible dependants for private healthcare. The product can be readily adapted to suit the specific needs of the company, and can be subdivided to offer differing levels of cover for differing sections of the work force. This can include the provision in a Flexible benefit scheme.

For large corporations we can create a trust scheme, where the corporation will fund claims, and Aviva will provide the administration and charge a fee for this service.

Who is Optimum 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. Due to the nature of the flexibility of the product, due consideration should be taken as to the selection of benefits, between the corporation and their adviser.

Should the customer wish to select our GuideWell option it should be noted that the employees must be made aware that unlike traditional PMI, all treatment must be through our approved facilities and specialists.

Should the customer wish to create a Trust scheme they should seek additional guidance from us and their own legal and financial team, and this will only be available to schemes of 500+ employees.

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 170KB).

Can Optimum be sold without advice?

No

How can I sell Optimum?

We would suggest that Optimum can be sold face to face or via telephone, we cannot support digital or postal sales.

Finding the right clients

Any business could realise benefits by offering a pro-active benefits package to promote wellbeing among its workforce. Optimum is designed for situations in which large economies of scale are possible, with services available for over 250 employees and the option to create a bespoke benefits package for each employer. Group PMI policies are a common purchase in the manufacturing, professional services, motor vehicle trade and engineering sectors. One reason for this is that the impact of sickness absence can be felt much more in industries requiring professionals with specific skill sets.

  • Are your offices located close to local businesses?
  • Are you networking with key decision makers?
  • Could you run a seminar that introduces PMI to potential clients?
Overcoming objections

Clients with 250 or more employees are likely to have a first-hand understanding of the dramatic impact that illness or injury can have on a workforce. But these are some of the most common objections we hear:

  • “It’s too expensive.” Optimum is a bespoke product, which means that we can offer great flexibility in the benefits and costs associated with cover. You’ll have an opportunity to work with our Account Managers closely, and create a proposition that meets your clients’ budgets as closely as possible. Ultimately, without PMI in place, employees may have to wait for NHS treatment, which can affect the overall productivity of a business.
  • “We don’t need a PMI policy for our employees.” A group PMI policy can help employers recruit and retain valuable employees, and reduce the costs of ill health in the workplace. Our clinical expertise not only helps staff get prompt access to private medical care, it also means that individuals can be offered appropriate treatments that could enable a more prompt return to work. For example, BacktoBetter offers employees rapid access to a qualified clinician who can help deal with musculoskeletal pain.
  • “PMI is not our top priority” If you understand your client’s business in depth, you’ll have an insight to their plans for the future – expansion, perhaps, or specialisation in a particular market. Good health among employees, and ways to keep absence-related costs to a minimum, can play a key role in a business’s economic future.
  • “We already have a policy in place…” That’s excellent news because it demonstrates that your clients have understood the value of providing PMI for their employees. We’re happy to offer a consultation process which may show not only cost savings, but also enhanced benefits to the business by switching to Optimum.

Alternatives to Optimum

We know how important it is to contain costs. As an alternative to Optimum, you can offer Optimum Access (PDF 92KB). This policy offers three levels of cover, which will give employees access to private consultations and diagnostics – it’s a starting point from which an employer can offer a new benefits scheme with a limited budget. It’s important that your clients get the right level of cover, so speak to our National Accounts teams if you’d like to find out more about this product.

Answering clients’ technical questions

Our National Accounts managers are on hand to answer questions in person for Optimum clients. This gives you an exceptional level of support from a provider – but we recognise that it’s also important to show your own detailed insights. Here are a few of the questions we’re asked regularly.

  • “What’s the difference between acute conditions and chronic conditions?” An acute condition is a disease, illness or injury that’s likely to respond quickly to treatment so that you can return to your previous level of health. Chronic conditions are those illnesses, diseases or injuries that either continue indefinitely, have no known cure, come back (or are likely to come back), need long term monitoring or need on-going control or relief of symptoms, such as diabetes or Crohn’s disease. Chronic conditions aren’t usually covered by Optimum, but acute conditions are – but as it’s a bespoke product, we’ll work with your clients if they’d like to include cover for routine monitoring of chronic conditions in their policy.
  • “What are hospital lists?” Your clients can choose a selection of hospitals where they’d like employees to receive treatment. They do this by selecting one of the following ‘lists’ of facilities.
    • Key hospital list – this provides access to a nationwide network of 248 private hospitals
    • Extended hospital list – most Optimum customers choose to have this list as standard – it's the same as the key list but contains more hospitals around the central London area

Use our online Hospital List Checker to show clients the facilities available in their area.

