What is private health insurance?
In most instances, private health insurance (sometimes referred to as private medical insurance (PMI) or private healthcare cover) covers the cost of private medical treatment for acute conditions that develop after your policy has started (depending on the details of your plan).
An acute condition is a disease, injury or illness that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, injury or illness, or which leads to your full recovery.
Private health insurance comes with the benefit that appointments can often be made at a time and location that's convenient for you.
Does private health insurance cover chronic conditions?
Private health insurance doesn't usually cover the cost of private medical treatment for chronic conditions. A chronic condition is a disease, illness or injury that has 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 requires your rehabilitation or for you to be specially trained to cope with it
- It continues indefinitely
- It has no known cure
- It comes back or is likely to come back
How might a small business owner benefit from small business health insurance?
When you own a small business, your people are often vital to its success. It takes a long time to build up a team around you who you fully trust to grow your business and support you in achieving your vision and goals. When you do find the right people, it's natural that you'd want to make sure that they feel supported and valued.
Small business health insurance can benefit your business in a number of ways, including:
Employee retention: Including private health insurance in your employee benefits package can be a great way to retain top team members by showing them that they're a valued part of the business. It helps to show you're investing in their health and wellbeing as much as they're investing themselves in your business. It's also a benefit that's highly valued by employees. According to one survey, 42.7% of UK employees said that private medical insurance was the benefit they would most like to see as part of their employee benefits package.1
Recruitment: Not only can small business healthcare cover help to retain existing employees, it can also be a great incentive to help attract new team members. According to one study by Canada Life Group, 85% of employees are more likely to work for employers who offer clearly labelled benefits.2 When you own a small business, it can be difficult to attract the best quality candidates for a position, particularly when you may not be able to offer the same level of salary that a larger company may be able to. Offering a benefits package that includes things such as private healthcare cover can therefore be a great added incentive.
Health information and support: Our small business health insurance gives you and your team access to health information and support online and over the phone. Unlimited access to our online GP service, Doctor@Hand (provided by Doctor Care Anywhere) is included as standard and gives you and your team access to a 20 minute GP appointment online or over the phone, at a time and place that suits you. Doctor Care Anywhere's fair usage policy applies. Appointments are subject to availability. Plus, you and your team will have access to health information and support over the phone from our team of nurses, counsellors, midwives and pharmacists via our Health at Hand service.
Flexible appointments: With small business healthcare cover, you and your team can have more flexibility and choice over your medical appointments, including where and when you're treated.
How might employees benefit from small business health insurance?
Peace of mind: As well as having benefits for the business, small business health insurance also has a number of benefits for your team. When one of your employees has a health worry, it can be difficult for them to concentrate on anything else. It can start to impact their sleep and their productivity at work. Small business health insurance can provide peace of mind that, should your employees have a health worry, they can access help and support promptly via services such as an online GP and health information telephone helpline.
Convenient appointments: Medical appointments can be difficult for employees to attend, particularly when they're at inconvenient times or locations. With private healthcare cover, your team will have much more control over their appointments. They could have an appointment in the evening after work, or at the weekend. At AXA Health, our small business health insurance provides access to our 24/7 (subject to appointment availability) online GP service, Doctor@Hand (provided by Doctor Care Anywhere). This gives you and your team access to a 20 minute phone or video appointment with a GP at a time and place that suits them.
Treatment in a private hospital: It also comes with the benefit that employees will receive eligible treatment in a private hospital, usually with their own private room. Private medical facilities are now widely available again and ready to see private patients, which means you will be able to use your plan to access eligible treatment. Due to the current Covid-19 pandemic there may be some local disruption in certain areas, but we continue to work closely with private hospitals to understand the impact for our customers.
Access to 24/7 health information: At AXA Health, our small business health insurance also gives your team access to our 24/7 medical information telephone helpline, Health at Hand. Whether they have a question about a prescription or are feeling burnt out at work, they'll be able to pick up the phone and speak to a nurse, pharmacist, counsellor or midwife at a time and place that's convenient for them.*
*Health at Hand nurses and counsellors are Available 24/7, midwives and pharmacists are available 8am-8pm Monday-Friday, 8am-4pm Saturday and 8am-12pm Sunday
How does private health insurance differ from other health plans?
