Optimum, our private medical insurance for 250+ employees
Our private medical insurance is flexible, so you can adapt the level of cover to suit your business needs. We also offer benefits that can help keep your employees fit and active.
Quality medical treatment at the right time, in the right place.
Full cover for cancer treatment on referral from a specialist.
Mental health pathway
An end-to-end service based on clinical need, guided by clinical expertise, with a range of treatment options and no need for a GP referral.
Why choose us?
With Optimum private medical insurance, you can take care of your business, as well as your employees.
Adapt cover to suit your needs
We understand that no two businesses are the same. That's why with Optimum, you can create a level of cover to suit the needs of your business. Enhance your cover with additional benefits or decrease it to suit your budget. So, everyone gets access to the right treatment, at the right time, and the right price.
We want to help you support your employees as they seek to live their best life. That means encouraging them to consider their wellbeing in terms of everything they do - what they eat, how active they are, their mental health, how they sleep and how they spend and save their money.
What's covered with Optimum?
Optimum is completely flexible, so you can build a package to suit your company. To help you make your decision, here are some of the more commonly chosen benefits and exclusions.
Your cover includes
- Acute conditions
Our Private Medical Insurance covers treatment for short-term illnesses or injuries that respond quickly to treatment and which leads to a full recovery.
- Hospital charges and specialist fees
Our private medical insurance provides cover for things like out-patient consultations and treatment, as well as specialists' fees and hospital accommodation.
- Treatment for back, neck, muscle or joint pain (musculoskeletal conditions)
Optimum includes BacktoBetter, an independent musculoskeletal case management service for members, to help them get better and back to work quicker.
- Cancer cover
Full cover for cancer treatment - including radiotherapy and chemotherapy - on referral from a specialist.
- Diagnostic tests
Such as pathology, X-rays, CT scans and physiological tests such as ECGs.
You're not covered for
Below are some examples of standard exclusions, however they may change, depending on the benefits chosen.
- Chronic conditions
We don't cover incurable or long-term illnesses or conditions, such as diabetes, epilepsy and asthma. Cancer is not considered a chronic condition, and will be covered.
- Cosmetic procedures
We will only cover cosmetic surgery that immediately follows an accident or treatment for cancer. See the policy document for full terms and details.
- Addictions or substance misuse
We don’t cover alcohol, drug or solvent addictions or misuse as standard, or treat any illness or injury resulting from them.
- Pregnancy and childbirth
We don't cover treatment for pregnancy or childbirth, other than the complications specified in the policy wording.
A full list of what we do and don't cover can be found in the Optimum product brochure PDF (1.9 MB).
Adapt your cover
You can choose to increase your cover with additional benefits, which will increase your premium. Or, decrease your cover to suit your business needs and budget.
Increase your cover
Increase your cover with these policy options
- Dental and optical
Cover for routine dental treatment, treatment for accidental dental injuries and optical expenses, each up to a specific limit.
- Mental health pathway
An end-to-end service based on clinical need, guided by clinical expertise, with a range of treatment options and no need for a GP referral.
- Upgrade your hospital options
You can choose to upgrade to our Extended Hospital List - increasing the number of hospitals you're able to use, predominantly in the Greater London area. See our hospital options.
- Enhanced cancer cover
We'll pay for cancer treatment recommended by the specialist, as well as aftercare or palliative care.
- GP referred services
Includes consultations and diagnostic tests with a specialist for chronic conditions, GP referred radiology, pathology for non-musculoskeletal conditions and GP referred therapies for non-musculoskeletal conditions - up to a specified amount in combined total for each member, every policy year.
- Gender identity benefit
Provides access to specialist support, advice and treatment whilst waiting for a NHS Gender Identity Clinic assessment.
Reduce your cover
It's quick and easy to reduce your costs with one or more of the following options
- Six week option
Reduce your premium by choosing to use the NHS for in-patient or day-patient treatment if it's available on the NHS within 6 weeks. Your employees will still be covered for private out-patient treatment, but private in-patient or day-patient treatment will only be covered if NHS treatment isn't available within 6 weeks.
- Member excess
You can add an excess to your policy. With a £100 excess for example, members would be responsible for paying the first £100 of any costs. This would only apply once for each member, every policy year.
- Reduce out-patient cover
Place a monetary limit on the amount that can be claimed each policy year for out-patient treatment.
- Hospital coverage
Reduce the number of hospitals that can be accessed for in-patient and day-patient treatment.
Get more for your employees
If Optimum isn't right for your company, you could benefit from Optimum Referral or you could choose a Private Medical Trust.
Optimum Referral is a healthcare product that draws upon our breadth of clinical and customer service expertise to deliver quality, sustainable healthcare tailored to your and your members’ needs. Its open referral approach gives us the opportunity to add real value to your members. We’ll use our clinical knowledge and independent quality data to signpost them to an appropriate treatment provider. And, we’ll help to keep private medical insurance sustainable by ensuring that your healthcare is procured effectively and efficiently.
Private Medical Trusts
If you have at least 500 employees, you may choose to fund your company's private healthcare with a Healthcare Trust. As this isn't an insurance contract, you'll attract funding benefits, such as not paying Insurance Premium Tax on the claims fund. We can provide the day-to-day admin and management of the trust - including claims assessment and payment - so you don't have to.
A Healthcare Trust can give you more control over the type of medical benefits provided, as your business can set the rules of the trust. It can also provide Stop Loss Insurance to protect the liability of the company by absorbing the exposure to costs above a certain level.
Group scheme leavers
When an employee leaves your company, has their membership removed by your company or if they decide to leave the policy and are no longer covered by your private health insurance scheme, don't forget to let them know that they may be able to continue their cover on an individual policy.
