Group Private Medical Insurance
Group Private Medical Insurance is essentially cover for two or more employees that is funded by the employer. It enables members on cover to have access to fast-track appointments at a local private hospital at a time convenient to them. It covers the cost of GP referred consultations, diagnosis and treatment for acute conditions (conditions that are treatable).
Chronic conditions are not covered on private health insurance. A chronic condition is a disease, illness or injury which has one or more of the following characteristics
Chronic Conditions
Your insurer will typically not cover the long-term treatment of chronic conditions. These are diseases, illnesses or injuries that have one or more of the following characteristics:
It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests.
It needs ongoing or long-term control or relief of symptoms
It continues indefinitely
It comes back or is likely to come back
You need to be rehabilitated or specifically trained to cope with it
It has no known cure
A chronic example would be something like Asthma. The day-to-day management of asthma or other chronic conditions like Osteoporosis, will not be covered under your PMI policy.
So, while the costs of routine long-term treatment and monitoring of illnesses such as Asthma will not be claimable, it’s important to note that acute flare-ups of chronic conditions may be covered. This will depend on the terms of your policy and underwriting.
Emergency treatment
Private hospitals do not treat emergencies and so if you were to need immediate treatment you would need to go to the nearest A & E department.
Once you have sought immediate treatment you can then access your private health insurance cover, if it is appropriate for you to be moved to a private hospital some insurances will cover a private ambulance.
Cover will not include cover for pregnancy or childbirth, however, complications due to pregnancy or childbirth can sometimes be covered.
Direct Payment
The cost of treatment and hospital stay is paid directly by the insurer to the private hospital. Outpatient cover can be covered in full or limited to a set amount. Sometimes there may be a shortfall which will need to be covered by the policyholder - dependent on how comprehensive a cover you have in place.
Covering Dependents.
You can choose to cover the employee only or employee and partner, employee partner and children. There are multiple- insurers in the marketplace that provide Group Private Medical insurance with varying levels of cover and different hospital lists to choose from.
Hospitals
Independent private hospitals work with all health insurance providers but are not owned by insurance companies. Hospital lists become important when you have members that are likely to need to access London hospitals, as the fees charged by London hospitals are significantly higher.
Excess
You can apply an excess to your group private medical Insurance so that employees on the cover will be considerate of whether they need to claim on the insurance or whether they are prepared to wait for access to treatment on the NHS.
Applying an excess can help to control the policy against small claims and so protect the policy from claim related increases at renewal. You can add and remove members throughout the year but you cannot change provider mid-year. It is classed by HMRC as a benefit in kind and so a P11D will need to be completed for each employee on the policy.
Underwriting
Underwriting is what sits behind the policy and dictates what can and can’t be claimed on the policy. For new policies moratorium underwriting is very popular as no medical questionnaire is needed. It typically applies a blanket rule that means that every member on the policy will not be covered for pre-existing conditions they have had in the last 5 years before the cover start date. Once you have been free of symptoms and have not had treatment or check-ups associated with that condition and been on the policy with no break in cover for 2 years - you will then be covered. *This is subject to the terms and conditions of the policy in question.
It is important that if you are thinking of changing providers you do so on the basis that the underwriting is continued and pulled over onto the new insurance policy as changing your provider should not negatively impact the existing members underwriting.
What Are The Benefits Of Group Private Medical Insurance
In some industries Group Private Medical Insurance is expected as part of the overall remuneration package. Most business owners would look to offer health insurance as a way of mitigating risk of long-term absence for key members of staff.
Supporting staff through illness and enabling staff to return to work sooner can minimise the risk of disruption to your business. It also provides peace of mind to the employee and can help with both recruitment and retention. A group private medical insurance policy can support your company health and wellbeing policy.
How To Get Group Private Medical Insurance
Group Private Medical Insurance can be purchased directly with an insurer or you can choose to use an intermediary (broker) to do the work for you. A health insurance specialist, such as Pegasus Benefits, will following a consultation establish the requirements and needs of the business and its members.
They will then take the time to request the appropriate product cover, receiving multiple quotes from various private medical insurance providers to provide you with a market report.
They will be able to use the market feedback to negotiate the premiums and will provide you with their recommendation explaining the differences between the different products available.
If you would like to find out more about the service provided by Pegasus Benefits, then visit our contact form by using the button below.