Getting you and your team back to work quickly
The aim of small business health insurance is to get you and your team back to work quickly through prompt access to diagnosis and eligible treatment. This differs from a number of other health plans that are available, including:
- Health cash plans. Health cash plans can be used to spread the cost of everyday, routine healthcare bills including dental check ups and eye tests. Whereas private health insurance aims to get you and your team back to work quickly by giving you fast access to eligible treatment, health cash plans allow you to subsidise the cost of routine healthcare check ups for you and your team.
- Critical illness cover. Critical illness cover will pay out a lump sum if you're diagnosed with a specified critical illness. It doesn't usually cover the cost of private medical treatment.
- Accident, sickness and unemployment cover/income protection. This provides you with a set monthly payment if you're out of work due to accident, sickness or unemployment in order for you to cover the cost of certain bills. It doesn't usually cover the cost of private medical treatment.
- Life insurance. With life insurance, a cash sum is paid out to nominated beneficiaries in the event of death.
- Key person insurance. Key person insurance compensates the business for financial losses that would arise as a result of the death or extended incapacity of an important member of the business.
What underwriting options are available and what can't I claim for?
Find the option to suit your business
Underwriting allows you to decide how you'll cover team members for any conditions they might have before joining us. The underwriting option that you choose can affect the cost of your healthcare cover. The underwriting options available are:
- Fully underwritten. This means that any pre-existing medical conditions that you or your team might have aren't covered. This option requires you and your employees to declare your medical history when you join.
- Two-year moratorium. Any pre-existing medical conditions may be covered after two years, provided you've been completely trouble free from advice, treatment or a special diet for at least a year after joining. A pre-existing condition is any disease, injury or illness that:
- You have received medication, advice or treatment for in the relevant period before the start of cover, or
- You have experienced symptoms of in the relevant period before the start of cover.
- Continued medical exclusions. If you're joining us from another private health insurance provider, you can continue any underwriting arrangements that you had with your previous provider across to your new plan. The rules and benefits of your new plan with AXA PPP healthcare will apply.
- Medical history disregarded. This underwriting option means that we'll cover you and your team for pre-existing medical conditions, subject to your membership terms. This option is available if you're looking to cover 15 people or more. With this option, we don't ask for medical history declarations from you and your team. All pre-existing conditions are accepted subject to the rules and benefits of the plan.
Conditions that you and your team can't claim for
Exclusions are conditions that you and your team wouldn't be able to claim for under your small business health insurance plan. As with most healthcare cover, there are certain things that our small business healthcare plans don't cover. Here are some of the more significant exclusions:
Treatment of any medical conditions your employees had, or had symptoms of, before they joined, unless you've chosen a ‘continued medical exclusions' or ‘medical history disregarded' policy.
- Routine pregnancy and childbirth.
- Outpatient drugs and dressings.
- Treatment of long-term, on-going or recurrent conditions (chronic), for example diabetes or asthma.
- Treatment needed as a result of training for or taking part in any sport for which you are paid, receive a grant or sponsorship (not counting travel costs) or are competing for prize money.
- Cosmetic treatment.
- Fees if you choose to use a hospital that is not in our Directory of Hospitals.
Full details of what we cover, any limits to cover and the exclusions can be found in the membership handbook.
How can I save money on private health insurance and how does it impact tax?
Cost saving options
At AXA Health, we have a number of cost-saving options available that can help you to look after the health and wellbeing of your team while keeping costs down. Our cost-saving options include:
- Paying annually. Save 5% by paying your subscription yearly instead of monthly.
- Choose your excess. Depending on what you choose for your plan, you may be able to reduce your annual subscription by including an excess of between £50 to £750 per employee.
- Choose your underwriting options. The underwriting options that you choose can affect the cost of your plan.
- Fix your subscription for two years. While it doesn't affect the cost of your plan, this option allows you to know exactly how much you'll be investing in each employee for two years. Tax changes may still apply.
When you provide private health insurance to your team, it's considered a ‘benefit-in-kind'. This means that your employees will need to pay tax on the benefit amount.
At the end of each tax year, employers have to complete a P11D expenses and benefits form for every employee who has received expenses or benefits in addition to their salary. (This doesn't include routine business expenses and benefits like travel and company car fuel.)
Read our blog post to find out more about how private medical insurance affects your tax.
Why choose AXA Health for your small business health insurance?
At AXA Health, our small business health insurance comes with a number of benefits for you, your team and your business.