We may be able to offer them continued cover on one of our individual private health insurance plans, if they take out the new plan within 45 days of their leaving date. Benefits, exclusions, terms and conditions on an individual plan may differ from those of the company scheme they were previously covered by, and the cost will depend on the product and options they choose.
Employees leaving your company can call us on 0800 142 142 to find out more.
Lines are open Monday to Friday, 9am-6pm. For our joint protection, telephone calls may be recorded and/or monitored. Calls to 0800 numbers from UK landlines and mobiles are free.
Which policy could group scheme leavers transfer to?
Healthier Solutions is our individual private health insurance which offers a range of cover to suit their needs. The terms and benefits may differ from the company scheme they were previously covered by. They can find out more on our private health insurance pages, or call us on the number above.
Get a quote
How to make a claim
It's quick and easy to make a claim
See your GP
Your employee should visit their GP if they're feeling unwell. If their GP wants them to see a medical professional, they should tell them they have private health insurance cover. It's simpler for your employee to ask for an open referral, so we can help find the best medical facility and consultant for them covered by your policy. if you choose our Optimum referral product your employees will always need to ask for an open referral.
If they have a mental health or musculoskeletal condition, there's no need for them to see a GP.
Call our claims team
Once your 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:
Monday to Friday: 8:00am to 6:30pm
Saturday: 9:00am to 1:00pm
Calls may be monitored and recorded.
We'll settle quickly
We'll usually settle all eligible bills directly with the provider of treatment, usually the hospital or specialist.
How to make a claim
How do you make a health insurance claim?
When you’re unwell and need to make a claim on your health insurance, we’ll do all we can to get you the healthcare you need, as soon as we can.
Here’s how you make a claim in four simple steps – and a few things to keep in mind along the way.
1. Ask your GP for a referral
First of all, see your GP, or use our digital GP app, and they’ll refer you for any investigations or treatment you need. Be sure to tell them you have private health cover with us.
There are two types of GP referral:
• An open referral is where your GP says what kind of treatment you need, but doesn’t name a particular specialist or hospital.
• A named referral is where your GP gives the name of a specific specialist, at a particular hospital. Though you’re not bound by this, and we can offer you other options, if needed.
It’s a good idea to ask for an open referral, so there’s more flexibility with where you’re treated. If you have Expert Select or Optimum Referral, you’ll need an open referral.
If your cover includes BacktoBetter or our Mental Health Pathway, you don’t need a GP referral to make a claim for musculoskeletal or mental health symptoms – just call us direct through MyAviva - your secure online account, or by phone.
Remember! Get in touch with us before you have tests or treatment, so you know they’re eligible for cover. That way, you won’t have any unexpected costs.
2. Start your claim and we’ll get things moving
The easiest way to start your claim is through MyAviva. When you log in simply select your policy or scheme and you’ll see the option to start your claim. Alternatively, you can also start a claim over the phone.
Whichever way you choose, we’ll ask you about your symptoms and explain the best next steps, in line with your cover. We’ll also guide you through the process and answer any questions you have.
Sometimes, we ask for more information to get a better picture of your condition. Otherwise, we aim to make a decision on your claim straight away, explain which tests and treatments we can pre-approve and connect you with the hospital or clinic to book your appointment there and then.
Where will you get your treatment?
You’ll either see a specialist at a hospital on your list, or, if you have Expert Select or Optimum Referral, at a choice of hospitals we’ll help guide you towards. If it’s available, you could get treatment at a facility that has expertise in treating specific conditions, like cataracts or knee pain.
The nationwide hospitals we use are based on ratings from independent regulators, like the Care Quality Commission – with most rated outstanding or good. We’ll also only recommend specialists who meet the standards of their relevant professional governing bodies, like the General Medical Council. So you know you’ll get the high standard of care you’d expect.
3. If you’re referred for more treatment
Hopefully by now you’ll be starting to feel better. But if your specialist refers you for more treatment we haven’t already approved, let us know, so we can check it’s covered. In MyAviva you can submit your update or start a Live Chat to speak to someone in the claims team there and then. You can also call us, if you’d feel more comfortable talking over the phone, or email us with any questions you may have.
Remember! For some treatments and tests, we’ll ask you for a procedure code. So check with your specialist, and have it handy when you get in touch.
4. And finally, we’ll settle the bills
Once you’ve had the care you need, we’ll settle bills we’ve authorised directly with your provider – so you don’t have to worry.
We’ll let you know through MyAviva if you need to pay any part of a bill, like if you have an excess or benefit limit. If any bills are sent your way, just send us a copy and we’ll do the rest.
Here’s a quick recap of how to make a claim:
1. Ask your GP for an open referral – and get in touch with us before you have any tests or treatment. For BacktoBetter or Mental Health Pathway, just contact us direct.
2. Start your claim and book your appointment at an agreed hospital.
3. Let us know if you’re referred for more treatment – and check for a procedure code.
4. We’ll settle authorised bills direct, so you don’t have to worry.
And that’s it! Four easy steps, and a friendly claims team on hand for guidance and support each step of the way.
So you can focus on your treatment, and getting back to health.
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Looking for something else?
We offer a range of flexible insurance options to support your employee and business needs.
Group Income Protection
We can support employees on long-term absence due to an illness or injury. And we'll help them return to work.
Group Critical Illness
We'll pay your employees a tax-free lump sum if they're diagnosed with a critical illness, or undergo surgery, covered by the policy.
Our cover will help look after your employee's family financially and emotionally if the worst happens.