  • “What’s the difference between an in-patient, out-patient and
    day-patient?”
    An in-patient is someone who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons. As a day-patient, employees would be admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but would not occupy a bed overnight. An out-patient is someone who attends a hospital, consulting room or out-patient clinic and is not admitted, either as a day-patient or in-patient.
  • “Which type of underwriting would my client have to use?” We’ll work with you and your client to find the most efficient and effective way of underwriting cover – whether it’s a new policy, or a transfer from another provider. The majority of Optimum policies are written on Medical History Disregarded underwriting due to their size. For more details about our wide range of underwriting choices, look at the overview tab on this page

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What makes our Group Private Medical Insurance different?

It’s a competitive market. Your clients want to be sure they’re getting the right Group PMI policy for their business: we’ll make time to understand their needs and work with them to build a policy that meets their objectives.

Bespoke benefits

Your clients can choose the benefits they believe to be most beneficial for their workforce.

We draw on extensive clinical expertise to create policies that can help your clients reduce the costs associated with sickness in the workplace and promote wellbeing among their workforce.

Why choose Aviva’s Optimum policy?

  • We excel in delivering Private Medical Insurance products. At the Health Insurance Awards, we’ve been awarded the title ‘Best Group PMI provider’ and ‘Health Insurance Company of the Year’ in 2010, 2011, 2012, 2013, 2014, 2015, 2016 and 2017.
  • We’ll match your clients’ existing cover. If your clients want to transfer from another provider, we’ll match their current benefits. Optimum is a completely bespoke product.
  • We offer dedicated account management. This is provided to every adviser who would like to offer our Optimum product to his or her clients. Our National Accounts team can visit you to help create Optimum policies that meet clients’ needs as closely as possible.
  • Our claims process promotes prompt returns to health (and the workplace). We’ve set up dedicated teams to focus on specific medical conditions; our in-house clinicians work closely with claims advisers to offer one-on-one support so that we can treat each claim on a case by case basis.
  • We believe our Cancer Pledge sets the standard for providers. The levels of cancer cover we provide are at your client’s discretion. As Optimum is a completely bespoke policy your clients can tailor their cancer benefits to their exact needs as shown in our Optimum Cancer Cover brochure (PDF 963KB). Read more details about our Cancer Pledge.
  • We help remove the stresses associated with making an insurance claim. When it comes to helping employees, we focus on what’s important – making a recovery and returning to work, rather than dealing with paperwork. With their employers, we’ll make time to help them manage their claims costs, and explore innovative ways to manage overall spend without affecting the member experience.
  • We stay abreast of industry issues and continually evolve our products. We’re committed to staying abreast of healthcare developments, government, legislation and economic issues that could help employers use benefits to promote health and improve productivity and profitability.

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Optimum claims

Get to know more about our claims process, so you can offer insights about Optimum to your clients.

When it comes to making a claim, our focus is very much on the individual employee concerned: helping them return to health and get back to work as quickly as possible. To do that, we commit heavily to ensuring our claims process is as smooth and stress-free as possible.

  • Employees have case-by-case support for complex and lengthy claims
  • We’ll use our experience and clinical insights to guide them, individually, to the right treatment
  • Most of our claim outcomes are decided over the phone, without any need for the employee to complete any paperwork
  • Associated stress levels are reduced for employees
  • Group administrators can monitor claim levels online
Our approach to claims

When employees need to make a claim, they’ve become patients: people whose needs differ from case to case. They may not be feeling 100% when they call, so our claims teams and in-house clinicians are sympathetic to their needs.

We’ll help as much as possible, often eliminating the need for employees to complete paperwork. Our staff work in an environment where they can familiarise themselves with the details of each claim they’re working on.

Specialist expertise and support

Our advisers are divided into dedicated specialist condition management teams which means that we have dedicated banks of expertise, focusing on areas such as cardiothoracic, oncology and mental health.

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.

Cancer claims

If your clients’ employees need to make a claim for cancer, they’ll find that our approach takes the sensitive nature of this condition very much into consideration. We have a specialist oncology team who are trained to help patients deal with different types of cancer, and this team have support from our clinicians.

As soon as an employee makes a claim we’ll be on hand to give them support. The case will be assigned to a dedicated member of the oncology team. This way, there’s one point of contact – a named individual who can get to know your clients' employees and ensure consistency of service.

The choice of cancer cover levels is entirely at your client’s discretion when they take out an Optimum policy. But our Cancer Pledge means that, across the board, we’ve enhanced the levels of cover that we are able to provide. For example, we place no limits on radiotherapy, chemotherapy or targeted therapies that use licensed and clinically proven drugs (like Herceptin or Avastin), and we’ll also pay for bone strengthening drugs in full when cancer cover is in place.