Expert help available 24/7: Our small business health insurance gives you and your people access to our 24/7 health information telephone helpline, Health at Hand. Whether it's a question about a prescription or a pregnancy-related query, our Health at Hand team of nurses, counsellors, midwives and pharmacists is just a phone call away.*
Online GP service: Our small business health insurance gives you and your team access to our 24/7 online GP service, Doctor@Hand (provided by Doctor Care Anywhere). With Doctor@Hand, you'll have access to a 20 minute GP appointment online or over the phone, at a time and place that suits you (subject to appointment availability). This could be in the evening or at the weekend, so you can minimise the amount of time that you and your team need to be away from work. Doctor@Hand GPs can also prescribe the medication you need during your consultation (outpatient drugs are not covered by your plan).
Working Body service: Musculoskeletal problems (issues affecting the bones, muscles and joints) can have a big impact on all areas of someone's life. With our Working Body service, you and your team can speak to a physiotherapist over the phone, without the need for a GP referral. They'll assess the symptoms, discuss what they could mean and help to plan what to do next. Working Body comes as standard on all small business healthcare cover plans. Working Body is available to our healthcare members aged 18 years or over. Any face to face treatment required is only payable under the plan if you have chosen the Therapies option.
Proactive Health Gateway: Our online health and wellbeing platform, the Proactive Health Gateway, is here to support you and your team with your health and wellbeing goals. Packed with tools and insight, the platform is able to learn and respond to your responses and interests, and supports you and your team with your health and wellbeing goals. Using the AXA Health Age Calculator, you and your team can find out how your real age compares to your ‘Health Age’. Once you find out your health age, we’ll provide you with tailored and in depth guidance and tips to help improve your health.
Employee Assistance Programme: Our Employee Assistance Programme provides you and your team with 24/7 access to phone support for psychological and mental health conditions, including fully-trained counsellors. Our team is also on hand to support you and your people through everyday struggles such as debt, mortgages and relationship problems. Our Employee Assistance Programme is available as an additional cover option that can be added to your plan.
Cancer and heart care: If one of your team is affected by cancer or a heart condition, it has a big effect on the whole team. Our experienced team of nurses are there for your people at the end of the phone, 24 hours a day, 365 days a year. They know all about the side effects, medication and how your employee may be feeling. They're also on hand to support family and colleagues too.
Health and wellbeing benefits: As AXA Health members, you and your team will have access to discounts across products at ActivePlus, our online health store.
*Health at Hand nurses and counsellors are Available 24/7, midwives and pharmacists are available 8am-8pm Monday-Friday, 8am-4pm Saturday and 8am-12pm Sunday
What different cover options are available?
You know your business better than anybody. That’s why we think that the best way for you to get the healthcare cover that’s right for you and your team is to give you the chance to build your plan yourself. We’re offering a choice of private medical insurance cover options and benefits that you can choose from, so you only pay for the cover you need.*
*If you are buying cover for 1-2 people only, you will need to include either the Treatment option or the Diagnostics Only option in your plan.
Included as standard
Whatever options you choose, all new SME customers will have access to the following as standard:
- Doctor@Hand. Unlimited access to Doctor@Hand, our online GP service, available by video or over the phone 24/7 (subject to availability), delivered by Doctor Care Anywhere. Doctor Care Anywhere's fair usage policy applies.
- Working Body. Our Working Body service gives you access to a physiotherapist over the phone without the need for a GP referral. They can offer guidance and support for issues affecting the bones, muscles and joints. This service is available to members aged 18 or over.
- Heart and cancer nurses. Heart and cancer nurses, available by phone, who are dedicated to supporting you and your family.
- Health at Hand. Our telephone helpline is open 24/7 for health information and support from nurses and counsellors. Pharmacists and midwives are available from 8am-8pm Monday to Friday, until 4pm on Saturday, and until 12pm on Sunday.
- Proactive Health Gateway. This gives your team access to wellbeing support that’s tailored to their individual goals. They can use the AXA Health Age Calculator to find out their ‘Health Age’ and follow in-depth guidance to help improve their health and wellbeing.
Choose from the below options to create a plan that works best for your business and budget:
- Treatment option. Cover for hospital procedures and operations, including surgery. With this option, you can choose from NHS Cancer Support or Comprehensive Cancer Cover. Cover includes radiotherapy and chemotherapy for cancer when you include Comprehensive Cancer Cover. If you choose NHS cancer support there is no cover for cancer treatment.
- Diagnostics Only option. Waiting for a health condition to be diagnosed can be a worrying time. This option aims to fast-track the process of finding out what’s wrong if you or one of your employees becomes unwell.
