Corporate Health Insurance
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What does Corporate
Private Health Insurance pays for healthcare treatment in private medical facilities. The cover provided can vary considerably depending on the options you select.
Most plans will cover inpatient treatment in full which means that your employees would be covered for treatment, testing and consultations where a hospital bed is required either overnight or just for the day.
In order to be covered for initial consultations and diagnostic testing where a hospital bed is not required then some level of outpatient cover will need to be selected. This is recommended to avoid NHS outpatient waiting lists.
How does Corporate Medical Insurance work?
The level of cover and type of treatment required will determine the exact process but the main variation depends on whether the policy includes outpatient cover.
No Outpatient Cover
With Outpatient Cover
Naturally, holding a policy with no outpatient cover does run the risk of an employee having to go through the NHS outpatient waiting list for testing and initial consultations.
Although the level of outpatient cover makes a sizable difference to the premiums it does ensure that the initial consultations and testing can be done privately.
Tip: It is very common for organisations to include at least some level of outpatient cover as it allows the speediest access to diagnosis and treatment.
It is common for plans to cover therapies up to the outpatient limit with GP referred therapies being an additional option with some providers.
Tip: Some organisations place an excess on the policy (such as £100) which the employee would have to pay themselves to discourage frivolous claims.
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The Fact Find:
For larger schemes over and above 200 employees there are many options available to tailor the scheme to suit your needs.
No two organisations are the same and there are a range of corporate health plans in the marketplace, many being flexible in their nature enabling you to select and alter options to suit your budget and ensure the cover provided fits your workforce.
As with any health insurance scheme you tend to get what you pay for. The leading insurers in the UK will tend to start with a very basic option which covers inpatient treatment in full, providing cover for more serious illnesses where a stay in hospital may be require while offering little in the way of outpatient benefit.
The core coverage can then be built upon to create a scheme which fits your requirements. Outpatient cover increases as the schemes become more comprehensive. Outpatient cover would permit your employees to receive private treatment in the form of consultations, diagnostic tests and scans as an outpatient.
Where your employee may be placed on an NHS waiting list to see a specialist for diagnosis on the NHS, including outpatient treatment on your corporate medical insurance scheme would ensure employees are able to see a specialist privately and bypass the NHS waiting lists.
As with a basic health plan, a mid range medical scheme will cover inpatient treatment in full.
In addition it will often provide a level of outpatient treatment which is limited to a monetary cap, say £1,000 per employee per annum.
With a mid range plan a number of additional outpatient options can be selected which are detailed below, these include alternative medicine, dental and optical benefits and outpatient psychiatric cover.
The key advantage with any large group health insurance schemes is that the plan can be tailored, cover can be taken out whilst other options can be added, it all depends on where you feel your priorities lie.
It probably comes as no surprise that a comprehensive medical insurance scheme will tend to cover both inpatient and outpatient treatment in full. The only time the NHS would be required is in the case of an emergency or a chronic condition where the NHS is better placed to treat the condition in the long term.
Over and above outpatient treatment there are a number of other op tions to consider which affects the cost per employee including how the corporate health insurance scheme is underwritten, whether an excess is required or a six week wait option is chosen.
There are three ways in which a large medical insurance scheme can be underwritten.
Full Medical Underwiting (FMU)
Requires each and every member of the scheme completing a full medical applicaiton declaring their full medical history.
An excess is the option to have employees pay a set amount per year or per claim towards any treatment they may receive.
Removes some of the administration encountered with a fully medically underwritten scheme. Moratorium underwriting simply means that a condition should an employee have suffered a medical condition in the past five years it will not be covered for the first two years of they are a member of the scheme. Should they not suffer from this condition during those first two years cover could be reinstated for that condition.
Medical History Disregarded
When setting up a large scheme given the size of the risk pool that you present to the insurer, generally speaking any scheme covering more than 20 employees can be underwritten with medical history disregarded. As this option presents a greater risk to the insurer the premiums will be more expensive than a scheme which is either underwritten on an FMU or Moratorium basis.
Should an employee need to claim on the policy they would need to pay the excess towards the treatment. An excess can often range from as little as £50 up to £500. The higher the excess the greater the discount on the premiums as the greater a proportion of the cost lies with the insured party.
Six week wait option
An options which can be used to reduce the cost per employee, setting up a scheme including the Six Week Wait option simply means that if there is an NHS delay of six weeks or more for the eligible operation or treatment required, the employee is eligible for treatment privately.
Should the NHS waiting list be less than six weeks the employee would be required to recieve treatment via the NHS.
Often treated as an additional extra on a group health plan policy the alternative medicines option covers treatment such as physiotherapy, osteopathy and homeopathy. The level of treatment is often capped at a monetary limit of say £1,000 per policy year or limited to 10 sessions per annum.
Covering both inpatient and outpatient therapies often up to a monetary limit, this includes treatment such as Cognitive Behavioural Therapy.
Many of the insurers in the market are starting to actively promote healthy living and are developing a proactive rather than reactive approach to healthcare. In some cases employees can build up points for healthy eating and exercising and in turn help to reduce your premiums whilst building up their own health points to spend on eating out or weekends away.
From the majority of health insurers you can now also expect a 24 hour GP Helpline, health and fitness club membership discounts and an online health management tool to track your healthy living progress and goals.
This policy overview should provide you with a good basic understanding of how a group health scheme is structure and the type of decisions you will need to make when considering setting up a plan.
In addition you will need to consider the type of plan that best fits your employees, some health policies now offer a more proactive approach towards the members health by rewarding them for healthy living and exercise.
Other plans are suited for organisations with an older workforce. Whatever you require we are here to help, please do not hesitate to pop us an email or give us a call.
10/01/2015 N Tanner
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