According to the Association of British Insurers, private medical insurance is designed to cover treatment for curable, short-term illness or injury known as “acute conditions”. Some illnesses and treatments are rarely covered.
Charles Cotton of the Chartered Institute of Personnel and Devlopment warns that this is something that employers need to spell out to staff: “It’s important for employers to communicate to staff what is covered by PMI and what’s not, so employee expectations are managed.
“This can be an issue where employees assume critical treatments are covered, whereas only acute treatments are. Acute covers curable, short-term illnesses or injuries that are expected to respond quickly to treatment so the patient can return to health, whereas critical covers incurable illnesses or injuries. That said, firms may feel they have to stump up for critical if they fear the bad publicity that could occur and the impact on their brand.”
Provider schemes vary but most offer basic packages – which cover the essentials of private health insurance including patient tests, surgery as an inpatient or day patient, hospital accommodation and nursing care and cash payment for treatment received as an NHS inpatient. Comprehensive plans often provide private hospital treatment including physiotherapy and complementary practitioner treatment. At the other end, some schemes are simply a cash plan to help towards healthcare costs such as some hospital treatment, physiotherapy and dental bills.
However, there is also the tailored approach, which emphasizes the relevance of the illness to the workplace. For example, AXA PPP’s Back to Health scheme provides prompt access to physiotherapy, specialist consultations, MRI scans and medical treatment to help get employees fit and back to work again as soon as possible. It’s a cost-effective alternative to more traditional PMI because the scheme only pays for the treatment of medical conditions where the employee is prevented from undertaking their normal work duties. Medical conditions that do not affect their ability to carry out their duties are not covered by the plan – so employers don’t have to pay for them. Chris Rofe of AXA PPP explains: “It’s really flexible about what we do and don’t pay for. It’s probably 50%-60% cheaper than a traditional PMI premium. If I was a lorry driver and I’ve got full blown access to PMI and I have a skin condition I can go to a GP and dermatologist. So I am incurring a lot of cost. If I had a broken leg, under Back to Health the leg treatment gets paid for, but I wouldn’t get the skin condition paid for. That’s why it’s more cost-effective.”
Dr Doug Wright, principal clinical consultant at Aviva UK Health, explains: “Evidence now shows that tailoring treatment plans to the individual’s personal needs has a far better outcome for all parties – the individual recovers quicker, employers benefit from reduced sickness absence costs and our medical insurance claims costs, and therefore future premium increases are controlled.”
Aviva’s Back-Up service is another example of the approach. Developed with professional rehabilitation provider HCML, Aviva claims Back-Up significantly improves the speed of recovery and return-to-work rate for customers. Rather than having to wait to see their GP, customers with back and neck problems are referred to the Back-Up service to speak to a dedicated case manager who conducts an in-depth assessment and offers practical and clinical advice and support. According to Dr Wright, “A personalised rehabilitation plan is then tailored to individual needs. The case manager can also work with their line manager to advise how they can be helped safely and effectively at work.”