- Outpatient option. Cover if you or your team need to see a specialist about a health concern. When you use our Fast Track Appointment service, appointments can be arranged at a time and place that's convenient for you. Choose from Standard, Enhanced or Full outpatient cover, depending on the level of benefits you want to offer.
- Therapies option. This option pays for fees for outpatient treatment by a therapist (physiotherapist, osteopath or chiropractor), homeopath or acupuncturist.
- Mental Health option. This includes psychiatric treatment by psychologists and cognitive behavioural therapists when referred by a specialist. Your employees won’t need a GP referral to access help and support. They can simply call our Stronger Minds team to arrange an assessment with a counsellor or psychologist. Stronger Minds is available to members aged 18 and over.
- Extended Cover option. This option gives your team greater flexibility and choice over where they’re treated. Plus, extra cover for planned, pre-approved treatment abroad and cover for the routine management of a number of specified chronic conditions including asthma, diabetes and epilepsy.
- Private GP option. This option makes it easy for you and your employees to see a private GP in person, promptly, at a time that’s convenient for you and your business.
- Employee Assistance Programme. When members of your team are going through difficult times, such as divorce or money problems, they may find it hard to concentrate on work. This option gives them a professionally trained expert to talk to, whenever they need it.
- Dentist and Optician Cashback. Help your employees look after their teeth and eyesight with cashback towards dentists’ fees, glasses, contact lenses and eye tests.
^Private medical facilities are now widely available again and ready to see private patients, which means you will be able to use your plan to access eligible treatment. Due to the current Covid-19 pandemic there may be some local disruption in certain areas, but we continue to work closely with private hospitals to understand the impact for our customers.
To find out more about the options available, including what is and isn't covered, call our small business experts on 0800 389 7413
(Lines are open 8.30am-5.30pm Monday to Friday. We may record and/or monitor calls for quality assurance, training and as a record of our conversation.
How does the claims process usually work?
The below briefly explains how the claims process usually works:
- Ask your GP for an open referral: If your GP recommends you see a specialist, tell them that you want to go private and ask for an open referral (an open referral is where your GP states that treatment is necessary and which type of specialist you require that treatment from, but they do not specify the specialist's name). This means our Fast track Appointments service can help you find a suitable specialist and make a convenient appointment for you.
- Call us before you see the specialist/start any treatment: Call as soon as you've seen your GP. This will mean that you won't end up paying for treatment that you're not covered for.
- We'll check your cover and let you know what happens next: We may ask you to provide more information, for example from your GP.
Small business health insurance terminology explained
Decoding the Jargon
- Acute condition: An acute condition is a disease, illness or injury that is likely to respond quickly to treatment that aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.
- Chronic condition: A chronic condition is a disease, illness or injury that has one or more of the following characteristics:
- It needs ongoing or long-term monitoring through consultations, examinations, check-ups or tests.
- It needs ongoing control or relief of symptoms.
- It requires your rehabilitation, or for you to be specially trained to cope with it.
- It continues indefinitely.
- It has no known cure.
- It comes back or is likely to come back.
- Day-patient: A patient who is admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.
- Directory of Hospitals: The list of hospitals, day-patient units and scanning centres that are available for you to use under the terms of your plan.
- Excess: Excess is the amount you'll need to pay towards a claim that you make on your health insurance. Your excess is paid yearly and can be different for each person covered on the plan.
- Inpatient: A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.
- Open referral: An open referral is where your GP states that treatment is necessary and which type of specialist you require that treatment from, but they do not specify the specialist's name.
- Outpatient: A patient who attends a hospital, consulting room, or outpatient clinic and is not admitted as a day-patient or an inpatient.
- Pre-existing medical conditions: A pre-existing medical condition is any disease, illness or injury that:
- You have received medication, advice or treatment for in the five years before the start of your cover, or
- You have experienced symptoms of in the five years before the start of your cover whether or not the condition was diagnosed.
- Subscription (sometimes called a premium): This is the financial cost of insurance cover. It can be paid annually or in monthly instalments during the duration of the insurance policy.
- Underwriting: The process of underwriting involves insurance companies deciding:
- What levels of cover it can offer you.
- How much your subscription should be.
- How to cover any existing medical conditions you may have.
To find out more about the options available, including what is and isn't covered, call our small business experts on 0800 389 7413 or get a quote
Lines are open 8.30am-5.30pm Monday to Friday. We may record and/or monitor calls for quality assurance, training and as a record of our conversation.
Sources and references
1Cover Magazine, 2018
2Canada Life Group