Group Private Medical Insurance

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23-02-2021

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

No Outpatient Cover

Including Outpatient Cover

Outpatient Cover Included

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.

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Read why Trailmix, the rapidly expanding mobile gaming start-up chose to set up Private Medical Insurance for their workforce.

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?

For Employers

  • 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.

For Employees

  • 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.
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How Much Does Group Private Health Insurance Cost?

There are five main factors that decide the cost of a policy:

  • The size of the company
  • The age of each employee
  • Your location
  • Your underwriting
  • The level of cover you choose.

Below we’ve provided examples of the average cost of cover per employee for variously-sized businesses. To do so, we’ve made the following assumptions:

  • There is a £1,000 outpatient cap
  • There’s a £100 excess on the policy
  • The client has chosen a mid-tier hospital list.
Average cost per employee per month
10 Employees

£54.54

50 Employees

£35.36

100 Employees

£28.79

These premiums are for illustration only. The cost per employee depends on a wide array of factors. If you want to compare quotes from the top UK insurers call us on 02074425880 or email help@drewberry.co.uk.

Policy Options Which Impact The Cost Of PMI

There are a number of options you can choose which will impact the level of cover and the overall cost of a Group Private Medical Insurance scheme.

  • Excess
    An excess means each member pays a set amount per year or per claim towards treatment. This reduces the cost of a claim for an insurer and therefore cuts premiums.
  • Psychiatric cover
    Psychiatric care is one of the most sought-after options but also among the most expensive. This reflects how difficult many mental health problems are to treat. However, given that each year the UK loses £70 billion due to mental health issues, it’s a great additional benefit.
  • Dental and optical cover
    While policies typically cover surgical procedures such as cataract removal or wisdom tooth extraction, this isn’t the case for routine dental and optical care, e.g. eye tests or dental checkups. Adding this enables employees to see an optician or dentist under the policy.
  • Cover for family members
    Many employers allow employees to add immediate family to the policy. This can be at the cost of the employee or the employer.
  • Additional hospitals
    Most insurers have multiple ‘tiers’ of facilities. If you’re happy to not pay the extra premium for access to the top facilities in the country, usually those in Central London, it can reduce the cost of cover.
  • 6 week NHS wait option
    Your policy will only pay for inpatient treatment if the NHS waiting list for that particular procedure exceeds 6 weeks.

Your Medical Underwriting Options

Your underwriting impacts premiums and what your policy covers staff for. There are three main options, plus a fourth for switching insurers.

Full Medical Underwriting (FMU)

Full medical underwriting sees employees disclose their medical history. The insurer will likely exclude pre-existing conditions, but employees will know exactly which exclusions apply from the start.

This option is usually the cheapest because it excludes pre-existing conditions upfront. However, as employees must declare all medical history, there’s usually lots of paperwork.

Moratorium Underwriting

Moratorium underwriting requires much less initial information. It sees a condition excluded if, at the start of the policy, the employee has suffered from it in the past 5 years.

Employees don’t need to make any medical disclosures upfront. Instead, at claims stage the insurer checks their medical history to make sure that condition hasn’t occurred during a period where it would be disqualified.

Nadeem Farid, Head of Employee Benefits at Drewberry

Moratorium underwriting is one of the most commonly chosen options.

It allows for pre-existing conditions to be covered after employees have spent two consecutive years on the policy without receiving any advice, medication or treatment for that condition.

Nadeem Farid
Head of Employee Benefits

Medical history disregarded (MHD)

MHD underwriting is the best underwriting available. It ignores any pre-existing conditions, no matter when your employees have suffered from them. As the name suggests, your employees’ previous medical history is totally disregarded and they’re able to claim for any eligible condition under the policy’s terms.

It’s the most expensive type of medical underwriting because it’s so all-encompassing. Medical history disregarded underwriting is only available to a large company, usually starting with at least 20-25 people.

How is It Taxed?

Employers usually pay for employees’ Private Medical Insurance from pre-tax earnings. HMRC typically treats premiums as a business expense.

For staff, employer Medical Insurance is a P11D taxable benefit in kind, so they pay additional tax on this cover.

