Group Health Insurance provides your employees with access to private healthcare paid for by an insurer. This allows them to bypass lengthy NHS waiting lists for eligible conditions, getting them back on their feet and in work again faster than if they’d had to wait for NHS care.
What Does Group Private Medical Insurance Cover?
It’s important to recognise that Private Medical Insurance is designed to supplement and complement the NHS rather than replacing it fully. It therefore doesn’t cover every medical need that may arise.
Medical treatment is broadly split into:
- Inpatient care
Where a patient needs a hospital bed overnight, for example post-surgery. Also includes day-patient treatment, where a patient needs a bed just for the day. All policies cover both as standard.
- Outpatient care
An optional extra, this includes all healthcare where a patient doesn’t need a hospital bed, for example diagnostic tests and scans.
In addition most policies cover cancer care in full as part of the inpatient treatment. It provides access to cutting-edge cancer treatment, including drugs and procedures that don’t tend to be available on the NHS because the cost is prohibitive.
While outpatient cover is optional when setting up a policy (not having it cuts costs), relying on NHS outpatient care runs the risk of delaying private inpatient treatment.
No Outpatient Cover
Including Outpatient Cover
To avoid this delay, employers can:
- Add full outpatient cover
Covers all eligible outpatient procedures.
- Choose limited outpatient cover
Covers outpatient procedures up to a set limit per patient per policy year, often £1,000.
Providing employees with access to private healthcare services can cut time spent off sick (potentially on reduced sick pay) by enabling them to bypass NHS waiting lists. They receive treatment promptly when they need it most.
Digital GP Services
Most Group Private Medical Insurance schemes now come with a digital GP service, offering phone or video GP appointments (usually 24 / 7) from the comfort of your own home.
Staff no longer need to wait for an NHS GP appointment. It also means they can be seen outside office hours, so they don’t need to miss work, take holiday or use unpaid leave.
Chronic vs Acute Conditions
There are two broad types of medical conditions:
- Acute conditions
Pass with time / treatment, for example joint pain needing a joint replacement.
- Chronic conditions
Won’t go away with treatment, these lifelong conditions include diabetes and asthma.
So, while a policy covers acute conditions, it won’t treat chronic conditions. The NHS will therefore continue to take care of conditions such as asthma and diabetes.
Other Healthcare Exclusions
Most insurers have a number of standard exclusions which often include:
- Emergency care
- Ongoing management and treatment of chronic conditions
- Kidney dialysis
- Fertility treatment / IVF
- Pregnancy and childbirth (unless there are complications)
- Treatment for alcoholism / substance abuse
- HIV / AIDS
- Pre-existing conditions (dependent on underwriting).
What are the Benefits of Group Health Insurance?
- Reduced sickness absence
- Gets employees treatment faster and therefore back to work sooner
- It’s a valued employee benefit and can therefore improve employee retention and recruitment
- Premiums are usually an allowable business expense against corporation tax (although there are other tax rules – see below)
- If employers pay for family members via salary sacrifice, it may reduce your National Insurance bill.
- Fast access to private medical care that your employer pays for
- Can cut time spent off sick on reduced sick pay
- Potentially offers cover for therapies, e.g. physiotherapy. This can help with back pain office workers often suffer with
- Employers may choose to allow you to add family members to the scheme, offering them the same cover
- Potential cover for pre-existing conditions if your group scheme is large enough.