In addition, we’ve learned how important it is to make things as comfortable as possible for patients during treatment. To do this, we offer extensive aftercare that includes rehabilitation and consultations with a dietician, as well as money towards a prosthesis or a wig if necessary. Everyone who makes a claim will benefit from personal advice given by a member of our oncology team who will be there to help and support your clients’ employees from diagnosis through to treatment and aftercare. We make sure there’s a named contact, as a case manager, which means our teams can get to know the employees – and their needs – on an individual basis.

Networks

If we have a network for a member's condition or suspected condition, we will tell them where they can have their treatment. If your client has chosen the Extended hospital list, then their employees don't have to use our networks.

BacktoBetter claims

We include the BacktoBetter service as standard, unless your clients choose not to offer this option to their employees. BacktoBetter addresses most musculoskeletal issues - please see our BacktoBetter brochure (post 1 October 2018) (PDF 1.73MB) for full details of this service, which you’re welcome to share with prospective Optimum clients.

Telephone clinical assessment (TCA)

Our advisors arrange for a clinical case manager from one of our independent clinical case management providers to contact the member to assess their symptoms. We always aim to provide this assessment at a time that's convenient for them.

For Musculoskeletal pain there's no need to wait to see a GP. Members just need to contact the customer service helpline and describe their symptoms.

If eligible, our advisors will arrange for a clinical case manager from one of our independent clinical case management providers to contact the member to assess their symptoms. We always aim to provide this assessment at a time that's convenient for them.

The clinical case manager will work out what the most appropriate course of action is – that’s everything from advice to help relieve the pain, to an appointment with a physiotherapist, or a recommendation to seek immediate help. No matter how large or small the problem, we’ll make sure that the employee is looked after by a clinical case manager. This is a very personal treatment plan. By intervening promptly, we can help individuals return to work faster and ensure access to the most clinically-appropriate treatment before the condition deteriorates.

We understand that members may have already gone to see their GP, in these cases, they can move straight to the standard claims process if:

  • their GP has recommended osteopathy or chiropractic treatment, or
  • their condition doesn't relate to their back or neck (spine), and
  • their GP has recommended radiology, pathology or referral to a specialist.

Otherwise members must continue to follow the Backtobetter pathway.

Helping your clients make a claim

In theory, employees should find all the information they need in their policy documents. However, you may receive a call from a Group Administrator with queries about the process. If that happens, we can help you guide them through the four simple steps they’ll need to share with employees who want to make a claim.

Group PMI claims - Step 1

Employees need to visit their GP as normal, and let the GP know they have cover with Aviva. If they’re suffering from back, neck or any other muscle or joint pain, then they don’t need to see their GP: by calling us, we can arrange assessment and start treatment from there if required. For all other types of illness or injury, they’ll then need to check with us to make sure their policy covers any recommended tests, treatment or consultations. They should:

Call the claims team: 0800 158 3344 Monday to Friday 8.00am – 8.00pm Saturday 8.00am – 1.00pm Calls to and from Aviva may be monitored and/or recorded

Group PMI claims - Step 2

Employees will need to give us their personal details, including:

  • a policy number and company name
  • a description of the symptoms and condition
  • what the GP has said, and
  • the name of the specialist and where they practice, we will confirm if the specialist and/or hospital is recognised by us.

If employees are given an open referral, they may not know the specialist’s name in advance. If that's the case, then we'll just need to know which kind of specialist it is. If we need more information from a GP then we'll do our best to get this quickly.

If we have a network for a member's condition or suspected condition, we will tell them where they can have their treatment. If your client has chosen the Extended hospital list, then their employees don't have to use our networks.

Group PMI claims - Step 3

If the specialist recommends hospital treatment, the member must contact us to let us know what treatment has been recommended and the procedure code (CCSD). We’ll then confirm whether the treatment is covered and let the member know if they can get it through our networks, at a hospital on their list or another facility recognised by us.

Group PMI claims - Step 4

All eligible bills will be settled directly with the hospital. Most specialists send their bills straight to us. If employees do get a bill at home, they – or their Group Administrator – can forward it on to us at:

Bill Payment Team,
Aviva Health UK,
Chilworth House,
Templars Way,
Eastleigh
SO53 3RY

Systems that support administrators’ needs

Using Healthpoint, Group Administrators can log in to generate reports on claims to date. We can help your clients use this information to pinpoint areas of concern such as high levels of musculoskeletal injury in a physical working environment, for example.

This helps your clients meet their Health and Safety responsibilities, and encourages employers to take a pro-active role in promoting wellbeing among staff. In turn, this could lead to reduced costs of absence due to sickness or injury.

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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)