As an employer, tax rules require you to fill out a P11D form declaring that you’ve provided employees with a benefit in kind. You’ll also usually need to pay employer’s National Insurance on the premiums as well.

Who Are The Best UK Group Health Insurance Providers?

There are four main providers in the market. Each offers very different policies and pricing structures:

  • Aviva
  • AXA
  • Bupa
  • Vitality

In addition to the core cover all of the leading providers now provide a video GP service. Other benefits also include counselling helplines, wellbeing services and high street discounts.

Being an independent insurance broker we work with all the leading insurers in the UK. Given our scale and expertise we are in a great position to negotiate the best deal for your company.

Do You Require International Cover?

If you are looking at health insurance to cover staff abroad there are other international providers including Cigna, Aetna and Allianz which we would consider when comparing quotes and providing recommendations.

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Common Group PMI Questions

  • Can Small Businesses Get Cover?

    The good news is that any small business with 2 or more employees can take out cover. We provide advice to businesses of all sizes from single director companies to large international organisations.

    If you are the sole director of a limited company you might want to take a look at the director health insurance options here.

  • How Do You Make A Claim?

    When your employees need to make a claim, they’ll need to get authorisation from the insurer. They’ll look at the medical need for the claim (e.g. a GP referral).

    Once the employee receives the claims authorisation number, they can take it to an appropriate private facility for treatment.

    This treatment will usually be faster than would be available on the NHS. However, even with the best Private Medical Insurance, the process will start with a referral from an NHS GP. This is because PMI usually excludes GP (also known as primary) care.

    Once your employees have a GP referral, their treatment will depend on the level of cover on the policy.

  • Are Pre-existing Medical Conditions Excluded?

    This will depend on the underwriting of the policy.

    The vast majority of group health insurance is underwritten on a Moratorium or Full Medical Underwriting basis. In both cases pre-existing conditions will be excluded from cover.

    There is a more expensive option called Medical History Disregarded (MHD) which often requires at least 20 employees to be covered.

    With MHD cover all policy members are covered for all treatment regardless of any pre-existing conditions.

  • Will We Need A Medical?

    Employees are not required to have a medical when setting up cover.

    If you opt for full medical underwriting they will be required to complete a detailed medical application.

    However, if you opt for moratorium underwriting no application will be required. The policy would simply exclude all pre-existing conditions from the previous 5 years for the first 2 years of cover.

  • Will It Cover Medical Treatment Abroad?

    This will depend on the level of cover you choose to provide.

    Some insurers provide cover for a set number of days while travelling abroad while others offer additional travel options that need to be bolted on to the plan.

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Where Does It Fit With an Employee Benefits Package?

Firstly, it’s one of the most popular employee benefits and therefore goes a long way towards promoting goodwill among your employees.

Secondly, it forms a valuable cornerstone to any employee benefits package. Other benefits you might look at include:

  • Group Life Insurance
    Pays a cash lump sum to an employee’s family if they pass away while working for your company.
  • Group Income Protection
    Works with your company’s sick pay policy to offer cover in the form of a continuation of a worker’s monthly income if they are ill or injured. Some insurers provide a discount if you provide your team with both income protection and medical insurance.
  • Group Critical Illness Cover
    Offers your employees a lump sum if they’re diagnosed with a critical illness such as cancer, heart attack or stroke.

Compare Group Health Insurance Quotes & Get Expert Advice

Not everyone has the time or expertise to do the heavy lifting to implement this type of wellbeing scheme. Out team of expert advisers have the knowledge and whole-of-market access to quote you the best premiums from the leading UK insurers.

Letting us do the heavy lifting means you can focus on what you’re best at: Delivering your own proposition.

Why Speak to Us?

We started Drewberry™ because we were tired of being treated like a number.

We all deserve a first class service when it comes to things as important as protecting our health and our finances. Below are just a few reasons why it makes sense to talk to us.

If you need help setting up group private medical insurance give us a call on 02074425880 or email help@drewberry.co.uk.

The staff have been very knowledgeable and I have enjoyed working with Nadeem on setting up our plan.

Kim S
22/06/2020
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